Radiological evaluation of the frontal recess area and the frontal sinus for the purpose of endoscopic sinus surgery

Abstract

Introduction: Endoscopic surgery of the frontal recess and sinus proves to be a challenge due to the large anatomical variability of this area, the proximity of the olfactory groove and the orbit. These difficulties are often compounded by exacerbation of inflammation or intraoperative bleeding. Possible complications of endoscopic frontal sinus surgeries are cerebrospinal fluid leakage, orbital damage, bleeding from the anterior ethmoid artery, frontal recess disease – postoperative obstruction of the drainage pathway of the frontal sinus. For this reason, detailed knowledge of anatomy, a thorough preoperative radiological evaluation and appropriate surgical skills are crucial in performing this type of procedure. Aim: The aim of the study was to develop a checklist of elements that ought to be considered before endoscopic surgery of the frontal sinus. Methods: The study presents a review of the latest literature including 40 publications about radioanatomy of the frontal recess and sinus, complications of endoscopic surgery in this area and methods of their prevention. Results: The elements that ought to be assessed in computed tomography before frontal sinus endo-scopic surgery are the frontoethmoidal cells, the insertion of the uncinate process, the measurement of the angulation of the posterior wall of the frontal sinus and its dimensions, the anatomy of the olfactory groove, the location of the anterior ethmoid artery, the possible sinus aplasia. Conclusions: Proper use of the multiplanar computed tomography reconstruction technique enables the recognition of anatomical variabilities, the prediction of intraoperative difficulties and the selection of appropriate tools, which improve the surgical process and its safety.