Radiological Study of Posterior Cells in Relation to Frontal Sinus Drainage Pathway and its Effect on Surrounding Anatomy in the Western Part of Nepal

Aims and background: Anatomical variations of frontal recess cells significantly influence the frontal sinus drainage pathway and increase the risk of complications during endoscopic sinus surgery.Understanding posterior cell variations and their relation to the anterior ethmoidal artery (AEA) is crucial.This study aims to evaluate the prevalence of posterior frontal recess cells and to determine whether there is association between the presence of posterior frontal recess cells and distance of AEA from various anatomical structures.Materials and methods: A prospective cross-sectional study was conducted among 100 patients with 200 sides undergoing computed tomography (CT) nose and paranasal sinuses (PNSs) at Pokhara Academy of Health Sciences.The files were analyzed over a period of 6 months to assess the volume, pneumatization of the frontal sinus, types of posterior frontal recess cells, location of the AEA, and depth of the olfactory fossa.Data were analyzed using SPSS v22.Descriptive and inferential statistics (Chi-square, independent t-test) were applied.Results: Five percent of the frontal sinuses were unpneumatized.The median frontal sinus volume was 3.68 cm 3 .Suprabulla cells, supraorbital ethmoid cells, and suprabulla frontal cells (SBFCs) were present in 68%, 57%, and 7%, respectively.The presence of supraorbital ethmoid cells was significantly linked to the location of the AEA in the mesentery.There was a significant association between the presence of SBFCs and increasing distance of the AEA from the posterior border of the frontal ostium and from the second lamella.Similarly, a significant association was found between the presence of supraorbital ethmoid cells and increasing distance of the AEA from the posterior border of the frontal ostium and from the third lamella.Conclusion: Posterior frontal recess cells are common in the Nepalese western population and can significantly influence AEA anatomy.Preoperative CT evaluation is essential to minimize surgical complications.Clinical significance: Variations in the posterior cells of the frontal sinus drainage pathway exist.This can significantly impact the surrounding anatomy of the AEA.Computed Tomography scans of the nose and PNS should be evaluated before surgery to reduce the risk of complications during surgery.