scholarly journals The Prevalence of Frontal Cells and Their Relation to Frontal Sinusitis: A Radiological Study of the Frontal Recess Area

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Ahmed Z. Eweiss ◽  
Hisham S. Khalil
Keyword(s):  
Frontal Sinus ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Sinus Disease ◽  
Radiological Study ◽  
Frontal Recess ◽  
Mucosal Disease ◽  
Significant Difference ◽  
Axial Ct ◽  
Frontal Sinuses

Background. The frontal recess area represents a challenge to ENT surgeons due to its narrow confines and variable anatomy. Several types of cells have been described in this area. The agger nasi cells are the most constant ones. The frontal cells, originally classified by Kuhn into 4 types, have been reported in the literature to exist in 20%–41% of frontal recesses. Aim of the Study. To identify the prevalence of frontal recess cells and their relation to frontal sinus disease. Methods. Coronal and axial CT scans of paranasal sinuses of 70 patients admitted for functional endoscopic sinus surgery (FESS) were reviewed to identify the agger nasi, frontal cells, and frontal sinus disease. Data was collated for right and left sides separately. Results. Of the 140 sides reviewed, 126 (90%) had agger nasi and 110 (78.571%) had frontal cells. 37 frontal sinuses were free of mucosal disease, 48 were partly opacified, and 50 were totally opacified. There was no significant difference found in frontal sinus mucosal disease in presence or absence of frontal cells or agger nasi. Conclusions. The current study shows that frontal cells might be underreported in the literature, as the prevalence identified is noticeably higher than previous studies.

Role of the Agger Nasi Cell in Chronic Frontal Sinusitis

1996 ◽  
Vol 105 (9) ◽  
pp. 694-700 ◽  
Author(s):  
Joseph B. Jacobs ◽  
Barry A. Shpizner ◽  
Eugenie Brunner ◽  
Richard A. Lebowitz ◽  
Roy A. Holliday
Keyword(s):  
Frontal Sinus ◽  
Clinical History ◽  
Sinus Surgery ◽  
Frontal Sinusitis ◽  
Sinus Disease ◽  
Computed Tomographic ◽  
Mucosal Disease ◽  
Region Data ◽  
History Of

Agger nasi cells contribute to nasofrontal duct (NFD) obstruction and chronic frontal sinus disease. To investigate this relationship, we conducted a review of the surgical outcome and computed tomographic imaging in 26 patients with chronic frontal sinusitis. Coronal and sagittal images were used to delineate the anatomic variability and mucosal disease in the NFD and frontal sinus region. Data from coronal and sagittal images were compared. The results were also correlated with the outcome of frontal sinus surgery in patients with a clinical history of chronic frontal sinus disease. Our data suggest that agger nasi cell pneumatization with narrowing of the frontal sinus outflow tract is a significant cause of persistent frontoethmoid pain and chronic frontal sinusitis. Sagittal reformatted images are more capable than coronal images of demonstrating agger nasi cell encroachment on the NFD, as well as NFD mucosal disease. Endoscopic frontal sinusotomy is an effective treatment for chronic frontal sinus disease.

scholarly journals Frontal Recess Cells in International Frontal Sinus Anatomy Classification (IFAC); Prevalence, Infection Incidence, and Relation to Frontal Sinus Infection in Chronic Sinusitis Patients

2022 ◽  
Author(s):  
Ahmed Abdelfattah Bayomy Nofal ◽  
Mohammad Waheed El-Anwar
Keyword(s):  
Infection Rate ◽  
Frontal Sinus ◽  
Sinus Surgery ◽  
High Infection Rate ◽  
Frontal Recess ◽  
Posterior Group ◽  
Significant Difference ◽  
High Infection ◽  
Medial Group ◽  
Anterior Group

AbstractFrontal recess cells have many types with different sizes, arrangement, and extend. It plays an important role in successful functional endoscopic sinus surgery (FESS) as most causes of failure are related to it. Outline the prevalence of the frontal recess cells, pathological incidence of each cell regarding to frontal sinus pathology. Prospective study on 100 consecutive patients (200 sides) complaining from nasal and sinus symptoms which did not respond to medical management and indicated for FESS. Anterior group was infected in 30.8%; agger nasi cell (ANC) present in 97% (25.8% infected, 74.2% not infected), supra agger cell (SAC) present in 48% (39.6% infected, 60.4% not infected), supra agger frontal cell (SAFC) present in 11% (36.4% infected, 63.6% not infected). Posterior group was infected in 24.8%; supra bulla cell (SBC) present in 72% (30.6% infected, 69.4% not infected), supra bulla frontal cell (SBFC) present in 23% (17.4% infected, 82.6% not infected), supra orbital ethmoid cell (SOEC) present in 42% of cases (19% infected, 81% not infected). Medial group [frontal septal cell (FSC)] was present in 21% (33.3% infected, 66.7% not infected). FSC, SAC, SAFC, and SBC showed high infection rate in association with infected frontal sinus, while, the SOEC, ANC, and SBFC did not have such high infection rate. Frontal recess cells show no difference in their prevalence either if the frontal sinus infected or not, however their infection rate show significant difference.

scholarly journals Unilateral Transnasal Endoscopic approach to Frontal Sinuses: Draf IIc

2013 ◽  
Vol 4 (2) ◽  
pp. ar.2013.4.0058 ◽  
Author(s):  
K. Mohammed ◽  
Al Komser ◽  
Andrew N. Goldberg
Keyword(s):  
Frontal Sinus ◽  
Normal Mucosa ◽  
Sinus Surgery ◽  
Frontal Recess ◽  
Exposed Bone ◽  
Transnasal Endoscopic Approach ◽  
Frontal Sinuses ◽  
Surgical Manipulation ◽  
Draf Iii ◽  
Surgical Option

For chronic sinusitis surgery, the Draf III approach provides a common median drainage pathway for bilateral frontal sinuses from orbit to orbit. The Draf IIb provides unilateral drainage from orbit to septum. In several cases, inclusion of the nasal and frontal sinus septum in a Draf IIb was advantageous without extension to the opposite frontal recess. The proposed nomenclature is Draf IIc. This study was designed to (1) develop a surgical option for chronic frontal sinusitis where access to one frontal recess is limited or unnecessary and (2) minimize unnecessary surgical manipulation of uninvolved areas. Revision endoscopic frontal sinus surgery was performed on two patients with persistent frontal sinus opacification. Surgery crossed midline including one frontal recess with resection of the superior nasal septum. The surgical result was assessed on endoscopy and computed tomography (CT). The postoperative course was unremarkable with relief of frontal pressure. Postoperative CT scan showed well-aerated frontal sinuses with a widely patent common drainage pathway. Postoperative nasal endoscopy revealed normal mucosa with no exposed bone or edema. The Draf IIc extends the Draf IIb across the midline, without including the opposite frontal recess. This can be accomplished most easily using an interfrontal sinus septal cell or an eccentric interfrontal sinus septum. The Draf IIc is a surgical option in cases of chronic or recalcitrant frontal sinus diseases, including unilateral or bilateral obstruction, where access to the ipsilateral frontal recess is limited or favorable anatomy allows drainage with reduced manipulation of an uninvolved side.

Association of Radiological Evidence of Frontal Sinus Disease with the Presence of Frontal Pain

2005 ◽  
Vol 19 (2) ◽  
pp. 167-173 ◽  
Author(s):  
John M. DelGaudio ◽  
Sarah K. Wise ◽  
Justin C. Wise
Keyword(s):  
Frontal Sinus ◽  
Frontal Sinusitis ◽  
Inclusion Criteria ◽  
Computed Tomography Scan ◽  
Disease Extent ◽  
Sinus Disease ◽  
Frontal Recess ◽  
Significant Difference ◽  
The Relationship ◽  
Tomography Scan

Background Rhinosinusitis is a common cause of frontal pain. We evaluated the relationship between frontal pain and the type and degree of frontal sinus disease in chronic rhinosinusitis (CRS) patients. Methods Inclusion criteria were presence of frontal sinusitis or frontal recess obstruction on computed tomography scan. Office notes and operative reports were reviewed to determine the presence and location of frontal pain and categorization of sinus disease. Results Two-hundred seven patients were identified with frontal recess obstruction and/or frontal sinus disease. Thirty-one of 37 frontal mucocele patients (84%) had frontal pain. Twenty of 70 polyp patients (29%) had frontal pain, with only 7 of 38 patients (18%) with complete frontal opacification having pain. In patients with CRS without polyps or mucocele, 59 of 100 (59%) had frontal pain, with 21 of 38 (55%) with complete opacification having pain. This difference between the distribution of frontal pain was significant (p < 0.005) among the mucocele, polyp, and nonpolypoid CRS groups. Additionally, among nonmucocele CRS groups exhibiting complete opacification, there was a significant difference in proportion of patients exhibiting frontal pain (p < 0.005). When the nonmucocele groups (i.e., polypoid and nonpolypoid CRS patients) were combined and stratified for disease extent, a difference in the distribution of frontal pain was found (p < 0.025), with the mild-to-moderate thickening group showing the highest proportion of pain. Conclusion Frontal pain was more common in nonpolypoid CRS patients than in polyp patients. Furthermore, in nonmucocele CRS, patients with mild-to-moderate thickening exhibited more frontal pain.

scholarly journals Radiological study of the myriad variations in frontal sinus anatomy: an institutional study

2019 ◽  
Vol 5 (2) ◽  
pp. 369
Author(s):  
Sreenivas Vepamininti ◽  
Soumya M. Seetharam ◽  
Jomy George ◽  
Hemanth Vamanshankar ◽  
Poonam K. Saidha
Keyword(s):  
Paranasal Sinuses ◽  
Frontal Sinus ◽  
Chronic Sinusitis ◽  
Signs And Symptoms ◽  
Anatomical Variations ◽  
Sinus Disease ◽  
Radiological Study ◽  
Medical College ◽  
Sinus Drainage ◽  
Axial Ct

<p class="abstract"><strong>Background:</strong> The frontal sinus is a challenging area for endoscopic surgeons. The variations in the frontal sinus differs so much among individuals that there are forensic applications. A detailed radiological study of the sinus is important for understanding the pathophysiology of sinusitis and as a prerequisite for frontal sinus drainage procedures. Aims and objectives were to document the anatomical variations of the frontal sinus (radiological) and to correlate the variations with the signs and symptoms of sinusitis.</p><p class="abstract"><strong>Methods:</strong> Coronal and axial CT paranasal sinuses scans of 30 consecutive patients who attended the Otolaryngology clinic OPD in St. John’s medical college and hospital, Bangalore, India with signs/symptoms of  chronic sinusitis were evaluated between January to July 2018.  </p><p class="abstract"><strong>Results:</strong> The average frontal sinus diameter in patients with sinusitis was 6.65 mm. The prevalence of frontal cells in our study was 48%. Agger nasi cells were the most common cells seen. Frontal sinus disease was found in 72% of the studied sides in the scans.</p><p class="abstract"><strong>Conclusions:</strong> Frontal sinus anatomy varies with different ethnicities. It is very important to study the frontal sinus anatomy before exploring the sinus for disease clearance and avoid surgical complications.</p>

scholarly journals Remote Training of Functional Endoscopic Sinus Surgery With Advanced Manufactured 3D Sinus Models and a Telemedicine System

2021 ◽  
Vol 8 ◽  
Author(s):  
Masanobu Suzuki ◽  
Erich Vyskocil ◽  
Kazuhiro Ogi ◽  
Kotaro Matoba ◽  
Yuji Nakamaru ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Three Dimensional ◽  
South Australia ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Telemedicine System ◽  
Frontal Recess ◽  
Travel Restrictions ◽  
3D Printed

Objective: Traditionally, cadaveric courses have been an important tool in surgical education for Functional Endoscopic Sinus Surgery (FESS). The recent COVID-19 pandemic, however, has had a significant global impact on such courses due to its travel restrictions, social distancing regulations, and infection risk. Here, we report the world-first remote (Functional Endoscopic Sinus Surgery) FESS training course between Japan and Australia, utilizing novel 3D-printed sinus models. We examined the feasibility and educational effect of the course conducted entirely remotely with encrypted telemedicine software.Methods: Three otolaryngologists in Hokkaido, Japan, were trained to perform frontal sinus dissections on novel 3D sinus models of increasing difficulty, by two rhinologists located in Adelaide, South Australia. The advanced manufactured sinus models were 3D printed from the Computed tomography (CT) scans of patients with chronic rhinosinusitis. Using Zoom and the Quintree telemedicine platform, the surgeons in Adelaide first lectured the Japanese surgeons on the Building Block Concept for a three Dimensional understanding of the frontal recess. They in real time directly supervised the surgeons as they planned and then performed the frontal sinus dissections. The Japanese surgeons were asked to complete a questionnaire pertaining to their experience and the time taken to perform the frontal dissection was recorded. The course was streamed to over 200 otolaryngologists worldwide.Results: All dissectors completed five frontal sinusotomies. The time to identify the frontal sinus drainage pathway (FSDP) significantly reduced from 1,292 ± 672 to 321 ± 267 s (p = 0.02), despite an increase in the difficulty of the frontal recess anatomy. Image analysis revealed the volume of FSDP was improved (2.36 ± 0.00 to 9.70 ± 1.49 ml, p = 0.014). Questionnaires showed the course's general benefit was 95.47 ± 5.13 in dissectors and 89.24 ± 15.75 in audiences.Conclusion: The combination of telemedicine software, web-conferencing technology, standardized 3D sinus models, and expert supervision, provides excellent training outcomes for surgeons in circumstances when classical surgical workshops cannot be realized.

Comparison between Three-Dimensional and Triplanar Computed Tomography Imaging of the Frontal Recess

2009 ◽  
Vol 23 (5) ◽  
pp. 502-505 ◽  
Author(s):  
Seth J. Isaacs ◽  
Parul Goyal
Keyword(s):  
Computed Tomography ◽  
Frontal Sinus ◽  
Three Dimensional ◽  
Surgical Techniques ◽  
Ct Images ◽  
Outflow Tract ◽  
Sinus Surgery ◽  
3D Ct ◽  
Sinus Disease ◽  
Frontal Recess

Background Despite advances in endoscopic surgical techniques, management of frontal sinus disease remains challenging. Much of this is related to the complex nature of frontal recess anatomy. A thorough understanding of frontal recess anatomy is paramount for the safety and success of frontal sinus surgery. Three-dimensional (3D) computed tomography (CT) may allow surgeons to obtain a more complete preoperative assessment of frontal recess anatomy. The purpose of this study was to determine if reconstructed 3D CT images as an adjunct to conventional triplanar imaging provide additional information regarding the frontal recess anatomy. Methods A prospective study was performed. Two otolaryngologists reviewed the CT scans of 25 patients referred for routine paranasal sinus disease. The findings from review of the triplanar CT images were compared with the findings from review of the 3D reconstructions. Each study was assessed for (1) frontoethmoidal cells, (2) agger nasi cell, (3) subrabullar and frontal bullar cells, (4) intersinus septal cell, (5) superior uncinate process attachment site, and (6) and frontal sinus outflow tract. The examiners rated the usefulness of each study to identify each of the aforementioned anatomic subsites using a modified 5-point Likert scale. Results Intersinus septal cells, supraorbital ethmoid cells, and the anterior–posterior dimension of the frontal sinus outflow tract were better defined on the reconstructed 3D CT images. Conclusion Three-dimensional CT is a useful adjunct to the conventional triplanar studies for the evaluation of frontal sinus and recess anatomy. This technique can define certain anatomic variants more effectively than 2D multiplanar reconstructed images.

Pre- and Postoperative Imaging Analysis for Frontal Sinus Disease following Conservative Partial Middle Turbinate Resection

1998 ◽  
Vol 77 (4) ◽  
pp. 326-334 ◽  
Author(s):  
Iyad S. Saidi ◽  
John F. Biedlingmaier ◽  
Michael I. Rothman
Keyword(s):  
Frontal Sinus ◽  
Middle Turbinate ◽  
Sinus Surgery ◽  
Mr Images ◽  
Sinus Disease ◽  
Frontal Recess ◽  
Postoperative Mri ◽  
Preoperative Ct ◽  
Magnetic Resonance Imaging Mri ◽  
Mucosal Thickening

The prudence of partial or complete middle turbinate resection during endoscopic sinus surgery (ESS) is controversial. The greatest concern regarding partial resection relates to the effect on the frontal recess and the development of frontal sinus disease. The purpose of this study was to radiographically evaluate the frontal sinus in patients who had undergone ESS with partial conservative middle turbinate resection. We reviewed the charts and operative records from 195 consecutive cases of ESS performed by a single surgeon (JFB) over a two-year period. Thirty-three of 117 patients who had undergone ESS with conservative partial middle turbinate resection without frontal recess exploration agreed to return for magnetic resonance imaging (MRI) of their sinuses. The preoperative computed tomography (CT) scans and postoperative MR images were reviewed and graded (1–3) by a single neuroradiologist. Significant frontal sinus disease (grades 2 and 3) was seen in 15 of 52 sides preoperatively (29%), and in 14 sides postoperatively (27%). During the postoperative MRI studies, only six frontal sinus sides demonstrated minimal mucosal thickening (grade 1) which had not been apparent on preoperative CT. This radiographic analysis suggests that conservative partial middle turbinate resection during ESS does not adversely affect the frontal sinus. We believe that the surgical technique employed when resecting the middle turbinate, and the avoidance of unnecessary dissection in the recess are both important factors in preventing the development of frontal sinus disease following ESS.

scholarly journals The frontal sinus- physiological and pathophysiological aspects- an endoscopist’s perspective: a review

2020 ◽  
Vol 6 (10) ◽  
pp. 1937
Author(s):  
Manish Munjal ◽  
Sanjeev Puri ◽  
Garima Matta ◽  
Shubham Munjal
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Surgical Interventions ◽  
Frontal Recess ◽  
Conventional Procedure ◽  
Minimally Invasive Surgical

<p class="abstract">In this era of minimally invasive surgical interventions, the knowledge of the physiology and pathophysiology of the frontal sinus is vital to the endoscopic rhinologist. The conventional procedure of sinus surgery has given way to functional endoscopic sinus surgery whereby now the emphasis is not on cleaning the sinus but reverting the function of the sinus. The surgery is only done at the frontal recess only. The physiology and pathophysiology of the frontal sinus needs an introspection.</p>

Modified Lothrop procedure in cystic fibrosis patients: does it have a role?

2013 ◽  
Vol 127 (7) ◽  
pp. 666-669 ◽  
Author(s):  
M-C Jaberoo ◽  
M-A Pulido ◽  
H A Saleh
Keyword(s):  
Cystic Fibrosis ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Open Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Tertiary Referral ◽  
Sinus Disease ◽  
Operative Complications ◽  
Study Setting

AbstractBackground:The management of frontal sinus disease in cystic fibrosis patients represents a challenge for many surgeons. Procedures can vary from the minimally invasive to those involving extensive open surgery.Objective:This study describes the outcomes of the endoscopic modified Lothrop procedure, in terms of safety and morbidity, for cystic fibrosis patients with frontal sinus disease who did not improve following traditional functional endoscopic sinus surgery.Method and results:The study setting was a tertiary referral unit in a London teaching hospital, the largest national base for adult cystic fibrosis patients. Two patients diagnosed in childhood with cystic fibrosis presented with histories of recurrent, severe frontal sinusitis; both had previously undergone multiple endoscopic sinus surgical procedures. The modified Lothrop procedure was performed on both patients. The outcome measures were symptom resolution and post-operative complications.Conclusion:The endoscopic modified Lothrop procedure was beneficial in the cystic fibrosis patients with frontal sinus disease who failed to respond to standard functional endoscopic sinus surgery procedures.

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