The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS)

Abstract

The frontal recess and frontal sinus anatomy can vary from simple to complex. The variations in the anatomy of the frontal recess and frontal sinus are considerable but almost all variations can be classified if the various cell patterns are analyzed. This consensus document was developed to improve the ability of the surgeon to understand these possible variations, plan the surgery, and communicate these complexities when teaching or reporting outcomes. Once the surgeon understands the anatomical pattern of the frontal sinus and recess cells, the extent of surgery can be planned. This document presents a classification of the extent of surgery based on the anatomical classification.

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

“…Frontoethmoidal cells are anterior ethmoid air spaces occupying the frontal recess that may alter the frontal sinus drainage pathway (FSDP) and encroach into the frontal opening and sinus . They may increase the risk of frontal sinusitis .…”

“…Recently, Wormald and the co-authors modified the nomenclature and definitions of Lee and Kuhn, introducing the International Frontal Sinus Anatomy Classification (IFAC) ( Table 2). 3 The classification was developed through a consensus among the authors.…”

“…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. 15 Their prevalence is unknown.…”

The “Cross‐court draf IIb” procedure for advanced nasal septum or frontal sinus pathology and nasal septum pathology

“…The frontal sinus is considered the most difficult sinus to access surgically due to its variable anatomy and challenging position . Because endoscopic surgical skills and tools have advanced, both interest in frontal sinus surgical approaches and frequency of frontal sinus surgery have blossomed .…”

Book Review: Differential Diagnosis in Neuroimaging: Brain and Meninges

“…Discussion of the septum fails to mention the maxillary crest and crest of the palatine bone in addition to the ethmoid, vomer, and quadrangular cartilage. It is worth pointing out that there is an effort in the rhinology community to move away from the Kuhn frontal cell classification toward a simpler frontal sinus classification system with a recent paper published by Wormald et al (2016; PMID: 26991922), 1 and thus this information would have been useful.…”