The non-functioning or dysfunctional sinus is completely isolated from the remainder of the nasal cavity with no hope of normal ventilation despite the most aggressive medical therapy. Most often these sinuses are the result of mucosal stripping/removal during prior radical surgeries. The reason for these radical operations include treatment of neoplasm, but most often is for revision of inflammatory disease when prior procedures have not been successful at restoring ventilation and maintaining patent ostia. When faced with a dysfunctional sinus, rhinologists typically have two choices: repeat the radical obliterative procedure or attempt to restore function and ventilation by reestablishing a drainage pathway into the nasal cavity. This latter option seems to represent the best long-term chance for surgical success in these difficult cases, with repeat ablative procedures as a last resort.