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 with canine fossa approach (CFA) for surgical treatment of anterior maxillary sinus diseases. Patients and methods A randomized prospective clinical study, in which 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 CFA. Patients were evaluated between February 2018 and October 2019. The two groups were compared regarding 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 min) compared with PLRA group I (27 min) (P