Management of frontal sinus disease has evolved considerably with the advent of endoscopic paranasal sinus instrumentation. With this evolution has come the increased demand for anatomic competence among otolaryngologists. Armed with a better understanding of the complex frontal sinus and anterior ethmoid complex anatomy, the otolaryngologist can target the anatomic abnormalities that predispose an individual to frontal sinus disease and limit the effectiveness of medical and surgical management.