The role of the resessus frontalis's anatomical variations on chronic rhinosinusite cases

Rhinosinusitis is a disease characterised by paranasal sinus mucosa infections or noninfectious inflammation, multifactorial disease which can be seen alongside systemic diseases affecting immune system and cilliary functions. The whole anatomy and physiology of sinuses has to be understood in order to achieve success without complications on medical treatment. Endoscopical treatments are used effectively especially on chronic rinosinusitis not responding to maximal treatment, after mucocilliary activities importance is understood, and endoscopes and computer tomography are introduced. One of the problematic areas for endoscopic sinusitis surgery is frontal sinus. Frontal sinusitis disease evaluation is difficult because of it?s closeness to vital organs such as anterior cranial fossa, the structure of frontalis, and anatomical variations.The purpose of this approach is studying the resessus frontalis region, which is not fully understood and still debated in literature, radiologically and anatomically in detail and guiding treatment by defining the changes occuring because of anatomical variations and inflammatory changes in this region. We created groups from patients who applied to our clinic with sinus and frontal headache problems, and a control group. Group I (Control) were composed of patients who had no sinonasal or frontal headache problems, Group II (sinonasal sympthom) were compsed of patient with sinonasal sympthoms and problems, Group II were composed of patients with sinonasal problems and frontal headaches. Coronal and parasagittal reconstructions were done and computer tomography for sinus on axial plan were taken fro all patients.The results of this study on resessus frontalis region were like this: Group II with sinonasal and headache problems had statistically higher agger nazi cells and intersinus septum cells. Bulla frontalis, frontal cell type II and IV were statistically higer on patients with frontal sinusitis and/or frontal recess disease, frontal cell type III had a significant effect on these patients. For patients with sinonasal problems, cells obstructing recessus frontalis posterior were statistically higher. All this data shows that success in surgery on frontal sinus and/or recessus frontalis without complications, relies on paranasal computer tomography on parasagittal plan prior to the surgery.