Surgical and Radiologic Anatomy

, Volume 39, Issue 2, pp 161–168 | Cite as

Usefulness of three-dimensional computed tomographic anatomy in endoscopic frontal recess surgery

  • Paolo FarnetiEmail author
  • Anna Riboldi
  • Vittorio Sciarretta
  • Ottavio Piccin
  • Paolo Tarchini
  • Ernesto Pasquini
Anatomic Bases of Medical, Radiological and Surgical Techniques



The endoscopic bidimensional vision offered by the endoscope during endoscopic sinus surgery involves difficulty in visualizing surgical field depth which makes it difficult to learn this surgical technique and makes it necessary for the endoscopic surgeon to mentally create a three-dimensional (3D) picture of the paranasal sinuses anatomy. In particular, frontal recess surgery requires good knowledge of its anatomic position, also since it is necessary to use angled endoscopes, which distort the view, and angular instruments which are difficult to use. Purpose of this project is to offer to the endoscopic surgeon a detailed 3D model of the nose and paranasal sinuses with particular attention to the frontal recess.


A 3D reconstruction of the frontal recess and its related structures, starting from computer tomography scans of the human skull, was realized using a professional 3D graphics software.


A detailed reconstruction of the main structures which contribute to form the frontal recess was obtained. Particular attention was paid when reproducing the agger nasi cells, uncinate process, ethmoidal bulla, anterior ethmoidal cells, frontoethmoidal cells and their anatomic variants.


This is the first experience reported in literature regarding this new technique of iconographic didactics applied to endoscopic sinus surgery. It represents a new frontier, which surpasses and integrates the previous didactic techniques to help the surgeon to mentally create a 3D image of the paranasal sinuses.


Three-dimensional Endoscopic anatomy Paranasal sinuses Frontal recess Frontal sinus 



This manuscript describes an original work and is not under consideration by any other journal. All authors approved the manuscript and its submission and have no conflict of interest to declare.

Supplementary material

Supplementary material 1 (MP4 12911 kb)


  1. 1.
    Daniels DL, Mafee MF, Smith MM, Smith TL, Naidich TP, Brown WD, Bolger WE, Mark LP, Ulmer JL, Hacein-Bey L, Strottmann JM (2003) The frontal sinus drainage pathway and related structures. Am J Neuroradiol 24:1618–1627PubMedGoogle Scholar
  2. 2.
    Hosemann W, Gross R, Goede U, Kuehnel T (2001) Clinical anatomy of the nasal process of the frontal bone (spina nasalis interna). Otolaryngol Head Neck Surg 125:60–65CrossRefPubMedGoogle Scholar
  3. 3.
    Lawson W (1994) The intranasal ethmoidectomy: evolution and an assessment of the procedure. Laryngoscope 104:1–49CrossRefPubMedGoogle Scholar
  4. 4.
    Lessa MM, Voegels RL, Cuntha Filho B, Sakae F, Butugan O, Wolf G (2007) Frontal recess anatomy study by endoscopic dissection in cadavers. Braz J Otorhinolaryngol 3:204–209CrossRefGoogle Scholar
  5. 5.
    Lund VJ, Stammberger H, Fokkens WJ, Beale T, Bernal-Sprekelsen M, Eloy P, Georgalas C, Gerstenberger C, Hellings P, Herman P, Hosemann WG, Jankowski R, Jones N, Jorissen M, Leunig A, Onerci M, Rimmer J, Rombaux P, Simmen D, Tomazic PV, Tschabitscherr M, Welge-Luessen A (2014) European position paper on the anatomical terminology of the internal nose and paranasal sinuses. Rhinol Suppl 24:1–34Google Scholar
  6. 6.
    Stammberger H (1991) Functional endoscopic sinus surgery. BC Dekker, PhiladelphiaGoogle Scholar
  7. 7.
    Stammberger H, Lund V (2008) Anatomy of the nose and paranasal sinuses. In: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery, vol. 2, 7th edn. Hodder Arnold, London, pp 1315–43Google Scholar
  8. 8.
    Weber R, Draf W, Kratzsch B, Hosemann W, Schaefer SD (2001) Modern concepts of frontal sinus surgery. Laryngoscope 111:137–146CrossRefPubMedGoogle Scholar
  9. 9.
    Wigand M (1990) Endoscopic Anatomy of the Paranasal Sinuses. In: Wigand M (ed) Endoscopic surgery of the paranasal sinuses and anterior skull base. Thieme, New York, pp 18–56Google Scholar
  10. 10.
    Woodham JD, Doyle PW (1991) Surgical landmarks and resections for the safe performance of conservative endoscopic sinus surgery. J Otolaryngol 20:451–454PubMedGoogle Scholar
  11. 11.
    Wormald PJ (2005) Surgery of the frontal recess and frontal sinus. Rhinology 43:82–85PubMedGoogle Scholar
  12. 12.
    Wormald PJ (2013) Anatomy of the frontal recess and frontal sinus with three-dimensional reconstruction. In: Wormald PJ (ed) Endoscopic sinus surgery: anatomy, three-dimensional reconstruction and surgical technique, 3rd edn. Thieme, New York, pp 45–80Google Scholar

Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • Paolo Farneti
    • 1
    Email author
  • Anna Riboldi
    • 2
  • Vittorio Sciarretta
    • 3
  • Ottavio Piccin
    • 3
  • Paolo Tarchini
    • 3
  • Ernesto Pasquini
    • 4
  1. 1.Department of Experimental, Diagnostic and Specialty Medicine, Dimes, Bologna University Medical SchoolEar, Nose and Throat Unit of Sant’Orsola-Malpighi HospitalBolognaItaly
  2. 2.Three-dimensional Medical Virtual Designer at “Riboldi Multimedia Studio”BolognaItaly
  3. 3.Ear, Nose and Throat Unit of Sant’Orsola-Malpighi HospitalBolognaItaly
  4. 4.Ear, Nose and Throat Metropolitan Unit, Surgical Department, AUSL Bologna, Bellaria HospitalBolognaItaly

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