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 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.

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

scholarly journals Anatomical variations in superior attachment of uncinate process and localization of frontal sinus outflow tract

2017 ◽  
Vol 3 (2) ◽  
pp. 176
Author(s):  
Arun G. ◽  
Sanu P. Moideen ◽  
Mohan M. ◽  
Khizer Hussain Afroze M. ◽  
Aparna S. Thampy
Keyword(s):  
Frontal Sinus ◽  
Uncinate Process ◽  
Outflow Tract ◽  
Sinus Surgery ◽  
Type I ◽  
Type Ii ◽  
Cross Sectional ◽  
Type Iii ◽  
Frontal Recess ◽  
Type Iv

<p class="abstract"><strong>Background:</strong> Uncinate process (UP) is a part of ethmoid bone, which is a thin sickle shaped projection on the lateral wall of nose. UP extends from the frontal recess superiorly and inferiorly to the ethmoid process of inferior turbinate. Various studies have shown that superior attachment of uncinate process (SAUP) is the key to frontal recess region in endoscopic sinus surgeries (ESS). But these studies have yielded conflicting results, showing multiple patterns and classifications of superior attachment of uncinate process. Knowing the anatomic variations of SAUP will help the surgeon to plan the endoscopic sinus surgery and to avoid the unwanted complications. Hence this study was conducted to observe and classify the superior attachment of uncinate process and to localize the frontal sinus outflow tract<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> We did a retrospective cross sectional study, consisting of 100 patients including both sexes, above the age of 10 years. We excluded pregnant ladies, patients with prior sinus surgeries, sinonasal tumours, nasal polyposis, and craniofacial trauma<span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> We observed Type I SAUP, in 67.5% (n=135) cases, Type II SAUP in 18.5% (n=37), Type III attachment in 9.5% (n =19) and Type IV in 4.5% (n=9). Bilaterally similar attachments observed in 96% cases. Rest of the cases (4%), the attachment patterns was varying between sides<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The site of SAUP is highly variable. The most common type of SAUP is Type I (67.5%) followed by Type II (18.5%), Type III (9.5%) and Type IV (4.5%)<span lang="EN-IN">.</span></p>

Endoscopic Anatomic Characterization of the Frontal Recess and Its Implications in Frontal Sinus Surgery

ORL ◽  
2008 ◽  
Vol 70 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Zhou Bing ◽  
Han Demin ◽  
Liu Huachao ◽  
Huang Qian ◽  
Zhang Luo ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Sinus Surgery ◽  
Frontal Recess ◽  
Frontal Sinus Surgery

Association between the insertion type of the uncinate process and the development of Frontal Sinus Mucoceles - is there a relationship?

2020 ◽  
Author(s):  
Mafalda S. Barroso ◽  
Bernardo C. Araújo ◽  
João Jacinto ◽  
Catarina Marques ◽  
Ilídio Gama ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Uncinate Process

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

2019 ◽  
Vol 12 ◽  
pp. 117955061988494
Author(s):  
Seiichiro Makihara ◽  
Shin Kariya ◽  
Mitsuhiro Okano ◽  
Tomoyuki Naito ◽  
Kensuke Uraguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Frontal Sinus ◽  
Significant Positive Correlation ◽  
Japanese Patients ◽  
Cell Types ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Frontal Sinusitis ◽  
Frontal Recess ◽  
The Relationship

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.

scholarly journals Frontal recess anatomy and frontal sinusitis association from the perspectives of different classification systems

B-ENT ◽  
2021 ◽  
Vol 17 (1) ◽  
pp. 7-12
Author(s):  
Ozgur Kemal ◽  
◽  
Emel Tahir ◽  
Asli Tanrivermis Sayit ◽  
Egemen Cengiz ◽  
...  
Keyword(s):  
Classification Systems ◽  
Frontal Sinusitis ◽  
Frontal Recess

scholarly journals Systematic analysis of the literature in search of defining systemic sclerosis subsets

2021 ◽  
pp. jrheum.201594
Author(s):  
Tatiana Nevskaya ◽  
Janet E. Pope ◽  
Matthew A. Turk ◽  
Jenny Shu ◽  
April Marquardt ◽  
...  
Keyword(s):  
Gene Expression ◽  
Systemic Sclerosis ◽  
Original Data ◽  
Response To Therapy ◽  
Classification Systems ◽  
Skin Involvement ◽  
Multisystem Disease ◽  
Systematic Analysis ◽  
Tissue Samples ◽  
Gene Expression Signatures

Objective Systemic sclerosis (SSc) is a multisystem disease with heterogeneity in presentation and prognosis. An international collaboration to develop new SSc subset criteria is underway. Our objectives were to identify systems of SSc subset classification and synthesize novel concepts to inform development of new criteria. Methods Medline, Cochrane MEDLINE, CINAHL, EMBASE and Web of Science were searched from their inceptions to December 2019 for studies related to SSc sub-classification, limited to humans without language or sample size restrictions. Results Of 5686 citations, 102 articles reported original data on SSc subsets. Subset classification systems relied on extent of skin involvement and/or scleroderma-specific autoantibodies (n=61), nailfold capillary patterns (n=29), molecular, genomic and cellular patterns (n=12). While some systems of subset classification confer prognostic value for clinical phenotype, severity, and mortality; only subsetting by gene expression signatures in tissue samples has been associated with response to therapy. Conclusion Subsetting on extent of skin involvement remains important. Novel disease attributes including SSc-specific autoantibodies, nailfold capillary patterns and tissue gene expression signatures have been proposed as innovative means of SSc subsetting.

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