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Açar G, Gökşan AS, Aydoğdu D. Computed tomography based evaluation of the association between sphenoid sinus pneumatization patterns and variations of adjacent bony structures in relation to age and gender. Neurosurg Rev 2024; 47:349. [PMID: 39046640 PMCID: PMC11269448 DOI: 10.1007/s10143-024-02594-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/25/2024] [Accepted: 07/19/2024] [Indexed: 07/25/2024]
Abstract
Many studies revealed that the sphenoid sinus pneumatization (SSP) affects the protrusion/dehiscence of adjacent structures including optic canal (OC), foramen rotundum (FR), vidian canal (VC), and carotid canal (CC). Knowledge of this relationship bears vital importance to identify the safest surgical route during transsphenoidal procedures. Therefore, we aimed to determine the individualized prevalence of the protrusion/dehiscence of adjacent structures based on sagittal and coronal SSP (SSSP and CSSP) patterns. Computed tomography images of 300 patients were analysed to identify the SSSP and CSSP types, and the protrusion/dehiscence of adjacent structures was determined. The relationship between the variables was examined using statistical analysis in terms of age, gender, and laterality. The most prevalent SSSP type was postsellar (62.7%), followed by sellar (30%), presellar (6.6%), and conchal (0.7%). In 71.3% of patients, five types of CSSP were observed, with 23.6% and 21.7% exhibiting Type IV and V, respectively. Our results indicated that postsellar type, Type IV and V CSSP associated with the highest likelihood of protrusion/dehiscence of OC, FR, VC, and CC. Furthermore, no significant correlation was observed between these qualitative variables and gender, with the exception of the VC dehiscence, the protrusion of OC and CC. No notable differences were identified with respect to laterality. Also, the probability of having postsellar type, Type IV and V CSSP, as well as the protrusion of OC, VC, and CC, decreased with increasing age. Further detailed analysis of this association is required to predict the size of the surgical window and to prevent neurovascular injury.
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Affiliation(s)
- Gülay Açar
- Department of Anatomy, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, 42090, Turkey.
| | - Ahmet Safa Gökşan
- Department of Anatomy, Faculty of Medicine, Aksaray University, Merkez, Aksaray, 68100, Turkey
| | - Demet Aydoğdu
- Department of Radiology, Faculty of Medicine, Necmettin Erbakan University, Meram, Konya, 42090, Turkey
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Serindere M, Belgin CA. Evaluation of the relationship between sphenoid sinus morphology and area and volume by computed tomography. Oral Radiol 2024; 40:138-147. [PMID: 37749336 DOI: 10.1007/s11282-023-00711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/04/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES The aim of this study is to investigate the effect of sphenoid sinus pneumatization types, Onodi cell (OC), internal carotid artery (ICA), optic nerve (ON) on sinus volume and area on computed tomography (CT) images. METHODS The CT images of 150 patients were evaluated. Sphenoid sinus pneumatization types, OC prevalence, protrusion and dehiscence of ICA and ON, the volume and area were evaluated. RESULTS The sinus volume and area were statistically higher in patients with bilateral protrusion of ICA and ON then patients without protrusion of ICA and ON. The mean volume and area of sinus were 9949.4 ± 351.0 mm3 and 4570.9 ± 1604.9 mm2, respectively. The volume and area of sphenoid sinus did not differ significantly between groups with and without OC. The postsellar b type sphenoid sinus had the highest volume, while conchal type has the least volume. CONCLUSIONS Bilateral protrusion and dehiscence of ICA and bilateral protrusion of ON caused a significant increase in the sphenoid sinus volume and area. The presence of ICA and ON, the pneumatization of the sinus is an anatomical structure that can affect the sinus volume and area. Before the operation, three-dimensional evaluation should be performed to determine whether these structures are bilateral/unilateral and it should be remembered that the sinus volume and area can change.
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Affiliation(s)
- Mehmet Serindere
- Department of Radiology, Hatay Education and Research Hospital, Hatay, Turkey.
| | - Ceren Aktuna Belgin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hatay Mustafa Kemal University, Hatay, Turkey
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Sagar S, Jahan S, Kashyap SK. Prevalence of Anatomical Variations of Sphenoid Sinus and Its Adjacent Structures Pneumatization and Its Significance: A CT Scan Study. Indian J Otolaryngol Head Neck Surg 2023; 75:2979-2989. [PMID: 37974780 PMCID: PMC10645943 DOI: 10.1007/s12070-023-03879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/07/2023] [Indexed: 11/19/2023] Open
Abstract
The purpose of our study was to assess the prevalence of variations and type of sphenoid sinus and its adjacent structures pneumatization and its significance. This prospective study included 114 patients who underwent CT of the paranasal sinuses. The CT scan in axial, coronal and mid sagital section were analysed to assess the type of pneumatization of the sphenoid sinus and its adjacent structures like; anterior clinoid process, greater wing of sphenoid and pterygoid process. The sphenoid sinus pneumatization was classified into Conchal, Presellar, and Sellar types, later comprised of sellar and post-sellar types. Out of 114 cases of pneumatized sphenoid sinus, 5.2% cases were conchal type, 26.3% cases Presellar type and 68.4% cases sellar type. The one or more adjacent structures was pneumatized in 71 (62.2%) of cases. The adjacent structures which found to be pneumatized are anterior clinoid process in 26.3%, Pterygoid process in 23.6%, and greater wing of sphenoid in 12.3% cases. The pneumatization of adjacent structures was more prevalent in sellar type of sphenoid sinus, followed by pre-sellar type and no pneumatization in conchal type. The anterior clinoid process pneumatization was present in 26.1% of cases, in which 3 (2.6%) cases in pre-sellar type and 27 (23.5%) cases in sellar type. It was unilaterally pneumatized in 13 (11.4%) and bilaterally in (17 (14.9%) cases. The pterygoid process pneumatization was present in 27 (23.6%) of cases, unilateral in 16 (14%) cases and bilateral in 11 (9.6%) cases. The Greater wing of sphenoid pneumatization was found in 14 (12.3%) cases, no cases in conchal types, 2 (1.8%) in pre-sellar type, and 12 (10.4%) in sellar type There was no statistically difference found in between right and left side of sphenoid sinus and its structure pneumatization. The extent of pneumatization of the sphenoid sinus has clinical and surgical implications in sinus diseases, sellar and central skull base lesions.
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Affiliation(s)
| | - Shirin Jahan
- Department of Anatomy, Government Medical College, Fatehpur, Uttar Pradesh India
| | - Sushil Kumar Kashyap
- Department of ENT and HNS, MLB Medical College, Campus, House No- IV/14, Jhansi, Uttar Pradesh India
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Gandhi K, Patil ST, Kumar B, Patel M, Chawre P, Ahmad M, Pandita K, Parate SB. Morphometry and Intracranial Relations of the Sphenoid Sinus in Context to Endoscopic Transnasal Transsphenoidal Surgery. Cureus 2023; 15:e40187. [PMID: 37431332 PMCID: PMC10329853 DOI: 10.7759/cureus.40187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Introduction Due to the variable degree of pneumatization, the shape and size of the sphenoid sinus are irregular. An endoscopic intranasal transsphenoidal approach is made in sphenoid sinus pathologies, sphenoid sinusitis, and sellar and parasellar diseases. A diagnostic approach to the sphenoid sinus is also done to get a better MRI scan of the pituitary. The present study aims to describe the variant types of sphenoid sinus, morphometry, anatomy, and relations of sphenoid sinus, which will be helpful to surgeons during an endoscopic approach to the sphenoid sinus. Materials and methods We studied 76 cadaveric sphenoid sinuses that were exposed by taking a sagittal section of 38 formalin-fixed cadaveric heads. After examining the inter-sphenoidal septum, it was removed to observe the inside aspect of the sphenoid sinus. Different dimensions of the sinus were noted down. The bulges inside the sinus due to neurovascular structures in relation to the sinus were observed. Results The most prominent type found was the sellar in 68.4% of cases preceded by the postsellar in 23.7% of cases. Presellar type of pneumatization was seen only in 7.9% of cases and the conchal type was absent. Intersphenoid septum was seen in 92,1% of cases, out of which 11.4% of septums were deficient on the posterior aspect. An internal carotid artery bulge in the sphenoid sinus was seen in 46% of cases. In 27.6% and 19.7% of sphenoid sinuses, bulging of the optic and vidian nerves, respectively, were seen. Some of these structures were dehiscent in the sphenoid sinus. Conclusions To get more space in the sphenoid sinus, the septa in the sinus are removed by surgeons, which may damage the walls of the sphenoid sinus. Knowledge of the relations of neurovascular structures with the sphenoid sinus will be helpful to surgeons during the transsphenoidal endoscopic approach to avoid any injury to these structures.
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Affiliation(s)
- Kusum Gandhi
- Anatomy, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Sumit T Patil
- Anatomy, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Brijesh Kumar
- Anatomy, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Manmohan Patel
- Anatomy, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Prashant Chawre
- Anatomy, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Mohtashim Ahmad
- Anatomy, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Kawal Pandita
- Hospital Administration, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Swapna B Parate
- Anatomy, SMBT Institute of Medical Science & Research Center, Nashik, IND
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Singh A, Manjunath K, Singh H. Relationship of sphenoid sinus to adjacent structures in South India: a retrospective cross sectional study. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-021-00191-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Sphenoid sinus is one of the most inaccessible paranasal sinuses. Advent of minimally invasive trans-nasal trans-sphenoidal approach over the past few years has provided an additional armament in the hands of skull-base surgeons to access pathologies adjoining base of skull. Close relationship of vital neurovascular structures with sphenoid sinus and variability of their protrusions into the sinus make these structures more vulnerable to iatrogenic trauma during surgical procedures. Preoperative assessment of such variations is imperative to avoid unintentional damage. The present study is a retrospective study conducted on CT scan records of 140 patients with an aim to evaluate prevalence of vital structures invaginating into sphenoid sinus and their clinical implications. The internal carotid artery (ICA), optic nerve (ON), maxillary nerve (MN), and Vidian nerve (VN) were assessed for protrusion into the sphenoid sinus and their dehiscence. Attachment of septum to protruding structures was also assessed. Data was statistically analyzed in the form of frequency and percentage to evaluate the prevalence of neurovascular invaginations into sphenoid sinus and their clinical implications.
Results
ICA invagination was observed in 16% of males and 12% of females with males showing higher frequency on left side. Protrusion of ON was seen in 13% of males and 10% of females with higher prevalence in bilateral category. Twenty-four percent of study population had MN prominences which included 13% of males and 11% of females with higher reflection of bilateral presentation. Highest prevalence of 44% was observed in VN protrusions with equal distribution (22%) among each sex. Majority of these were bilaterally located. Dehiscence of ICA was observed in 9%, ON in 29%, MN in 10%, and VN in 30% of study population. Dehiscence brings these structures closure to sinus mucosa with increased risk of involvement in sinus disease. Septal attachment to ICA and ON was present in 7% and 15% cases respectively.
Conclusion
Preoperative assessment of anatomical configuration of sphenoid sinus and associated neurovascular structures is mandatory to minimize per-operative complications. This study provides statistical data on anatomical variations in neurovascular structures protruding into the sphenoid sinus, their dehiscence, and septal attachments in South Indian population.
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Kulich M, Long R, Reyes Orozco F, Yi AH, Hao A, Han JS, Hur K. Racial, Ethnic, and Gender Variations in Sinonasal Anatomy. Ann Otol Rhinol Laryngol 2022:34894221126255. [PMID: 36200783 DOI: 10.1177/00034894221126255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Complications during endoscopic sinus surgery often result from unfavorable anatomy. The prevalence rates of such anatomic findings vary tremendously in the literature, in part due to the small, homogenous populations previously studied. OBJECTIVE To characterize the prevalence of sinonasal anatomic variants among ethnic groups and genders seen at an academic medical center. METHODS This is a retrospective cross-sectional study of adult subjects who underwent CT imaging of the sinuses from January 2019 to November 2020 at a tertiary academic setting. CT scans were analyzed systematically by 3 trained study personnel for the presence of critical sinus anatomic variants that endoscopic sinus surgeons typically evaluate for preoperatively. Chi-squared tests and analyses of variance were conducted to detect differences in the prevalence of structural findings between genders and races/ethnicities. RESULTS A total of 489 subjects (57% female) were included: 44 Asian, 14 Black/African American, 101 Hispanic/Latino, 203 White, 127 Other. The prevalence of the following anatomical variants differed by race/ethnicity: Haller cells, Type 3 optic nerve, Onodi cells, maxillary septations, sphenoid lateral recess, anterior clinoid process pneumatization, and carotid artery dehiscence. Asian subjects had higher rates of Haller cells (48% vs 16%, P < .001) and Type 3 optic nerve (18% vs 4%, P = .022) compared to Hispanic subjects, as well as a higher prevalence of Onodi cells (39% vs 17%, P = .003) compared to White subjects. Males had a higher prevalence of mesenteric anterior ethmoid arteries (62% vs 45%, P < .001) and dehiscent carotid arteries (30% vs 21%, P = .024). CONCLUSION Certain sinonasal anatomic variants, which have direct implications for complications during endoscopic sinus surgery, were found to be significantly more prevalent in some demographic groups. Surgeons should be aware of these differences in their review of preoperative imaging for safe surgical planning.
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Affiliation(s)
- Marta Kulich
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan Long
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Francis Reyes Orozco
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashley Hyunjung Yi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Audrey Hao
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jane S Han
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kevin Hur
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Yesiltepe S, Kurtuldu E, Bayrakdar IS, Yilmaz AB. Cone beam computed tomography evaluation of sphenoid sinus in different sagittal skeletal pattern. Eur Oral Res 2022; 56:143-148. [PMID: 36660221 PMCID: PMC9826704 DOI: 10.26650/eor.20221000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/12/2022] [Accepted: 02/20/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose The purpose of this study is to explore sphenoid sinus variations in individuals with various sagittal skeletal anomalies using cone-beam computed tomography (CBCT). Materials and methods We retrospectively analyzed sphenoid sinus pneumatization on CBCT images of 126 patients aged 18-86 years. The anteroposterior skeletal relationships of the maxilla and mandible were classified as skeletal class I, II or III using the A point-nasion-B point (ANB) angle measured in the sagittal plane. The extensions of the sphenoid sinus were evaluated on three planes including axial, sagittal and coronal sections. Results The study population consisted of 84 females (66.7%) and 42 males (33.3%), including 52 (41.3%) class I, 38 (30.1%) class II, and 36 (28.6%) class III cases. The conchal type of sphenoid sinus was not encountered. Presellar sinuses were detected in only 3 (5.8%) class I cases. Incomplete sinuses were detected in 16 (30.8%) class I, 7 (18.4%) class II, and 15 (41.7%) class III cases. Complete sinuses were detected in 33 (63.4%) class I, 31 (81.6%) class II, and 21 (58.3%) class III cases. Lateral extensions were found in 103 (40.9%) of the 252 sinus walls: 33 (31.7%) in class I, 45 (59.2%) in class II, and 25 (34.7%) in class III sinuses. Conclusion Regional sphenoid sinus anatomy can be carefully examined via CBCT. The sphenoid sinus pneumatization did not differ significantly in patients exhibiting different types of sagittal skeletal closure, with the exception of the lesser wing type.
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Affiliation(s)
- Selin Yesiltepe
- Department of Oral and Maxillofacial Radiology, Faculty of
Dentistry, Adnan Menderes University, Aydın,Turkey,To whom correspondence should be addressed: Dr. Selin Yesiltepe Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Adnan Menderes University, Aydın,Turkey
| | - Elif Kurtuldu
- Dentomaxillofacial Specialist, Sakarya Oral and Dental
Health Center, Ministry of Health, Sakarya,Turkey
| | - Ibrahim Sevki Bayrakdar
- Department of Oral and Maxillofacial Radiology,
Faculty of Dentistry, Eskisehir Osmangazi University,
Eskişehir,Turkey
| | - Ahmet Berhan Yilmaz
- Department of Oral and Maxillofacial Radiology,
Faculty of Dentistry, Ataturk University, Erzurum,Turkey
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Fadda GL, Petrelli A, Urbanelli A, Castelnuovo P, Bignami M, Crosetti E, Succo G, Cavallo G. Risky anatomical variations of sphenoid sinus and surrounding structures in endoscopic sinus surgery. Head Face Med 2022; 18:29. [PMID: 36057720 PMCID: PMC9440488 DOI: 10.1186/s13005-022-00336-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures. Methods In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP). Results The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p < 0.0001) with protrusion of the ICA. Accessory septa were detected in 30.4% of cases with various sites of attachment. Conclusion To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy.
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anastasia Urbanelli
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Insubria, Como, Italy
| | - Erika Crosetti
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Giovanni Succo
- Oncology Department, Head & Neck Surgery, University of Turin, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
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Parameshwar Keerthi BH, Savagave SG, Sakalecha AK, Reddy V, L YU. The Evaluation of Variations in Patterns of Sphenoid Sinus Pneumatization Using Computed Tomography in a South Indian Population. Cureus 2022; 14:e23174. [PMID: 35433147 PMCID: PMC9009218 DOI: 10.7759/cureus.23174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background and objective Knowledge about sphenoid sinus pneumatization is critical for skull base surgeries and functional endoscopic sinus surgery (FESS) in order to avoid serious complications like postoperative meningitis, sinusitis, cerebrospinal fluid (CSF) rhinorrhea, and intracranial hematoma. In this study, we aimed to assess the proportion of anatomical variants in sphenoid sinus pneumatization and to determine the common sphenoid pneumatization pattern in a South Indian population. Methods This retrospective study was conducted over a period of six months from July 2019 to December 2019 among 573 patients who underwent non-contrast CT (NCCT) or contrast-enhanced CT (CECT) of the brain, paranasal sinuses (PNS), orbit, and face. Results Most of the patients were in the age group of 20-39 years. The male-to-female ratio was 2.45:1. Among the posterior extensions, the most common variant was type D, followed by type C, type B, and type A. Among the clival extensions, the most common variant was Cliv-A, followed by Cliv-B, Cliv-C, and Cliv-D. The most common lateral wall pneumatization was bilateral lateral wall pneumatization followed by unilateral sinus wall pneumatization. Lat-A was the most common lateral wall pneumatization pattern followed by Lat-D, Lat-B, and Lat-C. Conclusion Our study intends to classify the sphenoid sinus pneumatization pattern and identify the most common variant among them, thereby guiding the skull base and FESS surgeons in choosing the correct mode of the operative procedure and also anticipating and avoiding complications of surgery.
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Sphenoid Sinus and Related Neurovascular Structures-Anatomical Relations and Variations on Radiology-A Retrospective Study. Indian J Otolaryngol Head Neck Surg 2021; 73:431-436. [PMID: 34722226 DOI: 10.1007/s12070-020-01966-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022] Open
Abstract
The aim of this study was to evaluate sphenoid sinus pneumatisation and its anatomical relation with adjacent neurovascular structures in Indian population. We performed a retrospective cross-sectional study, in which the pattern of sphenoid sinus pneumatization was studied on high-resolution computed tomography scans (n = 400), and association of the optic nerve, vidian canal and foramen rotundum along with related morphometric measurements were studied. Out of 400 CT scans, 60.5% were males. Majority had sellar type of pneumatization (89.5%) and single intersinus septum (68%). The most common configuration of relation of optic nerve canal was DeLano type 2 (34.75%). Vidian canal (VC) and Foramen rotundum (FR) were found dehiscent in 40.5% and 6.38% respectively. Average distance of FR from midline on right and left side was 16.3 ± 2.19 mm and 16.7 ± 2.23 mm respectively. Average distance of VC from midline on right and left side was 12.4 ± 5.84 mm and 12.4 ± 4.18 mm respectively. Average right FR to VC distance was 4.17 ± 2.16 mm and left FR to VC was 4.44 ± 2.20 mm. Anatomical variations of the sphenoid sinus are well known. In the present study, we have tried to highlight the importance of knowledge of various anatomical variations in relations to sphenoid sinus as they are critical in planning of surgery. Pre-operative radiological study and correlation is inevitable to assess type and extent of sinus pneumatisation, bony dehiscence and septal terminations to avoid injury to vital structures.
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Hiremath SB, Gautam AA, Sheeja K, Benjamin G. Assessment of variations in sphenoid sinus pneumatization in Indian population: A multidetector computed tomography study. Indian J Radiol Imaging 2021; 28:273-279. [PMID: 30319202 PMCID: PMC6176678 DOI: 10.4103/ijri.ijri_70_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose: The purpose of our study was to assess the prevalence of variations in the extent of sphenoid pneumatization in the Indian population and compare with existing literature. Materials and Methods: This retrospective study included 500 patients who underwent CT of the paranasal sinuses. The multiplanar reformations of paranasal sinus were assessed for the type of pneumatization of the sphenoid sinus and type of clival, lateral recess, lesser wing, and anterior recess extensions. Results: The conchal, presellar, incomplete sellar, and complete sellar types comprised 0%, 1.2%, 22.2%, and 76.6% of patients. The extensions of pneumatization subtypes in the study population were clival in 76.6% subjects; lateral recess, lesser wing, and anterior recess in 59.7%, 20.4%, and 20.4% of sinuses, respectively. The pure forms were seen in 25.4% and combined forms in 61% of sinuses. The presellar type (1.2%) was less common and sellar type (98.8%) being common in our population compared to the Caucasian and East Asian population. The sphenoid sinuses were extensively pneumatized in our population compared to the Chinese and Caucasian population, the prevalence being 76.6%, 68%, and 44.5% for clival; 59.7%, 46%, and 28.3% for lateral recess; 20.4%, 32%, and 12% for lesser wing extension, respectively. The pure forms were relatively less common and combined forms being more common compared to the Chinese and Caucasian population in our study. Conclusion: The extent of pneumatization of the sphenoid sinus has clinical and surgical implications in sellar and central skull base lesions, and variability in different populations confirms that ethnicity influences the differences in prevalence.
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Affiliation(s)
- Shivaprakash B Hiremath
- Department of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Amol A Gautam
- Department of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Keerthy Sheeja
- Department of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Geena Benjamin
- Department of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
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Movahhedian N, Paknahad M, Abbasinia F, Khojatepour L. Cone Beam Computed Tomography Analysis of Sphenoid Sinus Pneumatization and Relationship with Neurovascular Structures. J Maxillofac Oral Surg 2021; 20:105-114. [PMID: 33584051 DOI: 10.1007/s12663-020-01326-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background The sphenoid sinus is considered as the most variable pneumatized structure of the skull. Purpose The aim of the present study was to determine the prevalence of the Onodi cell as well as to evaluate the relationship between the sphenoid sinus type of pneumatization and the presence of surrounding neurovascular protrusion using cone beam computed tomography (CBCT). Methods The CBCT images of 500 patients/996 sides [203 males (40.6%) and 297 females (59.4%)] were analyzed in this study. The type of sphenoid sinus pneumatization, prevalence of internal carotid artery (ICA) and optic nerve (ON) protrusion and dehiscence, and also the frequency of Onodi cell were assessed. Results The percentages of the conchal, presellar, sellar, postsellar (a), and postsellar (b) types of pneumatization were 1%, 11.5%, 35.5%, 38.9%, and 13.1%, respectively. The more the sphenoid sinuses pneumatized, the greater the frequency of ON and ICA protrusion and dehiscence of their wall to the sinus. The prevalence of Onodi cell was 38.8%. A significant correlation was found between ON dehiscence and the presence of Onodi cells. Conclusion The present study demonstrated a significant relationship between the sinus type and frequency of neurovascular protrusions. Therefore, the sphenoid sinus extent of pneumatization might be useful in predicting the risk of iatrogenic damage to the surrounding structures.
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Affiliation(s)
- Najmeh Movahhedian
- Oral and Maxillofacial Radiology Department, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Paknahad
- Oral and Dental Disease Research Center, Oral and Maxillofacial Radiology Department,Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Abbasinia
- Student Research Committee, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Khojatepour
- Oral and Maxillofacial Radiology Department, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran
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Anatomographic Variants of Sphenoid Sinus in Ethiopian Population. Diagnostics (Basel) 2020; 10:diagnostics10110970. [PMID: 33227888 PMCID: PMC7699225 DOI: 10.3390/diagnostics10110970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022] Open
Abstract
Neurosurgeons often neglect the sphenoid sinus due to its deep location and difficulties in accessing during surgical interventions. Disease of the sphenoid sinus is difficult to diagnose since its presenting symptoms are difficult to recognize. Moreover, compared with other paranasal sinuses, the sphenoid sinus is considered the most variable air sinus in terms of its degree of pneumatization, number and position of inter-sinus septa, and its relationship with the surrounding anatomical structures. Anatomical variations of the sphenoid sinus are significant from a neurosurgical point of view. Understanding of these variations and its relationships with surrounding structures such as the internal carotid artery, optic nerve, and pituitary gland are clinically relevant to minimize injuries associated with surgical procedures that involve sphenoid sinus. We implemented principles of imaging using computed tomography to elucidate any anatomical variations of the sphenoid sinus in the Ethiopian population. We conducted a prospective study in 200 patients with ages 18-79, who underwent scans of the sphenoid sinus at the Tikur Anbessa Referral Teaching Hospital in 2017-2018. Our findings revealed an incidence of anatomographical variations in terms of pneumatization that varied between 2-50%. These variants include 2% conchal, 25.5% presellar, 50% sellar, and 22.5% postsellar pneumatization. We also demonstrated anatomographic variants in terms of septation, 77.5% single complete septa, 11.5% single incomplete, 10% double septa, and 1% absence of septa. In summary, the sellar pneumatization was found to be the most clinically relevant anatomographic variant among Ethiopians participating in the study, of which 90% were tomographically single septated. These variants must be taken into consideration during trans-sphenoidal surgery and knowledge of the variations has clinical implication in minimizing injuries during invasive surgical procedures involving the sphenoid sinus.
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Arsov B, Antunovic R, Kovac Bilic L, Hodzic Redzic S, Bilic M. Morphological, anatomical, radiological and clinical features of Mladina type 6 nasal septum deformations in humans. Eur Arch Otorhinolaryngol 2020; 277:3375-3380. [PMID: 32749605 DOI: 10.1007/s00405-020-06215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study was to prove the higher frequency of the type 6 deformations overall compared to the results obtained by conventional diagnostic methods, such as computed tomography images and clinical examination. METHODS The study was performed at the Institute of Anatomy, where a total of 114 randomly selected skulls were examined. The skulls were then scanned in a fixed position using the cone-beam technique (CBCT). The literature epidemiological data of the clinical incidence of type 6 in studies that also used Mladina classification were obtained. RESULTS There was a statistically significant difference (p < 0.0001) in the frequency of type 6 deformation as diagnosed by visual inspection (22.8%) and computed tomography (7.9%). The frequency obtained by CT imaging amounted 7.9% and was almost the same as the results obtained by a clinical examination which varied between 9 and 11%. CONCLUSIONS The frequency of type 6 nasal septal deformation is higher by visual inspection of the skulls than by computed tomography imaging at a level of significance of 0.05. The incidence of type 6 findings on coronal CT images of paranasal sinuses is approximately the same as that found with anterior rhinoscopy. Type 6, visible or concealed; probably have one-fourth to one-fifth people in population, so the number of clinically overlooked and/or unrecognized types 6 is much greater than we thought it to be.
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Affiliation(s)
- Borna Arsov
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Romano Antunovic
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Lana Kovac Bilic
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Selma Hodzic Redzic
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Mario Bilic
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
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Nautiyal A, Narayanan A, Mitra D, Honnegowda TM, Sivakumar. Computed Tomographic Study of Remarkable Anatomic Variations in Paranasal Sinus Region and their Clinical Importance - A Retrospective Study. Ann Maxillofac Surg 2020; 10:422-428. [PMID: 33708589 PMCID: PMC7944018 DOI: 10.4103/ams.ams_192_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/12/2020] [Accepted: 03/29/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION With the advent of functional endoscopic sinus surgery and coronal computed tomography (CT) imaging, more attention has been paid toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the pre- and post-operative assessment. The anatomical variants with some accompanying pathologies would directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. Our study intends to explore the anatomy of paranasal air sinus through CT and to describe its variants, which may predispose to chronic sinusitis and complications in endoscopic sinonasal surgery. MATERIALS AND METHODS This was a retrospective study carried out in a tertiary institution. Two hundred and fifty patients without paranasal sinus symptoms who presented for head CT studies and gave consent for a coronal section scan of the paranasal sinuses to be taken in addition to the axial section of the head were included in the study. The CT examination was performed with GE Hispeed-NX/I Base-2002 Dual Slice Helical CT machine. RESULTS Among 250 study population, 100 were females and 150 males. Among these 423 cases of anatomical variants were observed. The most common anatomical variants were pneumatization of the middle nasal turbinates 30.73%. This is followed by agger nasi cells 21.64%, Haller's cells 22.91%, septal deviation 21.91%, and sphenoid sinus septation (20.18%). DISCUSSION CT is the gold standard in the radiologic investigation of the paranasal sinuses, sinonasal lesions, and inflammatory disease or pre- and post-surgical assessment. It has the capability of disclosing in greatest detail any anatomical variations, which could be causing or precipitating the sinusitis.
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Affiliation(s)
- Amit Nautiyal
- Department of Nuclear Medicine and Radiology, Institute of Nuclear Medicine and Molecular Imaging, AMRI Hospitals, Kolkata, West Bengal, India
| | - Arun Narayanan
- Department of Periodontics, Kannur Dental College, Kerala, India
| | - Deepanjan Mitra
- Department of Nuclear Medicine and Radiology, Institute of Nuclear Medicine and Molecular Imaging, AMRI Hospitals, Kolkata, West Bengal, India
| | | | - Sivakumar
- Department of ENT, Kannur Medical College, Kerala, India
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Raseman J, Guryildirim M, Beer-Furlan A, Jhaveri M, Tajudeen BA, Byrne RW, Batra PS. Preoperative Computed Tomography Imaging of the Sphenoid Sinus: Striving Towards Safe Transsphenoidal Surgery. J Neurol Surg B Skull Base 2020; 81:251-262. [PMID: 32499999 DOI: 10.1055/s-0039-1691831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/04/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction Preoperative high-resolution computed tomography (HRCT) is essential in patients undergoing transsphenoidal surgery to identify potential high-risk anatomic variations. There is no consensus in the literature, as to which grading system to use to describe these variants, leading to inconsistent terminology between studies. In addition, substantial variability exists in the reported incidence of anatomic variants. In this study, we performed an institutional imaging analysis and literature review with the objective of consolidating and clearly defining these sphenoid sinus anatomical variations. In addition, we highlighted their surgical implications and propose a checklist for a systematic assessment of the sphenoid sinus on preoperative CT. Methods Review of the literature and retrospective analysis assessing several imaging parameters in 81 patients who underwent preoperative HRCT imaging for endoscopic transsphenoidal tumor resection from January 2008 through July 2015 at Rush University Medical Center. Results The most common sphenoid pneumatization patterns were sellar (45%) and postsellar (49%) types. Anterior clinoid process (ACP) pneumatization was seen in 17% of patients with high concordance of ipsilateral optic nerve (ON) protrusion. ON protrusion and dehiscence was present in 17 and 6% of patients, respectively. Internal carotid artery (ICA) protrusion and dehiscence was present in 30 and 5% of patients, respectively. Dehiscence rates from local bone invasion overlying the ICA and ON occurred in 17 and 4% of cases, respectively. Conclusions Our study highlights and reviews the key variants that have potential to impact surgical complications and outcomes in a heterogeneous patient population. The proposed preoperative CT checklist for patients, undergoing transsphenoidal surgery, consistently identifies these higher risk anatomical variants.
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Affiliation(s)
- John Raseman
- Department of Diagnostic Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
| | - Melike Guryildirim
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - André Beer-Furlan
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Miral Jhaveri
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard W Byrne
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
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Farhan N, Naqvi SU, Rasheed B, Sattar A, Khan M, Rahim A, Murtaza G. Identification of Significant Anatomical Variations in the Nose and Anterior Skull Base Using Computed Tomography: A Cross-Sectional Study. Cureus 2020; 12:e8449. [PMID: 32642362 PMCID: PMC7336695 DOI: 10.7759/cureus.8449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction This study is aimed at the identification of anatomic variations in the nose, paranasal sinuses (PNS), and anterior skull base, which are substantially important to ensure safe and complete endoscopic sinus and skull base surgery. Materials and methods This cross-sectional study was conducted at the Dow Institute of Radiology, Dow International Medical College, Dow University Hospital. We included adult patients (i.e., those aged 18 years or older) undergoing a non-contrast CT of the nose and PNS. Two consultant radiologists reviewed the scans on the picture archiving and communication system independently. Any conflict was resolved with consensus. Anatomical variations in the nose, PNS, and anterior skull base of both sides were evaluated. Results We reviewed the CT of the PNS of 130 patients with an age of 35.8 ± 14.48 years (mean ± standard deviation). The proportion of men (64/130; 49.2%) and women (66/130; 50.8%) was equal. All patients had one or more variations. The most common abnormality was a deviated nasal septum (DNS), observed in 115 of 130 participants (88.5%) with unilateral occurrence predominant. It was followed by inferior nasal turbinate hypertrophy and agger nasi cells in 76.2% and 67.7% patients, respectively. Optic nerve variation type I (160/260 sinuses; 61.5%) and Keros type II, for olfactory depth (162/260 sinuses; 62.3%), were most common. Conclusions Here we report anatomical variations in PNS in all patients of our study; the commonest of all anatomical variations was a DNS. A CT scan is instrumental in surgical planning and patient safety in functional endoscopic sinus surgery.
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Affiliation(s)
- Naureen Farhan
- Diagnostic Radiology, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Syeda Uzma Naqvi
- Otolaryngology, Head & Neck Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Binish Rasheed
- Diagnostic Radiology, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Amjad Sattar
- Diagnostic Radiology, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Maria Khan
- Diagnostic Radiology, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, PAK
| | - Anila Rahim
- Diagnostic Radiology, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, PAK
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Sphenoid sinuses: pneumatisation and anatomical variants-what the radiologist needs to know and report to avoid intraoperative complications. Surg Radiol Anat 2020; 42:1013-1024. [PMID: 32394118 DOI: 10.1007/s00276-020-02490-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Sphenoid sinuses are pneumatised structures, placed in the body of the sphenoid bone, with highly variable morphology. The strict relationships with vascular and nervous structures determine the importance of their anatomical variants in otorhinolaryngology and neurosurgery; a precise understanding of the complex anatomy and anatomic variations of these structures is pivotal for radiological diagnosis of paranasal sinuses pathology and for surgical planning, to avoid potential complications. Our aim is to describe the anatomical variants of sphenoid sinuses, and to help general radiologists and specialists in endoscopic surgery in becoming familiar with these sensitive anatomical structures. METHODS A literature search of PubMed and Embase (Elsevier) databases was performed using the keywords "sphenoid sinus" and "anatomy, "sphenoid sinus" and "anatomic variants", "sphenoid sinus", and "anatomic variations". RESULTS We described the anatomical variants of the sphenoid sinuses anatomy, according to their size, shape, degree of pneumatisation, protrusion of anatomical structures into their lumen, superimposition of ethmoid cells (Onodi cells), and presence of accessory septations CONCLUSION: The information provided by this study may help in the identification and description of the anatomical variations of the sphenoid sinuses and their relationship to neurovascular structures.
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Assessment of sphenoid sinus types in patients with cleft lip and palate on cone-beam CT. Eur Arch Otorhinolaryngol 2020; 277:1101-1108. [PMID: 31982946 DOI: 10.1007/s00405-020-05810-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to examine the sphenoid sinus morphology and variations in patients with cleft lip and palate (CLP) on cone-beam computed tomography (CBCT) images, and to compare them with healthy controls. METHODS CBCT images of 54 patients (28 males and 26 females,) with CLP and 54 age- and gender-matched healthy individuals (28 males and 26 females) were retrospectively evaluated. Sphenoid sinus main types (conchal, presellar, sellar, postsellar), sellar subtypes, clival and lateral extensions, and sinus septation were analyzed in CLP and control groups. The data were statistically analyzed using Chi-square test to compare the groups. RESULTS A statistically significant difference was found between CLP and control groups for sphenoid sinus main types (p < 0.05). Presellar type was more commonly observed in CLP group (18.5%), while the postsellar (31.5%) and clival (17.7%) types were more frequent in control group. There was a significant difference between the groups among different sellar sinus subtypes (p < 0.05). A significant difference was detected between the groups for clival extensions of sphenoid sinus (p < 0.05), but no difference was found for the lateral extensions (p > 0.05). No significant difference was determined between groups for sphenoid sinus septation (p > 0.05). CONCLUSION Significant differences were found between the CLP and control groups in terms of sphenoid sinus main types, sellar subtypes and the clival extensions. Knowledge of sphenoid sinus pneumatization in patients with CLP is important for preventing complications during transsphenoidal surgery.
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Papavasileiou G, Hajiioannou J, Kapsalaki E, Bizakis I, Fezoulidis I, Vassiou K. Vidian canal and sphenoid sinus: an MDCT and cadaveric study of useful landmarks in skull base surgery. Surg Radiol Anat 2020; 42:589-601. [PMID: 31950213 DOI: 10.1007/s00276-019-02414-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/30/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To present the anatomical variations of vidian canal (VC) and sphenoid sinus (SS), relative to other anatomical landmarks of skull base area, which may be helpful for safer surgical approach to this area. MATERIALS MDCT scans (128-row MDCT system) of 90 patients (mean age 62 years) and six cadaveric heads were studied, and the following parameters were evaluated: mean length and types of VC, distance between VC and foramen rotundum (FR) and optic canal (OC), position of the VC regarding the lateral pterygoid plate (MPTG) and petrous ICA, pneumatization of SS, position of intrasinus septum regarding ICA and OC, bone dehiscence and protrusion of ICA and OC into SS. Six cadaveric heads underwent MDCT and endoscopic dissection, and the type and length of VC were evaluated. The statistical significance was assessed using Chi-square (χ2) test. Significance level was set at p < 0.05. RESULTS A statistical analysis was performed between the measurements at both sides, as well as between measurements in MDCT and dissection of the six cadaveric heads. Statistically significant difference was found between right and left sides in the horizontal and vertical distances between FR and VC, as well as between VC and OC. Also, there was a statistically positive correlation between type II of VC and lateral pneumatization on the right side. There was not statistically significant difference concerning VC type and length between MDCT and dissection measurements. CONCLUSION Surgeons addressing skull base surgery must be familiar with the anatomical and positional variations of VC and SS in the preoperative CT images so as to avoid serious complications during surgery.
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Affiliation(s)
| | - Jiannis Hajiioannou
- Department of Otorhinolaryngology, University Hospital of Larissa, Larissa, Greece
| | - Eutixia Kapsalaki
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
| | - Ioannis Bizakis
- Department of Otorhinolaryngology, University Hospital of Larissa, Larissa, Greece
| | - Ioannis Fezoulidis
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
| | - Katerina Vassiou
- Department of Anatomy, Faculty of Medicine, Biopolis, University of Thessaly, Larissa, Greece
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Shirama YB, Adamu A, Ahmed SS, Iseh KR, Ma’aji SM, Baba SM. Relationship between Sinonasal Anatomical Variations and Symptom Severity in Patients with Chronic Rhinosinusitis. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:20-25. [PMID: 35531588 PMCID: PMC9067629 DOI: 10.4103/jwas.jwas_63_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 11/05/2022]
Abstract
Background Anatomical variations are subtle structural abnormalities around the osteomeatal complex that might obstruct paranasal sinus drainage and ventilation. The role of these anatomical variants in chronic rhinosinusitis is still controversial and unclear. The aim of this study was to determine the prevalence of anatomical variations and their relationship with the severity of symptoms in patients with chronic rhinosinusitis. Materials and Methods This was a cross-sectional study conducted among randomly selected patients with chronic rhinosinusitis. Sinonasal Outcome Test-20 (SNOT-20) was used to assess the patient's severity of symptoms. Computed tomographic scan was used to determine the presence of anatomical variations. The relationship between anatomical variations and symptom severity was determined using the Statistical Products and Service Solution (SPSS) version 20.0. Results There were 70(58.3%) males and 50(41.7%) females within the age range of 17-60 years. SNOT-20 scoring showed 6(5.0%) of the patients with mild symptoms, 69(57.5%) with moderate, 37(30.8%) with severe, and 8(6.7%) with profound symptoms. The prevalence of sinonasal anatomical variants was 26.7%, which comprised of septal deviation (10.8%), agger nasi (6.7%), concha bullosa (4.2%), Haller cells (3.3%), and Onodi cells (1.7%). There was a statistically significant relationship between the anatomical variations and symptom severity (P = 0.000). Conclusion This study found a significant relationship between anatomical variations and severity of chronic rhinosinusitis. The prevalence of anatomical variants was found to be 26.7%.
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Affiliation(s)
- Yakubu Bababa Shirama
- Department of Radiology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Auwal Adamu
- Department of Otorhinolaryngology, Head and Neck Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria,Address for correspondence: Dr. Auwal Adamu, Department of Otorhinolaryngology, Head and Neck Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. E-mail:
| | - Sa’idu Sule Ahmed
- Department of Radiology, Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Kufre Robert Iseh
- Department of Otorhinolaryngology, Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | | | - Sule Muhammad Baba
- Department of Radiology, Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Devaraja K, Doreswamy SM, Pujary K, Ramaswamy B, Pillai S. Anatomical Variations of the Nose and Paranasal Sinuses: A Computed Tomographic Study. Indian J Otolaryngol Head Neck Surg 2019; 71:2231-2240. [PMID: 31763326 PMCID: PMC6848411 DOI: 10.1007/s12070-019-01716-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/11/2019] [Indexed: 11/27/2022] Open
Abstract
To evaluate the anatomical variations in computed tomographic (CT) images of paranasal sinuses and to investigate association between them. DESIGN Retrospective study. SETTING Tertiary care center in the southern part of India. SUBJECTS Radiological images of paranasal sinuses belonging to chronic rhinosinusitis patients managed between June 2016 and November 2018. METHODS The studied characteristics in the CT images included the deviated nasal septum (DNS), concha bullosa (CB), Haller cell (HC), Onodi cell (OC), pneumatization of anterior clinoid process (ACP), pterygoid base (PB), superior turbinate, inferior turbinate, crista galli (CG), and nasal septum. The height of the lateral lamella of the cribriform plate, the sphenoid pneumatization pattern, and the optic nerve relationship with sphenoid sinus were studied separately. The associations between these factors, and with maxillary sinus opacifications were also investigated. A total of 151 adult patients' CT images were analyzed. The most common manifestations noted were DNS, CB and pneumatized PB, seen in 83.4%, 49% and 47% of the patients respectively. The rates of HC, OC, pneumatized septum, pneumatized CG, and pneumatized ACP were 39%, 23%, 27%, 43% and 27% in that order. Rates of most of these variations were within the range reported in the literature. Chi square test revealed that the OC was independently associated with pneumatized CG and pneumatized septum. The maxillary sinus opacification was related to DNS and CB, but not with protrusion of tooth root into the sinus. Most of the anatomical variations were comparable with the reports across the globe, however, the associations between these variations weren't common in our cohort.
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Affiliation(s)
- K. Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka 576104 India
| | - Shreyanka M. Doreswamy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka 576104 India
| | - Kailesh Pujary
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka 576104 India
| | - Balakrishnan Ramaswamy
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka 576104 India
| | - Suresh Pillai
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka 576104 India
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Yeung W, Twigg V, Carr S, Sinha S, Mirza S. Radiological "Teddy Bear" Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery. J Neurol Surg B Skull Base 2018; 79:401-406. [PMID: 30009122 PMCID: PMC6043166 DOI: 10.1055/s-0037-1615749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022] Open
Abstract
Objectives Internal carotid artery (ICA) injury remains a rare but potentially fatal complication of transsphenoidal pituitary or anterior skull base surgery. Preoperative imaging must be scrutinized to minimize risk. On axial computed tomography (CT), the protrusions of the ICAs into the sphenoid resemble a "teddy bear." This article aims to describe the sign, its grading system (0-2) and quantify its presence. Design Retrospective review of preoperative CT imaging. Setting Tertiary referral center in the United Kingdom. Participants One hundred patients who underwent endoscopic transsphenoidal surgery for pituitary disease were enrolled. Main Outcome Measure The presence and grading of the "teddy bear" sign were assessed on preoperative CT imaging. Results A grade 2 (strongly positive) "teddy bear" sign was identified in 40% at the level of the superior pituitary fossa, 78% at the inferior pituitary fossa, and 59% at the clivus. A grade 1 (intermediate) sign was seen in 23.5, 7.5, and 10% of cases, respectively. In 5% of cases, the sign was grade 0 at all levels-indicating poor intraoperative localization of the ICA. Conclusion The "teddy bear" sign is a useful preoperative tool for identification of anatomy predisposing patients to a higher risk of ICA injury. Those patients who have an absent or grade 0 "teddy bear" sign require extra care to ensure intraoperative localization of the ICAs which may include the use of neuronavigation or a Doppler probe. A grade 2 sign predicts good intraoperative localization of the ICA intraoperatively to inform the safe lateral limit of sellar bone resection.
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Affiliation(s)
- W. Yeung
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - V. Twigg
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - S. Carr
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - S. Sinha
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - S. Mirza
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Asal N, Bayar Muluk N, Inal M, Şahan MH, Doğan A, Arıkan OK. Carotid canal and optic canal at sphenoid sinus. Neurosurg Rev 2018; 42:519-529. [PMID: 29926302 DOI: 10.1007/s10143-018-0995-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/22/2018] [Accepted: 06/13/2018] [Indexed: 12/01/2022]
Abstract
In the present study, we investigated the relationship between sphenoid sinus, carotid canal, and optic canal on paranasal sinus computed tomography (PNSCT). This study was performed retrospectively. PNSCT images of 300 adult subjects (159 male, 141 female). Sphenoid sinus (pneumatisation, dominancy, septation, inter-sinus septa deviation), anterior clinoid process pneumatisation, Onodi cell, carotid and optic canals (width, dehiscence, classification) were measured. In males, type 3 pneumatised sphenoid sinus (in both sides) and in females type 2 pneumatised sphenoid sinus (right side) and type 3 pneumatised sphenoid sinus (left side) were detected more. Anterior clinoid pneumatisation was present 47.2% in males and 39.7% in females. In male group, more septation (i.e. 22.6%, ≥ 3 septa) in sphenoid sinus were detected. Onodi cell was present 26.6 and 19.1% in males and females, respectively. Carotid canal protrudation to the sphenoid sinus wall was present 23.9-32.1% in males and 35.5-36.2% in females. Dehiscence in carotid canal was detected more in females (34%) compared to males (22%). Optic canal protrudation was 33.3 and 30.5% in males and females. Type 4 optic canal was detected more in both gender. Optic canal dehiscence was detected 11.3 and 9.9% in males and females. Carotid and optic canal diameters were higher in males. In pneumatised sphenoid sinuses and in females, type 3 carotid canal (Protrudation to SS wall) (bilaterally) and type 1 optic canal type (No indentation) (ipsilateral side) were detected more. In elderly patients, carotid and optic canal width increased. When carotid canal protrudation was detected, there was no indentation in optic canals In pneumatised SS, carotid canal protrudation was observed with a greater risk in surgery. However, type 1 (non indentation) optic canal was present in highly pneumatised SS with lower risk for the surgery. In women, the risk of carotid canal protruding (about 1/3) is greater than that of males, and carotid canal dehiscence rates are also higher in females. Therefore, physicians should be very careful during the preparatory stages of the sphenoid sinus surgery. Otherwise, it may not be possible to prevent lethal carotid artery bleeds.
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Affiliation(s)
- Neşe Asal
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey. .,, Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 blok, No: 6-3/43, 06610, ANKARA, Çankaya, Turkey.
| | - Mikail Inal
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Mehmet Hamdi Şahan
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Adil Doğan
- Faculty of Medicine, Radiology Department, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Famurewa OC, Ibitoye BO, Ameye SA, Asaleye CM, Ayoola OO, Onigbinde OS. Sphenoid Sinus Pneumatization, Septation, and the Internal Carotid Artery: A Computed Tomography Study. Niger Med J 2018; 59:7-13. [PMID: 31198272 PMCID: PMC6561078 DOI: 10.4103/nmj.nmj_138_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: The air spaces of the nasal cavity and the sphenoid sinus (SS) constitute a convenient corridor to access lesions of the skull base using the endoscopic endonasal transsphenoidal approach (EETA). Safe EETA depends on the SS and skull base anatomy of the patient. Individual variations exist in the degree and pattern of SS pneumatization. This study aims to examine the variations in SS pneumatization, the inter-sphenoid septum (ISS), and their relationship with the internal carotid artery (ICA) among adult Nigerians. Materials and Methods: We reviewed computerized tomography (CT) images of 320 adult patients that had imaging for various indications. This excluded those with traumatic, inflammatory, or neoplastic process that may alter anatomical landmarks. The images were evaluated for the types of SS pneumatization, number and insertion of ISS, and the protrusion of ICA into the sinus cavity. Results: Prevalence of SS pneumatization types: 1.9% conchal, 1.2% presellar, 56.6% sellar, and 40.2% postsellar. The lateral extension of SS occurred into the pterygoid in 138 patients (45.1%), greater wing 112 (35%), lesser wing 37 (11.6%), the full lateral type was seen in 97 (30.3%) patients. One ISS occurred in 150 (46.9%) patients, 162 (50.6%) had multiple, and 8 (2.5%) had none. ISS insertion into ICA bony covering occurred in 101 (31.6%) patients, whereas protrusion of ICA into SS cavity occurred in 110 (34.4%) patients. Conclusion: Variations of the SS, ISS, and ICA anatomy are present among native Africans. Detailed imaging evaluation of each patient is considered for EETA is mandatory.
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Affiliation(s)
- Olusola C Famurewa
- Department of Radiology, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Bolanle O Ibitoye
- Department of Surgery, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Sanyaolu A Ameye
- Department of Surgery, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Christianah M Asaleye
- Department of Radiology, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Oluwagbemiga O Ayoola
- Department of Radiology, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Olaoluwa S Onigbinde
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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Volumetric assessment of sphenoid sinuses through segmentation on CT scan. Surg Radiol Anat 2017; 40:193-198. [PMID: 29270712 DOI: 10.1007/s00276-017-1949-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 11/24/2017] [Indexed: 10/14/2022]
Abstract
PURPOSE Computed tomography represents the gold standard for the assessment of morphological characteristics of sphenoid sinuses, whose anatomy has acquired a novel interest because of the recent introduction of transsphenoidal surgery and robot-assisted procedures. One of the most relevant parameters for planning surgical intervention is the volume of sphenoid sinuses, and with time few population studies have been published. However, at present, no data are available concerning the relation between volume and anatomical variants of sphenoid sinuses. METHODS We retrospectively evaluated head CT-scans of 100 patients (age range 25-99 years; mean age males 45.0; mean age females 50.5 years) to calculate the volume of sphenoid sinuses through automatic segmentation. Possible statistically significant differences according to sex and variants of pneumatization, and type of sinus were assessed, respectively, through Student's t test and one-way ANOVA test (p < 0.05). RESULTS Average volume of sphenoid sinuses in males was 10.005 ± 5.101 cm3, in females 7.920 ± 3.176 cm3. Differences according to sex were statistically significant (p < 0.05). Patients with pneumatization of pterygoid processes, dorsum sellae and anterior clinoid processes had a significantly higher volume than unaffected subjects. Moreover, differences of volume according to the type of sphenoid sinus were statistically significant (p < 0.05). CONCLUSIONS Results show that volume of sphenoid sinuses strongly depend upon the type of sinus and possible pneumatization variants. Moreover, the important of ethnic variability is confirmed.
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Senturk M, Guler I, Azgin I, Sakarya EU, Ocal R, Agirgol B, Alatas N, Tolu I, Kilinc M. Sphenoethmoid Cell: The Battle for Places Inside of the Nose Between a Posterior Ethmoid Cell and Sphenoid Sinus: 3D-Volumetric Quantification. Curr Med Imaging 2017; 13:478-483. [PMID: 29249918 PMCID: PMC5709517 DOI: 10.2174/1573405613666170126150024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
Background Sphenoethmoid cells may be above the sphenoid sinus with/ or without con-tact to optical nerve. Although sphenoethmoid cells are theoretically considered to possibly influence the sphenoid sinus volume, we could not find any study in the literature on this issue. Aims The aim of our study was to detect sphenoethmoid cells and measure the sphenoid sinus vol-ume using multiplanar computerized tomography and also investigate the correlation between the presence of sphenoethmoid cells and the sphenoid sinus volume. Methods Retrospectively 141 patients who had available paranasal computerized tomography images were included in this study. The sphenoid sinus volumes of each patient were calculated individually for each side, and the relationship between the presence of sphenoethmoid cell and sphenoid sinus volume was investigated. Results Sphenoethmoid cells were detected at 106 (37.5%) of the total 282 sides in 141 patients. No gender difference was observed. The total sphenoid sinus volume was significantly lower in the group of patients who had bilateral sphenoethmoid cells than in the sphenoethmoid cell negative group. In patients with a unilateral sphenoethmoid cell, a significant decrease in the sphenoid sinus volume was observed only for the side where the sphenoethmoid cell was located. Conclusion It was observed that the sphenoethmoid cells caused a significant reduction in the sphe-noid sinus volume on the side where they were located. In the case of low sphenoid sinus aeration, the sphenoethmoid cell should be kept in mind. Further studies with an extended patient series are required to explore this issue.
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Affiliation(s)
- Mehmet Senturk
- Department of Otolaryngology Head and Neck Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Ibrahim Guler
- Department of Radiology, Medical Faculty, Selçuk University, Konya, Turkey
| | - Isa Azgin
- Department of Otolaryngology Head and Neck Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Engin Umut Sakarya
- Department of Otolaryngology Head and Neck Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Ramazan Ocal
- Department of Otolaryngology Head and Neck Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Betul Agirgol
- Department of Otolaryngology Head and Neck Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Necat Alatas
- Department of Otolaryngology Head and Neck Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Ismet Tolu
- Department of Radiology, Konya Training and Research Hospital, Konya, Turkey
| | - Mehmet Kilinc
- Department of Otolaryngology Head and Neck Surgery, Konya Training and Research Hospital, Konya, Turkey
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Alrumaih RA, Ashoor MM, Obidan AA, Al-Khater KM, Al-Jubran SA. Radiological sinonasal anatomy. Exploring the Saudi population. Saudi Med J 2017; 37:521-6. [PMID: 27146614 PMCID: PMC4880651 DOI: 10.15537/smj.2016.5.13904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To assess the prevalence of common radiological variants of sinonasal anatomy among Saudi population and compare it with the reported prevalence of these variants in other ethnic and population groups. METHODS This is a retrospective cross-sectional study of 121 computerized tomography scans of the nose and paranasal sinuses of patients presented with sinonasal symptoms to the Department of Otorhinolarngology, King Fahad Hospital of the University, Khobar, Saudi Arabia, between January 2014 and May 2014. RESULTS Scans of 121 patients fulfilled inclusion criteria were reviewed. Concha bullosa was found in 55.4%, Haller cell in 39.7%, and Onodi cell in 28.9%. Dehiscence of the internal carotid artery was found in 1.65%. Type-1 and type-2 optic nerve were the prevalent types. Type-II Keros classification of the depth of olfactory fossa was the most common among the sample (52.9%). Frontal cells were found in 79.3%; type I was the most common. CONCLUSIONS There is a difference in the prevalence of some radiological variants of the sinonasal anatomy between Saudi population and other study groups. Surgeon must pay special attention in the preoperative assessment of patients with sinonasal pathology to avoid undesirable complications.
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Affiliation(s)
- Redha A Alrumaih
- Department of Otolaryngology/Head and Neck Surgery, College of Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia. E-mail.
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Turkdogan FT, Turkdogan KA, Dogan M, Atalar MH. Assessment of sphenoid sinus related anatomic variations with computed tomography. Pan Afr Med J 2017; 27:109. [PMID: 28819530 PMCID: PMC5554694 DOI: 10.11604/pamj.2017.27.109.7391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/19/2016] [Indexed: 12/01/2022] Open
Abstract
Introduction Frequent and broad application of endoscopic sinus surgery (ESS) in parallel with experience makes it imperative to know the anatomy and the existing pathology very well before surgery. This study examines the association between anomalies in the sphenoid sinus area in paranasal sinuses computed tomography (PNS-CT) and pathological findings and determines variations of sphenoid sinus. Methods A total of 200 cases (100 women, 100 men) who had PNS-CT in the emergency and radiology polyclinics within the period of one year were included in this study. Bone tissue anomalies and soft tissue pathologies were assessed in the CT. Results Pterygoid process was found in 36.75% of our cases, anterior clinoid pneumatization was found in 21.25%; vidian canal in 34.25%, foramen rotundum in 17.5% and ICA in 12.75% had protrusion into the sphenoid sinus; 8.25% were found to have onodi cell, 11.25% were found to have multiple septation, 16.75% were found to have mucosal thickening and 2.5% were found to have retention cyst. Conclusion The importance of PNS-CT in terms of determining anatomic variations before ESC and predicting possible complications during surgery has been emphasized once more. In our study, as sphenoid sinus pneumatization increased, the projection of neighbouring vein and nerve structures into the sinus was found to increase as well.
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Affiliation(s)
| | | | - Murat Dogan
- Adnan Menderes Universty, Department of Otorhinolaryngology, Aydın, Turkey
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Dalati HA, Jabbr MS, Hammadi IS. Uncommon Optic Nerve Course in the Sphenoid Sinus. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:175-176. [PMID: 30787780 PMCID: PMC6298362 DOI: 10.4103/1658-631x.204867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We present a case of bilateral, free optic nerves passing through the sphenoid sinus associated with bilateral anterior clinoid process pneumatization, in addition to bilateral vidian nerves protrusion with pterygoid process pneumatization.
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Itagi RM, Adiga CP, Kalenahalli K, Goolahally L, Gyanchandani M. Optic Nerve Canal Relation to Posterior Paranasal Sinuses in Indian Ethnics: Review and Objective Classification. J Clin Diagn Res 2017; 11:TC01-TC03. [PMID: 28571226 DOI: 10.7860/jcdr/2017/23447.9510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/06/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Posterior paranasal sinuses consisting of posterior ethmoid and sphenoid sinuses show varying pneumatization and relationship to Optic Nerve Canal (ONC). Most commonly ONC is superolateral to sphenoid sinus, however varied protrusion of ONC into the sinuses may occur. Rarely it may pass completely through the sinus. Optic Nerve (ON) is covered by a thin bony layer or by periosteum and sinus mucosa without bone. Extensive pneumatization of sphenoid sinus and bony dehiscence predisposes to ON injury. The posterior ethmoid cell namely the Onodi cell is of great surgical importance when the ON is along its lateral wall and surrounds the nerve. These varied relations imply that a detailed knowledge of the intimate relationship of ONC with the posterior paranasal sinuses is necessary to avoid unintentional complications during the surgeries involving the ONC region. AIM To assess relationship of ONC to the posterior paranasal sinuses in Indian Ethnic study group. MATERIALS AND METHODS Retrospective review of 100 paranasal sinus Computed Tomography (CT) scans were done using 64 row Multi Detector Computed Tomography (MDCT). Multiplanar reformation images were assessed for ONC relation to posterior ethmoid and sphenoid sinuses, wall dehiscence, and Pneumatization of Anterior Clinoid Process (PACP). RESULTS 200 optic nerve canals were assessed and grouped into four types based on the modification of Delano et al., classification. The most common OCN was Type-1 (60%), followed by Type-2 (15%), Type-3 (14%) and Type-4 (11%). Dehiscence was seen in 35(17.5%) mostly in Type-3 canals. PACP was seen in 30 (15%). CONCLUSION Knowledge of ON relationship to posterior paranasal sinuses will reduce the devastating complications during sinus surgeries. Our modified ONC classification is based on the bony canal morphology and the degree of protrusion into sinuses. As with other reported studies worldwide, Type-1 ONC is the commonest among the Indians also. Type-2 and 3 ONC with sinus wall dehiscence and PACP are the most important anatomical variations which may potentially predispose to risk of surgical injury to the optic nerves.
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Affiliation(s)
| | | | - Kiran Kalenahalli
- Head of Department, Department of Radiology, Sagar Hospitals, Bangalore, Karnataka, India
| | - Lakshmikanth Goolahally
- Consultant Radiologist, Department of Radiology, Sagar Hospitals, Bangalore, Karnataka, India
| | - Manju Gyanchandani
- Consultant Radiologist, Department of Radiology, Sagar Hospitals, Bangalore, Karnataka, India
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Gibelli D, Cellina M, Gibelli S, Oliva AG, Termine G, Sforza C. Anatomical variants of sphenoid sinuses pneumatisation: a CT scan study on a Northern Italian population. Radiol Med 2017; 122:575-580. [PMID: 28357538 DOI: 10.1007/s11547-017-0759-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/21/2017] [Indexed: 01/09/2023]
Abstract
Sphenoid bone may be affected by different variants of pneumatisation, which have a relevant importance from a clinical and surgical point of view. The description of such variants in different populations may give useful information. However, few articles describe the variability of sphenoid pneumatised structures and none of them focuses on Northern Italian population. Variants of pneumatisation of sphenoid bone were described in a sample of 300 Northern Italian patients who underwent a CT scan. More than fifty-seven percent of patients showed a form of anatomical variant: the most common form was the pneumatised pterygoid processes (39.6%), followed by dorsum sellae (32.9%) and clinoid processes (20.3%), without statistically significant differences between males and females (p > 0.01). In 26.3% of patients, a combined pneumatisation of these three structures was observed, being the combination pterygoid processes-dorsum sellae the most frequent (11.3%). In 9.3%, all the three sphenoid structures were affected. This article is the first description of the prevalence of different variants of pneumatisation in a Northern Italian population: the occurrence of such forms has to be acknowledged for their possible clinical and surgical consequences.
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Affiliation(s)
- Daniele Gibelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, V. Mangiagalli 31, Milan, Italy.
| | - Michaela Cellina
- Reparto di Radiologia, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefano Gibelli
- Reparto di Otorinolaringoiatria, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Giovanni Termine
- Reparto di Otorinolaringoiatria, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Chiarella Sforza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, V. Mangiagalli 31, Milan, Italy
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Yeğin Y, Çelik M, Altıntaş A, Şimşek BM, Olgun B, Kayhan FT. Vidian Canal Types and Dehiscence of the Bony Roof of the Canal: An Anatomical Study. Turk Arch Otorhinolaryngol 2017; 55:22-26. [PMID: 29392047 DOI: 10.5152/tao.2017.2038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 12/18/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To determine the prevalence of Vidian canal types and dehiscence of the bony roof of the canal. Methods This study included 594 patients (391 males and 203 females; average age, 32.43±11.98 years; range, 18-65 years). Computed tomography (CT) images were analyzed in terms of the prevalence of Vidian canal types and dehiscence of the bony roof of the canal. Results Vidian canal types 1, 2, and 3 based on the sphenoid sinus body were found on the right side in 33.8%, 29.7%, and 6.5%, and on the left side in 36.4%, 27.4%, and 36.2% of the patients, respectively. Dehiscence of the bony roof of the canal was found on the right side in 22.2% of the patients and on the left side in 26.6%. In terms of Vidian canal types based on the sphenoid sinus floor, types 1, 2, 3, and 4 were found on the right side in 53.5%, 27.4%, 7.6%, and 11.5%, and on the left side in 54.9%, 26.6%, 6.6%, and 11.9% of the patients, respectively. On the right side, Vidian canal type 2 was significantly (p=0.002) more frequent in males than in females. Conclusion When studying the complex anatomy of the sphenoid sinus, it is essential to consider Vidian canal types. Before endoscopic sinus surgery the Vidian canal and other anatomical structures should be carefully evaluated in all patients during preoperative paranasal sinus CT imaging to avoid complications.
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Affiliation(s)
- Yakup Yeğin
- Clinic of Otorhinolaryngology, Bakırköy Dr. Sadi Konuk Training and Research Hospital İstanbul, Turkey
| | - Mustafa Çelik
- Clinic of Otorhinolaryngology, Bakırköy Dr. Sadi Konuk Training and Research Hospital İstanbul, Turkey
| | - Ahmet Altıntaş
- Clinic of Otorhinolaryngology, Fatih Medical Park Hospital, İstanbul, Turkey
| | - Baver Maşallah Şimşek
- Clinic of Otorhinolaryngology, Bakırköy Dr. Sadi Konuk Training and Research Hospital İstanbul, Turkey
| | - Burak Olgun
- Clinic of Otorhinolaryngology, Fatih Medical Park Hospital, İstanbul, Turkey
| | - Fatma Tülin Kayhan
- Clinic of Otorhinolaryngology, Fatih Medical Park Hospital, İstanbul, Turkey
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Rahmati A, Ghafari R, AnjomShoa M. Normal Variations of Sphenoid Sinus and the Adjacent Structures Detected in Cone Beam Computed Tomography. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2016; 17:32-7. [PMID: 26966706 PMCID: PMC4771050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
STATEMENT OF THE PROBLEM The sphenoid sinus is a common target of paranasal surgery. Functional endoscopic sinus surgery is likely to endanger the anatomic variations of vital structures adjacent to the sphenoid sinus. PURPOSE The aim of this study was to determine the variations of sphenoid sinus and the related structures by using cone-beam computed tomography (CBCT). MATERIALS AND METHOD In this descriptive-analytic study, CBCT images of 103 patients aged above 20-years were selected (206 sides). Degree of pneumatization of sphenoid sinus, pneumatization of the anterior clinoid process, pterygoid process, protrusion of optic canal, vidian canal, and foramen rotundum, as well as prevalence of sinus septa were recorded. Examinations were performed using On-Demand software (Version 1); data were analyzed by using chi-square test. RESULTS There was a statistically significant correlation between the pterygoid pneumatization and vidian canal protrusion (p< 0.001), and foramen rotundum protrusion (p< 0.001). The optic canal protrusion was found to be significantly associated with the anterior clinoid pneumatization and pterygoid process (p< 0.001). Statistically significant relationship was also observed between the carotid canal protrusion and pterygoid process pneumatization (p< 0.001). CONCLUSION The anatomical variations of the sphenoid sinus tend to give rise to a complexity of symptoms and potentially serious complications. This variability necessitates a comprehensive understanding of the regional sphenoid sinus anatomy by a detailed CBCT sinus examination.
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Affiliation(s)
- Azadeh Rahmati
- Dept. of Oral Radiology, School of Dentistry, International Branch University, Guilan, Iran.
| | - Roshanak Ghafari
- Dept. of Oral Radiology, School of Dentistry, International Branch University, Guilan, Iran.
| | - Maryam AnjomShoa
- Dept. of Anatomical Science, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
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Dasar U, Gokce E. Evaluation of variations in sinonasal region with computed tomography. World J Radiol 2016; 8:98-108. [PMID: 26834948 PMCID: PMC4731353 DOI: 10.4329/wjr.v8.i1.98] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/05/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases.
METHODS: The study included 400 cases (191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography (CT) examination in axial plane. Reformatted CT images were studied in all planes.
RESULTS: Age range of the patients was 20-83 (mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell (74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus (P < 0.001). Besides, the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus, and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant (P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases (P = 0.004 and P = 0.002, respectively).
CONCLUSION: Sinonasal region has a great number of variations, and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations.
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Anusha B, Baharudin A, Philip R, Harvinder S, Shaffie BM, Ramiza RR. Anatomical variants of surgically important landmarks in the sphenoid sinus: a radiologic study in Southeast Asian patients. Surg Radiol Anat 2015; 37:1183-1190. [PMID: 25990686 DOI: 10.1007/s00276-015-1494-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Failure of a surgeon to understand the local variations of the anatomical landmarks of the sphenoid sinus is a potential risk factor to cause damage to the optic nerve (ON) or internal carotid artery (ICA) that lies on the walls of the sphenoid sinus. The aim of this study was to identify the anatomical variants of the sphenoid sinus and its related surrounding structures among the Southeast Asian (SEA) population, based on computed tomography (CT) scans. MATERIALS AND METHODOLOGY This cross-sectional study analyzed 300 CT scans of the brain, paranasal sinuses (PNS), and head and neck (H&N) at a tertiary referral centre in Malaysia utilizing the Osirix software. The images were reconstructed into 1 mm cuts on bone window. Demographic details and scan findings were documented in a standardized data collection sheet. RESULTS The rates of ON dehiscence, ICA dehiscence and ICA protrusion in the SEA population were 7.0, 3.0 and 10.0 %, respectively. The rate of ON protrusion was 2.3 %. There was no statistically significant relationship (p > 0.05) noted on Chi-square test, between anterior clinoid process (ACP) pneumatization and ON protrusion. The rate of Onodi cells in our population was 14.3 %. The average vertical distance of the ostia from the roof of the posterior choanae was 1.42 cm (±0.32). The horizontal distance of the ostia from the anterior end of the superior turbinate was 1.58 cm (±0.41) and the oblique distance of the ostia from the anterior nasal spine was 5.35 cm (±0.48). Independent t tests showed that there is a statistically significant difference between the means of each of these parameters (p < 0.001) and their international averages. CONCLUSION The rate of ON protrusion is lower in the SEA population, whereas the rates of ON dehiscence, ICA dehiscence and ICA protrusion fall within the range of international averages. In our population, ACP pneumatization is not related to ON protrusion. The distance of the ostia from given landmarks was significantly shorter than in other studies.
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Affiliation(s)
- B Anusha
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, 30990, Ipoh, Perak, Malaysia.
| | - A Baharudin
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - R Philip
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, 30990, Ipoh, Perak, Malaysia
| | - S Harvinder
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, 30990, Ipoh, Perak, Malaysia
| | - B Mohd Shaffie
- Department of Diagnostic Imaging, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - R R Ramiza
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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R SL, T S G, N VK, Guru AT. POSITIONAL VARIATION OF OPTIC NERVE IN RELATION TO SPHENOID SINUSES AND ITS ASSOCIATION WITH PNEUMATISATION OF ANTERIOR CLINOID PROCESS : A RADIOLOGICAL STUDY. JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE 2015; 2:4719-4728. [DOI: 10.18410/jebmh/2015/663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2024]
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CT of Anatomic Variants of the Paranasal Sinuses and Nasal Cavity: Poor Correlation With Radiologically Significant Rhinosinusitis but Importance in Surgical Planning. AJR Am J Roentgenol 2015; 204:1255-60. [PMID: 26001236 DOI: 10.2214/ajr.14.13762] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of sinonasal anatomic variants and to assess their relation to sinonasal mucosal disease. MATERIALS AND METHODS A retrospective evaluation of 192 sinus CT examinations of patients with a clinical history of rhinosinusitis was conducted. The CT scans were evaluated for the presence of several anatomic variants of the sinonasal cavities, and the prevalence of each variant was calculated. Prevalences of all sinonasal anatomic variants were compared between patients who had minimal to no apparent imaging evidence of rhinosinusitis and those who had radiologic evidence of clinically significant rhinosinusitis. RESULTS The most common normal variants were nasal septal deviation, Agger nasi cells, and extension of the sphenoid sinuses into the posterior nasal septum. We found no statistically significant difference in the prevalence of any of the studied anatomic variants between patients with minimal and those with clinically significant paranasal sinus or nasal cavity disease. CONCLUSION Analysis of every routine CT scan of the paranasal sinuses obtained for sinusitis or rhinitis for the presence of different anatomic variants is of questionable value unless surgery is planned.
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Lateral orbital wall fracture as a mechanism of blow-out fracture in a patient with extensive pneumatization of the sphenoid bone. J Craniofac Surg 2015; 25:e12-3. [PMID: 24275778 DOI: 10.1097/scs.0b013e3182a2eceb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report a patient with a lateral orbital wall fracture that occurred as a result of a blow-out fracture. The patient has extensive pneumatization of the sphenoid sinus, and the air extends into the lateral orbital wall. It makes the lateral orbital wall much thinner unusually, being more vulnerable to a sudden increase in intraorbital pressure. Pure blow-out fracture of the lateral orbital wall has not been reported in the medical literature. Therefore, this is the first case report of a lateral orbital wall fracture occurring as a blow-out mechanism.
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Anusha B, Baharudin A, Philip R, Harvinder S, Shaffie BM. Anatomical variations of the sphenoid sinus and its adjacent structures: a review of existing literature. Surg Radiol Anat 2014; 36:419-427. [PMID: 24146215 DOI: 10.1007/s00276-013-1214-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/10/2013] [Indexed: 01/24/2023]
Abstract
The sphenoid sinus, one of the posterior groups of sinuses, has long been regarded as a 'neglected sinus' due to the anatomical location, poor understanding and poor accessibility, till the advent of endoscopes and modern imaging techniques. Increasing knowledge and greater understanding of this sinus has permitted an evolution in surgical practices and boundaries. Various literatures of the past report a great variety of rates of pneumatization, rates of optic nerve protrusion and dehiscence, as well as internal carotid artery (ICA) protrusion and dehiscence. One similarity noted among these studies is that the rates vary according to the ethnicity of the patients. Recommendations have also been made along the way with regard to modified surgical techniques. This review aims to describe the pneumatization of sphenoid sinus and the topographical relation of the optic nerve and ICA in different populations.
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Affiliation(s)
- B Anusha
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia,
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Chougule MS, Dixit D. A Cross-Sectional Study of Sphenoid Sinus through Gross and Endoscopic Dissection in North Karnataka, India. J Clin Diagn Res 2014; 8:AC01-5. [PMID: 24959426 PMCID: PMC4064884 DOI: 10.7860/jcdr/2014/7947.4243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/02/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sphenoid sinus has got importance due to trans-sphenoid approach to the pituitary gland. This study is an attempt to know the variations in North Karnataka population, through cadaveric dissection and CT scan study. OBJECTIVE We want to study variations in sphenoid sinus and its percentage in North Karnataka population. MATERIAL AND METHODS Endoscopic examination and dissection of sphenoid sinus was carried out in 30 cadavers (three female and 27 male) using 0°, 30°, 70° rigid nasal endoscopes. Sections were then made in the sagittal plane to confirm the anatomical findings and to take the necessary measurements with millimeter strips. RESULTS In six of cadavers pre-sellar, in four it was sellar and in 20 it was post-sellar while conchal type of sphenoid sinus was absent. The septa terminated on bone covering internal carotid artery (ICA) in seven cadavers while in two cadavers they terminated on the bone covering Optic nerve (ON). Findings of CT scan study were pre-sellar-8, sellar-14 and post-sellar-37 and in case of one subject left side sinus was conchal. Pneumatization of greater wing of sphenoid was observed in two sinuses, of pterygoid process in four sinuses and of anterior clinoid process in two sinuses. We also found onodi cell in one sinus. CONCLUSION Sphenoid sinus shows various types of pneumatisation, and this place the sinus in close proximity to important neurovascular structures that are present around the sinus. Newer techniques are used to confirm surgical landmarks making these techniques very safe.
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Affiliation(s)
- Manisha S. Chougule
- Faculty, Department of Anatomy, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Daksha Dixit
- Faculty, Department of Anatomy, KLE University’s Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Hwang SH, Joo YH, Seo JH, Cho JH, Kang JM. Analysis of sphenoid sinus in the operative plane of endoscopic transsphenoidal surgery using computed tomography. Eur Arch Otorhinolaryngol 2013; 271:2219-25. [PMID: 24362681 DOI: 10.1007/s00405-013-2838-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
Recently, the endoscopic transsphenoidal approach for sphenoid sinus or intracranial lesion has gained more popularity and the study of the surgical anatomy and relationships of the sphenoid sinus has gained increased significance. The aim of this study was to clarify the anatomical features of the sphenoid sinus including surrounding structures as seen in the operative view of endoscopic transsphenoidal surgery. The various distances in the sphenoid sinus as well as the relationships between the sphenoid sinus ostium (SO) and important structures such as the optic canal (OC) and carotid artery (CA) according to the presence of Onodi cell (sphenoethmoidal cell; Onodi group vs. non-Onodi group) were assessed using multiplanar and three-dimensional model of CT scans in 100 patients. The SO was more inferior in Onodi group and located superior to the lowest point of the sella. The horizontal distance from the SO to sella was approximately 13 or 14 mm depending on the existence of Onodi cells. Regardless of Onodi cell, the whole course of the OC in the sinus ran superolaterally to inferomedially in the endoscopic view. However, Onodi cell made the angles from the SO to OC larger. In Onodi group, the CA was located from the SO in a superolateral direction, but in non-Onodi group, the CA was located from the SO in the inferolateral direction. This study provides anatomical information about the sphenoid sinus, with important surgical distances between the SO and surrounding structures measured, which is essential to avoid complications during transsphenoidal surgery.
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Affiliation(s)
- Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Bucheon St. Mary`s Hospital, The Catholic University of Korea, 327 Sosa-ro Wonmi-gu, Bucheon, Gyeonggi-do, 420-717, Republic of Korea
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Ozturan O, Yenigun A, Degirmenci N, Aksoy F, Veyseller B. Co-existence of the Onodi cell with the variation of perisphenoidal structures. Eur Arch Otorhinolaryngol 2012; 270:2057-63. [PMID: 23274877 DOI: 10.1007/s00405-012-2325-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/11/2012] [Indexed: 10/27/2022]
Abstract
The presence of the Onodi cell (OC) may be accompanied by morphological variations of the neighboring anatomic structures. Such variations carry significant surgical implications and challenges. Pneumatization of the sphenoid sinus induces anterior clinoid pneumatization (ACP), affects the type of the Vidian nerve (VN) canal or alters the courses of the internal carotid artery (ICA), and the optic nerves (ONs) are strongly depending on it. Onodi cell pneumatization may reach and surround the optic nerve in various extension. Our aim in the study was to investigate the effect of Onodi cell's potential co-existence on these structures. This study was planned as a retrospective and cross-sectional study. This study performed in a tertiary referral center. Coronal computerized tomography images of 999 patients were examined. Using an 64 slices tomography machine, images taken at 3-mm sections were reconstructed using a bone algorithm and evaluated. OCs were present at 212 of the total 320 sides in 160 patients. Type-2 was found to be the most prevalent type of VN canal configuration (Type-2: VN canal partially protrudes into the sphenoid sinus or into the floor of the sphenoid) among all patients (66.5 %) and among those with OCs (71.2 %). The presence or absence of the OC did not cause a statistically significant alteration of the intrasphenoidal course of the VN. The presence of OCs was found to be significant (p < 0.01) in accompanying pneumatization of the anterior clinoid process (34.4 %, 73/212), protrusion (80.1 %, 170/212) and dehiscence (36.3 %, 77/212) of the optic nerve, and protrusion (59 %, 125/212) and dehiscence (20.8 %, 44/212) of the ICA. In 108/320 sides where OCs were absent, no significant correlations existed. This study shows that in the co-existence of an OC, ACP, protrusion and dehiscence of the optic nerve and ICA are encountered at significantly higher rates, while the course of the VN is not necessarily altered.
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Affiliation(s)
- Orhan Ozturan
- Department of Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
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Rusu MC, Didilescu AC, Jianu AM, Păduraru D. 3D CBCT anatomy of the pterygopalatine fossa. Surg Radiol Anat 2012; 35:143-59. [DOI: 10.1007/s00276-012-1009-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 08/09/2012] [Indexed: 11/29/2022]
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Heskova G, Mellova Y, Holomanova A, Vybohova D, Kunertova L, Marcekova M, Mello M. Assessment of the relation of the optic nerve to the posterior ethmoid and sphenoid sinuses by computed tomography. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153:149-52. [PMID: 19771141 DOI: 10.5507/bp.2009.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to observe the relationship of the sphenoid sinus and posterior ethmoid cells with the optic nerve. MATERIAL AND METHODS 34 CT scans (68 sides) of paranasal sinuses of patients older than 18 years were retrospectively reviewed. Images were assessed in two planes--axial and coronal. We observed the position and relationship of the optic nerve to the posterior ethmoid and sphenoid sinuses, bony dehiscence and protrusion of the optic nerve into sinuses, and pneumatization of the anterior clinoid process. RESULTS The most frequent position of optic nerve (ON) was a location close to the posterior ethmoid and sphenoid sinuses without contacting or indentation of the wall--55.9% (38 nerves). The bulging of ON to sphenoid sinus was found in 14.7% (10 nerves) and the course of the nerve through sinus in 16 nerves (23.5%). The position of ON intimately to both sinuses was observed in 5.9% (4 nerves). Protrusion of ON, dehiscence of the bony wall and pneumatization of anterior clinoid process (ACP) was seen in 12 (35.3%), 4 (11.8%) and 9 (26.5%) patients, respectively. Both the protrusion of ON and ACP pneumatization were present in 8 (23.5%) patients on the right side and in 5 (14.7%) patients on the left side. CONCLUSION Variations of posterior ethmoid and sphenoid sinuses are numerous and may entail potential risk of injury of the ON during sinus surgery. Knowledge of individual differences and configurations in the operation area may help the surgeon to prevent complications. Computed tomography is the preferred radiographic modality for evaluation of bony variations and the pathology of this region.
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Affiliation(s)
- Gabriela Heskova
- Jessenius Faculty of Medicine in Martin, Institute of Anatomy, Comenius University in Bratislava, Mala Hora STR. N. 4, Martin, 037 54, Slovakia.
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