Computed tomography analysis of frontal cell prevalence according to the International Frontal Sinus Anatomy Classification

Choby, Garret; Thamboo, Andrew; Won, Tae Bin; Kim, Jooyeon; Shih, Liang Chun; Hwang, Peter H.

doi:10.1002/alr.22105

Cited by 37 publications

(49 citation statements)

References 18 publications

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“…Choby et al assessed the prevalence of frontoethmoidal cells according to the IFAC and evaluated the inter‐rater agreement. One hundred CT scans were assessed.…”

Section: Discussionmentioning

confidence: 99%

“…However, although the currently available CT technology and data processing have greatly developed since the time of Lee and Kuhn's study, the authors of the IFAC did not verify their classification in a large group of patients using a DICOM viewer with adjustable planes. The results of the two recent studies show high inter‐rater reliability of the IFAC …”

Section: Introductionmentioning

confidence: 99%

“…The results of the two recent studies show high inter-rater reliability of the IFAC. 13,14 On the other hand, the European anatomical position paper distinguished lateral frontoethmoidal cells, which were neglected in the IFAC and Lee and Kuhn classifications. 2,3 These cells were characterised in a recently published case series of patients with CRS.…”

mentioning

confidence: 99%

“…differences in CT slice thickness, type of CT reconstruction, ethnicity, patient selection and precision in cell definition (accuracy of classification).In the study by Langille et al,4 two reviewers evaluated 1 mm CT axial scans for the presence of frontal cells (type 1-4) as described by Lee and Kuhn. An overall moderate agreement was found between the two researchers for the identification of any frontal cell, and low to moderate for the identification of individual types of frontal cells.Choby et al14 assessed the prevalence of frontoethmoidal cells according to the IFAC and evaluated the inter-rater agreement. One hundred CT scans were assessed.…”

mentioning

confidence: 99%

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Three‐dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC)

Gotlib

Kołodziejczyk

Kuźmińska

et al. 2019

Clinical Otolaryngology

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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.

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“…Choby et al assessed the prevalence of frontoethmoidal cells according to the IFAC and evaluated the inter‐rater agreement. One hundred CT scans were assessed.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Three‐dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC)

Gotlib

Kołodziejczyk

Kuźmińska

et al. 2019

Clinical Otolaryngology

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“…This study improves our understanding of CRSsNP types and characteristics, as we aim to better predict disease outcomes and treatment responses in this patient group. In another study that assessed the prevalence of various frontal recess cells and interrater reliability among 3 independent reviewers, Choby et al . evaluated 100 computed tomography (CT) scans and delineated frontal recess anatomy using the recently‐described International Frontal Sinus Anatomy Classification scheme.…”

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confidence: 99%

A focus on quality

Wise¹

2018

Int Forum Allergy Rhinol

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Anatomic misconceptions regarding the agger nasi cell: A preliminary analysis utilizing endoscopic anatomic dissection and three‐dimensional computed tomography

Bolger

Ishii²

2022

Clinical Anatomy

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The agger nasi cell is a key anatomic landmark in endoscopic frontal sinus surgery.However, discord amongst authors regarding anatomic definition and prevalence raises questions of its suitability as a surgical landmark. The purpose of this investigation is to evaluate the agger nasi cell using radiographic imaging correlated with endoscopic anatomic dissection to consider the cell's role as a surgical landmark and to explore if three-dimensional computed tomography (3D-CT) technology can provide enhanced insight into this anatomy. CT scans of 11 cadaveric sinonasal complexes were studied using triplanar CT or 3D-CT scanning with stereoscopic 3D imaging. Endoscopic dissections were performed and video recorded. Attention was given to identify agger nasi pneumatization and its origin. Pneumatization of the agger nasi region was noted in 4/11 cases (36.4%) (in two cases the pneumatization arose from the frontal recess, in two from a true agger nasi cell). The agger nasi region appeared as solid unpneumatized bone in 4/11 cases (36.4%). In 3/11 cases (27.3%) limited pneumatization was noted, bordering on but not pneumatizing the agger nasi proper. It may be confusing for otolaryngologic surgeons in training to rely on the "agger nasi cell" as a surgical landmark due to misconceptions regarding the anatomy, prevalence and anatomic definitions. Using standard CT scans to teach anatomy may have shortcomings as compared to the gold standard of surgical dissection. However, new 3D-CT holds promise to more accurately reflect small microanatomic features and provide an improved road map of a patient's anatomy in surgery.

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Computed tomography analysis of frontal cell prevalence according to the International Frontal Sinus Anatomy Classification

Abstract: This study describes the normative distribution of frontal recess cells in a nondiseased population according to IFAC and demonstrates favorable interrater reliability of the classification system.

Cited by 37 publications

References 18 publications

Three‐dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC)

Three‐dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC)

A focus on quality

Anatomic misconceptions regarding the agger nasi cell: A preliminary analysis utilizing endoscopic anatomic dissection and three‐dimensional computed tomography

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