At the meeting, Professor Richard Harvey presented the Carolyn’s Window Approach (CWA) for frontal sinus surgery. The technique attracted considerable interest because it creates a direct surgical corridor to the frontal sinus, allowing surgeons to operate using a 0° endoscope rather than angled scopes.

During the discussion, someone asked a simple but important question:

Would this technique work in Asian patients?

Asian nasal anatomy is often described as having a lower radix height and narrower external nasal corridors compared with Western populations. In theory, this could make the straight surgical trajectory used in the Carolyn’s Window Approach more difficult.

At that moment, I did not have an answer. But the question stayed with me.

Over the following months, I talked to my mentor, Dr. Kornkiat, my junior colleagues, and other experts including Dr. Kachorn, the first author of the original study. Some suspected that the narrower nasal anatomy might limit the working space. Others believed the difference might not be clinically important. Surprisingly, despite these discussions, there was no study directly addressing the question.

About a year later, I met Professor Harvey again at another meeting. By that time, we had already begun doing it at our institution. We reviewed patients who underwent frontal sinus surgery using the Carolyn’s Window Approach and analyzed both their nasal anatomy and surgical outcomes.

When I shared the preliminary findings, the message was straightforward:

the technique appeared to work just as well in our patients.

All procedures in our series were successfully performed using a 0° endoscope, and the frontal sinus was accessed in every case. Postoperative outcomes were also favorable, with patency rates of 94.1% at three months and 86.3% at six months.

In other words, the anatomical differences that initially raised concern did not seem to limit the feasibility of the approach.

Professor Harvey’s response was simple:

“You should publish it. And you should include measurements of the external nose, too."

That conversation became the final push to complete the study.

One of the interesting insights from this work is that external nasal appearance does not necessarily predict internal surgical accessibility. Although Asian noses often appear narrower externally, the Carolyn’s Window Approach relies on creating a bone-defined internal corridor along the frontal process of the maxilla. Once this corridor is established, the line of sight to the frontal sinus becomes reproducible and relatively independent of external nasal proportions.

In the end, the study answered the question that started with a brief moment during a conference discussion.