Contemporary surgical treatment of patients with frontal sinusitis is based on a graduated approach determined by the patient's history and the extent of disease present. Most patients with inflammatory disease of the frontal sinus respond well to an anterior ethmoidectomy and clearing of agger nasi cells encroaching upon the frontal recess. In more advanced cases, a frontal sinusotomy with enlargement of the ostium may be performed to facilitate frontal sinus drainage and ventilation. For patients in whom conventional endoscopic techniques have not been successful, the floor of the frontal sinus is removed with a drill, usually with the assistance of image-guidance technology. Frontal sinus obliteration is reserved for patients with advanced disease for whom endoscopic management has been unsuccessful. Although patients with refractory frontal sinusitis can present a therapeutic challenge, proper surgical management usually results in successful control of symptoms and overall improvement in quality of life.