Introduction Extensive disease in the maxillary sinus is difficult to clear with standard instrumentation during traditional endoscopic sinus surgery, so access to the anterior and anterolateral walls of the maxillary sinus is often difficult despite the creation of a large maxillary antrostomy or the use of adjuvant surgical procedures such as canine fossa puncture to gain improved access and allow for good debridement of maxillary sinus. Objective To study the outcome of prelacrimal approach compared to canine fossa approach for surgical treatment of anterior maxillary sinus diseases. Patients and methods A randomized prospective clinical study, in which a total of 40 patients with recurrent anterior maxillary sinus lesion were divided into two equal groups: Group (I) included 20 patients who underwent endoscopic prelacrimal recess approach (PLRA), and group (II) included 20 patients who underwent endoscopic canine fossa approach (CFA). Patients were evaluated between February 2018 to October 2019. The two groups were compared as regard facial pain, facial numbness, cheek swelling, nasal obstruction, epiphora, inferior turbinate destabilization, inferior turbinate nasolacrimal duct flap status, crustations, synechiae, bleeding, infection, and antrochoanal polyp recurrence. Results Operation time was significantly longer in CFA group II ( 38 minutes ) compared to PLRA group I ( 27 minutes ) ( p value was