The evolution of sinus surgery over the last 50 years has largely been characterized by a shift from open to endoscopic approaches. Endoscopic techniques in addition to powered instrumentation and surgical navigation have allowed for safe and effective surgery for both inflammatory and neoplastic diseases of the sinuses. While purely endoscopic methods have become the standard of care in sinus disease, a combined endoscopic and open approach is sometimes necessary for lesions that are otherwise difficult to access from only an endonasal approach. The combined approach is especially relevant for frontal sinus pathology in which endoscopic access even with the endoscopic modified Lothrop procedure (EMLP) would be limited.