The Relationship Between the Width of the Frontal Recess and the Frontal Recess Cells in Japanese Patients

Objective: The agger nasi cell (ANC) is an easily identifiable landmark when approaching the frontal sinus. The success of endoscopic frontal sinus surgery may be influenced by the width of the frontal recess (FR). The aim of this study is to examine the relationship between the FR width and the ANC size in Japanese patients. In addition, the effect of various frontal recess cells (FRCs) on the development of frontal sinusitis has been examined. Materials and methods: Multiplanar computed tomography (CT) scans of the nasal cavities and paranasal sinuses in 95 patients (190 sides) before endoscopic sinus surgery were reviewed. The presence of FRCs, the thickness of the frontal beak (FB), the ANC size, and the anterior-to-posterior (A-P) length of the frontal isthmus (FI) and FR were evaluated in patients with and without frontal sinusitis. Results: The prevalence of the ANC, frontal cell types 1, 2, 3, and 4, frontal bullar cell (FBC), suprabullar cell, supraorbital ethmoid cell, and interfrontal sinus septal cell was 85.3%, 11.6%, 0%, 7.9%, 0%, 25.3%, 45.8%, 16.8%, and 15.3%, respectively. The ANC volume showed a significant positive correlation with the A-P length of the FI and FR. The incidence of frontal sinusitis in the patients with FBCs was significantly higher than that without FBCs. Conclusion: A large ANC offers a greater potential to facilitating the approach to the frontal sinus because of the extensiveness of the FR in Japanese patients. The presence of FBCs may be related to a higher incidence of frontal sinusitis.

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The Effect of Middle Turbinate Resection upon the Frontal Sinus

American Journal of Rhinology ◽

10.2500/105065895781873737 ◽

1995 ◽

Vol 9 (4) ◽

pp. 191-196 ◽

Cited By ~ 53

Author(s):

Paul B. Swanson ◽

Donald C. Lanza ◽

Eugenia M. Vining ◽

David W. Kennedy

Keyword(s):

Frontal Sinus ◽

Statistical Difference ◽

Severe Disease ◽

Middle Turbinate ◽

Sinus Surgery ◽

Ct Scans ◽

Control Group ◽

Case Group ◽

Frontal Sinusitis ◽

Frontal Recess

Diversity of opinion exists among otolaryngologists regarding the importance of preserving the middle turbinate during sinus surgery. The purpose of this study is to determine whether or not middle turbinate resection has a bearing upon postoperative disease within the frontal sinus. In this retrospective analysis of 110 consecutive patients with chronic or recurrent acute sinusitis, 69 (case group) had previous middle turbinectomy and 41 patients (control group) had intact middle turbinate after prior sinus surgery. In 42 patients, CT scans were scored and defined as having either mild-moderate or severe disease. Frontal sinusitis seen on CT scan was present in 75% (30 of 40) of case sides and 45% (9 of 20) of control sides, and this difference was significant (P < 0.05). The height of middle turbinate resection was measured, and there was no statistical difference in frontal sinusitis between patients with high and low resection. Therefore, this work does not support the concept that middle turbinate resection results in a lower incidence of frontal recess disease.

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The Intersinus Septal Cell: Anatomic, Radiologic, and Clinical Correlation

American Journal of Rhinology ◽

10.2500/105065896782159675 ◽

1996 ◽

Vol 10 (5) ◽

pp. 299-302 ◽

Cited By ~ 21

Author(s):

Robert M. Merritt ◽

John P. Bent ◽

Frederick A. Kuhn

Keyword(s):

Computed Tomography ◽

Frontal Sinus ◽

Sinus Surgery ◽

Ct Scans ◽

Detailed Knowledge ◽

Type I ◽

Type Ii ◽

Frontal Sinusitis ◽

Clinical Correlation ◽

Modern Era

Functional endoscopic frontal sinus surgery requires detailed knowledge of intranasal anatomy. Occasionally frontal sinusitis involves the intersinus septal cell (ISSC), which has not been described in the modern era of nasal endoscopy and computed tomography (CT). To study the ISSC, we reviewed 300 CT scans: 200 clinical and 100 cadaveric. We found ISSC in 70 (35%) of clinical scans, with six subjects having multiple ISSC. The cadaveric prevalence was slightly less at 31%. We further classified the ISSC according to the following criteria: type I, enclosed completely within the thin intersinus septum or bridging its entire inferior-superior extent; type II, bordered partially by this thin septum and partially by the thick septal base formed by the nasofrontal bone; type III, enclosed completely within the nasofrontal bone, often extending between frontal recesses rather than the actual sinuses. This report supplements our radiologic ISSC analysis with our experiences in five clinical cases.

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Computed Tomography Analysis of the Anterosuperior Portion of the Bulla Lamella in Chinese Subjects and Its Surgical Significance in Endoscopic Frontal Sinusotomy

ORL ◽

10.1159/000518366 ◽

2021 ◽

pp. 1-7

Author(s):

Muhan Shi ◽

Yuxiao Wu ◽

Yuguang Wang ◽

Min Wang ◽

Fei Yuan ◽

...

Keyword(s):

Computed Tomography ◽

Statistical Analysis ◽

Chronic Rhinosinusitis ◽

Frontal Sinus ◽

Surgical Skills ◽

Ct Scans ◽

Frontal Sinusitis ◽

The Relationship ◽

Chinese Subjects ◽

Tomography Analysis

Introduction: The anterosuperior portion of the bulla lamella can extend into the frontal sinus and form the supra bulla frontal cell (SBFC) and supraorbital ethmoid cell (SOEC). This can affect the frontal drainage pathway and make surgery more challenging. Objectives: The aim of the study was to compare the anatomical characteristics of SBFC and SOEC in Chinese chronic rhinosinusitis (CRS) patients and explore the relationship between the cells and frontal sinusitis (FS). The surgical skills in dealing with these cells were also studied. Methods: We prospectively identified SBFC and SOEC in 114 patients with CRS by computed tomography (CT). The sides of the patients were divided into groups A (with FS) and B (without FS). CT scans were analyzed to distinguish the SBFC, SOEC, and the drainage pathway. Statistical analysis was conducted to determine whether the cells were associated with the occurrence of FS. Results: The prevalence of frontal cells was as follows: SBFC: 9.65%, SOEC: 21.93%. There was an association between the presence of SBFC and FS (p < 0.05). The anterior drainage pathway was present in patients with SBFC and SOEC, anterolateral pathway in those with SBFC/SOEC coexisting with the frontal septal cell, and anteromedial pathway in those with SBFC/SOEC coexisting with the supra agger frontal cell. Conclusions: There was an association between the presence of SBFC and the occurrence of FS. Extension of the anterosuperior portion of the bulla lamella into the frontal sinus obstructed the drainage pathway posteriorly. Understanding the anatomy may help surgeons thoroughly dissect the bulla lamella.

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Is it More Reasonable to Categorize Frontal Cells on the Basis of their Location Rather than on their Type?

Ear Nose & Throat Journal ◽

10.1177/014556131008900905 ◽

2010 ◽

Vol 89 (9) ◽

pp. E19-E21

Author(s):

Altan Yildirim

Keyword(s):

Frontal Sinus ◽

Chronic Sinusitis ◽

Cell Types ◽

Ct Scans ◽

Frontal Sinusitis ◽

Concha Bullosa ◽

Frontal Recess ◽

Group A ◽

Left And Right ◽

Group B

Frontal cells appear in two locations—in the frontal recess and in the frontal sinus. The aim of this study was to analyze the anatomic and clinical differences between the frontal cells at each location. The author reviewed 487 left and right sides of coronal computed tomography (CT) scans of the sinuses obtained from 300 consecutively presenting patients (600 sides) who were being evaluated for chronic sinusitis. For the purposes of this study, the frontal cells were classified according to location; group A cells were located in the area of the frontal recess (Bent and Kuhn cell types I and II), and group B cells were those that had invaded the frontal sinus itself (Bent and Kuhn cell types III and IV). The presence or absence of frontal sinusitis and concha bullosa was determined, as was the degree of frontal sinus pneumatization. Analysis revealed statistically significant differences between group A and group B in all three parameters; the prevalence of frontal sinusitis and hyperpneumatization of the frontal sinus was higher in group B, and the prevalence of concha bullosa was higher in group A (all p < 0.05). These findings imply that it might be more reasonable both clinically and anatomically to categorize frontal cells based on their location rather than on their Bent and Kuhn type.

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Radiological Correlation between Pneumatization of Frontal Sinus and Height of Fovea Ethmoidalis

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3072 ◽

2007 ◽

Vol 21 (5) ◽

pp. 626-628 ◽

Cited By ~ 6

Author(s):

Cesur Gumus ◽

Altan Yildirim

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Skull Base ◽

Frontal Sinus ◽

Ct Scans ◽

The Relationship

Background We need more data about the variations of skull base to minimize the complications of ethmoidectomy. The aim of this study was to analyze the relationship between the pneumatization of the frontal sinus and height of the fovea ethmoidalis. Methods Paranasal coronal computed tomography (CT) scans of 487 sides of 300 patients were evaluated. The presence of the frontal cell and pneumatization of the frontal sinus were studied with respect to the height of the fovea ethmoidalis. Results We found a statistically significant correlation between the frontal cell and frontal sinus hyperpneumatization (p = 0.000). We determined that there was a deeper fovea ethmoidalis in the sides that have a frontal cell (p ≤ 0.001) and in the sides that have hyperpneumatization of the frontal sinus (p = 0.000). We also observed flatter fovea ethmoidalis in the sides that have hypopneumatization of the frontal sinus (p ≤ 0.001). Conclusion The presence of a frontal cell or hyperpneumatization of the frontal sinus on CT scan should alert the clinician that there may be a deep fovea ethmoidalis.

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Coronal Computed Tomography Analysis of Frontal Cells

American Journal of Rhinology ◽

10.1177/194589240301700310 ◽

2003 ◽

Vol 17 (3) ◽

pp. 163-168 ◽

Cited By ~ 46

Author(s):

Tanya K. Meyer ◽

Mehmet Kocak ◽

Michelle M. Smith ◽

Timothy L. Smith

Keyword(s):

Computed Tomography ◽

Frontal Sinus ◽

Cross Sectional Study ◽

Type I ◽

Frontal Sinusitis ◽

Cross Sectional ◽

Type Iii ◽

Frontal Recess ◽

Type Iv ◽

Anatomic Variants

Background Described by Schaefer in 1916, frontal cells have been implicated as a cause of frontal recess obstruction. In this cross-sectional study, we determine the prevalence of frontal cells and other anatomic variants and examine their relationships. Methods Coronal computed tomography scans of the sinuses performed from January 2000 to June 2001 were evaluated for frontal cells, other anatomic variants, and sinus disease. Of 1009 scans evaluated, 768 scans were included for data collection. Frontal cells were classified. Results In this population, 20.4% of individuals had frontal cells (14.9% had type I, 3.1% had type II, 1.7% had type III, and 2.1% had type IV). The presence of frontal cells was positively associated with hyperpneumatization of the frontal sinus (p = 0.01) and negatively associated with hypopneumatization of the frontal sinus (p < 0.01). Individuals with frontal cells had an increased prevalence of concha bullosa compared with individuals without frontal cells (41.4% versus 24.1%, p < 0.01). The prevalence of frontal mucosal thickening was increased in individuals with type III and type IV cells compared with individuals without frontal cells (38.5 and 69.0% versus 17.1%, p = 0.04 and p < 0.01). Conclusion The prevalence of frontal cells among a population undergoing sinus computed tomography is 20.4%. Frontal cells are associated with other variants of sinonasal pneumatization and should be suspected when these variants are noted. The presence of frontal cells does not invariably lead to frontal sinusitis but may contribute to the mechanical obstruction of the frontal recess and should be appropriately addressed during the surgical management of frontal sinusitis.

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

American Journal of Rhinology ◽

10.1177/194589240501900209 ◽

2005 ◽

Vol 19 (2) ◽

pp. 167-173 ◽

Cited By ~ 11

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.

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

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2009.23.3350 ◽

2009 ◽

Vol 23 (5) ◽

pp. 502-505 ◽

Cited By ~ 7

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.

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Computed tomographic analysis of the prevalence of International Frontal Sinus Anatomy Classification cells and their association with frontal sinusitis

The Journal of Laryngology & Otology ◽

10.1017/s0022215120002066 ◽

2020 ◽

Vol 134 (10) ◽

pp. 887-894

Author(s):

N Seth ◽

J Kumar ◽

A Garg ◽

I Singh ◽

R Meher

Keyword(s):

Computed Tomography ◽

Frontal Sinus ◽

Clinical Symptoms ◽

Cell Types ◽

Frontal Sinusitis ◽

Prevalence Rates ◽

Computed Tomographic ◽

Significant Difference ◽

Left And Right ◽

Tomographic Analysis

AbstractObjectivesTo determine the radiological prevalence of frontal cells according to the International Frontal Sinus Anatomy Classification in patients undergoing computed tomography of the paranasal sinuses for clinical symptoms of chronic rhinosinusitis, and to examine the association between cell classification and frontal sinusitis development.MethodsA total of 180 (left and right) sides of 90 patients were analysed. The prevalence of each International Frontal Sinus Anatomy Classification cell was assessed. Logistic regression analysis was used to compare the distribution of various cells in patients with and without frontal sinusitis.ResultsThe agger nasi cell was the most commonly occurring cell, seen in 95.5 per cent of patients. The prevalence rates for supra agger cells, supra agger frontal cells, supra bullar frontal cells, supra bullar cells, supra-orbital ethmoid cells and frontal septal cells were 33.3 per cent, 22.2 per cent, 21.1 per cent, 36.1 per cent, 39.4 per cent and 21.1 per cent, respectively. There was no significant difference in the occurrence of any of the cell types in patients with frontal sinusitis compared to those without (p > 0.05).ConclusionThe presence of any of the International Frontal Sinus Anatomy Classification cells was not significantly associated with frontal sinusitis.

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Extended endoscopic frontal nasal sinus surgery in management of chronic and recurrent frontal sinus diseases

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00104-x ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Ahmed Sobhi Abdelaal ◽

Mohamed Kamel Al Awady ◽

Tawfik Abdelaty Elkholy

Keyword(s):

Frontal Sinus ◽

Anatomical Variation ◽

Sinus Surgery ◽

Frontal Sinusitis ◽

Office Visits ◽

Nasal Sinus ◽

Frontal Sinus Surgery ◽

Operative Care ◽

Intimate Relation

Abstract Background The anatomical variation of the frontal sinus and its intimate relation to the skull base and orbit makes its surgery demanding. The extended endoscopic frontal sinus surgery allows wide better drainage and preventing the recurrence of the disease. Fourteen patients underwent EEFSS from May 2017 to May 2019. These patients are nine patients presented by chronic recurrent frontal sinusitis, three patients presented by chronic recurrent fronto ethmoidal mucocele and two patients with chronic recurrent external frontal fistula. Draff III done for ten patients of them and Draff IIB done for four patients of them. This study is designed for evaluating the efficacy of the extended endoscopic frontal sinus surgery (E E F S S) in management of chronic and recurrent frontal sinus diseases. Results The neo opening of the restored frontal sinus was remained opened with Draff III with high success rate; two patients from four patients with Draff IIb were with closed nasofrontal duct. The main follow-up was 12 months; the patients were followed up post-operatively for many office visits without any other manifestations. Conclusion The chronic recurrent frontal sinus diseases can be treated successfully with extended endoscopic frontal sinus surgery (E E F S S). The extended endoscopic frontal sinus surgery (Draff III) provides good results with low morbidity and less post-operative care.

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