In the 1920s, the Lynch frontoethmoidectomy was considered an advancement from the more radical operations that had been done for the treatment of frontal sinus disease. The operation was designed to reestablish communication between the floor of the frontal sinus and the anterior ethmoid cells. The operation gained popularity for several reasons: It is a direct approach to the frontal sinus using a small incision that is considered cosmetic; it provides the surgeon with the ability to enter the frontal sinus and remove diseased mucosa or mucoceles; and the nasofrontal duct is approached under direct visualization.

The surgical technique of the Lynch procedure requires the removal of the lateral wall of the nasofrontal duct. However, most surgeons experienced a high rate stenosis of the duct. Different types of stents and local mucosal flaps were tried in an attempt to maintain long-term patency of the nasofrontal duct.

In this chapter, I will provide a description of the procedure and include my experience with a modification of the Lynch surgical technique that provides another surgical technique in frontal sinus surgery in association with endoscopic techniques and frontal sinus trephination. The approach is much the same that was also utilized for external ethmoidectomy. With the introduction of endoscopic sinus surgery in the 1980s and later on the development of computer-assisted image guidance surgery and the development of precise instruments for frontal sinus surgery, the Lynch surgical procedure largely fell into disuse.