Prevalence of Frontal Recess Cells and Their Effect on the Development of Frontal Sinusitis According to the International Frontal Sinus Anatomy Classification: A Retrospective Computed Tomography Analysis

Frontal recess is an important region in endoscopic surgery in terms of its complex anatomic structure and excessive pneumatized cell variations. With the International Frontal Sinus Anatomy Classification (IFAC), classification and nomenclature of cellular variations in this region have been facilitated. The aim of the present study was to determine the incidence of frontal recess cell variations in computed tomography (CT) according to IFAC and to investigate the possible effect of these cells on the development of frontal sinusitis. In this observational, retrospective, and cross-sectional study, the frontal recess cell variations on both sides of the patients who underwent paranasal sinus CT examination were analyzed according to IFAC, and the possible relationship between these cellular variations and the presence of frontal sinusitis was evaluated by statistical methods. A total of 428 sides of 214 paranasal sinus computed tomography were examined. Agger nasi cell (ANC) was observed in 90.8%, while supra agger cell (SAC) were detected in 57.9% and supra agger frontal cell (SAFC) in 20.5%. Supra bulla cell (SBC) were observed in 80.1% of the sides and supra bulla frontal cell (SBFC) in 19.3%. Supraorbital ethmoid cell (SOEC) were detected on the 41.8% of sides, while frontal septal cells (FSCs) were observed in the 28.9%. The results of the present study showed that the prevalence of cells, especially other than ANC cells varies between populations. In addition, the presence of SAC, SAFC, SBC, SBFC, and SOEC appeared to be associated with a tendency to the development of frontal sinusitis. © 2025 by Mutaz B. Habal, MD