Anterior Ethmoid Cells

During the development of ethmoid pneumatiza-tion, some cells may extend inferiorly and laterally to reach the medial orbital floor and the most inferior portion of the lamina papyracea, below the ethmoid bulla and lateral to the uncinate process (infraorbital ethmoid cells or Haller cells) (Fig. 2.15) (StackpolE and EdElStEiN 1997). When large in size, these cells may narrow the ethmoid infundibulum. Size and

Ethmoid Infundibulum Variants
Fig. 2.15. Bilateral infraorbital ethmoid cells (IEC; Haller cells). Black arrows indicate the asymmetry of the fovea ethmoidalis (FE)

morphology of the ethmoid bulla are also highly variable: this cell may dislocate the ethmoid infun-dibulum and uncinate process (horizontalized). This variant has been considered by some authors to predispose for recurrent maxillary sinusitis. However, the definitive relationship between the presence of this variant and recurrent sinusitis is still debated (Stammberger and Wolf 1988; Bolger et al. 1991; Laine and Smoker 1992).

When extensively pneumatized, the ethmoid bullae may protrude into the middle meatus between the uncinate process and the middle turbinate and may narrow or obstruct the OMU (Figs. 2.3, 2.9, 2.13).

Agger nasi cells are the result of anterior extension of ethmoid cells to pneumatize the lacrimal bones (Figs. 2.6, 2.7, 2.9). Due to their location, agger nasi cells may obstruct the frontal recess.

Bulla frontalis indicates an ethmoid cell extending towards the frontal sinus. It is a rather complex variant and has been described in Sect. 2.1.3

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