Article

Hidden unilateral agenesis of the frontal sinus: human cadaver study of a potential surgical pitfall

Department of Otorhinolaryngology-Head and Neck Surgery, Ankara University School of Medicine, Ankara, Turkey.
American journal of otolaryngology (Impact Factor: 1.08). 05/2009; 31(4):231-4. DOI: 10.1016/j.amjoto.2009.02.010
Source: PubMed

ABSTRACT The aim of the study was to attract attention to the surgical significance of unilateral agenesis of the frontal sinus hidden by the overlapping expansion of the contralateral sinus toward the agenetic side.
Retrospective review of endoscopic transnasal sinus dissections of 55 human cadavers (42, formalin fixated; 13, fresh frozen) was done in a tertiary care academic medical center. Surgical and radiologic findings were noted.
Absence of right frontal sinus ostium in the presence of a connection between the right and left frontal sinuses was demonstrated in 2 (3.6%) cadavers. An absent and an incomplete septum between the frontal sinuses were also noted in these cadavers. No accompanying abnormality of other sinuses was found, and no evidence of previous sinus surgery was noted in these 2 cadavers.
If one of the frontal sinus ostia cannot be found during sinus surgery, although this sinus and its recess can be seen on the thick-sliced coronal computed tomographic (CT) scans, keep in mind that it may be (3.6%) an agenetic frontal sinus hidden by the extensive pneumatization of the contralateral sinus that is crossing the midline. It may not be possible to foresee this variant preoperatively by endoscopic examinations or thick-sliced CT scans. If there is suspicion, thin-sliced CT scans with reconstruction will be ideal to confirm the agenesis of the frontal sinus and to avoid complications. In the presence of such variant of frontal sinus, 1-sided successful frontal sinusotomy is adequate because this sinus or cell will already be drained through the treated frontal recess.

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    ABSTRACT: 278 I In nt te er rn na at ti io on na al l J Jo ou ur rn na al l o of f M Me-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited. Abstract Agenesis of the paranasal sinuses is an uncommon clinical condition that appears mainly in the frontal (12%) and maxillary (5-6%) sinuses; in some populations, it appears at a higher pro-portion. This study investigated the prevalence of agenesis of the frontal sinuses using dental volumetric tomography (DVT) in Turkish individuals. The frontal sinuses of 410 patients were examined by DVT scans in the coronal planes for evidence of the absence of the frontal si-nuses. A bilateral and unilateral absence of the frontal sinuses was seen in 0.73% and 1.22% of cases, respectively. In one case, both agenesis and aplasia of the frontal sinus was seen (0.24%). The low percentage of frontal sinus agenesis must be considered during pre-surgical planning related to the sinuses. DVT may be used as a diagnostic tool for the examination of frontal sinus aplasia.
  • [Show abstract] [Hide abstract]
    ABSTRACT: 278 I In nt te er rn na at ti io on na al l J Jo ou ur rn na al l o of f M Me-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited. Abstract Agenesis of the paranasal sinuses is an uncommon clinical condition that appears mainly in the frontal (12%) and maxillary (5-6%) sinuses; in some populations, it appears at a higher pro-portion. This study investigated the prevalence of agenesis of the frontal sinuses using dental volumetric tomography (DVT) in Turkish individuals. The frontal sinuses of 410 patients were examined by DVT scans in the coronal planes for evidence of the absence of the frontal si-nuses. A bilateral and unilateral absence of the frontal sinuses was seen in 0.73% and 1.22% of cases, respectively. In one case, both agenesis and aplasia of the frontal sinus was seen (0.24%). The low percentage of frontal sinus agenesis must be considered during pre-surgical planning related to the sinuses. DVT may be used as a diagnostic tool for the examination of frontal sinus aplasia.
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    [Show abstract] [Hide abstract]
    ABSTRACT: 278 I In nt te er rn na at ti io on na al l J Jo ou ur rn na al l o of f M Me-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited. Abstract Agenesis of the paranasal sinuses is an uncommon clinical condition that appears mainly in the frontal (12%) and maxillary (5-6%) sinuses; in some populations, it appears at a higher pro-portion. This study investigated the prevalence of agenesis of the frontal sinuses using dental volumetric tomography (DVT) in Turkish individuals. The frontal sinuses of 410 patients were examined by DVT scans in the coronal planes for evidence of the absence of the frontal si-nuses. A bilateral and unilateral absence of the frontal sinuses was seen in 0.73% and 1.22% of cases, respectively. In one case, both agenesis and aplasia of the frontal sinus was seen (0.24%). The low percentage of frontal sinus agenesis must be considered during pre-surgical planning related to the sinuses. DVT may be used as a diagnostic tool for the examination of frontal sinus aplasia.