PMID- 28418817
OWN - NLM
STAT- MEDLINE
DCOM- 20170816
LR  - 20180506
IS  - 1097-6817 (Electronic)
IS  - 0194-5998 (Linking)
VI  - 156
IP  - 5
DP  - 2017 May
TI  - Virtual Mapping of the Frontal Recess: Guiding Safe and Efficient Frontal Sinus 
      Surgery.
PG  - 946-951
LID - 10.1177/0194599817699562 [doi]
AB  - Objective To define relationships between the frontal sinus opening, ostia of 
      other frontal recess cells, and endoscopic landmarks and to develop a clinically 
      useful framework to guide frontal sinus surgery. Study Design Retrospective 
      review. Setting Tertiary care academic referral center. Methods Adult patients 
      with computed tomography (CT) without sinonasal pathology were included. Virtual 
      endoscopy (using OsiriX) and corresponding CT reconstructions were used to 
      identify all visible ostia in the frontal recess and characterize their positions 
      in spaces between the uncinate/agger nasi (U), bulla ethmoidalis (EB), and middle 
      turbinate (MT). Results Two hundred sides in 100 patients (median age 51 years, 
      62% female) were analyzed. The "center" of each map was defined as the 
      intersection of spaces between U, EB, and MT. The frontal sinus opening was in 
      the "center" in 53% of frontal recesses, lateral to this position in 29%, and 
      anterior in 11%. When the frontal sinus opening was at the "center," anterior 
      ostia drained frontal Kuhn T cells in 51% and intersinus septal cells in 23%. The 
      skull base attachment of the apical strut of the uncinate process demarcated 
      medial and lateral within the space between U and EB, with the opening to the 
      frontal sinus medial in 68% and lateral in 31%. Left-right asymmetry in frontal 
      sinus openings was noted in 46% of patients. Conclusion Combining preoperative 
      imaging and knowledge of these anatomic relationships may facilitate more 
      efficient frontal outflow tract identification and instrumentation. This 
      represents the first and largest description of ostial configurations relative to 
      endoscopic structural landmarks. LEVEL OF EVIDENCE: 4.
FAU - Patel, Neil S
AU  - Patel NS
AD  - 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Dearking, Amy C
AU  - Dearking AC
AD  - 2 St Cloud Ear, Nose, and Throat, St Cloud, Minnesota, USA.
FAU - O'Brien, Erin K
AU  - O'Brien EK
AD  - 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Pallanch, John F
AU  - Pallanch JF
AD  - 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
LA  - eng
PT  - Journal Article
DEP - 20170418
PL  - England
TA  - Otolaryngol Head Neck Surg
JT  - Otolaryngology--head and neck surgery : official journal of American Academy of 
      Otolaryngology-Head and Neck Surgery
JID - 8508176
SB  - IM
MH  - Academic Medical Centers
MH  - Adult
MH  - Aged
MH  - Anatomic Landmarks/*surgery
MH  - Cohort Studies
MH  - Endoscopy/methods
MH  - Female
MH  - Frontal Sinus/*diagnostic imaging/*surgery
MH  - Humans
MH  - Imaging, Three-Dimensional/methods
MH  - Male
MH  - Middle Aged
MH  - Preoperative Care/methods
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Tertiary Care Centers
MH  - Tomography, Spiral Computed/*methods
MH  - Tomography, X-Ray Computed/methods
MH  - Treatment Outcome
MH  - Virtual Reality Exposure Therapy/*methods
OTO - NOTNLM
OT  - 3D image analysis
OT  - frontal recess
OT  - frontal sinus anatomy
OT  - virtual endoscopy
EDAT- 2017/04/19 06:00
MHDA- 2017/08/17 06:00
CRDT- 2017/04/19 06:00
PHST- 2017/04/19 06:00 [pubmed]
PHST- 2017/08/17 06:00 [medline]
PHST- 2017/04/19 06:00 [entrez]
AID - 10.1177/0194599817699562 [doi]
PST - ppublish
SO  - Otolaryngol Head Neck Surg. 2017 May;156(5):946-951. doi: 
      10.1177/0194599817699562. Epub 2017 Apr 18.