Refractory recalcitrant FRONTAL SINUSitis is a challenge for rhinologists. Patients usually present with a range of complaints such as persistent FRONTAL headache, proptosis or FRONTAL swelling. There is a history of previous multiple SINUS surgeries. Nasal endoscopic exam shows significant pathology in the FRONTAL recess with scar formation. PNS CT scan may reveal total or localized FRONTAL SINUS opacification with or without orbital invasion. The posterior wall of the FRONTAL SINUS may be eroded. In this clinical setting, treatment options are limited. Routine FRONTAL SINUSotomies including Draf type IIa procedure have failed. The osteoplastic flap approach has been stated as a golden standard for these cases. Endoscopic FRONTAL SINUSotomy Draf type III procedure has been proposed as a viable and effective solution for these cases. It seems that Draf type III procedure could manage the majority of difficult FRONTAL SINUS cases and obviate the need for doing osteoplastic flap approach and its associated complications. In this presentation, we preliminarily/primarily report two cases of Draf type III procedure. Preoperative considerations, operative techniques and postoperative results will be discussed. High quality videos will fully illustrate the surgical steps.

Background & Objective: The FRONTAL SINUS is regarded as one of the human paranasal SINUSes located in the FRONTAL bone as a triangular-shaped cavity, which originates as separated space from the anterior ethmoid cells. Computed Tomography (CT) is a completely non-destructive technique that uses a high density of contrast to identify the air inside any bony SINUS with soft tissue demarcated by air within a particular nasal cavity. This study aimed to measure the anteroposterior length, width, and height of FRONTAL SINUS in different age groups of both genders with axial, coronal, and sagittal CT scans, as well as identifying the pneumatization of that SINUS according to the extent represented by CT scans. Materials & Methods: A prospective study was conducted on a random sample of 250 subjects attending the Radiology Section of both Baghdad Medical City and Salah Al-Deen Teaching Hospitals from February 2019 to January 2020. Different age and gender groups from these individuals underwent measurement of the anteroposterior length, width, and height of FRONTAL paranasal SINUS in axial, sagittal, and coronal CT scans. Results: The FRONTAL air cells belonged to the anterior group including four types and one medial group with a prevalence of 37. 6%, 18%, 16. 8%, 6. 8%, and 20. 8%, respectively, through a series of CT scan sections. The mean values of FRONTAL SINUS length, width, and height for males were 19. 8± 8. 7 mm, 32. 8± 8. 7 mm, and 29. 7± 8. 8 mm, respectively; and for females were 14. 9± 8. 3 mm, 25. 4± 9. 2 mm, and 22. 5± 9. 2 mm, respectively. Conclusion: A high incidence of FRONTAL SINUS cell types and supraorbital cells suggested the superioposterior partition of FRONTAL SINUS which tends to demonstrate more pneumatization than other partitions.

Introduction: The FRONTAL SINUS is the most variable part of the paranasal SINUSes in terms of symmetry, anatomical features and degree of development. The aim of this study was to assess the morphometric changes of the FRONTAL SINUS in cone-beam computed tomography (CBCT) images. Materials & Methods: In this cross-sectional study, 200 CBCT images were examined for anatomical variations such as the presence of FRONTAL SINUS, SINUS symmetry, lateral FRONTAL SINUS extension (LFSE) to orbital roof, scalloping, septum and type of septum. Moreover, Crista Galli (CG) was divided into three equal segments of anterior, middle and posterior in order to have a precise criterion for determining the location of the FRONTAL recess in coronal plane. The data were analyzed using ANOVA with T-test and Chi-square at significant level of P<0. 05. Results: Of 200 cases, 113 and 87 ones were male and female with the mean age of 18‒ 88 years. The results showed that FRONTAL SINUS was bilateral in all cases and symmetric in 113(57%) cases. The LFSE to orbital roof had a significant relationship with gender, so that at the external onethird, the LFSE was less frequent in women than men (P<0. 001). The most frequent location of the FRONTAL recess was in the posterior one-third of CG (85 (43%)) with significant difference (P=0. 012). Conclusion: In this study, FRONTAL SINUSes were rather symmetric, and the use of the anatomical CG marker in multiplanar (MPR) images was not feasible method for rapid detection of the FRONTAL recess location in coronal plane.