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Background: The interfrontal septal cell, which often takes the shape of a wishbone on axial CT scan, was first described by Van Alyea more than 50 years ago; however, its potential role in disease of the frontal sinus was only recently recognized. The purpose of this study was to correlate the incidence and dimensions of this "frontal wishbone" (FWB) with the presence of frontal sinus disease., Methods: The dimensions, drainage pathways, and disease state of the FWB were measured in 150 consecutive sinus CT scans performed at a tertiary care referral center. Statistical analysis was performed to correlate the FWB configuration to the presence of frontal sinus disease., Results: A FWB was present in 77.3% of patients. The wishbone drained through a discrete ostium into either the left (54.8%), the right (45.2%), or the bilateral (0.8%) frontal sinuses. In those scans with mucosal thickening or opacification of the frontal sinus (36%), concurrent FWB disease was found in 82%. Patients with a large (>1 cm) FWB in the anterior-posterior dimension were more likely to have a diseased frontal sinus (p = 0.02)., Conclusion: The term FWB is used to describe an air cell within the interfrontal septum, which may play a role in the pathogenesis of frontal sinus disease.

Background: As the population ages, the mean age of patients with chronic rhinosinusitis (CRS) likely will increase as will the frequency of endoscopic sinus surgery (ESS) in the older population. The purpose of this study was to compare symptom presentation, CT scores, endoscopy scores, and quality of life (QOL) measures in patients >60 years of age as compared with younger patients., Methods: A prospective cohort of 18 patients >60 years and 121 patients < or =60 years undergoing ESS for CRS were studied. Patient factors, symptom severity, and CT scores were examined preoperatively. Endoscopy and QOL scores were compared pre- and postoperatively between the two groups., Results: The prevalence of allergies, polyps, asthma, aspirin sensitivity, and revision surgery was similar in each age group. There was no statistically significant difference in the visual analog scale scores of symptom severity in each age group. Older patients had scores that were similar to younger patients with regard to CT (13.11 versus 11.63; p = 0.419), preoperative endoscopy (8.22 versus 7.96; p = 0.828), postoperative endoscopy (3.06 versus 4.82; p = 0.100), and change in endoscopy (-5.17 versus -3.15; p = 0.083). Older patients had similar preoperative, postoperative, and change scores when compared with younger patients on the Rhinosinusitis Disability Index (-15.33 versus -20.63; p = 0.318) and Chronic Sinusitis Survey (14.35 versus 23.11; p = 0.126)., Conclusion: Older patients with CRS present with symptoms and patient factors that are comparable with younger patients and have a similar degree of improvement on endoscopy scores and QOL measures after ESS.