The original concept of wide endoscopic sphenoethmoidectomy for sinonasal polyposis has been a well-established principle since 1995. However, with the evolution of the understanding of sinonasal physiology, this might change. The authors present arguments based on the evolutionary and developmental concept of ethmoidal function. They suggest that the ethmoids are separate organs with an independent evolution with an active ostial function, not a simple static ventilation port. They suggest a further modification in the functional surgery of sinonasal polyposis to eradicate the diseased mucosa while preserving the medial mucosa of the middle turbinate and the mucosa of each ostium as far as practical. The modifications include a subperiostial dissection of the lamina papyracea, dissection of the mucosa of the uncinated process preserving as much as possible the maxillary ostial muocsa and fontanelles, dissection of all ethmoidal mucosa from the lateral surface of the middle turbinate and upper border of the inferior turbinate, dissection and preservation of the fronto-ethmoid outflow tract and the sphenoid ostium (which is preserved depending on the contents of the sinus after aspiration). The short-term efficacy of this technique is reported by the authors but long-term results are still pending with possible complications, such as mucocele formation, adhesions and recurrences. Although physiologically appealing, it seems to be a real surgical juggling act and, in real life, difficult to apply. However it might open the way for a more ‘functional’ FESS.