A survey of contemporary management of frontal sinus disease in the United Kingdom.

Surgery for frontal sinus disease historically has required an external approach. With the advent of endoscopic sinus surgery, endoscopic treatment for various frontal sinus pathologies has been described. This survey examined how widespread the use of endoscopy in frontal surgery has become. We were interested both in the acute emergency situation and in the more chronic situations such as mucocoeles. The replies of 266 practising United Kingdom surgeons to a postal questionnaire were evaluated. While 45% of surgeons regularly practise functional endoscopic sinus surgery (FESS), approximately 25% would attempt endoscopic drainage of acute frontal sinusitis and most perform an external trephine. Most surgeons also rely on external approaches to manage mucocoeles or pyocoeles (54%), although some (39%) attempt endoscopic drainage if the cyst lies sufficiently medially. Even with recurrent or intractable disease one-third attempt endoscopic surgery. When external surgery is used in the United Kingdom, only a small number of surgeons favour obliteration.