Objectives Two major classifications of frontoethmoidal cells, Lee and Kuhn and the IFAC (International Frontal Sinus Anatomy Classification), distinguish anterior, posterior and medial cells. The European anatomical position paper includes also lateral cells. According to the IFAC, anterior cells push the frontal sinus drainage pathway (FSDP) medially, posteriorly or posteromedially. Posterior cells push the FSDP anteriorly. The only medial cell, pushing the FSDP laterally is the frontal septal cell, which is attached to or located in the interfrontal sinus septum. The aim of this study was to verify the IFAC and characterise cells, which are inconsistent with this classification. Design A radioanatomic analysis. Setting Tertiary university hospital. Participants One hundred and three Caucasian adult patients with no inflammatory changes in paranasal sinuses CT. Main outcomes measure Results of assessment of multiplanar reconstruction of thin slice CT. Results Two types of cells that cannot be classified using the IFAC were found: (a) Lateral cells extending between the skull base and the anterior buttress, pushing the FSDP anteromedially or medially, present in 34 (16.5%) of the sides, (b) Paramedian cells: medially based, not adjacent to the interfrontal septum, pushing the FSDP laterally and posteriorly, present in 33 (16%) of sides. Suprabulla cells and suprabulla frontal cells were found to push the FSDP in directions other than anterior 28% and 31% of the time respectively. Conclusions Neglecting lateral and paramedian cells may lead to inconsistent results between radioanatomical studies and impede communication between surgeons. They should be included in existing classifications of frontoethmoidal cells.

The European Anatomical Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses distinguishes anterior, posterior, medial and lateral frontoethmoidal cells. The lateral cells have not been characterized yet. Other classifications (Lee and Kuhn, International Frontal Sinus Anatomy Classification) neglect them. The aim of this study is to describe lateral frontoethmoidal cells in rhinosinusitis patients. Method: Analysis of medical records and computed tomography (CT) examinations using multiplanar reconstruction with adjustable planes. The lateral cell extending between the frontal beak and the skull base pushing the frontal sinus drainage pathway medially/anteromedially was identified in 6 patients. These cells could not be classified as anterior, posterior or medial according to existing classifications. Four patients were operated on previously due to sinonasal symptoms. The lateral frontoethmoidal cell is an underestimated anatomical variation that may contribute to the persistence of inflammatory disease and can be easily overlooked preoperatively.

Purpose The olfactory groove (OG) is a common site of iatrogenic cerebrospinal fluid (CSF) leak during endoscopic sinus surgery. We aimed to evaluate the prevalence of CSF leak during endoscopic removal of osteomas involving the OG and identify CT findings indicating increased risk of this complication. Methods A retrospective review was conducted of patients operated on for frontoethmoidal osteoma from 11 years in a single institution. A retrospective review of the literature, 1999 to 2019, of perioperative complications in patients operated on for frontoethmoidal osteoma using endoscopic or combined approaches. Results Case series: 73 patients were identified including 17 with the OG involvement. The only case of CSF leak occurred in a patient with spongious part of osteoma at the OG. Among six osteomas with spongious component at the OG, one was detached and five had to be drilled down, leaving a small remnant in four. In contrast, all the 11 osteomas with ivory part at the OG were safely detached and completely removed from the OG after debulking. The prevalence of CSF leak was not statistically different between the patients without and with involvement of the OG. Systematic review of the literature: Among the 273 identified patients there were 8 cases of intraoperative CSF leaks (3%) including 2 from the OG (0.7%). Conclusion Involvement of the OG does not significantly increase the risk of intraoperative CSF leak. However, this risk may be increased in patients with the spongious part of the tumor attached to the OG.

Introduction Endoscopic medial maxillectomy is currently the most commonly used endoscopic approach to the maxillary sinus inverting papilloma. The possible complications of this procedure include epiphora, crusting and empty nose syndrome. Another method, a prelacrimal recess approach, enables preservation of the nasolacrimal duct and inferior nasal turbinate, but offers limited possibility of postoperative endoscopic follow-up. Aim To evaluate the combined middle and inferior meatus antrostomy approach to treat the maxillary sinus inverting papilloma. Material and methods A retrospective assessment of the medical records of consecutive patients operated on due to the maxillary sinus inverting papilloma in a single centre was performed. Results Fourteen patients operated on using combined antrostomies, with a follow-up of 2 years, are presented. In 2 patients, the tumor involved the prelacrimal recess. One of these patients was successfully operated on using combined antrostomies. In the second patient combined antrostomies were accompanied by a prelacrimal recess approach. None of the 14 patients had intraoperative complications. No recurrence was observed. No drying, empty nose syndrome, lacrimation, floppy turbinate or mucus recirculation was observed. Two patients complained of permanent cheek numbness. Follow-up endoscopy was easily performed with a rigid endoscope through both antrostomies in all patients except one. Conclusions Combined antrostomies appear effective to treat the maxillary sinus inverted papilloma. They are associated with minimal invasiveness and complications and enable easy endoscopic follow-up. In patients with prelacrimal recess involvement, it can be supplemented by the prelacrimal recess approach or, if needed, converted to an endoscopic Denker procedure.

Probably every laryngologist in his career will face off an issue of foreign body removal. It can be problematic especially that foreign body cause the trauma of surrounding tissues or may translocate unpredictably. A space of the middle and lower throat is the most common location. Occasionally it can be located in less obviously place, which force the laryngologist to prevent more viligant diagnostic. A foreign body pounded within soft tissue of the oral cavity is the example. A case report of a metallic foreign body inherent in the tongue for more than six weeks before the final treatment is presented.