The frontal intersinus septal air cell: a new hypothesis of its origin

Abstract

Background and purpose: Air cells are often seen within the frontal intersinus septum. These cells have traditionally been thought to arise from displaced ethmoid cells from the frontal recess. This study explores the possibility that such cells may actually be diverticula from the frontal sinuses themselves and not of a direct ethmoid origin.

Materials and methods: A prospective study of 200 consecutive CT scans in the coronal and axial planes was performed on patients without a history of recent trauma. The images were interpreted independently by a radiologist and an otolaryngologist. The CT studies were evaluated for the presence of a central intersinus septal air cell. If such a cell was identified, it was further classified as either being completely isolated from both frontal sinuses by a bony rim or as a communicating diverticulum from one of the frontal sinuses. If a central cell was present, it was also assessed for how much of the height of the intersinus septum it involved (lower one-half or full height).

Results: There was a complete concordance of the results between the 2 observers. An intersinus septal air cell was seen in 61 (30.5%) of the 200 cases, and 85.3% of these cells were clearly seen to communicate anteromedially with either one of the frontal sinuses or both frontal sinuses (3 cases). In 9 (4.5%) of the 200 cases, the central cell had no demonstrable connection to either frontal sinus. Of the 61 cases with a central cell, 55 (90.16%) of the cells occupied the full height of the septum, and 6 (9.84%) only involved the lower half of the septum.

Conclusion: Contrary to the present convention that frontal intersinus septal cells originate as displaced ethmoid cells from the frontal recess, we found that most such cells are actually diverticula from the frontal sinuses themselves.

Fig 1.

Coronal (A) and axial (B) noncontrast CT scans of the paranasal sinuses show an air cell within the intersinus septum. On the coronal image, the cell seems to arise within the septum. However, on the axial image the cell is seen to be a diverticulum from the left frontal sinus.

Fig 2.

Coronal (A) and axial (B) noncontrast CT scans of the paranasal sinuses show an air cell within the intersinus septum. On the coronal image, the cell seems to arise within the septum. However, on the axial image the cell is seen to be a diverticulum from the right frontal sinus.

Fig 3.

Coronal (A) and serial axial (B,C) noncontrast CT scans of the paranasal sinuses show 2 air cells within the intersinus septum. On the coronal image, the cells seem to arise within the septum. However, on the axial images, 1 cell is a diverticulum from the left frontal sinus (B), and the other cell is a diverticulum from the right frontal sinus (C).

Fig 4.

Coronal (A) and axial (B) noncontrast CT scans of the paranasal sinuses show an air cell within the intersinus septum. On both the coronal and axial images, no communication with either frontal sinus was seen. This is a true septal cell.