Study On The Correlation Between The Morphology Of Frontal Sinus Drainage Channel And The Occurrence And Development Of Chronic Frontal Sinusitis

Objective: To explore the relationship between the morphology of the frontal sinus opening and the frontal sinus opening in the middle nasal passage and the surrounding air chambers and the occurrence and development of chronic frontal sinusitis.Methods: 1.42 patients with chronic unilateral isolated frontal sinusitis diagnosed by CT scan and clinical history were selected(23 cases of the left frontal sinusitis among them,19 cases of right frontal sinusitis).Mimics 21.0 software was used to conduct 3D reconstruction of frontal sinus and agger nasi cell in a total of 84 sides of the 42 patients with high-resolution CT,and relevant parameters of frontal sinus ostium and agger nasi cell were measured.The correlation between the parameters of frontal sinus ostium and the size of agger nasi cell was analyzed.The statistical software SPSS26.0 was used to analyze the correlation between the parameters related to frontal sinus ostium and the agger nasi cell;The parameters of frontal sinus ostium and the size of agger nasi cell were compared between the healthy side and the affected side;Multiple linear regression was used to explore the main factors affecting the horizontal sectional area of the frontal sinus;The frontal sinus ostium was divided into positive,0 and negative grades to compare the difference of frontal sinus ostium grading composition ratio between the healthy side and the affected side;In addition,the difference of frontal sinus ostium related parameters was compared among different frontal sinus ostium grading on the affected side.2.Thirty-four patients diagnosed by CT scan and clinical history as chronic unilateral frontal sinusitis,with a Lound-Mackay score of 1-3,and with the opening of the frontal sinus drainage channel clearly identified in the middle nasal meatus(18 cases were left frontal sinusitis and 16 cases were right frontal sinusitis)were selected.The Mimics 21.0 software was used to reconstruct the ethmoid bulla on68 sides of the 34 patients with high resolution CT.The coronal,sagittal and horizontal openings of the frontal sinus drainage channels in the middle nasal meatus and the relevant parameters of the ethmoid bulla were measured.Statistical software SPSS26.0 was used to analyze the correlation between the opening size of frontal sinus drainage channel in the middle nasal meatus and the size of the ethmoid bulla;The opening size of the frontal sinus drainage channel in the middle nasal meatus and the size of the ethmoidal bulla were compared between the healthy side and the affected side;The channels of frontal sinus drainage were divided into four types,and the composition of channels of frontal sinus drainage on the healthy side and the affected side was compared.In addition,the openings of the channels of frontal sinus drainage in the middle nasal canal and the size of the ethmoidal bulla were compared among different channels of frontal sinus drainage on the affected side.Results: 1.The volume of agger nasi cell was positively correlated with FI(In sagittal CT image,the shortest distance between the most prominent part of the frontal beak and the posterior wall of the frontal sinus)(r=0.306,P<0.05),the surface area of the agger nasi cell was positively correlated with FI(r=0.227,P<0.05),while the volume of the agger nasi cell is not correlated with FB(Thickness of the frontal beak)(r=0.125,P>0.05),There was no correlation between the agger nasi cell and FR(CT sagittal image: Distance between the most prominent portion of the frontal beak and the ethmoidal chamber of the ethmoid sinus at the highest attachment point at the skull base)(r=0.052,P>0.05).2.Compared with the healthy side,the FB value and the upper and lower diameter of the agger nasi cell were larger on the affected side(P<0.05),FI value,FI cross-sectional area and horizontal cross-sectional area were significantly less than the healthy side(P<0.05).3.Multiple linear regression showed that FI cross-sectional area was an independent factor affecting the horizontal cross-sectional area of the frontal sinus(P<0.05).4.There was no difference in the ratio of different frontal sinus ostium grade between the affected side and the healthy side(P>0.05).5.RS values(The distance between the most prominent part of the frontal beak and the turning point of the cranial base of the posterior wall of the frontal sinus),RS cross-sectional area and horizontal cross-sectional area were significantly different in different frontal sinus ostium grades(P<0.05).6.The size of the coronal opening is negatively correlated with the anteroposterior diameter of the ethmoid bulla(r=-0.475,P<0.05),is negatively correlated with the volume of the ethmoid bulla(r=-0.282,P<0.05),and is negatively correlated with the surface area of the ethmoid bulla(r =-0.306,P<0.05);the horizontal opening size is negatively correlated with the anteroposterior diameter of the ethmoid bulla(r=-0.301,P<0.05),and negatively correlated with the surface area of the ethmoid bulla(r=-0.250,P<0.05).7.Compared with the healthy side,the coronal,sagittal and horizontal openings of the frontal sinus drainage channels in the middle nasal meatus were smaller on the affected side(P<0.05),the left-right diameter,anteroposterior diameter,upper and lower diameter,volume and surface area of the ethmoid bulla were significantly higher than those of the healthy side(P<0.05).8.Fisher’s exact probability method found that there was a significant difference in the composition ratio of the frontal sinus drainage channel between the affected side and the contralateral side(χ 2 = 10.076,P<0.05).9.The size of the sagittal opening of the frontal sinus drainage channel in the middle nasal passage is significantly different in the frontal sinus drainage channel of the affected side in different ways(P<0.05),and the sagittal opening between the uncinate process and middle turbinate-middle nasal passage was larger than that of the interlaminar area-middle nasal passage(P<0.05).Conclusion: 1.There is a weak correlation between the size of the agger nasi cell and FI,and FI is an independent factor affecting the horizontal sectional area of the frontal sinus.In addition,different classifications of the frontal sinus ostium can affect the size of the drainage pathway of the frontal sinus by influencing RS value,RS sectional area and horizontal sectional area.2.The size of the opening of the middle nasal passage of the frontal sinus drainage channels was weakly negatively correlated with the size of the ethmoid bullar,and compared with the healthy side,the ethmoid bulla of the affected side was larger,and the opening of the frontal sinus drainage channels in the middle nasal passage was smaller.