الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
This study evaluates the role of multidetector CT especially sagittal CT in evaluation of anatomical variations of frontal sinus pathway drainage in patients with chronic frontal sinusitis and will undergo FESS operation.
This study is designed to make the surgical procedures as safe, accurate, rapid, and with less complication as possible. Complete evaluation was recommended for patients who have failed medical treatment and have history suggestive of chronic sinusitis regardless of the findings on routine examination.
This study includes twenty patients presented to the E.N.T. out patient Clinic of El-Minia University Hospital with signs and symptoms of chronic rhinosinusitis. Their age ranged from 20 years to 55 years with a mean age of 41.4 were represent 11 males (55%) and 9 females(45%).
Every patient was subjected to the following:
a- Full history taking.
b- Complete clinical examinations.
c- CT scanning: All patients were undergone multiplanar CT.
The sagittal plane was selected because it the best view that demonstrates more details about frontal sinus anatomy and anatomic variations of frontoethmoidal recess and related structures.
d- FESS operation.
Most patients with frontal sinusitis can be managed with appropriate medical therapy. Antibiotics, decongestants, and other sinus medications lead to a resolution of mucosal inflammation and the re-establishment of sinus drainage. In advanced cases, however, ostial stenosis and infection may persist, necessitating surgical intervention. The frontal sinus and its drainage pathways can be visualized as an hourglass configuration with the isthmus or point of narrowest diameter being the frontal ostium. The ostium opens inferiorly into an anatomic region known as the frontal recess. This recess, through which the frontal sinus drains, is located in the most superior portion of the middle meatus just behind the anterior attachment of the middle turbinate to the lateral nasal wall. The frontal recess may be conceptualized as an inverted cone whose apex is directed superiorly toward the frontal sinus ostium, the middle turbinate forms the medial boundary of the recess, and the lamina papyracea is its lateral limit. The superior boundary is the floor of the frontal sinus and its ostium. Inferiorly, the recess opens into the ethmoid infundibulum. The anterior boundary is the agger nasi, and the posterior boundary is either the skull base or a well-pneumatized bulla ethmoidalis. In addition to the frontal ostium, other air cells may also drain into the frontal recess, including agger nasi, supraorbital ethmoid, and infundibular cells. Extensive pnematization of the ethmoid bulla and the agger nasi or lateralization of the middle turbinate may obstruct this already narrow drainage pathway and predispose to frontal pathologic conditions. The intricate and variable anatomy of the frontal sinus drainage challenges even the most accomplished sinus surgeon. Because of the variability of the anatomy in this region, image guidance is often helpful even in the absence of previous surgery. In addition to these intraoperative advantages, the image-guidance workstation can be used preoperatively to understand better each patient’s individual anatomy.