Title: Relationship of Agger Nasi Cell and Uncinate Process Attachment: A Retrospective Study of Radiological Imaging in Indian Population

Authors: Dr Arun Yadav, Dr Kavish Kapoor, Dr Meghna Poonia

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i9.52

Abstract

Frontal sinus drainage pathway (FSDP) is a difficult area to access in endoscopic surgery of paranasal sinus region. Anatomy of this region is influenced by presence of Agger nasi cells (AN) and type of Uncinate process (UP) attachment superiorly. This retrospective descriptive study attempted to measure frequency these two important anatomical features in Indian population.

Aim: the aim of this study was to measure the frequency of agger nasi cell and evaluate their relationship with superior attachment of uncinate process

Materials and Methods: Retrospective analysis of the Non contrast computed tomograms of nose and paranasal sinus region (NCCT PNS) involving 280 sides were performed. These scans were evaluated for presence of agger nasi cells and superior attachment of uncinate process.

Results: Agger nasi cells was present in 236 of 280 sides. Uncinate process can be delineated in 272 out of 280 sides; 112  reached Lamina Papyracea (LP), 57 reached Middle Turbinate (MT) and 67 reached Skull Base (SB). Agger nasi cells were present in 88.88% sides at lamina papyracea attachment, 80.28% sides at middle turbinate attachment and 89.33% sides at skull base attachment. Statistical analysis of data provided a chi-square value of 0.2556 and P-value of 0.880. Study results indicated that relationship between the presence of agger nasi and superior attachment of uncinate process is not significant statistically at P value of < 0.05.

Conclusion: The agger nasi cell was present 84.28% scans and superior attachment of uncinate process can be traced in 97.14% of scans. However relationship was not significant between presence of agger nasi cell and superior attachment of uncinate process.

Keywords: Agger nasi cell, Uncinate process, Frontal sinus drainage pathway, Lamina papyracea, Middle turbinate, Skull base. 

References

  1. Wormald PJ: The agger nasi cell: the key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg 2003: p 497-507.
  2. Brunner E, Jacobs JB, Shpizner BA, Lebowitz RA,Holliday RA. Role of the agger nasi cell in chronic frontal sinusitis. Ann Otol Rhinol Laryngol. 1996Sep;105(9):694 -700.
  3. Stammberger H, Kopp W, Dekornfeld TJ, et al. Special endoscopic anatomy. In: Stammberger H, Hawke M, eds. Functional endoscopic sinus surgery: the Messerklinger technique. Philadelphia: BC Decker Publishers; 1991: p 61–90.
  4. Landsberg R, Friedman M. A computer–assisted anatomical study of the nasofrontal region. Laryngoscope. 2001;111:2125-2130.
  5. McLaughlin RB, Rehl RM, Lanza D. Clinically relevant frontal sinus anatomy and physiology. Otolaryngol Clin North Am. 2001;34:1-22.
  6. Kennedy DW, Senior BA . Endoscopic sinus surgery: a review. Otolaryngol ClinNorth Am. 997;30:313- 330.
  7. Jacobs JB, Lebowitz RA, Sorin A, et al. Preoperative sagittal CT evaluation of the frontal recess. Am J Rhinol. 2000;14:33 - 37.
  8. Kim KS, Kim HU, Chung IH, et al. Surgical anatomy of the nasofrontal duct: anatomical and computed tomographic analysis. Laryngoscope. 2001;111:603 - 608.
  9. Liu SC, Wang CH, Wang HW. Prevalence of the uncinate process, agger nasi cell and their relationship in a Taiwanese population n. Rhinology. 2010 Jun;48(2):239 - 44.
  10. Ercan I, Cakir BO, Sayin I, Başak M, Turgut S. Relationship between the superior attachment type of uncinate process and presence of agger nasi cell: a computer - assisted anatomic study. Otolaryngol Head Neck Surg. 2006 Jun;134(6):1010 - 4.
  11. Rahul Shivraj, cimona Dsouza, George Pinto. Influence of superior attachment of the uncinate process on the presence of agger nasi. International Journal of Recent Scientific Research. 2014 Nov; 5(11):1988-1990.

Corresponding Author

Dr Kavish Kapoor

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.; Contact: 9560776464

Address: Department of Radiodiagnosis, 158 Base Hospital c/o 99 APO