Histologically, benign sinus diseases can behave aggressively, potentially causing sight- and life-threatening conditions requiring surgical treatment. Four patients illustrating acute and chronic infection, single and multiple sinus polyposis, and mucoceles are presented and discussed to illustrate how the principles of craniofacial exposure, resection, and reconstruction may be employed to treat aggressive sinus disease. The bicoronal and buccal sulcus approaches minimize visible scarring; wide exposure of the orbital contents and dura reduce the risk of excessive bleeding, neurologic complications, and orbital volume derangements. Immediate cranial bone grafting and the well-vascularized galeal-frontalis myofascial flap obliterate the dead space and isolate the extradural space from contaminated facial cavities, diminishing the risk of infection. The craniofacial surgical approach is particularly appropriate for the management of aggressive frontoethmoidal and multiple sinus involvement because it allows the treatment of sinus cavities under direct vision and complete resection of sinus disease.