The role of agger nasi air cells in patients requiring revision endoscopic frontal sinus surgery

To determine the association of agger nasi air cell disease with frontal rhinosinusitis, assessed by computed tomography (CT), in patients who require revision functional endoscopic sinus surgery (FESS). We prospectively collected data on patients undergoing revision FESS at a tertiary care medical center over an 18-month period. Sinus CT scans were graded as per Lund-Mackay. Frontal sinus findings on CT scan were correlated with the presence or absence of disease in agger nasi air cells. Eighty patients underwent revision FESS in an 18-month period. A total of 160 sides were evaluated by sinus CT scan with agger nasi being present in all but 11 sides (93%). One patient did not have a pneumatized frontal sinus on 1 side and so 148 sides were available for study. Frontal sinus disease was present in 119 and absent in 29 sides. The average CT grade of patients with frontal rhinosinusitis was 8.4 while it was only 3.0 in patients without frontal rhinosinusitis ( P = 0.000). Agger nasi air cell disease was present in only 3 of 29 (10%) sides in patients without frontal rhinosinusitis and was present in all 119 (100%) sides of patients with frontal rhinosinusitis ( P = 0.0000). Agger nasi air cells are a common anatomic feature, present in 93% of our patients. Agger nasi air cell disease correlates strongly with frontal sinus disease as assessed by sinus CT scan in patients undergoing revision FESS. In addition, frontal sinus disease correlates with the severity of overall sinus disease as determined by sinus CT scan.