European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 7, pp 1795–1801 | Cite as

Impact of residual frontal recess cells on frontal sinusitis after endoscopic sinus surgery

  • Tsuguhisa Nakayama
  • Daiya Asaka
  • Akihito Kuboki
  • Tetsushi Okushi
  • Hiromi Kojima



Endoscopic sinus surgery (ESS) is a well-established treatment for chronic rhinosinusitis (CRS). However, ESS for frontal sinusitis remains complicated and challenging. The aim of this study was to identify the relationship between residual frontal recess cells and primary ESS failure in the frontal sinus.


We prospectively collected information on 214 sides of 129 patients with CRS who underwent standard ESS from June 2010 to May 2011. To identify risk factors, we retrospectively analyzed clinical data and computed tomography (CT) images before and 3 months after surgery.


The posterior side of the frontal recess cells remained relatively common: suprabullar cells (SBCs) were found in 12.2% (16 sides), suprabullar frontal cells (SBFCs) in 20.3% (12 sides), and supraorbital ethmoid cells in 23.7% (14 sides). In contrast, the anterior side of the frontal recess cells, agger nasi cells, supra agger cells, and supra agger frontal cells remained at < 10.0%. Frontal septal cells persisted in 25.0% (5 sides). The presence of residual frontal recess cells was an independent risk factor for postoperative frontal sinus opacification as were well-recognized risk factors such as nasal polyps, the peripheral eosinophil count, and the CT score. Among residual frontal recess cells, SBCs and SBFCs were independent risk factors for opacification.


Residual frontal recess cells, especially SBCs and SBFCs, were independent risk factors for postoperative opacification of the frontal sinus. Complete surgical excision of frontal recess cells may improve surgical outcomes.


Chronic rhinosinusitis Frontal sinus surgery Frontal recess cells Frontal recess anatomy Computed tomography 



We thank Angela Morben, DVM, ELS, from Edanz Group (, for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest relevant to this report.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyJikei University School of MedicineTokyoJapan

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