Surgical Anatomy

The nasal process of the frontal bone is thick and forms a "beak" that restricts both the anterior access to and drainage of the frontal sinus (Fig. 14.26a, b). The frontal intersinus septum varies greatly in its position. The extent and direction of pneumatization vary more than in any other area of the paranasal sinuses. The frontal sinus often has more than one drainage channel. Pneumatized cells can travel up into the frontal bone in all directions; anteriorly these form high agger

Pneumatization Frontal Bone
Fig. 14.26 a Preoperative and b postoperative sagittal CT scans moved to create a large median drainage channel.
Supraorbital Ethmoid Cell
Fig. 14.27 a View of the right lateral nasal wall: red in the frontal sinus; yellow in the suprabullar recess (*) and below into the retrobullar recess; and orange in a posterior ethmoid cell.

nasi air cells, otherwise known as bulla frontalis, whereas if they extend above the septum they are called intersinus septal cells, and behind the frontal recess they form supraorbital cells (Fig. 14.27a, b).

The main concern in this procedure is the cribriform plate that is positioned behind the coronal plane that connects the frontal recesses. Laterally lie the lamina papyracea of the ethmoid bone, the anterior ethmoid air cells, and part of the orbital component of the frontal bone. Not infrequently the me

Ethmoid Bone
show the thick nasal beak of the anterior wall that has been re-
Frontal Sinus Drain Hole
b Shows how the supraorbital cell (*), an extension of the su-prabullar recess, can be mistaken for the frontal sinus. Access to the frontal sinus can be seen as a small anterior dark hole (arrow).

dian drainage procedure is indicated because the lateral support has been removed in an external procedure, allowing collapse of the orbital contents medially (Fig. 14.28). The anterior boundary of the frontal recess is made of very thick bone, but this is a safe area to operate in as it is away from both the cribriform plate and the anterior ethmoid artery (Sim-men, 1997).

External Ethmoidectomy
Fig. 14.28 Right frontal stenosis following a previous external ethmoidectomy.
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