Frontal Recess Cells Research Articles

Semi-Automated Virtual Endoscopy of the Frontal Recess.

Virtual endoscopy (VE) is the computer-based reprocessing of diagnostic imaging to simulate endoscopy of an anatomic region of interest. VE of the Frontal Sinus Outflow Tract (FSOT) may assist surgical planning and education. VE was performed on 16 normal sinus computed tomography (CT) scans for a total of 32 sides using the "path-to-target" tool on the TruDi surgical navigation system (ver. 2.3; Acclarent, Irving, CA, USA). To aid orientation during VE, planning points were placed on the middle turbinate, ethmoidal bulla, and skull base. The VE representation of anatomy and FSOT accuracy was manually confirmed by reviewing the corresponding orthogonal CT images and comparing them to the computed pathway. Of the 32 sides, the software successfully calculated the FSOT in 22 sides (69%). Of those 22 sides, the calculated FSOT, depicted in the VE sequences accurately represented the FSOT. Among sides with an accurately calculated FSOT, the VE sequences depicted a "fly-through" from a starting point in the middle meatus around various frontal recess cells to the end point in the frontal sinus. This pilot study demonstrates that software-generated VE of the FSOT is indeed feasible but requires confirmation by the surgeon for accuracy. Instances in which the software did not achieve its objective may drive further refinements of the protocol. VE of the FSOT should be explored as a tool for preoperative planning and surgical education.

Computed Tomographic Analysis of the Relationship between Frontal Recess Cells and Isolated Frontal Sinusitis

Objective: The relationship between frontal recess (FR) cells and frontal sinusitis is a topic of controversy. Numerous studies have explored this connection, but the majority have encompassed patients with frontal sinusitis in combination with chronic rhinosinusitis, with or without polyps. For a stronger causal link, it's crucial to focus on isolated frontal sinusitis (IFS), though primary IFS is exceptionally rare. This study aims to investigate the role of FR cells in the development of IFS. Methods: Two reviewers examined FR cells in triplanar computed tomography scans of 22 patients with 25 sides of IFS and 50 patients with healthy sinuses. The prevalence of each cell type was determined using the International Frontal Sinus Anatomy Classification (IFAC), and logistic regression analysis was used to determine whether any FR cells were associated with IFS. Results: Our results showed that supraorbital ethmoid cells (SOEC) (p <0.001) and supra agger frontal cells (p =0.038) were significantly more prevalent in the IFS group than in the control group. Logistic regression analysis revealed that the presence of SOEC was associated with a 4.79-fold greater risk of IFS (95% CI, 1.30–17.65, p =0.018). Conclusion: The FR cells may play a role in the development of frontal sinusitis. Among the IFAC cell types, SOEC appears to be associated with IFS.

Computed Tomographic Study of Frontal Sinus Cells and Opacification as Per the International Frontal Sinus Anatomy Classification.

International frontal sinus anatomy classification (IFAC) was introduced in 2016 to standardize the nomenclature of the cells in the frontal recess region, facilitate better communication between surgeons and precision in surgical planning, and improve surgical teaching. This study aims to estimate the radiological prevalence of the different frontal recess cells according to the IFAC and to evaluate the relationship of these cells with the frontal sinus opacification in patients with chronic rhinosinusitis. In this study, 90 participants diagnosed with chronic rhinosinusitis (CRS) who underwent computed tomogram (CT) of the para nasal sinuses were enrolled consecutively. The CT images were were studied in detail using RadiAnt DICOM viewer. The frontal recess cells were grouped as per the IFAC guidelines and their respective prevalence was calculated. The frontal recess cells were grouped as per the Opacification or mucosal thickening within these cells and the frontal sinuses were noted. A multivariate logistic regression analysis was done to evaluate the association between frontal sinus opacification and presence of various IFAC cells. A total of 640 IFAC cells were documented in 180 sides, of which 326 were anterior cells, 263 were posterior cells and 51 were medial cells. The most prevalent cell was the agger nasi cells(ANC), present in 91.7% of 180 sides, the supra agger nasi cells(SANC), Supra agger nasi frontal cells(SAFC), supra bulla cells(SBC), supra bulla frontal cells(SBFC), supra orbital ethmoidal cells(SOEC) and frontal septal cells(FSC) were present in 47.8%,37.8%, 65.6%,28.9%, 51.1% and 28.3% respectively. There was no significant association of presence of IFAC cells and frontal sinus opacification except for SBFC(p = 0.038). A significantly higher number of diseased frontal recess cells were seen with involved frontal sinuses when compared with non-involved frontal sinuses across all types of IFAC cells. The ANC were the most prevalent among all the IFAC cells and the FSC were the least prevalent. There was no significant association with the presence of different types of IFAC cells and frontal sinus opacification except for SBFC. However, there was a significantly higher number of diseased IFAC cells associated with frontal sinus opacification than in those without frontal sinus opacification.

A radiological study on anatomical variations of frontal sinus and its’ drainage pathway in a Nepalese adult population

Background: This study aims to assess anatomical variations in the frontal sinus and its drainage pathway within the Nepalese population. Methodology: This cross-sectional analytical study was conducted at the Department of ENT-HNS and Radiology, Maharajgunj Medical Campus in Nepal. Digital Imaging and Communications in Medicine (DICOM) computed tomography files of patients were analyzed over a year to assess pneumatization variations, frontal sinus size, presence of intersinus septa, olfactory fossa depth, frontal recess cells, and anterior ethmoidal artery position. Imaging files with obscuring disease processes or obtained in different positions, hindering frontal sinus or recess visibility, were excluded. Data analysis employed SPSS version 25, using descriptive statistics (median, range, interquartile range), Chi-squared tests, and Cramer’s V. Results: Among total sinuses analyzed, 7% exhibited unpneumatized frontal sinuses (3.3% bilaterally, 6.7% unilaterally). Median dimensions for right and left frontal sinuses were 10.2 x 11.15 x 11.7 mm and 10.2 x 11.1 x 11.6 mm, respectively. Predominant fin- dings included mixed upper uncinate process attachments, Type II olfactory fossa, agger nasi as the commonest anteriorly based cells, and supra bulla cells as the prevalent posteriorly based cells. Conclusion: Investigation of frontal sinus anatomy in the Nepalese population revealed distinct features. While generally well- developed, these sinuses exhibited relatively smaller dimensions compared to other ethnic groups. Consistent with prior studies, agger nasi and supra bulla cells were the most prevalent anteriorly and posteriorly based cells, respectively.

The Variants of Frontal Recess and Its Effect in the Development and Prevalence of Frontal Sinusitis in Patients in a Tertiary Care Hospital: A Retrospective Observational Study.

According to medical literature, the frontal recess' intricate physical structure resembles an inverted funnel. The anatomical structure is not distant from the frontal ostium. Surgery requires a good understanding of the frontal recess architecture because of the intricate anatomy of this relatively small area. The pathophysiological characteristics of frontal sinusitis and the process of sinus ventilation through the sinus ostium have been linked, according to medical literature. Medical studies show that one of the most important factors affecting the amount of drainage in the frontal sinuses is the size of the frontal sinus ostium. Inflammation brought on by frontal recess cells can frequently affect the airflow in the frontal sinuses. The drainage channel of the frontal sinus is stated as narrowing in the current investigation as an observed phenomenon. The aim of this study was to examine the frontal recess changes and how they might affect the emergence of frontal sinusitis. The classification of frontal recesses according to their various categories was the study's principal finding. The investigation of the causal elements that resulted in the development of frontal sinusitis was the study's secondary goal. In a hospital setting, a cohort of 200 patients with sinonasal disorders underwent a retrospective observational research. Over the course of a year, from July 2021 to June 2022, the study participants had evaluations at a tertiary care center. 200 CT PNS images of individuals who fit certain inclusion and exclusion criteria were examined in this study. Using the chi-square test, the study looked into the relationships between several risk factors, including age, gender, and the type of frontal recess. The presence of frontal sinusitis served as the main outcome indicator. This study included a total of 200 participants with a mean age was 43.38years (± 10.69). There was 146 (73%) male and 54 (27%) female were in the study. Type I frontal recess in 50 (25%), type II in 82 (41%), type III in 24 (12%) and type IV in 18 (9%) patients. The association of age (P = 0.141) and gender (P = 0.345) with frontal sinusitis was not significant. The statistical association between type of frontal recess and frontal sinusitis was statistically not significant. The association between age and the type of frontal recess was found to be statistically significant by Fischer's exact test with P value of 0.012 (< 0.05), whereas gender was not associated with the type of frontal recess by the same test. It is difficult to overstate the significance of the terms frontal recess, frontal sinusitis, and sinus ostium in this particular medical context. This article was a retrospective observational study that investigates the connection between frontal sinusitis and changes in the frontal recess in patients receiving care at tertiary medical facilities.

CT analysis of frontal recess air cell and fluid dynamics simulation of frontal sinus in people with different frontal sinus development after Draf1–3 surgery

ObjectiveTo explore the effects of Draf1–3 on frontal sinus airflow and frontal sinus irrigation in people with different frontal sinus developmentMethodsThe development of the frontal sinus and the distribution of the frontal recess cells were evaluated by CT scan in 150 adults (300 sides). The airflow changes into the frontal sinus and frontal recess after Draf were analyzed by Fluent software under a steady state and quiet inspiratory state. Nasal irrigation after Draf in adults with well-developed frontal sinus was simulated using 120 mL saline at a rate of 12 mL/s in a position at 45° to observe the changes in transient flow distribution.ResultsThe moderately developed type of the frontal sinus was the most common. The airflow patterns in the frontal sinus and frontal recess in the moderate development group were laminar, while several large vortexes were formed between the frontal sinus and frontal recess in the well-development group. The Draf exerted more significant effects on the patterns, pressure, and velocity of the airflow in the frontal sinus and frontal recess in the well development group than in the moderate development group. The volume fraction of saline in the frontal sinus increased significantly from Draf1 to Draf3, and the time required for a complete infiltration of saline in the frontal sinus mucosa was significantly reduced.ConclusionsDraf1–3 has different effects on the airflow field of the frontal sinus with different developmental types; and Draf1–3 can significantly improve the postoperative flushing of the frontal sinus.

Does Frontal Recess Cell Variation Associate with the Development of Frontal Sinusitis? A Narrative Review.

Chronic rhinosinusitis (CRS) can have a significant impact on quality of life. With persistent symptoms and the failure of initial medical treatments, surgical management is indicated. Despite the excellent results of endoscopic sinus surgery for persistent CRS, it is quite a challenging procedure for frontal sinusitis given the complex anatomy and location of the frontal sinus. Frontal recess cells significantly contribute to the complexity of the frontal sinus, and numerous studies have sought to establish their association with sinusitis. This review offers a comprehensive understanding of frontal recess cells, their different classifications, their prevalence among different populations, and their relationship to sinusitis. After an extensive review of the current literature, the International Frontal Sinus Anatomy Classification (IFAC) is the most recent classification method and a preferred practical preoperative assessment tool. Although the agger nasi cell is the most prevalent cell among all reported populations, ethnic variations are still influencing the other cells' distribution. Studies are inconsistent in reporting a relationship between frontal recess cells and sinusitis, and that is mainly because of the differences in the classification methods used. More research using a standardized classification method is needed to understand the association between frontal recess cells and sinusitis.

A Prospective Study on the Anatomical Variations of the Frontal Recess and its Association with Computer Tomographic Signs of Sinusitis.

The frontal recess region has a complex anatomy and HRCT scans of the paranasal sinuses (PNS) are the gold standard in evaluating it. Classification systems have been established to identify the frontal recess cells. The objectives of this study are to describe the incidence of anatomical variations, classify the anatomy of the frontal recess using the IFAC & Kuhn's classification systems, find the association between the anatomical variations and the incidence of CT signs of sinusitis. A prospective study of patients undergoing HRCT-PNS was carried out. The frontal recess region was evaluated and classified as per both classification systems. The prevalence of each frontal cell was identified; presence of CT signs of sinusitis was noted and the correlation between the two was evaluated. 272 sides of HRCT scans were evaluated. Prevalence of cells as per IFAC classification showed ANC - 98.2%, SAC-43.4%, SBC-33.1%, SAFC- 28.3%, FSC -25%, SBFC- 3.7% and SOEC- 2.2%. Prevalence of cells as per Kuhn's classification showed ANC - 98.2%, Type 1- 38.2%, SBC-32.7%, FSC -24.3%, Type 3- 16.9%, Type 2- 12.9%, Type 4- 4.8%, FBC- 2.6% and SOEC-2.2%. Sinusitis was seen in 27.2% cases. A significant association was noted between the presence of SOEC, FSC and sinusitis as per both classification systems. (P=0.049 and P<0.001 respectively). In conclusion the cells which lead to an anteriorly based drainage pathway are more common, but the presence of posteriorly based SOEC and medially based FSC have a higher association with sinusitis.

The Frontal Sinus Drainage in Relation to Frontal Sinus Surgery.

In order to perform a successful endoscopic frontal sinus surgery, prevent complications, and lower the recurrence risk, it is essential to understand the anatomy of the frontal sinus (FS) and frontal recess cells with many variations in frontal sinus drainage (FSD). Preoperative assessment of the FSD in three levels in order to find prognostic factors in the decision process regarding the kind and the extent of surgery when required. Three FSD levels were assessed by computed tomography in two dimensions; antero-posteriorly and laterally in 100 consecutive patients with chronic sinusitis symptoms. The first level represents the proper drainage of FS. The second level is the drainage of FS without the effect of the frontoethmoidal cells. The third level is the maximum drainage that can be achieved in a single FS. The relation of FSD levels to FS and frontoethmoidal cells pathology were assisted. Within 100 patients (200 sides, 186 FSs), for the proper FSD, antero-posterior (AP) length was 5.94 ± 3.42mm in opaque FS and 5.32 ± 2.87mm in clear FS and its lateral length was 3.04 ± 1.6mm in opaque FS and 2.30 ± 1.25mm in clear FS. For the functional FSD, AP length was 8.97 ± 2.7mm in opaque FS and 8.05 ± 2.7mm in clear FS and its lateral length was 7.51 ± 1.69mm in opaque FS and 7.58 ± 1.75mm in clear FS. In the anatomical FSD, AP length was 11.25 ± 3.07mm in opaque FS and 10.01 ± 2.87mm in clear FS and its lateral length was 11.1 ± 2.6mm in opaque FS and 10.95 ± 1.7mm in clear FS. This study offers essential data for preoperative assessment in order to improve surgeons' awareness of the frontoethmoidal region for optimal safe EFSS with lower incidence of complications and recurrences.

Precision Endonasal Endoscopic Surgery of the Frontal Recess Cells and Frontal Sinus Guided by the Natural Sinus Drainage Pathway.

BackgroundThe endoscopic endonasal approach to removing lesions in the nasal cavity and sinuses has become the modern first choice. However, if endoscopic surgery is performed without proper knowledge of sinus anatomy, there is a risk of residual lesions, recurrence, and even serious complications. Therefore, this article illustrates the importance of precise sinus opening guided by the natural sinus drainage pathway, using the anatomy of the frontal sinus (FS) and the frontal recess (FR) cells as an example.MethodA total of 82 sides cadaveric heads were dissected and analyzed, and the natural drainage pathways of the FR cells and FS were observed at 0°and 70°nasal endoscopic views, and the findings were summarized. The data of 79 patients who accepted endonasal endoscopic surgery (EES) guided by natural sinus drainage pathways to remove mucoceles in our department from January 2015 to January 2021 were retrospectively analyzed.ResultsTwo natural drainage pathways of the FR cells were discovered, identified, and named the medial pathway of the FR (MPFR) and the lateral pathway of the FR (LPFR). The 79 patients who accepted EES to remove mucoceles through the natural drainage pathways of FR cells and the FS showed significant improvement in clinical symptoms, and none of them had recurrence after surgery without serious complications.ConclusionThe EES of the FR cells and FS through the natural drainage pathways to remove the mucoceles facilitates exposure of the cells without residual lesions and without serious complications.

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

Frontal 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.

Three-dimensional computed tomography analysis of frontal recess cells according to the International Frontal Sinus Anatomy Classification (IFAC) - difficulties in identification of frontal recess cells in patients with diffuse primary chronic rhinosinusitis?

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt;The International Frontal Sinus Anatomy Classification (IFAC) is a consensus document created to standardize and specify the naming of cells within the region of the frontal recess and frontal sinus.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this study was to analyze the difficulties in identifying cells according to the IFAC in patients with diffuse primary chronic rhinosinusitis.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; Three independent reviewers examined triplanar computed tomography (CT) scans to assess the anatomy of the frontal recess using the IFAC system. CT scans were chosen randomly and divided into 3 groups: CT scans of patients not presenting sinus complaints (control group), CT scans of patients affected by diffuse primary chronic rhinosinusitis non-type 2, and CT scans of patients affected by diffuse primary chronic rhinosinusitis type 2.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Identification of all frontal cell types was accurate in patients not presenting sinus complaints (P-value &lt; 0.05). Patients scoring 9 or more points in the Lund-Mackay scoring system demonstrated a statistically increased risk of improper identification of frontal recess cells (P-value &lt; 0.0001).&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Due to a large number of possible anatomical variants and changes caused by the chronic inflammatory disease, the IFAC nomenclatura is easier to apply to non-type 2 primary diffuse CRS patients with low scores in the L-M score scale than to primary diffuse type 2 CRS patients with higher M-L scores.&lt;/br&gt.

Two Cases of Isolated Frontal Septal Cell Inflammation Treated with the Draf IIb Procedure

The frontal septal cell (FSC) is a medially based air cavity of the anterior ethmoid or the inferior frontal sinus, located in the interfrontal sinus septum. FSC pathologies are extremely rare although they are common frontal recess cells. We report on two patients with isolated FSC sinusitis presenting with frontal headache who were treated with Draf IIb endoscopic sinus surgery (ESS). Paranasal sinus computed tomography of the patients revealed a clear frontal sinus and FSC soft tissue density. The patients underwent a Draf IIb procedure through left-sided approach to treat FSC inflammation. After surgery, the patients no longer complained of headache, and the widened outflow tract was maintained without narrowing in endoscopic views during 2 years of follow-up. When a patient presents with continuous frontal headache, FSC inflammation should be considered. It can be successfully treated by Draf IIb ESS. (J Clinical Otolaryngol 2021;32:85-89)

Endoscopic frontal recess anatomy directed by the drainage pathways using the connecting plates as landmarks.

To investigate the anatomical features of frontal recess (FR) drainage, and the classification of FR cells and frontal sinus (FS). Fifty sides from 30 adult cadaver heads were examined. FR cells and FS along the drainage pathways were dissected under 0° and 70° endoscopic views using unique connecting structures between the uncinate process and the ethmoid bulla as landmarks. Connecting plates between the uncinate process and the ethmoid bulla were discovered and termed medial suprainfundibular plate (MSIP), which were observed on each cadaver head, and lateral suprainfundibular plate (LSIP) on 92% (46/50) sides. Separated by MSIP, two drainage pathways were identified and named medial pathways of the FR (MPFR) medial to the MSIP and the lateral pathways of the FR (LPFR) in the lateral side. Different drainage pathways of the FS were confirmed, in which drained into the MPFR in 37 and into the LPFR in 13 of the cadaver sides. MSIP is the critical landmark for the recognition of MPFR, LPFR, and the classification of FR cells. The FR resection along LPFR and MPFR facilitated excellent exposure of FS.

Frontal Sinus Variations and Prevalence of Frontal Recess Cells among Adult Egyptians: Computerized Tomography Study

Abstract Background: The frontal sinus is often considered as the most challenging area to approach in Functional Endoscopic Sinus Surgery (FESS). Considerable variations in the shape, capacity and symmetry of frontal sinus have been reported. Aim of Study: To provide better understanding of frontal sinus morphometry and anatomical variations of specific frontal recess cells and their prevalence among adult Egyptians. Material and Methods: Coronal and sagittal CT scans of sixty adult persons of the Egyptian population (30 males and 30 females, assigned into Group 1; from 20 to 30 years, group 2; from 31 to 50 years and group 3; more than 50 years) were done to demonstrate the anatomy of the frontal sinus. Results: A statistically significant difference in the width of the right sinus between group 2 and group 3 was revealed. Eighty percent of frontal sinuses were asymmetrical. Agger nasi cell was the most common encountered frontal recess cell and mostly bilateraly presented. The second common was Interfrontal sinus septal cell (IFSC). Statistically significant association was found between Fronta Bullar Cell (FBC) and frontal cell type 4 (FC4) but no statistically significant differ-ence was found between males and females except for frontal cell type 3 (FC3) which was higher among females than males. Statistically significant positive correlation between A-P length of left FR and AP length of right FR was revealed, while no significant correlation was found between AP length and volume of ANC. Conclusion: Awareness of frontal sinus dimensions frontal recess cells variations among Egyptians should be taken in consideration in safe frontal endoscopic surgery.

A prospective study of the prevalence of Kuhn’s frontal cells and their relation to frontal sinus disease

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The involvement of frontal cells in the frontal sinus disease pathology remains an understudied area. There are very few reports on the prevalence of frontal recess cells in India. In this context the present study was designed to determine the frequency of occurrence of Kuhn frontal cells and to determine whether the size of the frontal isthmus or the presence of frontal cells is related to the presence of frontal sinus disease.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study included 80 patients who presented with signs and symptoms of chronic rhino-sinusitis after satisfying the inclusion criteria to the Department of ENT in a tertiary care centre (Mahatma Gandhi Medical College and Research Institute) in Pondicherry from January 2017 to April 2018. The patients were subjected to detailed clinical history, basic preoperative blood investigations, diagnostic nasal endoscopy and High Resolution Computed Tomography of nose and para-nasal sinuses after which the diagnosis was established.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of the 80 study participants subjected to our study the number of individuals who had frontal sinusitis was 50%. The association between frontal sinusitis and Kuhn cells was insignificant. The mean value of anteroposterior diameter of the naso-frontal isthmus in case of patients with and without frontal sinusitis was 0.705-0.735. In case of transverse diameter it was 0.725-0.720 and in case of the area of the frontal isthmus it was 30.86-31.12 which had a p value of 0.49&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Therefore in our study we concluded that there is no significant relation for any particular frontal recess cell or the size of the nasofrontal isthmus for being the sole cause for chronic frontal sinusitis.&lt;/p&gt;

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

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. 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. 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. 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. 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.

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.

A computed tomographic analysis of frontal recess cells in association with the development of frontal sinusitis

ObjectiveThis study was done to determine frontal recess anatomy cell variations and its association with frontal sinusitis. The incidence of frontal recess cells in the population, the presence of frontal recess cell variations in chronic rhinosinusitis and non-chronic rhinosinusitis and the association of frontal recess cell variation in the development of frontal sinusitis were also assessed. MethodsThis was an observational, retrospective cross-sectional study of computed tomography (CT) scan of paranasal sinus that had been performed on patients in Hospital Universiti Sains Malaysia and Hospital Sultanah Bahiyah done from January 2009 until December 2016. The presence of frontal recess cells variation was compared with other populations. ResultsA total of 312 sides from 156 patients’ CT scan images were analyzed. Left and right sinuses were considered individually. A total of 63 sides showed evidence of frontal sinusitis, 37 were male and 26 were female, whereas 249 sides were clear from frontal sinus disease. It was not much difference in mean age for frontal sinusitis patient (46.51±14.00) and patients without frontal sinusitis (48.73±16.44). The percentage was almost equal for CRS and non-CRS groups regardless of side and gender. In our study, the frontal recess cell such as agger nasi cell was found in almost all patients 98.1%, frontal ethmoidal cell type 1, type 2, type 3 and type 4 comprised of 28.8%, 31.1%, 14.4% and 0% respectively. Whereas, suprabullar cell can be seen in 40.3%, supraorbital ethmoid cells 16.7%, frontal bullar cell 33.0% and inter-frontal sinus septal cells 10.8%. There was a statistically significant association between the presence of frontal bullar cell and the development of frontal sinusitis (p value<0.001). ConclusionThe frontal recess cells variation in Malaysian subjects were almost similar to those reported in other Asian populations such as Japanese, Taiwanese, Chinese and Korean. Our study found that frontal bullar cells had a significant association with the development of frontal sinusitis than other frontal recess cells. The understanding of the frontal recess anatomical structures was very important as this would lead to a successful treatment of CRS and at the same time it helped the surgeon to have a better plan of endoscopic sinus surgery to prevent the disease recurrence and surgical complication.

Impact of residual frontal recess cells on frontal sinusitis after endoscopic sinus surgery.

Endoscopic sinus surgery (ESS) is a well-established treatment for chronic rhinosinusitis (CRS). However, ESS for frontal sinusitis remains complicated and challenging. The aim of this study was to identify the relationship between residual frontal recess cells and primary ESS failure in the frontal sinus. We prospectively collected information on 214 sides of 129 patients with CRS who underwent standard ESS from June 2010 to May 2011. To identify risk factors, we retrospectively analyzed clinical data and computed tomography (CT) images before and 3months after surgery. The posterior side of the frontal recess cells remained relatively common: suprabullar cells (SBCs) were found in 12.2% (16 sides), suprabullar frontal cells (SBFCs) in 20.3% (12 sides), and supraorbital ethmoid cells in 23.7% (14 sides). In contrast, the anterior side of the frontal recess cells, agger nasi cells, supra agger cells, and supra agger frontal cells remained at < 10.0%. Frontal septal cells persisted in 25.0% (5 sides). The presence of residual frontal recess cells was an independent risk factor for postoperative frontal sinus opacification as were well-recognized risk factors such as nasal polyps, the peripheral eosinophil count, and the CT score. Among residual frontal recess cells, SBCs and SBFCs were independent risk factors for opacification. Residual frontal recess cells, especially SBCs and SBFCs, were independent risk factors for postoperative opacification of the frontal sinus. Complete surgical excision of frontal recess cells may improve surgical outcomes.