The study of frontal recess configurations based on computed tomography data and their association with frontal sinusitis

<b>Introduction:</b> The anatomy of the frontal sinus (FS) is challenging for both radiologists and ENT surgeons. The IFAC (International Frontal Sinus Anatomy Classification) aims to simplify the classification of anatomical variations of the frontoethmoidal complex.<b>Aim:</b> The purpose of this study was to analyze, based on computed tomography (CT) data of the paranasal sinuses, the prevalence of frontal recess cells according to the IFAC classification in patients with chronic frontal sinusitis and those without signs of FS inflammation, as well as to determine the relationship between the configuration of frontal recess cells and FS inflammation.<b>Materials and methods:</b> An analysis of CT scans of the paranasal sinuses from 120 patients (233 sides) who were treated at the M.V. Sklifosovsky Poltava Regional Clinical Hospital between 2023 and 2024, was conducted. The prevalence of various types of frontoethmoidal cells (FEC) was studied according to the IFAC classification. A correlational analysis was performed between the presence of FS opacification and the configuration of FEC.<b>Results:</b> The prevalence of agger nasi cells was 97.42%, supra agger cells 48.07%, supra agger frontal cells 27.61%, supra bulla cells 81.97%, supra bulla frontal cells 22.75%, supraorbital ethmoidal cells 18.03%, and frontal septal cells 28.76%. The largest differences in the prevalence of FEC between patients with and without FS inflammation were observed in the presence of supraorbital ethmoidal cells (26.92% and 15.47%, respectively) and frontal septal cells (21.15% and 30.94%, respectively). However, these differences were not statistically significant. In 157 (67.38%) of the studied sides, we identified cells with pneumatization extending into the FS, while in the remaining cases, the FEC were located below the FS ostium.<b>Conclusions:</b> The structure of the frontal cranium varies widely, as confirmed by CT analysis. The most common cell in our and other studies was the agger nasi cell (ANC), followed by the supra bulla cell (SBC), and the least common was the supraorbital ethmoid cel (SOEC). There was no clear relationship between the presence of a FEC and FS. There is a wide discrepancy in the literature in assessing the prevalence of FS penetrating cells. The IFAC classification is convenient and easy to use and helps to describe the frontal-site area in detail. The present results indicate the need for a more thorough study of the anatomical variations of the frontal sinuses, especially in the context of surgical planning and treatment of chronic nasal sinus diseases.