scholarly journals Anatomical Analysis of the Frontal Recess Cells in Endoscopic Sinus Surgery-An Indian Perspective

2009 ◽  
Vol 2 (3) ◽  
pp. 15-20 ◽  
Author(s):  
AK Agarwal ◽  
Shruti Dhingra ◽  
JC Passey ◽  
JM Kaul
Keyword(s):  
Frontal Sinus ◽  
Imaging Techniques ◽  
Sinus Surgery ◽  
Surgical Removal ◽  
Frontal Recess ◽  
Accessory Cells ◽  
Endoscopic Surgeon ◽  
Good Drainage ◽  
Air Cells ◽  
Indian Perspective

Abstract Surgery of the frontal sinus has gone a full circle from intranasal procedures to destructive and disfiguring external operations and now back to intranasal procedures but with endoscopes. Endoscopic surgery of the frontal sinus has always been a challenging experience because of the narrowness of the area, poor visibility, variable anatomy and encroachment by accessory cells such as agger nasi, frontal, intersinus septal cells on the drainage pathway. With the developments in optical aids such as endoscopes, which provide an angled view, better and brighter illumination, sophistication in the designs of instrumentation and development of imaging techniques, a renewed interest has been created in this area, but the knowledge of anatomy of this area is poor and does not meet the demands of the present day endoscopic surgeon. Moreover, no studies are available on Indian subjects. Our main interest in the present study was to study the various air cells which encroach the area of frontal recess and would need surgical removal to provide a good drainage and ventilation.

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

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.

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.

Indications for External Frontal Sinus Procedures for Inflammatory Sinus Disease

2009 ◽  
Vol 23 (3) ◽  
pp. 342-347 ◽  
Author(s):  
Samuel Hahn ◽  
James N. Palmer ◽  
Michael T. Purkey ◽  
David W. Kennedy ◽  
Alexander G. Chiu
Keyword(s):  
Inflammatory Disease ◽  
Frontal Sinus ◽  
Sinus Surgery ◽  
External Approach ◽  
Previous Surgery ◽  
Frontal Recess ◽  
Frontal Sinus Surgery ◽  
Previous Trauma ◽  
History Of ◽  
Type 3

Background In the modern age of endoscopic sinus surgery (ESS), there is an undefined role for external approaches in the treatment of inflammatory disease. This study examines the frontal sinus surgery practices of three experienced rhinologists with a focus on those who underwent an external approach. Our goal was to characterize these patients and propose indications for the use of an external approach alone or in combination with functional ESS (FESS) for frontal sinus inflammatory disease. Methods A retrospective review was performed of frontal sinus procedures performed for inflammatory disease at one institution from 2004 to 2007. Results Seven hundred seventeen procedures were performed, 38 (5.3%) of which were external alone (14 procedures) or in combination with FESS (24 procedures). Osteoplastic flap with obliteration (12/14) made up the majority of external alone procedures and the most common indication was neo-osteogenesis of the frontal recess. Trephination was the most common external adjunct to FESS (12/24), and often was performed for type 3 frontal recess cells or in the initial management of acute frontal bone osteomyelitis (FOM). Twenty-eight of 38 (74%) patients had a history of previous surgery. Of the 10 patients with no history of previous surgery, 6 (60%) had an external adjunct for frontal recess neo-osteogenesis. There were no major complications but 9/38 (23.7%) patients required revision surgery for persistent/recurrent symptoms. Conclusion External approaches alone and in combination with FESS are predominantly secondary to neo-osteogenesis of the frontal recess. Factors associated with neo-osteogenesis include previous trauma, endoscopic surgery, and FOM. External frontal sinus surgery provides adequate management of inflammatory disease but has a high revision rate.

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 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.

The Effect of Middle Turbinate Resection upon the Frontal Sinus

1995 ◽  
Vol 9 (4) ◽  
pp. 191-196 ◽  
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.

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.

scholarly journals Implication of frontal sinus mucocele’s location and intrasinus septation

2019 ◽  
Vol 12 (3) ◽  
pp. e226830
Author(s):  
K Devaraja ◽  
Hitesh Verma ◽  
Rajeev Kumar
Keyword(s):  
Surgical Approach ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Standard Of Care ◽  
Sinus Surgery ◽  
External Approach ◽  
Critical Factors ◽  
Successful Management ◽  
Air Cells

Mucocele of paranasal sinuses commonly affects frontal or frontoethmoidal air cells. With the evolution of endoscopic sinus surgery, the endoscopic marsupialisation has become the standard of care for these lesions. However, the external approach still has a role in selected cases of frontal sinus mucocele. The location of the mucocele and its communication with the natural outflow tract of the frontal sinus are some of the critical factors to be considered while choosing the surgical approach. We have discussed the management of three cases of frontal mucoceles having different locations and one of them having intervening septa. We emphasise that the successful management of far laterally located mucoceles and those with laterally situated septation require an external approach in conjunction with endoscopic marsupialisation.

Sign in / Sign up

Export Citation Format

Share Document