MULTIVARIATE REGRESSION MODEL FOR EVALUATING THE IMPACT OF FRONTAL RECESS VARIANTS ON THE FRONTAL SINUS LUND-MACKAY SCORE VIA COMPUTED TOMOGRAPHY
Main Article Content
Abstract
Objectives: to determine the independent prognostic value of frontal recess anatomical variants (agger nasi cell, frontal bulla cell, uncinate process attachment) for chronic frontal sinusitis using a multivariate analysis model.
Subjects and Methods: a cross-sectional analytic study was conducted on 211 sinus sides of patients undergoing multidetector computed tomography (CT) at Nhan Dan Gia Dinh Hospital from January 2024 to June 2025. Anatomical variants were identified on multiplanar CT scans. Frontal sinusitis was defined by a Lund-Mackay score ≥ 1. Data were analyzed using binary logistic regression to calculate adjusted Odds Ratios (aOR).
Results: the agger nasi cell was the most prevalent structure (90.5%), followed by uncinate process attachment to the lamina papyracea (52.1%) and the frontal bulla cell (20.9%). In the multivariate analysis, the frontal bulla cell emerged as the strongest independent predictor, increasing the risk of frontal sinusitis by 3.3-fold (aOR = 3.31; 95% CI: 1.47–7.42; p = 0.004). Uncinate process attachment to the lamina papyracea was also a significant independent predictor (aOR = 2.89; 95% CI: 1.26–6.64; p = 0.012). The agger nasi cell did not show statistical significance in the multivariate model (p > 0.05).
Conclusion: While the agger nasi cell is a fundamental landmark, the frontal bulla cell and the uncinate process attachment to the lamina papyracea are the decisive factors obstructing frontal sinus drainage. These findings underscore the surgical necessity of extending dissection posteriorly (removing the frontal bulla) and laterally (high uncinectomy) to effectively resolve the obstruction.
Keywords
Frontal recess, Frontal Bulla Cell, Agger nasi cell, Multivariate analysis, Frontal sinusitis
Article Details
References
2. Bolger WE, Parsons DS, Butzin CA. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. The Laryngoscope. 1991;101(1):56–64.
3. Bradley DT, Kountakis SE. The role of agger nasi air cells in patients requiring revision endoscopic frontal sinus surgery. Otolaryngology—Head and Neck Surgery. 2004;131(4):525–7.
4. Han D, Zhang L, Ge W, Tao J, Xian J, Zhou B. Multiplanar computed tomographic analysis of the frontal recess region in Chinese subjects without frontal sinus disease symptoms. ORL. 2008;70(2):104–12.
5. Kubota K, Takeno S, Hirakawa K. Frontal recess anatomy in Japanese subjects and its effect on the development of frontal sinusitis: computed tomography analysis. Journal of Otolaryngology-Head & Neck Surgery. 2015;44(1):21.
6. Lien CF, Weng HH, Chang YC, Lin YC, Wang WH. Computed tomographic analysis of frontal recess anatomy and its effect on the development of frontal sinusitis. The Laryngoscope. 2010;120(12):2521–7.
7. Wormald PJ. The key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg. 2003;129:497–507.
8. Turgut S, Ercan I, Sayın I, Başak M. The relationship between frontal sinusitis and localization of the frontal sinus outflow tract: a computer-assisted anatomical and clinical study. Archives of Otolaryngology–Head & Neck Surgery. 2005;131(6):518–22.