--- title: "International Frontal Sinus Anatomy Classification (IFAC) of Frontal Recess Cells" description: "ENT notes on IFAC classification of frontal recess cells." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/international-frontal-sinus-anatomy-classification-frontal-recess-cells" categories: ["Rhinology", "Classifications and Gradings in ENT"] video: "https://www.youtube.com/watch?v=G99LXC2tWHQ" image: "https://media.theentresident.com/og-images/international-frontal-sinus-anatomy-classification-frontal-recess-cells.png" --- # International Frontal Sinus Anatomy Classification (IFAC) of Frontal Recess Cells ENT notes on IFAC classification of frontal recess cells. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=G99LXC2tWHQ ## 👃 International Frontal Sinus Anatomy Classification of Frontal Recess Cells (IFAC) The **International Frontal Sinus Anatomy Classification (IFAC)** was published in **2016**. ⭐ It classifies the frontal recess cells based on their **anatomic origin** into **three groups**, and is **more inclusive** of the different cells than the earlier Kuhn's classification. > [What is Kuhn's Classification of frontal cells?](https://www.theentresident.com/ent-notes-lectures/modified-kuhn-classification-frontal-cells.md) > What is the Modified Kuhn's Classification of frontal cells? > Which cells got excluded from Kuhn's Classification? --- ### 📋 Groups in the IFAC Classification ⭐ The grouping is based on **how the cell pushes the frontal sinus drainage pathway**. | Group | Direction of Displacement of Drainage Pathway | Cells | | --- | --- | --- | | **Anterior cells** | Pushed **posteriorly, medially or posteromedially** | Agger nasi cell, Supra agger cell, Supra agger frontal cell | | **Posterior cells** | Pushed **anteriorly** | Supra bulla cell, Supra bulla frontal cell, Supraorbital ethmoid cell | | **Medial cell** | Pushed **laterally** | Frontal septal cell | --- ### 🔍 Anterior Cells #### 1- Agger Nasi Cell #### 🔍 Definition A cell sitting **anterior to the origin of the middle turbinate**, or **directly above the most anterior insertion of the middle turbinate** into the lateral nasal wall. ⭐ It is the **most anterior cell** seen in the region of the middle turbinate insertion. #### 2- Supra Agger Cell #### 🔍 Definition An **anterolateral ethmoid cell** lying **above the agger nasi cell**. ❌ Does **not** pneumatize into the frontal sinus. #### 3- Supra Agger Frontal Cell #### 🔍 Definition A **supra agger cell** that **pneumatizes into the frontal sinus**. ⭐ It has a **wide range of sizes**, depending on the extent of pneumatization. It may reach only the **floor** of the frontal sinus, or extend up to its **roof**. --- ### 🔍 Posterior Cells #### 1- Supra Bulla Cell #### 🔍 Definition A cell lying **above the bulla ethmoidalis**. ❌ Does **not** enter the frontal sinus. #### 2- Supra Bulla Frontal Cell #### 🔍 Definition A **supra bulla cell** that **pneumatizes along the skull base into the posterior frontal sinus**. #### 3- Supraorbital Ethmoid Cell #### 🔍 Definition An **anterior ethmoidal cell** that pneumatizes **over the roof of the orbit**, passing **anterior or posterior to the anterior ethmoidal artery**. --- ### 🔍 Medial Cell #### Frontal Septal Cell #### 🔍 Definition A **medially based cell** of the **anterior ethmoid** or the **inferior frontal sinus**, attached to or located **close to the interfrontal sinus septum**. ⭐ Being medially placed, it pushes the frontal sinus drainage pathway **laterally**. > How will you locate the frontal recess cells radiologically? --- ### ⭐ High Yield Rapid Revision Table | Cell | Group | Key Feature | | --- | --- | --- | | **Agger nasi cell** | Anterior | Anterior to the origin of the middle turbinate, or above its most anterior insertion | | **Supra agger cell** | Anterior | Anterolateral ethmoid cell above the agger nasi; does not enter the frontal sinus | | **Supra agger frontal cell** | Anterior | Supra agger cell pneumatizing into the frontal sinus | | **Supra bulla cell** | Posterior | Above the bulla ethmoidalis; does not enter the frontal sinus | | **Supra bulla frontal cell** | Posterior | Supra bulla cell pneumatizing along the skull base into the posterior frontal sinus | | **Supraorbital ethmoid cell** | Posterior | Pneumatizes over the roof of the orbit, anterior or posterior to the anterior ethmoidal artery | | **Frontal septal cell** | Medial | Close to the interfrontal sinus septum | --- ### 🧠 Viva Pearls * IFAC stands for International Frontal Sinus Anatomy Classification, published in 2016. * IFAC classifies frontal recess cells by their anatomic origin into anterior, posterior and medial groups. * IFAC is more inclusive of the different cells than Kuhn's classification. * Anterior cells push the frontal sinus drainage pathway posteriorly, medially or posteromedially. * Posterior cells push the drainage pathway anteriorly. * The medial cell pushes the drainage pathway laterally. * Anterior cells are the agger nasi, supra agger and supra agger frontal cells. * Posterior cells are the supra bulla, supra bulla frontal and supraorbital ethmoid cells. * The only medial cell is the frontal septal cell. * The bulla ethmoidalis itself is not part of the classification. --- ## About This Note This free ENT note on International Frontal Sinus Anatomy Classification (IFAC) of Frontal Recess Cells was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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