Frontal Sinus PPT 2
Frontal Sinus PPT 2
Frontal Sinus PPT 2
Superior Sphenoethmoid
omc meatus recess
Anterior functional unit:
Uncinate process:
Sickle shaped bone
Attaches inferiorly to inferior turbinate and palatine bone ,
anterosuperiorly to lacrimal bone.
True maxillary ostial opening is covered by the uncinate process
Uncinate along with a fold of mucosa (anterior and posterior
fontanelle) cover the opening of maxillary sinus.
Accessory ostia may be present in the fontanelle which can be
mistaken
Failure to correctly identify true ostia and connect it with common
sinus cavity may result in mucous recirculation phenomenon.
During recirculation mucous is redirected to natural ostia along the
mucociliary drainage pathway and re-enters sinus through accessory
ostia.
Ethmoid bulla:
Largest and most consistent anterior ethmoid cell
Attaches to lamina papyracea laterally and variable attachments to skull
base and basal lamella
HALLER CELL is a normal anatomy in this region
It is an infraorbital anterior ethmoid cell that pneumatizes into
maxillary sinus and may cause obstruction to maxillary ostium.
This complete removal of ethmoid bulla is critical to define medial
orbital wall as a landmark
Middle turbinate:
Complex shape divided into 3 segments- saggital,coronal and axial
Sagittal segment attaches to skull base at lateral lamella.
Coronal segment creates the basal lamella which separates anterior
ethmoid and posterior ethmoid cavities
Axial segment of middle turbinate attaches to lateral nasal wall and is
the entry point of terminal branch of sphenopalatine artery
Agger nasi, posterosuperior uncinate process
and frontal ethmoid cells:
Anterior structures encroaching on frontal recess include
1) agger nasi
2)lateral uncinate process and
3)frontal cells
Agger nasi:
Anterior most ethmoid cell
Medial border formed byuncinate process
Degree of pneumatization of agger nasi influences position of superior
uncinate process an the thickness of bony nasofrontal beak
The frontal recess drainage pathway is medial to uncinate process in85% of
cases.
Kuhn classification of frontal cell:
Type I - single frontal ethmoidal cell above agger nasi
Type II - Tier of cells in frontal recess above ager nasi cells
Type III - single massive cell pneumatizing into floor of frontal sinus
Type IV single isolated cell within frontal sinus
Wormold further modified the above classification
as type 3 cells as FEC that fill <50% of frontal sinus and type 4 if >50%
Posterior structures encroaching on frontal recess include:
1)supraorbital ethmoid cells
2)suprabulla cells
3)ethmoid bulla
Clinical significance of supraorbital ethmoid cells:
1)can cause obstruction of frontal recess
2)can be falsely mistaken for true frontal sinus leading to incomplete
removal surgical dissection
3)associated with low position of anterior ethmoid artery
Medial structures encroaching on frontal recess:
1)intersinus septal cells
2)medially inserting uncinate process