Articles Vol. 67 No. CĐ5-NCKH 04/05/2026

MORPHOLOGICAL CHARACTERISTICS OF THE ANTERIOR WALL CELL COMPLEX OF THE FRONTAL RECESS AND ITS ASSOCIATION WITH FRONTAL SINUS OPACIFICATION ON CT SCAN

Nguyen Thi Kieu Tho1,2,3,4, Le Phi Nhan5,6, Nguyen Dinh Chuong1,2,3,4
1 University of Medicine and Pharmacy at Ho Chi Minh City
2 Gia Dinh People’s Hospital
3 Đại học Y Dược Thành phố Hồ Chí Minh
4 Bệnh viện Nhân Dân Gia Định
5 Tien Giang General Hospital
6 Bệnh viện Đa khoa Tiền Giang
DOI: 10.52163/yhc.v67iCD5.4991
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Keywords
Anterior wall complex, Agger nasi cell, frontal cell, frontal recess, frontal sinus opacification
Abstract

Objectives: To describe the morphology and prevalence of the frontal recess anterior wall cellular complex and evaluate its association with frontal sinus opacification on CT scan.

Methods: A cross-sectional study was conducted on 174 patients at Nhan Dan Gia Dinh Hospital from January 2024 to June 2025. Anterior wall structures were identified on multiplanar CT and compared with frontal sinus opacification according to Lund-Mackay scores. Generalized Estimating Equations (GEE) were used to account for within-subject correlation between the two sides.

Results: Agger nasi cells were present in 90.6% of sides. Frontal cells (Kuhn classification) were observed in 45.6%. Agger nasi cells were associated with higher rates of frontal sinus opacification (OR=3.45; 95% CI: 1.18–10.12; p=0.035). The rate of opacification tended to increase with anatomical complexity: 12.5% in sides without Agger nasi or frontal cells, 22.8% in sides with isolated Agger nasi cells, and 32.9% in sides with both Agger nasi and frontal cells (p=0.032). High - extension frontal cells (Kuhn type III and IV) showed a trend towards higher opacification rates (48.5%) compared to low - extension types (28.7%), although this did not reach statistical significance (p=0.052).

Conclusion: The anterior wall cellular complex is an anatomical factor associated with frontal sinus opacification on CT scan. The coexistence of Agger nasi and frontal cells may suggest a combined narrowing effect within the frontal recess.

References
[1]
Daniels DL, Mafee MF, Smith MM, Smith TL, Naidich TP, Brown WD, et al. The frontal sinus drainage pathway and related structures. American journal of neuroradiology. 2003;24(8):1618–27. Google Scholar
[2]
Bent JP, Cuilty-Siller C, Kuhn FA. The frontal cell as a cause of frontal sinus obstruction. American journal of rhinology. 1994;8(4):185–92. doi:10.2500/105065894781874278 Google Scholar
[3]
Wormald PJ. The key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg. 2003;129:497–507. doi: 10.1016/S0194-5998(03)01581-X. Google Scholar
[4]
Kuhn FA, Bolger WE, Tisdal RG. The Agger nasi cell in frontal recess obstruction: an anatomic, radiologic and clinical correlation. Operative Techniques in Otolaryngology-Head and Neck Surgery. 1991;2(4):226–31. doi: 10.1016/S1043-1810(10)80085-5. Google Scholar
[5]
Wormald PJ, Hoseman W, Callejas C, Weber RK, Kennedy DW, Citardi MJ, et al., editors. The international frontal sinus anatomy classification (IFAC) and classification of the extent of endoscopic frontal sinus surgery (EFSS). International forum of allergy & rhinology; 2016: Wiley Online Library. doi: 10.1002/alr.21738. Google Scholar
[6]
DelGaudio JM, Hudgins PA, Venkatraman G, Beningfield A. Multiplanar computed tomographic analysis of frontal recess cells: effect on frontal isthmus size and frontal sinusitis. Archives of Otolaryngology–Head & Neck Surgery. 2005;131(3):230–5. doi: 10.1001/archotol.131.3.230. Google Scholar
[7]
Eweiss AZ, Khalil HS. The prevalence of frontal cells and their relation to frontal sinusitis: a radiological study of the frontal recess area. International Scholarly Research Notices. 2013;2013(1):687582. doi: 10.1155/2013/687582. Google Scholar
[8]
Kuhn FA. Chronic frontal sinusitis: the endoscopic frontal recess approach. Operative techniques in otolaryngology-head and neck surgery. 1996;7(3):222–9. doi: 10.1016/S1043-1810(96)80037-6 Google Scholar