Precision Endonasal Endoscopic Surgery of the Frontal Recess Cells and Frontal Sinus Guided by the Natural Sinus Drainage Pathway

Abstract

BackgroundThe endoscopic endonasal approach to removing lesions in the nasal cavity and sinuses has become the modern first choice. However, if endoscopic surgery is performed without proper knowledge of sinus anatomy, there is a risk of residual lesions, recurrence, and even serious complications. Therefore, this article illustrates the importance of precise sinus opening guided by the natural sinus drainage pathway, using the anatomy of the frontal sinus (FS) and the frontal recess (FR) cells as an example.MethodA total of 82 sides cadaveric heads were dissected and analyzed, and the natural drainage pathways of the FR cells and FS were observed at 0°and 70°nasal endoscopic views, and the findings were summarized. The data of 79 patients who accepted endonasal endoscopic surgery (EES) guided by natural sinus drainage pathways to remove mucoceles in our department from January 2015 to January 2021 were retrospectively analyzed.ResultsTwo natural drainage pathways of the FR cells were discovered, identified, and named the medial pathway of the FR (MPFR) and the lateral pathway of the FR (LPFR). The 79 patients who accepted EES to remove mucoceles through the natural drainage pathways of FR cells and the FS showed significant improvement in clinical symptoms, and none of them had recurrence after surgery without serious complications.ConclusionThe EES of the FR cells and FS through the natural drainage pathways to remove the mucoceles facilitates exposure of the cells without residual lesions and without serious complications.

Exploring the frontal recess: Specimens, endoscopy, and CT perspectives

“…The agger nasi cell is an easily identifiable landmark when approaching the frontal sinus [10]. According to Pend and associates [11], the frontal recess cells have an extremely intricate anatomical structure and can be divided into agger nasi, suprabullar, supra agger, supra agger frontal, supraorbital ethmoidal, frontal septal, and suprabullar frontal cells. In cases where the frontal recess is extensively pneumatized or when the attachment of the basal lamella protrudes, this recess takes on a tubular shape.…”

Comprehensive access strategies to the frontal sinus

“…In properly selected cases, frontal recess patency is achieved in 95–100% of the cases and revision surgery is required in a minority of patients [3,7 ▪▪ ,8,9 ▪ ]. Patients undergoing FSBD generally have a lower burden of disease than those undergoing traditional FESS procedures, making comparison of results difficult (Fig.…”

Exploring the uncharted: Missing anatomical names in the Terminologia Anatomica

“…Its apex points towards the frontal ostium, the narrowest part of the frontal sinus drainage pathway, while the inferior end blends into the anterior ethmoidal cells. Thus, the frontal recess is a connection between the frontal sinus and the middle nasal meatus, forming the inferior part of the frontal sinus drainage pathway (Dassi et al, 2020; Peng et al, 2022; Wormald, 2005). A comprehensive understanding of the frontal sinus drainage pathway's anatomy is paramount for clinicians engaged in operative procedures within this area.…”