Computed Tomographic Analysis of Frontal Recess Anatomy and its Effect on the Development of Frontal Sinusitis

Objectives/Hypothesis: To use computed tomography to determine the association of frontal recess cells with the development of frontal sinusitis. Study Design: Retrospective analysis. Methods: We retrospectively analyzed various frontal recess cells on spiral computed tomographic images of sinuses between November 2007 and May 2009. Exclusion criteria included previous sinus surgery, sinonasal polyposis, age younger than 18 years, maxillofacial fracture, incomplete sections of computed tomography, and sinonasal malignancy. We used logistic regression analysis to compare the distribution of various frontal recess cells in patients with frontal sinusitis and those without frontal sinusitis. Results: A total of 192 patients met the criteria, and only 363 sides were distinguishable. The presence of suprabullar cells, supraorbital ethmoid cells, frontal bullar cells, and recessus terminalis was significantly associated with the development of frontal sinusitis by multiple logistic regression models. Conclusions: The frequency of frontal recess cells analyzed in Taiwanese adult patients was similar to that analyzed in other Asian adult populations (Chinese and Korean). The frontoethmoid cells posterior and posterolateral to the frontal recess (suprabullar cells, frontal bullar cells, and supraorbital ethmoid cells) might reveal a more significant association with the development of frontal sinusitis than those anterior to the frontal recess (agger nasi cells, frontal cell types 1-3). The presence of supraorbital ethmoid cells on computed tomographic images might indicate the highest odds of frontal sinusitis, followed by the presence of suprabullar cells, frontal bullar cells, and recessus terminalis.