scholarly journals 3D CT stereoscopic imaging: an improved anatomical understanding of the anterior ethmoid sinus and frontal sinus drainage pathway

2020 ◽  
Vol 3 (3) ◽  
pp. 202-220
Author(s):  
S.J. Zinreich ◽  
F.A. Kuhn ◽  
N.R. London Jr. ◽  
D. Kennedy ◽  
M. Solaiyappan ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Three Dimensional ◽  
Uncinate Process ◽  
Small Sample ◽  
Middle Meatus ◽  
Stereoscopic Imaging ◽  
X Ray ◽  
Frontal Recess ◽  
Sinus Drainage

OBJECTIVE: The objective of this presentation is to display a series of new anatomical concepts and terms regarding the frontal si- nus, its drainage pathway and cells vs. spaces of the anterior ethmoid, based on Three-Dimensional Computer X-ray Tomography Stereoscopic Imaging (3DCTSI) and contrast these concepts to those reported in the current literature. METHODS: Given the new anatomic observations provided by 3DCTSI, and the widespread anatomic variations a small sample was initially selected to describe our observations. Six exemplary cases according to the “Classification of Fronto-Ethmoidal cells” by Kuhn, Bent et al., Lee et al., expanded by Wormald et al., and adopted by Ramakrishnan et al., Huang et al., and Void et al. (1-7) were chosen to illustrate our detailed anatomic observations. Additional observations and data of prevalence identified in a larger series will follow. RESULTS and CONCLUSION: Conceptually, the anterior ethmoid “cells” are in essence “spaces” with openings that communicate with the middle meatus and/or the ethmoidal infundibulum. The frontal sinus and frontal recess are a united and continuous three-dimensional, irregularly shaped space, the Frontal Sinus/Recess Space (FSRS). The uncinate process has two segments: the Ethmoidal Uncinate Process (EUP), which encompasses the Infundibular Space of the EUP (IS-EUP), currently known as the Agger Nasi cell; and the Turbinal Uncinate Process (TUP), which borders the Turbinal Infundibulum (TI) medially. The superior attach- ment of the EUP will be detailed in each of the six cases (Table 2). The middle meatus and infundibular passages are the drainage pathways from the frontal sinus and maxillary sinus to the nasal cavity.

scholarly journals Supplements and refinements to current classifications and nomenclature of the fronto-ethmoidal transition region by systematic analysis with 3D CT microanatomy

2021 ◽  
Vol 4 (4) ◽  
pp. 165-180
Author(s):  
S.J. Zinreich ◽  
F.A. Kuhn ◽  
D. Kennedy ◽  
M. Solaiyappan ◽  
A. Lane ◽  
...  
Keyword(s):  
Transition Region ◽  
Frontal Sinus ◽  
Uncinate Process ◽  
Classification Systems ◽  
Systematic Analysis ◽  
Stereoscopic Imaging ◽  
Complex Spaces ◽  
Frontal Recess ◽  
Anatomical Classification ◽  
Frontal Process

Objective: The microanatomy of the fronto-ethmoidal transition region has been addressed in several classifications. CT stereoscopic imaging (3DCTSI) provides improved display and delineates three defined complex “spaces”, the Frontal Sinus/Frontal Recess Space, the Infundibular Space of the Ethmoid Uncinate Process, and the Ethmoid Bulla Space (FSRS, IS-EUP, EB), none of which were adequately described with the “cell” terminology. We present details on the 3D microanatomy, variability, and prevalence of these spaces. Methods: 3D stereoscopic imaging displays (3DCTSI) were created from 200 datasets. The images were analyzed and categorized by a radiologist (SJZ), and consultant otolaryngologists, focusing on 3D microanatomy of the fronto-ethmoidal transition, the frontal recess/frontal sinus, and drainage pathways, in comparison to established anatomical classification systems. Results: The anterior ethmoid is subdivided into seven groups with the following core properties and prevalence: 1. The horizontal roof of the IS-EUP is attached to the superior half of the frontal process of the maxilla (19%); 2. The IS-EUP extends into the frontal recess (6.5%); 3. The IS-EUP extends into the frontal recess and the frontal sinus (18.5%); 4. A bulla is seen in the medial frontal sinus (3%); 5. The ethmoid bulla and supra bullar space extend into the frontal sinus (7%); 6. Lamellae extend into the FSRS antero-superiorly (25%); 7. FSRS expansion expands below the upper half of the frontal process of the maxilla (FSRS) (21%). Conclusion: 3-D analysis of the detailed anatomy provides important new anatomic information with the increased focus on precision surgery in the region.

scholarly journals Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769270 ◽  
Author(s):  
Etsuo Shoda ◽  
Shimpei Kitada ◽  
Yu Sasaki ◽  
Hitoshi Hirase ◽  
Takahiro Niikura ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Fracture Pattern ◽  
3D Ct ◽  
Trochanteric Fractures ◽  
Greater Trochanter ◽  
Lesser Trochanter ◽  
X Ray ◽  
Ct Classification ◽  
The Relationship

Purpose: Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Methods: Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. Results: In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. Conclusions: It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.

A Radiological Study Assessing the Prevalence of Frontal Recess Cells and the Most Common Frontal Sinus Drainage Pathways

2019 ◽  
Vol 33 (3) ◽  
pp. 323-330 ◽  
Author(s):  
Luan V. Tran ◽  
Ngoc H. Ngo ◽  
Alkis J. Psaltis
Keyword(s):  
Frontal Sinus ◽  
Building Blocks ◽  
Sinus Surgery ◽  
Virtual Planning ◽  
Frontal Recess ◽  
Planning Software ◽  
Anatomical Classification ◽  
Computed Tomography Scans ◽  
Vietnamese Population ◽  
Sinus Drainage

Background To date, there are numerous studies documenting the prevalence of frontal recess cells, but only 1 study using the newly developed International Frontal Sinus Anatomical Classification (IFAC) system. The identification of the frontal cells and their influence on the frontal drainage pathway plays an important role in endoscopic frontal sinus surgery. Objective The aim of this study is to document the radiological prevalence of various types of frontal cells, as classified by IFAC and the most common frontal sinus drainage pathways based on its anatomic relationships with these cells. Methods Using a novel preoperative virtual planning software (Scopis Building Blocks), consecutive computerized tomography scans of the sinuses of patients were analyzed for the prevalence of frontal cells, as classified by the by IFAC, and the frontal sinus drainage pathways at the Ear Nose Throat Hospital of Ho Chi Minh City, Vietnam. Results In this study, 208 computed tomography scans of consecutively selected frontal sinuses of 114 patients were included for analysis. The agger nasi cell was present in 95.7% of reviewed scans. The frontal cells prevalence was as follows: supra agger cell (SAC): 16.3%, supra agger frontal cell (SAFC): 13%, supra bulla cell (SBC): 46.2%, supra bulla frontal cell (SBFC): 4.3%, supra orbital ethmoid cell: 17.3%, and frontal septal cell: 10.6%. The most common frontal sinus pathway type in relation to frontal cells was medial to SAC (70.6%), medial to SAFC (81.5%), anterior to SBC (88.5%), and anterior to SBFC (100%). In cases that had 2 frontal cells group, the drainage pathway was medial to SAC/SAFC and anterior to SBC/SBFC in most cases. Conclusion This study documents the prevalence of frontal cells (classified by IFAC) using a novel preoperative virtual planning software in the Vietnamese population. It demonstrates predominantly medial anteromedial frontal drainage pathways as related to these frontal cells.

Virtual Mapping of the Frontal Recess: Guiding Safe and Efficient Frontal Sinus Surgery

2017 ◽  
Vol 156 (5) ◽  
pp. 946-951 ◽  
Author(s):  
Neil S. Patel ◽  
Amy C. Dearking ◽  
Erin K. O’Brien ◽  
John F. Pallanch
Keyword(s):  
Frontal Sinus ◽  
Tertiary Care ◽  
Middle Turbinate ◽  
Uncinate Process ◽  
Sinus Surgery ◽  
Preoperative Imaging ◽  
Level Of Evidence ◽  
Frontal Recess ◽  
Frontal Sinus Surgery ◽  
Sinus Opening

Objective To define relationships between the frontal sinus opening, ostia of other frontal recess cells, and endoscopic landmarks and to develop a clinically useful framework to guide frontal sinus surgery. Study Design Retrospective review. Setting Tertiary care academic referral center. Methods Adult patients with computed tomography (CT) without sinonasal pathology were included. Virtual endoscopy (using OsiriX) and corresponding CT reconstructions were used to identify all visible ostia in the frontal recess and characterize their positions in spaces between the uncinate/agger nasi (U), bulla ethmoidalis (EB), and middle turbinate (MT). Results Two hundred sides in 100 patients (median age 51 years, 62% female) were analyzed. The “center” of each map was defined as the intersection of spaces between U, EB, and MT. The frontal sinus opening was in the “center” in 53% of frontal recesses, lateral to this position in 29%, and anterior in 11%. When the frontal sinus opening was at the “center,” anterior ostia drained frontal Kuhn T cells in 51% and intersinus septal cells in 23%. The skull base attachment of the apical strut of the uncinate process demarcated medial and lateral within the space between U and EB, with the opening to the frontal sinus medial in 68% and lateral in 31%. Left-right asymmetry in frontal sinus openings was noted in 46% of patients. Conclusion Combining preoperative imaging and knowledge of these anatomic relationships may facilitate more efficient frontal outflow tract identification and instrumentation. This represents the first and largest description of ostial configurations relative to endoscopic structural landmarks. Level of Evidence: 4

The Frontal Cell as a Cause of Frontal Sinus Obstruction

1994 ◽  
Vol 8 (4) ◽  
pp. 185-192 ◽  
Author(s):  
John P. Bent ◽  
Carlos Cuilty-Siller ◽  
Frederick A. Kuhn
Keyword(s):  
Frontal Sinus ◽  
Mucociliary Clearance ◽  
Type I ◽  
Frontal Sinusitis ◽  
Cell Type ◽  
Radiographic Images ◽  
Frontal Recess ◽  
Sinus Cavity

The frontal cell is a rare anatomic anomaly that can become the etiology of chronic frontal sinusitis. It is an anterior ethmoid cell that can be differentiated from other ethmoid cells by serial analysis of sinus CT scans. Located cephalad to the middle meatus, it may obstruct natural mucociliary clearance by impinging on the frontal recess or the frontal sinus cavity. A classification of 4 types frontal cell (Type I-IV) is described. This anatomy is demonstrated in radiographic images of cadaver and patient sinuses. Four consecutive clinical cases of frontal cell obstruction of the frontal sinus are reviewed. In three instances, we performed a combined external and endoscopic intranasal frontal sinusotomy to effectively relieve the obstruction. We describe this technique in detail and provide a mean follow-up of 6 months for these four patients. With recognition of frontal cell obstruction of the frontal sinus, and proper treatment, the results appear to be very rewarding.

The International Classification of the radiological Complexity (ICC) of frontal recess and frontal sinus

2016 ◽  
Vol 7 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Peter John Wormald ◽  
Ahmed Bassiouni ◽  
Claudio A. Callejas ◽  
David W. Kennedy ◽  
Martin J. Citardi ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
International Classification ◽  
Frontal Recess

Three-dimensional reconstruction based on computed tomography images of the frontal sinus drainage pathway

2009 ◽  
Vol 124 (3) ◽  
pp. 291-296 ◽  
Author(s):  
S D Reitzen ◽  
E Y Wang ◽  
S R Butros ◽  
J Babb ◽  
R A Lebowitz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Frontal Sinus ◽  
Surgical Planning ◽  
Three Dimensional ◽  
Spatial Relationships ◽  
Computed Tomography Images ◽  
Dimensional Reconstruction ◽  
Sinus Drainage ◽  
Air Cells ◽  
Tomography Data

AbstractObjective:This study aimed to investigate the utility of three-dimensional reconstructions of paranasal sinus computed tomography data in depicting the anatomy of the frontal sinus drainage pathway.Methods:Twenty-nine patients underwent imaging of the sinuses for various clinical indications. Variations in frontal sinus recess anatomy were determined from 0.75-mm thick coronal, axial and sagittal computed tomography images. Three-dimensional, reformatted images were generated from manually segmented volumes of interest. Observations were made on the variation and usefulness of these reconstructions.Results:Three-dimensional, reformatted images of segmented volumes aided delineation of the spatial relationships of the frontal sinus, frontal sinus drainage pathway, infundibular and meatal direction of drainage, agger nasi cells, ethmoid bulla cells, supraorbital cells, and suprabullar cells.Conclusion:Three-dimensional, reformatted images of frontonasal anatomy enable improved understanding of the frontal sinus drainage pathway anatomy and of the spatial relationships between ethmoid air cells in this region. Such images may provide a useful adjunct to surgical planning and education.

scholarly journals Anatomical Variation in the Drainage Pattern of Frontal Sinus – A Cadaveric Study

2019 ◽  
Vol 08 (03) ◽  
pp. 117-120
Author(s):  
C. Gnanavelraja ◽  
S. D. Nalinakumari ◽  
M. Rajajeyakumar
Keyword(s):  
Frontal Sinus ◽  
Anatomical Variation ◽  
Intraoperative Complications ◽  
Uncinate Process ◽  
Sinus Surgery ◽  
Detailed Knowledge ◽  
Drainage Pattern ◽  
Postoperative Result ◽  
Sinus Drainage

Abstract Background A proper and detailed knowledge about the frontal sinus drainage pathway is essential for the radiologist to interpret the computed tomography scan of the paranasal air sinuses to find out normal and variant in the anatomy of frontal sinus ostium, and also for the surgeons to do endonasal sinus surgery particularly in the frontal sinus area with enough confidence and to give good postoperative result. With this background, the present study was focused to study the variation in the drainage pattern of frontal sinus in relation to uncinate process in cadaveric specimens. Materials and Methods The midsagittal section of head and neck portion of 40 cadaveric specimens with intact frontal sinus and frontal sinus drainage pattern were selected. By careful dissection, pattern of frontal sinus drainage was identified and pattern of drainage of frontal sinus in relation with uncinate process was studied. Result Frontal sinus drainage pattern is anteromedial to uncinate process (Type 1) in 28 specimens (70%) and posterolateral to uncinate process (Type 2) in 12 specimens (30%). Conclusion The results of our study show that the frontal sinus drainage pattern is more commonly present anteromedial to uncinate process compared with posterolateral position. This variation in the drainage pattern of frontal sinus should be kept in mind by the radiologist to give proper radiological interpretation and by the surgeons to avoid intraoperative complications and also to give good postoperative result.

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