7) in their study of two cohorts of 100 Caucasian and 100 Chinese patients undergoing ESS for ethnic variation in sinonasal anatomy on CT scan revealed a statistically significant difference in anatomical variations like choncha bullosa, paradoxical bending of middle turbinate, infrabullar and suprabullar cells, asymmetry in the anterior ethmoidal roof indicating racial factors influencing anatomical variations, Pneumatization of the agger nasi
In a study conducted by Dua and Chopra16 regarding CT scan paranasal sinuses findings in CRS, they found that in majority of patients osteomeatal complex and anterior ethmoids were involved in 88% patients, agger nasi
cells in 40%, concha bullosa and Haller cells in 16% of patients.
Vertical insertion of the middle turbinate: A sign of the presence of a well-developed agger nasi
Opening the agger nasi
cells usually provides a good view of the frontal recess.
Obstructive agger nasi
cells can be removed with either conventional or powered instruments.
In this article, we describe our discovery of a naturally draining ostium of an agger nasi
cells may block the frontal recess depending upon the degree of pneumatization thus identification on the CT scan is in cases of frontal sinusitis surgery.
Depending on the degree of pneumatization, agger nasi
cells can be bounded anteriorly by the frontal process of the maxilla, anterolaterally by the nasal and lacrimal bones, posterolaterally by the lamina papyracea, superiorly by the frontal sinus, inferolaterally by the uncinate process, and posteriorly by the anterior ethmoid complex.
Frontal Cell & Its Types: Frontal cells: Frontal cells arise above the agger nasi
cells and a little posterior to them.
Table 2 Our risk-assessment scoring system Structure Left Right Absent frontal sinus 0 or 1 0 or 1 Absent sphenoid sinus 0 or 1 0 or 1 Agger nasi
cells 0 or 1 0 or 1 Asymmetric sphenoid septum 0 or 1 0 or 1 Cribriform plate 0 or 1 0 or 1 Haller's cells 0 or 1 0 or 1 Internal carotid cover 0 or 1 0 or 1 Lamina papyracea 0 or 1 0 or 1 Optic nerve cover 0 or 1 0 or 1 Pneumatized ethmoid roof 0 or 1 0 or 1 Uncinate process 0 or 1 0 or 1 Key: 0: normal; 1: definite anomaly.
The intra and extramural pneumatisation of the ethmoid air cells was seen in 70% of the cases, with the Agger nasi
cells being most common type.
It is also important to avoid excessive removal near the attachment of the vertical portion of the middle turbinate or the agger nasi
because this might disrupt the attachment to the cribriform plate.