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    Anatomy of Frontal Sinus & Recess

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    anoop_aiims1
    This document discusses the anatomy of the frontal sinus and frontal recess. It describes the frontal sinus drainage pathway and various anatomical structures within the frontal recess like the agger nasi cell, frontal cells, supraorbital ethmoid cell, frontal bulla cell, and suprabullar cell. It also discusses the technique of balloon dilation of the frontal sinus outflow tract to widen the frontal sinus drainage pathway in a minimally invasive manner. Potential applications and complications of this procedure are mentioned.

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    Anatomy of Frontal Sinus & Recess

    Uploaded by

    anoop_aiims1
    396 views50 pages
    This document discusses the anatomy of the frontal sinus and frontal recess. It describes the frontal sinus drainage pathway and various anatomical structures within the frontal recess like the agger nasi cell, frontal cells, supraorbital ethmoid cell, frontal bulla cell, and suprabullar cell. It also discusses the technique of balloon dilation of the frontal sinus outflow tract to widen the frontal sinus drainage pathway in a minimally invasive manner. Potential applications and complications of this procedure are mentioned.

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    anatomy of frontal sinus & recess

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    anatomy of frontal sinus & recess

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    This document discusses the anatomy of the frontal sinus and frontal recess. It describes the frontal sinus drainage pathway and various anatomical structures within the frontal recess like the agger nasi cell, frontal cells, supraorbital ethmoid cell, frontal bulla cell, and suprabullar cell. It also discusses the technique of balloon dilation of the frontal sinus outflow tract to widen the frontal sinus drainage pathway in a minimally invasive manner. Potential applications and complications of this procedure are mentioned.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    396 views50 pages

    Anatomy of Frontal Sinus & Recess

    Uploaded by

    anoop_aiims1
    This document discusses the anatomy of the frontal sinus and frontal recess. It describes the frontal sinus drainage pathway and various anatomical structures within the frontal recess like the agger nasi cell, frontal cells, supraorbital ethmoid cell, frontal bulla cell, and suprabullar cell. It also discusses the technique of balloon dilation of the frontal sinus outflow tract to widen the frontal sinus drainage pathway in a minimally invasive manner. Potential applications and complications of this procedure are mentioned.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 50

    Anatomy of the Frontal Sinus and Frontal Recess

    Frontal Sinus Instructional Course

    Christopher T. Melroy, MD Frederick A. Kuhn, MD, FARS, FACS

    Frontal Sinus Anatomy


    The Frontal Recess is the most common single site of recurrent or persistent disease after intranasal ethmoidectomy.
    Kuhn FA & Kennedy DW, Analysis of Causes of Recurrent / Persistent Disease Following Intranasal Ethmoidectomy, 8th ISIAN, Baltimore Md., June 1989.

    Frontal Sinus Drainage Pathway

    Frontal sinus
    Internal infundibulum Internal frontal ostium Frontal recess

    Frontal Infundibulum

    Narrowing of the frontal sinus before it drains into the internal frontal ostium

    Frontal Infundibulum

    CM FS infun

    Frontal Recess
    Imagine yourself up in a frontal sinus floating down, over, and around the tops of a complicated group anterior ethmoid cells And finally entering the nose in the middle meatus, behind the uncinate

    THIS IS THE FRONTAL RECESS !!

    Frontal Recess

    Frontal Recess

    Agger nasi cell

    Frontal Sinus Anatomy


    Frontal Recess: Term first used by Killian in 1898 Used by J. Parsons Schaeffer 1916, 1920 Used extensively by Dr. Van Alyea 1934, 1939, 1941 and 1946
    Van Alyea, D.E., Archives of Otolaryng., 29:881-901, 1939.

    Frontal Sinus Anatomy


    (Embryology)

    Frontal Sinus Anatomy


    (Embryology)
    Schaeffer and Kasper - 4 frontal pits 1st pit - Agger Nasi cell 2nd pit - Frontal Sinus 3rd pit - Supraorbital ethmoid cell 4th pit - other anterior ethmoid cells
    Schaeffer, JP, Amer J Anatomy, 20:125-145, 1916. Kasper, KA, Archeves of Otolaryn, 23:322-343, 1936.

    Frontal Sinus Embryology


    (the frontal pits/furrows)
    Develop from the lateral nasal wall
    1st Agger Nasi cell 2nd Frontal Sinus

    3rd Supraorbital Ethmoid Cell


    Develops behind the FS and extends over the orbit

    Frontal Sinus Anatomy

    Frontal Sinus Anatomy

    Frontal Sinus Anatomy


    Frontal Recess Cells:
    Agger Nasi cell Frontal cells Supraorbital ethmoid cell Frontal Bulla cell Suprabullar cell

    Agger Nasi Cell


    ANC
    MT basal lam. Bulla lam.

    MT basal lam.

    Agger Nasi Cell, M.T. basal lamella

    Bulla Lamella M.T. basal lamella

    Frontal Sinus Anatomy


    Opaque Frontal Recess Obstructed by ANC

    Frontal Cells

    Current Definition Impinges on frontal recess or frontal sinus Communicates with frontal recess distinct from agger nasi, supraorbital ethmoid, suprabullar & frontal bullar 4 variations, types I-IV

    Frontal Cell Types


    Type I - Single cell, above Agger Nasi cell Type II - Tier of cells may invade frontal s. Type III - Single massive cell, invades frontal sinus, attached to ant. table Type IV - Single isolated cell in frontal sinus no obvious connection to frontal recess, not attached to ant. or posterior table

    Frontal Cells
    Type I Frontal cell Type II frontal cell

    Type II Frontal Cells

    * *
    A N C

    Type III Frontal Cell

    Type III Frontal Cells

    Type III Frontal Cell


    - fixing the bad result -

    III

    skull base

    Type IV Frontal Cell


    Type IV frontal cell Type IV frontal cell?

    no.

    Supraorbital Ethmoid Cell

    From 3rd frontal furrow Posterior and lateral to frontal sinus Pneumatizes into the frontal bone over the orbit and behind the FS May extend lateral to FS Partition separates this from FS

    Supraorbital Ethmoid Cell

    CM SOE

    The FS is anterior and medial to the SOE

    Supraorbital Ethmoid Cell


    Supraorbital ethmoid
    Pneumatizes over orbit, behind FS

    The FS is anterior and medial to the SOE

    Supraorbital Ethmoid Cell

    The FS is anterior and medial to the SOE

    Frontal Sinus Anatomy

    Frontal Sinus Anatomy


    Pre-op Post-op

    Frontal Sinus Anatomy (R)


    Pre-op Post-op

    SOE was mistaken for FS FS is closed

    FS is anterior and medial to SOE

    Frontal Bulla Cell


    Frontal Bulla Cell vs. Suprabullar Cell

    Frontal Bulla Cell

    Suprabullar Cell

    Suprabullar Cell
    Frontal ostium Supraorbital ethmoid cell

    Suprabullar Cell

    Interfrontal Sinus Septal Cell


    IFSSC Pneumatization of the septum between the frontal sinuses May involve a pneumatized crista galli May drain high into FS or low into frontal recess

    Interfrontal Sinus Septal Cell

    CM IFSSC

    Frontal Sinus Anatomy


    Must be mastered before performing frontal sinus surgery.

    Balloon Dilation of the Frontal Sinus Outflow Tract


    Frontal Sinus Instructional Course

    Christopher T. Melroy, MD Frederick A. Kuhn, MD, FARS, FACS


    Disclosure: I have received honoraria for physician training and speaking engagements from Acclarent, Inc.

    Balloon Frontal Sinusotomy


    Rationale
    Most minimally-invasive way to open a frontal sinus drainage pathway

    Concept
    Cell walls in the frontal recess are fractured to widen the frontal sinus drainage pathway

    Balloon Frontal Sinusotomy


    - technique -

    CM bratch

    Balloon Frontal Sinusotomy


    - technique -

    CM bratch

    Balloon Frontal Sinusotomy


    - technique -

    CM bratch

    Balloon Frontal Sinusotomy


    - technique -

    Balloon Frontal Sinusotomy


    - technique -

    CM bratch

    Balloon Frontal Sinusotomy


    - contraindications -

    Extensive polyposis Known skull base trauma or defect

    Balloon Frontal Sinusotomy


    Applications / Indications:
    Primary surgery Revision surgery Management of postop ostial stenosis Including use in the office Finding the frontal sinus Moving cell walls within the frontal sinus

    Balloon Frontal Sinusotomy


    - uses Management of postop ostial stenosis Including use in the office

    CM FS scar

    Balloon Frontal Sinusotomy


    - uses Moving cell walls within the frontal sinus

    Without trephination

    Without osteoplastic flap

    Balloon Frontal Sinusotomy


    - complications Complications (FDA database) Orbital injury n=2
    Passing guidewire through lamina No sequelae CSF leak n=1 One reported case: standard instrumentation was also used. Frontal surgery-> leak at sph. COMPLICATION RATE 0.010% of pts (1/10,000) = 0.0035% of sinuses

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