The frontal sinus, because of its proper anatomic features, has a particular relation with nasal cavities. Indeed, its anatomic opening (ostium) is strictly related to a complex ethmoidal structure prechamber mainly composed of the frontal recess.This constitutional feature makes the endoscopic approach more complex in comparison with other major sinuses treatment.In the following work, we present a systematization of surgical approach in relation to different pathologies, analyzing differences and results throughout the comparison of 2 groups: one treated with the endoscopic approach, and the other with open surgery.From these observations, we can assess that surgical approach choice must consider several parameters such as neoplasm localization, extension, dimension, and frontal recess anatomic features.