Role of Computed Tomography in Assessment of Frontal Sinus Prior to Functional Endoscopic Frontal Sinus Surgery

Background: Chronic rhinosinusitis is one of the most common chronic diseases refractory to treatment with the frontal sinus, providing a greater challenge surgically owing to its anatomical constraints during FESS; hence, the use of CT imaging, with its power of anatomical delineation, has become necessary for preoperative planning. Objective: To describe different anatomical variants related to the most frequent and critical complications during FESS of the frontal sinus to achieve safe endoscopic navigation, hence improving the outcome in Suez Canal University hospitals. Subjects and Methods: A total of forty-six individuals were included in this study. The average age of the patients was thirty-three years. CT images were used to detect different anatomical variants related to the frontal sinus. Results: CT images were analyzed and the results were interpreted with the age group ranging from 12 years old to 71 years old, with the bilateral frontal sinus being the most common type. Agger nasi cells were the most frequent fronto-ethmoidal recess cells, counting for 93.5%. The depth of the olfactory fossa was also assessed and classified by keros grades, with Grade II keros being the most frequent grade, accounting for 58.7%. Orbital complications were reported in three patients, accounting for 6.5% of the patients. Conclusion: Preoperative CT evaluation of patients prior to frontal sinus endoscopic surgeries with proper reporting of different anatomical variations is mandatory for safe endoscopic navigation. Further studies of larger sample sizes are needed to confirm these results.