Association of Frontal Recess Anatomy and Uncinate Process Variations With Frontal Sinusitis: A CT ‐Based Observational Study

INTRODUCTION: Frontal sinusitis is influenced by anatomical variations that impact sinus drainage pathways. Among these, frontal recess cells classified by the International Frontal Sinus Anatomy Classification (IFAC) and uncinate process variations play a key role. This study aimed to investigate the relationship between these anatomical structures and the development of frontal sinusitis. METHODS: This retrospective study included 144 patients (70 with frontal sinusitis, 74 controls) who underwent paranasal sinus computed tomography (PNSCT). Frontal recess cells were evaluated according to the IFAC, and uncinate process variations were assessed using the Landsberg and Friedman classification. Frontal sinusitis severity was determined by the Lund-Mackay scoring system. RESULTS: The prevalence of supra-agger (SAC) and supra-bullar cells (SBC) was significantly higher in the frontal sinusitis group (p < 0.001). A positive correlation was found between the presence of SAC, SBC and supra-bullar frontal cells and frontal sinus Lund-Mackay scores (p < 0.001, p < 0.001 and p = 0.002, respectively). No significant association was observed between uncinate process variations and frontal sinusitis (p = 0.167). CONCLUSION: Frontal recess cells, particularly SAC and SBC, appear to increase susceptibility to frontal sinusitis, likely by impairing drainage. Recognition of these anatomical variations may improve surgical planning and management outcomes in patients with frontal sinusitis.