of Cases %
Agger nasi 9 17.3% Pneumatisation of MT 18 34.6% Enlarged ethmoidal bulla 7 13.4% Paradoxical MT 6 11.5% Everted uncinate 1 1.9% Haller cell 4 7.6% Onodi cell 6 11.5% Frontal sinus cells 6 11.5% Table 7.
90% of the patients with right sided disease had DNS to right, with associated bilateral concha bullosa in 20% and left
agger nasi cell in 10%.
The
agger nasi cell in frontal recess obstruction: Anatomic and clinical correlation.
Post-treatment CT demonstrated thickening in the ethmoid and maxillary sinuses; a single frame from this scan showed the
agger nasi cell (figure 1).
Opening the
agger nasi cells usually provides a good view of the frontal recess.
Depending on the degree of pneumatization,
agger nasi cells can be bounded anteriorly by the frontal process of the maxilla, anterolaterally by the nasal and lacrimal bones, posterolaterally by the lamina papyracea, superiorly by the frontal sinus, inferolaterally by the uncinate process, and posteriorly by the anterior ethmoid complex.
Table 2 Our risk-assessment scoring system Structure Left Right Absent frontal sinus 0 or 1 0 or 1 Absent sphenoid sinus 0 or 1 0 or 1
Agger nasi cells 0 or 1 0 or 1 Asymmetric sphenoid septum 0 or 1 0 or 1 Cribriform plate 0 or 1 0 or 1 Haller's cells 0 or 1 0 or 1 Internal carotid cover 0 or 1 0 or 1 Lamina papyracea 0 or 1 0 or 1 Optic nerve cover 0 or 1 0 or 1 Pneumatized ethmoid roof 0 or 1 0 or 1 Uncinate process 0 or 1 0 or 1 Key: 0: normal; 1: definite anomaly.
Middle turbinate, Concha Bullosa, Uncinate process,
Agger Nasi cells, Haller cells and Posterior ethmoids showed very good agreement.
It is also important to avoid excessive removal near the attachment of the vertical portion of the middle turbinate or the
agger nasi because this might disrupt the attachment to the cribriform plate.
Agger Nasi Cells: We found pneumatization of the
agger nasi cells in 58(72.5%) nasal cavities.
The intra and extramural pneumatisation of the ethmoid air cells was seen in 70% of the cases, with the
Agger nasi cells being most common type.
Polyps blocking the frontal recess opening into the middle meatus were cleared,
agger nasi cells were exenterated, and mucus was drained from the frontal sinus.
