The anatomy and physiology of the maxillary sinus makes it one of the most challenging sinuses to approach endoscopically. Despite its complexity, management of maxillary sinus pathology is often taken for granted. However, key steps to the standard maxillary antrostomy and use of more advanced approaches to address diseases along the floor, anterior and lateral walls of the maxillary sinuses are critical in minimizing recurrences. In this expert lecture, we will highlight critical steps in completing an endoscopic maxillary antrostomy including appreciation of pre-operative imaging for variations in maxillary sinus anatomy, use of angled instrumentations, and appropriate management of the uncinate and middle turbinate. We will then discuss challenging locations to address and highlight advantages of a mega-antrostomy and Denker’s approach. In addition to reviewing the surgical approach, we will review key angled instrumentations to utilize when approaching the maxillary sinus.