The Agger Nasi Punch-Out Procedure (POP): maximizing exposure of the frontal recess.

INTRODUCTION For many patients with chronic frontal sinusitis, removal of the uncinate process and limited opening of the anterior ethmoid air cells is adequate to restore proper frontal sinus drainage and ventilation. For those with more advanced disease, however, surgery to enlarge the frontal sinus outflow tract may be required. Typically, the frontal recess is enlarged in the anteroposterior dimension through the clearance of agger nasi cells. The frontal ostium may then be identified and even enlarged if necessary. Surgery of the frontal recess can be technically challenging because of variability in its anatomy as well as its location within the anterosuperior depths of the nasal cavity. The proximity of the frontal recess to the orbit and intracranial cavity demands precision when operating in this region. Therefore, adequate exposure of the recess is critical to the performance of safe and effective frontal sinus surgery. We describe a simple technique to enhance exposure of the frontal recess and thereby facilitate identification and enlargement of the frontal ostium.