Experience with 130 patients requiring a lateral rhinotomy is reported. It is concluded that excellent surgical exposure is assured by this approach and that minimal postoperative complications are attributable to the incision. An understanding of the advantages and disabilities associated with each of several extensions may help to the surgeon to tailor the approach to individual case. The lateral rhinotomy approach allows wide access to the nose, some elements of skull base, the nasopharynx and the paranasal sinuses for removal of benign and malignant lesions.