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: 0.98). 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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    • "The frontal recess is a deep anterosuperior depression in the middle meatus, which forms a closed channel in its upper surface called the frontonasal duct 13-16. The shape, dimensions, and limits of the frontal recess are determined by its surrounding structures 2, and a frontal sinus cannot exist without a recess 5. However, anatomical variants may alter the configuration of the frontal recess 4,8. "
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    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 proportion. 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 sinuses. 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.
    International journal of medical sciences 04/2011; 8(3):278-82. · 2.00 Impact Factor
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    ABSTRACT: In adults, paranasal sinus agenesis is an uncommon anomaly that appears mainly in the frontal sinus. The aim of this study was to investigate the prevalence of agenesis of the frontal sinus using computed tomography in a population of Iranian individuals. Computed tomographic scans in the axial and coronal planes of the frontal sinus of 565 patients were examined for evidence of the absence of the frontal sinus. A bilateral agenesis of the frontal sinus was seen in 8.32% of cases, and unilateral absence of the frontal sinus was observed in 5.66%. The information provided in the current study is useful for some craniofacial surgeries and improves the anthropometric knowledge of humanity. There are limited studies on agenesis of the frontal sinus in the literature, but comparing our findings with the available data, there were differences regarding the incidence of this condition. This may be related to geographic and racial features. More studies on other population are required.
    The Journal of craniofacial surgery 11/2011; 22(6):e48-51. DOI:10.1097/SCS.0b013e318231e26c · 0.68 Impact Factor
  • The Journal of craniofacial surgery 07/2013; 24(4):1502-1503. DOI:10.1097/SCS.0b013e3182902d08 · 0.68 Impact Factor
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