{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T22:10:04Z","timestamp":1784239804269,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T00:00:00Z","timestamp":1536883200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated \u201creference standard\u201d classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty\u2010two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship\u2010trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter\u2010 and intrarater reliability were evaluated using Light's kappa (\u03ba), the interclass correlation coefficient (ICC), and simple proportion of agreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Interrater reliability showed pairwise \u03ba values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed \u03ba values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within\u2010rater ICC was 0.98.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22200","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T08:13:52Z","timestamp":1537085632000},"page":"39-45","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["International assessment of inter\u2010 and intrarater reliability of the International Frontal Sinus Anatomy Classification system"],"prefix":"10.1002","volume":"9","author":[{"given":"Ricardo","family":"Villarreal","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Health San Antonio  San Antonio TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bozena B.","family":"Wrobel","sequence":"additional","affiliation":[{"name":"Caruso Department of Otolaryngology Head and Neck Surgery University of Southern California, Keck School of Medicine  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6914-3235","authenticated-orcid":false,"given":"Luis F.","family":"Macias\u2010Valle","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Hospital Espa\u00f1ol de M\u00e9xico, Mexico City  M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg E.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Washington  Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Prihoda","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Health San Antonio Graduate School of Biomedical Sciences  San Antonio TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber U.","family":"Luong","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Texas Health Science Center at Houston  Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Christopher","family":"McMains","sequence":"additional","affiliation":[{"name":"Department of Surgery South Texas Veterans Health Care System  San Antonio TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik K.","family":"Weitzel","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research Fort Sam Houston  TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9845-2165","authenticated-orcid":false,"given":"William C.","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Texas Health Science Center at Houston  Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe","family":"Brunworth","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Saint Louis University School of Medicine  St Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Texas A&amp;M University College of Medicine\/Baylor Scott &amp; White Health  Temple TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salil","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Auckland Hospitals and University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constanza J.","family":"Vald\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010 Head and Neck Surgery Hospital del Salvador, Universidad de Chile  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashleigh","family":"Halderman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery University of Texas Southwestern Medical Center  Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Jang","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery &amp; Communication Sciences Duke University Medical Center  Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahuram","family":"Sivasubramaniam","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Auckland City Hospital, Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhipeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Caruso Department of Otolaryngology Head and Neck Surgery University of Southern California, Keck School of Medicine  Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-3324","authenticated-orcid":false,"given":"Philip G.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Health San Antonio  San Antonio TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,14]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"82","article-title":"Surgery of the frontal recess and frontal sinus","volume":"43","author":"Wormald PJ","year":"2005","journal-title":"Rhinology"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21893"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21756"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otot.2005.11.001"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26939"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.2500\/105065894781874278"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1043-1810(96)80037-6"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/194589240301700408"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2004.04.012"},{"key":"e_1_2_6_11_1","first-page":"1","article-title":"European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses","volume":"24","author":"Lund VJ","year":"2014","journal-title":"Rhinology"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21738"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2012.26.3774"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00146-016-0666-3"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.7748\/nr.22.3.35.e1297"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/85.3.257"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11336-007-9054-8"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0031643"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316446002000104"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.20982\/tqmp.08.1.p023"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316447303300309"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1941.00660040021003"},{"key":"e_1_2_6_25_1","first-page":"1","article-title":"Computed tomography analysis of frontal cell prevalence according to the International Frontal Sinus Anatomy Classification","volume":"00","author":"Choby G","year":"2018","journal-title":"Int Forum Allergy Rhinol"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2005.09.005"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2010.05.021"}],"container-title":["International Forum of Allergy &amp; 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