The surgical management of frontal sinus fractures is controversial in cranio-maxillofacial trauma, due to the complexity of the anatomy surrounding the frontal sinus and the potential for devastating complications if these fractures are improperly treated. The critical factor in the evaluation of the frontal sinus is the status of the nasofrontal duct, which must be patent if a decision is made to preserve the sinus. Compromise of the nasofrontal duct warrants the removal of the frontal sinus as a functional unit by either obliteration or cranialization. The authors present a diagnostic and therapeutic algorithm for the operative management of frontal sinus fracture and discuss the complications that have been encountered in the authors' experience with frontal sinus fractures.