DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20190762

Radiological study of the myriad variations in frontal sinus anatomy: an institutional study

Sreenivas Vepamininti, Soumya M. Seetharam, Jomy George, Hemanth Vamanshankar, Poonam K. Saidha

Abstract


Background: The frontal sinus is a challenging area for endoscopic surgeons. The variations in the frontal sinus differs so much among individuals that there are forensic applications. A detailed radiological study of the sinus is important for understanding the pathophysiology of sinusitis and as a prerequisite for frontal sinus drainage procedures. Aims and objectives were to document the anatomical variations of the frontal sinus (radiological) and to correlate the variations with the signs and symptoms of sinusitis.

Methods: Coronal and axial CT paranasal sinuses scans of 30 consecutive patients who attended the Otolaryngology clinic OPD in St. John’s medical college and hospital, Bangalore, India with signs/symptoms of  chronic sinusitis were evaluated between January to July 2018.  

Results: The average frontal sinus diameter in patients with sinusitis was 6.65 mm. The prevalence of frontal cells in our study was 48%. Agger nasi cells were the most common cells seen. Frontal sinus disease was found in 72% of the studied sides in the scans.

Conclusions: Frontal sinus anatomy varies with different ethnicities. It is very important to study the frontal sinus anatomy before exploring the sinus for disease clearance and avoid surgical complications.


Keywords


Frontal sinus, CT scan of paranasal sinuses, Agger nasi, Frontal cells, Frontal recess

Full Text:

PDF

References


Owen RG, Kuhn FA. Supraorbital ethmoid cell. Otolaryngol Head Neck Surg. 1997;116:254-61.

Sagar GRS, Jha BC, Meghanadh KR. A Study of Anatomy of Frontal Recess in Patients Suffering from ‘Chronic Frontal Sinus Disease. Ind J Otolaryngol Head Neck Surg. 2018;65(2):435–9.

Lund V. Anatomy of the nose and paranasal sinuses. In: Gleeson M, Kerr AG, editors. Scott Brown’s Otolaryngology: Basic Sciences. 6th ed. Oxford, UK: Butterworth-Heinemann; 1997: 1–30.

Wormald PJ. The agger nasi cell: the key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg. 2003;129(5):497–507.

Bent JP, Cuilty-Siller C, Kuhn FA. The frontal cell as a cause of frontal sinus obstruction. Am J Rhinol. 1994;8:185–91.

Alyea VOE. Frontal cells: an anatomic study of these cells with consideration of their clinical significance. Arch Otolaryngol. 1941;34:11–23.

Ahmed EZ, Khalil HS. The Prevalence of Frontal Cells and Their Relation to Frontal Sinusitis: A Radiological Study of the Frontal Recess Area. ISRN Otolaryngol. 2013;(2013):687582.

Krzeski A, Tomaszewska E, Jakubczyk I, Galewicz-Zielińska A. Anatomic variations of the lateral nasal wall in the computed tomography scans of patients with chronic rhinosinusitis. Am J Rhinol. 2001;15(6):371–5.

Meyer TK, Kocak M, Smith MM, Smith TL. Coronal computed tomography analysis of frontal cells. Am J Rhinol. 2003;17(3):163–8.

Han D, Zhang L, Ge W, Tao J, Xian J, Zhou B. Multiplanar computed tomographic analysis of the frontal recess region in Chinese subjects without frontal sinus disease symptoms. ORL. 2008;70(2):104–12.

Wormald PJ. The agger nasi cell: the key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg. 2003;129:497–507.

Landsberg R, Friedman M. A computer-assisted anatomical study of the nasofrontal region. Larygoscope. 2001;111(12):2125–30.

Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomical variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101(1):56–64.

Owen RG, Kuhn FA. Supraorbital ethmoid cell. Otolaryngol Head Neck Surg. 1997;116:254-61.

Lee WT, Kuhn FA, Citardi MJ. 3D computed tomographic analysis of frontal recess anatomy in patients without frontal sinusitis. Otolaryngol Head Neck Surg. 2004;131:164–73.