Skip to main content
SpringerLink
Log in

Endoscopic frontal recess anatomy directed by the drainage pathways using the connecting plates as landmarks

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the anatomical features of frontal recess (FR) drainage, and the classification of FR cells and frontal sinus (FS).

Methods

Fifty sides from 30 adult cadaver heads were examined. FR cells and FS along the drainage pathways were dissected under 0° and 70° endoscopic views using unique connecting structures between the uncinate process and the ethmoid bulla as landmarks.

Results

Connecting plates between the uncinate process and the ethmoid bulla were discovered and termed medial suprainfundibular plate (MSIP), which were observed on each cadaver head, and lateral suprainfundibular plate (LSIP) on 92% (46/50) sides. Separated by MSIP, two drainage pathways were identified and named medial pathways of the FR (MPFR) medial to the MSIP and the lateral pathways of the FR (LPFR) in the lateral side. Different drainage pathways of the FS were confirmed, in which drained into the MPFR in 37 and into the LPFR in 13 of the cadaver sides.

Conclusions

MSIP is the critical landmark for the recognition of MPFR, LPFR, and the classification of FR cells. The FR resection along LPFR and MPFR facilitated excellent exposure of FS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bent JP, Cuilty-Siller C, Kuhn FA (1994) The frontal cell as a cause of frontal sinus obstruction. Am J Rhinol 8:185–191

    Article  Google Scholar 

  2. Kuhn F (1996) Chronic frontal sinusitis: the endscopic frontal recess approach Operative techniques. Otolaryngol Head Neck Surg 7:222–229

    Google Scholar 

  3. Tran LV, Ngo NH, Psaltis AJ (2019) A radiological study assessing the prevalence of frontal recess cells and the most common frontal sinus drainage pathways. Am J Rhinol Allergy 33:323–330. https://doi.org/10.1177/1945892419826228

    Article  PubMed  Google Scholar 

  4. Wormald PJ, Hoseman W, Callejas C, Weber RK, Kennedy DW, Citardi MJ, Senior BA, Smith TL, Hwang PH, Orlandi RR, Kaschke O, Siow JK, Szczygielski K, Goessler U, Khan M, Bernal-Sprekelsen M, Kuehnel T, Psaltis A (2016) The international frontal sinus anatomy classification (IFAC) and classification of the extent of endoscopic frontal sinus surgery (EFSS). Int Forum Allergy Rhinol 6:677–696. https://doi.org/10.1002/alr.21738

    Article  PubMed  Google Scholar 

  5. Nakayama T, Asaka D, Kuboki A, Okushi T, Kojima H (2018) Impact of residual frontal recess cells on frontal sinusitis after endoscopic sinus surgery. Eur Arch Otorhinolaryngol 275:1795–1801. https://doi.org/10.1007/s00405-018-5003-7

    Article  PubMed  Google Scholar 

  6. Yoon JH, Moon HJ, Kim CH, Hong SS, Kang SS, Kim K (2002) Endoscopic frontal sinusotomy using the suprainfundibular plate as a key landmark. Laryngoscope 112:1703–1707. https://doi.org/10.1097/00005537-200209000-00033

    Article  PubMed  Google Scholar 

  7. Al KM, Goldberg AN (2013) Unilateral transnasal endoscopic approach to frontal sinuses: Draf IIc. Allergy Rhinol (Providence) 4:e82–e87. https://doi.org/10.2500/ar.2013.4.0058

    Article  Google Scholar 

  8. Draf W, Weber R, Keerl R, Constantinidis J (1995) Current aspects of frontal sinus surgery. I: Endonasal frontal sinus drainage in inflammatory diseases of the paranasal sinuses [in German]. HNO 43:352–357

    CAS  PubMed  Google Scholar 

  9. Stammberger H (1993) Complications of inflammatory paranasal sinus diseases including iatrogenically-induced complications [in German]. Eur Arch Otorhinolaryngol Suppl 1:61–102

    CAS  PubMed  Google Scholar 

  10. Stammberger H (1986) Endoscopic endonasal surgery–concepts in treatment of recurring rhinosinusitis. Part II Surgical technique. Otolaryngol Head Neck Surg 94:147–156

    Article  CAS  Google Scholar 

  11. Stammberger HR, Kennedy DW (1995) Paranasal sinuses:anatomic terminology and nomenclature. Ann Otol Rhinol Laryngol Suppl 167:7–16

    Article  CAS  Google Scholar 

  12. Wormald PJ (2005) Surgery of the frontal recess and frontal sinus. Rhinology 43:82–85

    PubMed  Google Scholar 

  13. Wormald PJ, Ananda A, Nair S (2003) The modified endoscopic Lothrop procedure in the treatment of complicated chronic frontal sinusitis. Clin Otolaryngol Allied Sci 28:215–220. https://doi.org/10.1046/j.1365-2273.2003.00692.x

    Article  CAS  PubMed  Google Scholar 

  14. Baban M, Mirza B, Castelnuovo P (2020) Radiological and endoscopic findings in patients undergoing revision endoscopic sinus surgery. Surg Radiol Anat 42:1003–1012. https://doi.org/10.1007/s00276-020-02427-5

    Article  PubMed  Google Scholar 

  15. Rusu MC, Sava CJ, Ilie AC, Sandulescu M, Dinca D (2019) Agger nasi cells versus lacrimal cells and uncinate bullae in cone-beam computed tomography. Ear Nose Throat J 98:334–339. https://doi.org/10.1177/0145561319840836

    Article  PubMed  Google Scholar 

  16. Lien CF, Weng HH, Chang YC, Lin YC, Wang WH (2010) Computed tomographic analysis of frontal recess anatomy and its effect on the development of frontal sinusitis. Laryngoscope 120:2521–2527. https://doi.org/10.1002/lary.20977

    Article  PubMed  Google Scholar 

  17. Mahmutoglu AS, Celebi I, Akdana B, Bankaoglu M, Cakmakci E, Celikoyar MM, Basak M (2015) Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis. J Craniofac Surg 26:87–90. https://doi.org/10.1097/SCS.0000000000001244

    Article  PubMed  Google Scholar 

  18. Friedman M, Bliznikas D, Vidyasagar R, Joseph NJ, Landsberg R (2006) Long-term results after endoscopic sinus surgery involving frontal recess dissection. Laryngoscope 116:573–579. https://doi.org/10.1097/01.MLG.0000202086.18206.C8

    Article  PubMed  Google Scholar 

  19. Beule A, Athanasiadis T, Athanasiadis E, Field J, Wormald PJ (2009) Efficacy of different techniques of sinonasal irrigation after modified Lothrop procedure. Am J Rhinol Allergy 23:85–90. https://doi.org/10.2500/ajra.2009.23.3265

    Article  PubMed  Google Scholar 

  20. Barham HP, Hall CA, Hernandez SC, Zylicz HE, Stevenson MM, Zito BA, Harvey RJ (2020) Impact of Draf III, Draf IIb, and Draf IIa frontal sinus surgery on nasal irrigation distribution. Int Forum Allergy Rhinol 10:49–52. https://doi.org/10.1002/alr.22447

    Article  PubMed  Google Scholar 

  21. Conger BJ, Riley K, Woodworth BA (2012) The Draf III mucosal grafting technique: a prospective study. Otolaryngol Head Neck Surg 146:664–668. https://doi.org/10.1177/0194599811432423

    Article  PubMed  Google Scholar 

  22. Dhepnorrarat RC, Subramaniam S, Sethi DS (2012) Endoscopic surgery for fronto-ethmoidal mucoceles: a 15-year experience. Otolaryngol Head Neck Surg 147:345–350. https://doi.org/10.1177/0194599812441570

    Article  PubMed  Google Scholar 

  23. Daniels DL, Mafee MF, Smith MM, Smith TL, Naidich TP, Brown WD, Bolger WE, Mark LP, Ulmer JL, Hacein-Bey L, Strottmann JM (2003) The frontal sinus drainage pathway and related structures. AJNR Am J Neuroradiol 24:1618–1627

    PubMed  PubMed Central  Google Scholar 

  24. Cheng SY, Yang CJ, Lee CH, Liu SC, Kuo CY, Lee JC, Shih CP (2017) The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis. Eur Arch Otorhinolaryngol 274:1905–1910. https://doi.org/10.1007/s00405-016-4441-3

    Article  PubMed  Google Scholar 

  25. Srivastava M, Tyagi S (2016) Role of anatomic variations of uncinate process in frontal sinusitis. Indian J Otolaryngol Head Neck Surg 68:441–444. https://doi.org/10.1007/s12070-015-0932-6

    Article  PubMed  Google Scholar 

  26. Stammberger H, Hosemann W, Draf W (1997) Anatomic terminology and nomenclature for paranasal sinus surgery [in German]. Laryngorhinootologie 76:435–449

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from National Natural Science Foundation of China (No. 81770985, No. 30973167).

Funding

This study was funded by the National Natural Science Foundation of China (NSFC), Grant No. 30973167 and Grant No. 81770985.

Author information

Authors and Affiliations

  1. Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People’s Republic of China

    Weihong Jiang, Shaobing Xie, Zhihai Xie, Bei Wu, Junyi Zhang, Hong Sun, Ruohao Fan, Jianyun Xiao, Suping Zhao & Xiang Chen

  2. Department of Rehabilitation, Brain Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of China

    Qingping Tang

Authors
  1. Weihong Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shaobing Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhihai Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qingping Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bei Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Junyi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hong Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ruohao Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jianyun Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Suping Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Xiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Weihong Jiang.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 9647 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, W., Xie, S., Xie, Z. et al. Endoscopic frontal recess anatomy directed by the drainage pathways using the connecting plates as landmarks. Eur Arch Otorhinolaryngol 278, 3315–3323 (2021). https://doi.org/10.1007/s00405-020-06577-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-06577-5

Keywords

Search

Navigation