Sadullah ŞİMŞEK, Akif İŞLEK
European Journal of Rhinology and Allergy - 2026;9(2):58-69
Objective: This study aims to investigate the two-dimensional relationship between the anterior frontal buttress and the frontoethmoidal angle and to assess its impact on surgical difficulty and complications in endoscopic frontal sinus surgery. Methods: A retrospective analysis was conducted on 35 adult patients who underwent EFSS between 2021 and 2024. Preoperative high-resolution sagittal computed tomography scans were used to measure angles between the frontal apex and the superior and inferior frontal buttresses, and between the frontal apex and the nasal spine, as well as the frontal recess diameter. Patient demographics, SNOT-22 and Lund-Mackay scores, surgical duration, complications, and revision history were recorded. Statistical correlations between anatomical measurements and surgical outcomes were analyzed. Results: Thirty-five patients were analyzed; the complication rate was 22.9% (n=8). Frontal apex-related angles did not differ by sex (all p>0.05). Patients with complications had significantly larger bilateral frontal apex-related angles and narrower bilateral frontal recess diameters (all p<0.05). They also had longer operative times and higher VAS difficulty (p < 0.05). Anatomical angles/FRD were not associated with revision status (p>0.05); however, revision cases had higher preoperative SNOT-22, higher pre- and postoperative LMS, and longer operative time (all p<0.05). Frontal apex-related angles correlated moderately with operative duration and VAS difficulty (r=0.383-0.590; p<0.05). Measurement reliability was excellent (inter-observer ICC=0.92; intra-observer ICC=0.93; both p<0.001). Conclusion: Preoperative sagittal CT assessment of the AFB-FEA relationship suggests that more unfavorable frontal outflow anatomy is associated with greater EFSS complexity and a higher risk of complications.
