title: The International Classification of the radiological Complexity (ICC) of frontal recess and frontal sinus.
abstract: The frontal sinus is considered the most challenging sinus to address surgically. There are no current classifications of the degree of surgical complexity of different frontal sinus configurations. The aim of this study is to develop a classification system of the degree of complexity of frontal recess surgery based on preoperative computed tomography (CT) scans.
  
  
  
  Authors were asked to submit a classification system. These were circulated to all authors. Selection of the final 3 classifications was based on a majority consensus. These classifications were compared further for time-taken, ease-of-use, and interrater agreement. These were assessed by the authors on 10 CT scans representing a range of anticipated surgical difficulty.
  
  
  
  Out of 3 compared classifications, classification A was the quickest to score (1.44 minutes vs 1.57 minutes and 2.25 minutes), subjectively easiest (3.23 vs 4.07 and 5 on a visual analogue scale [VAS]), and had a moderate interrater agreement (0.52 vs 0.42 and 0.79). In addition, the grading of complexity was as good whether measurements were taken on the CT scans or whether size of the frontal ostium was visually estimated.
  
  
  
  We propose a fast, easy classification to anticipate the complexity of surgery in the frontal sinus and recess, for patients undergoing primary surgery.
authors.affiliation: Department of Surgery-Otolaryngology, University of Adelaide, Adelaide, Australia.
authors.forename: Peter John
authors.initials: PJ
authors.lastname: Wormald
authors.affiliation: Department of Surgery-Otolaryngology, University of Adelaide, Adelaide, Australia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bassiouni
authors.affiliation: Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Callejas
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: David W
authors.initials: DW
authors.lastname: Kennedy
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas McGovern Medical School at Houston, Houston, TX.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Citardi
authors.affiliation: Division of Rhinology and Sinus/Skull Base Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, University of Utah, Salt Lake City, UT.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Orlandi
authors.affiliation: Department of ENT, Sankt Gertrauden Krankenhaus, Berlin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kaschke
authors.affiliation: Department of Otolaryngology, Tan Tock Seng Hospital, National University of Singapore, Singapore.
authors.forename: Jin Keat
authors.initials: JK
authors.lastname: Siow
authors.affiliation: Department of Otolaryngology, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Kornel
authors.initials: K
authors.lastname: Szczygielski
authors.affiliation: Professorial Unit, Royal National Throat Nose Ear Hospital, University College London, London, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Lund
authors.affiliation: Department of Otolaryngology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Wytske
authors.initials: W
authors.lastname: Fokkens
authors.affiliation: Department of Surgery-Otolaryngology, University of Adelaide, Adelaide, Australia.
authors.forename: Alkis J
authors.initials: AJ
authors.lastname: Psaltis
mesh_terms: D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000145:classification*; D014057:Tomography, X-Ray Computed
keywords: difficulty of surgery; endoscopic sinus surgery; frontal sinus; frontal sinus classification; surgical complexity