Preoperative Sagittal CT Evaluation of the Frontal Recess

Abstract

Endoscopic surgical approaches for chronic frontal sinusitis require the reestablishment of adequate frontal sinus ventilation and drainage for relief of symptoms. After the resection of anterior ethmoid mucosal disease and cellular structure, the anterior to posterior depth of the nasofrontal beak to the base of skull at the insertion of the ethmoidal bulla (frontal sinus ostium) often represents a critical margin for functional success. However, little information concerning this dimension is available. Depending on intraoperative surgical judgment of this distance, extended endoscopic surgical procedures involving additional bone resection may be indicated. These approaches may be hazardous due to the proximity of the cranial cavity and orbit. In addition, secondary stenosis can result from the subsequent inflammatory response. Improved CT imaging, high resolution sagittal reformatting, and computer workstations provide the ability to obtain direct preoperative measurements of the frontal recess. We used a paramedian sagittal section and recorded the maximal anterior to posterior depth from the nasofrontal beak to the base of skull at the insertion of the ethmoidal bulla in 20 patients, 31 sides, undergoing primary endoscopic frontoethmoidectomy. In addition, we found a positive correlation between this distance and agger nasi air cell size measured in the same 31 sides.

Multiplanar Computed Tomographic Analysis of Frontal Recess Cells

“…The advent of multiplanar CT imaging with the addition of sagittal reconstructions greatly improves the understanding of the frontal recess. 1,2 In addition to the inherent variation in size and diameter, the presence of various accessory cells such as frontal sinus cells and intersinus septal cells also contributes to the anatomic complexity of the frontal recess and the potential for obstruction of the frontal sinus. 3 Persistence of anatomic causes of obstruction of the frontal re-cess has been reported as a major cause of failure of endoscopic sinus surgery.…”

Relationship Between the Presence of Agger Nasi Cells and the Development of Frontal Sinusitis: a Computer-Assisted Anatomic Study

“…Frontal resesin sınırları; lateralde lamina paprisea, medialde orta konka, anteriorda AN hücrelerinin (eğer varsa) süperi-or duvarı ve posteriorda da etmoid bullanın postero-anterior duvarıdır (9). Yetişkinlerde, frontal resesin derinliği, eni ve sınırları anterior etmoid hücrelere ve komşu kemik yapıların embriyolojik olarak pnömatizasyon paternine bağlıdır (5,9).…”

“…Yetişkinlerde, frontal resesin derinliği, eni ve sınırları anterior etmoid hücrelere ve komşu kemik yapıların embriyolojik olarak pnömatizasyon paternine bağlıdır (5,9). AN hücresi, frontal resesi daraltıp, ön orta meatus pnömati-zasyonunu kötü yönde etkileyebilir (9). Frontal resesi daraltmasından dolayı varlığı frontal sinüs boşalım patolojilerine de neden olabilir.…”

Relationship of Agger Nasi Cell and Uncinate Process Attachment: A Retrospective Study of Radiological Imaging in Indian Population

“…Ultimately Superior attachment of UP determines the drainage pattern of FSDP. The agger nasi cell is the anterior most ethmoid cells and their presence and pneumatisation affect size of FSDP and frontal beak, agger nasi cell if involved can leads to chronic frontal sinusitis on affected side too [7] .…”