The Prevalence of Frontal Cells and Their Relation to Frontal Sinusitis: A Radiological Study of the Frontal Recess Area

Background. The frontal recess area represents a challenge to ENT surgeons due to its narrow confines and variable anatomy. Several types of cells have been described in this area. The agger nasi cells are the most constant ones. The frontal cells, originally classified by Kuhn into 4 types, have been reported in the literature to exist in 20%–41% of frontal recesses. Aim of the Study. To identify the prevalence of frontal recess cells and their relation to frontal sinus disease. Methods. Coronal and axial CT scans of paranasal sinuses of 70 patients admitted for functional endoscopic sinus surgery (FESS) were reviewed to identify the agger nasi, frontal cells, and frontal sinus disease. Data was collated for right and left sides separately. Results. Of the 140 sides reviewed, 126 (90%) had agger nasi and 110 (78.571%) had frontal cells. 37 frontal sinuses were free of mucosal disease, 48 were partly opacified, and 50 were totally opacified. There was no significant difference found in frontal sinus mucosal disease in presence or absence of frontal cells or agger nasi. Conclusions. The current study shows that frontal cells might be underreported in the literature, as the prevalence identified is noticeably higher than previous studies. 1. Introduction Functional endoscopic sinus surgery (FESS) has become one of the commonest surgical procedures performed by otolaryngologists [1]. The widespread adoption of FESS has improved the understanding of the anatomy of the nose and the paranasal sinuses. However, the area which still causes confusion to surgeons is the frontal recess [2]. Surgery in this area is challenging due to its narrow confines and variable anatomy [3]. Anatomically, the frontal recess is bounded medially by the middle turbinate and laterally by the lamina papyracea [4]. The posterior wall of the frontal recess is the bulla lamella. If the latter does not reach the skull base, the frontal recess may open into the suprabullar recess. The anterior wall is formed by the frontal process of the maxilla and the frontal bone, which thickens anterosuperiorly to form the frontal beak. In the posteromedial and superior region of the frontal recess lies the lateral wall of the olfactory fossa, which is the thinnest part of the anterior skull base [2]. This interesting anatomical area was described by Schaeffer in 1916 as the “nasofrontal region” [5]. However, the first detailed description of the various cells in this area was in 1941 by van Alyea [6], who used the term “frontal recess” rather than “nasofrontal duct.” Van Alyea used the name “frontal