Johari, Hafizah Husna
(2018)
Frontal recess anatomy and its association with the development of frontal sinusitis : computed tomography study.
Masters thesis, Universiti Sains Malaysia.
Abstract
Objective: This study was done to determine frontal recess anatomy cell variations and its
association with frontal sinusitis. The incidence of frontal recess cells in the population, the
presence of frontal recess cell variations in chronic rhinosinusitis and non-chronic rhinosinusitis
and the association of frontal recess cell variation in the development of frontal sinusitis were
also assessed.
Methodology: This was an observational, retrospective cross-sectional study of computed
tomography paranasal sinus that had been performed on patients in Hospital Universiti Sains
Malaysia and Hospital Sultanah Bahiyah done from January 2009 until December 2016.
Results: A total of 312 sides from 156 patients’ CT scan images were analyzed. Left and right
sinuses were considered individually. A total of 63 sides showed evidence of frontal sinusitis, 37
were male and 26 were female, whereas 249 sides were clear from frontal sinus disease. It was
not much difference in mean age for frontal sinusitis patient (46.51±14.00) and patients without
frontal sinusitis (48.73±16.44). The percentage were almost equal for CRS and non-CRS groups
regardeless of side and gender. In our study, the frontal recess cell such as agger nasi cell was
found in almost all patients 98.1%, frontal ethmoidal cell type 1, type 2, type 3 and type 4
comprised of 28.8%, 31.1%, 14.4% and 0% respectively. Whereas, suprabullar cell can be seenin 40.3%, supraorbital ethmoid cells 16.7%, frontal bullar cell 33.0% and inter-frontal sinus
septal cells 10.8%. The presence of frontal recess cells variation was compared with other
populations. There was a statistically significant association between the presence of frontal
bullar cell and the development of frontal sinusitis (p value < 0.001).
Conclusion: The frontal recess cells variation in Malaysian subjects were almost similar to those
reported in other Asian populations such as Japanese, Taiwanese, Chinese and Korean. Our study
found that frontal bullar cells had a significant association with the development of frontal
sinusitis than other frontal recess cells. The understanding of the frontal recess anatomical
structures was very important as this would lead to a successful treatment of CRS and at the
same time it helped the surgeon to have a better plan of endoscopic sinus surgery to prevent the
disease recurrence and surgical complication.
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