Anatomical variations of nasal and paranasal sinuses among Sudanese patients undergoing CT scan evaluation at Antalya Diagnostic Center – Khartoum – Sudan, 2017

Introduction: The anatomical variations of the paranasal sinus are common among populations. These variations are asymptomatic most of the time, yet it may be associated with some inflammatory or allergic conditions. Knowledge of these anatomic variations helps in choosing the operative techniques, reducing the surgical complication rates and explains recurrence of disease. Objective: The aim of this study was to investigate the incidence and type of the anatomical variations of the paranasal sinus among adult Sudanese population by using CT scan. Patients and Method: This is a retrospective descriptive and health facility-based study, conducted at Antalya Diagnostic Center, Khartoum, during the period from July to September 2017. Included in the study all patients referred to the center for CT scan of the sinuses (n=151). A simple random technique was used for anatomical variations; with a sample size of 76 patients. Data collection sheet was used included demographic data and the anatomical variations. Data was analyzed using SPSS version 22. Results: The total number of patients diagnosed with variations was 76, which constituted of 50.3% of all patients included in the study. The age of patients ranged between 16 to 65 years, with a mean age of 36.46 (±11.12SD) years. The most frequent age groups were (16 to 25) and (26 to 35) years which constituted (52.63%) of the patients. Males were 34 (44.7%) and females were 42 (55.3%), with a male to female ratio 1:1.23. Relationship between age and gender with anatomical variants was found not statistically significant. Ninety variations were detected among the study sample. Nasal septal deviation was the commonest variation observed in (26.7%), followed by Concha bullosa in (20%), Onodi Cells in (11.1%), Agger nasi in  (10%), frontal sinus hypoplasia in  (10%) and other variations in ( 22.2%) of cases. Most of the variants were unilateral (81.6%) and were more on the left side in (46.1%) of cases. Conclusions and recommendations: the commonest variation was Nasal septal deviation, variations were common among the age group 16 to 35 years with slight female predominance. The study emphasizes the importance of CT scan for the detection of anatomical variations of the paranasal sinus in every patients planned for nasal or sinus surgery

Setting of an endoscopic nasal reference point for surgical access to the anterior base through an anatomical study on cadavers

AbstractIntroductionDiseases of paranasal sinuses, nasal cavity, and skull base can be treated by endonasal operations using a nasal rigid endoscope. When conducting this kind of surgery, anatomical references are critical for safety.ObjectiveTo measure the distance from the posterior wall of the maxillary sinus to the skull base, according to socio-demographic characteristics, and to detail an anatomical reference point for paranasal sinus operations and for an access to the anterior skull base, comparing anatomical variations between right and left sides, gender, height, weight, age, and ethnicity in cadavers.MethodsMeasures were taken from the 90° angle (the starting point where deflection of the skull base begins to form the anterior wall of the sphenoid, also known as Δ90°) to the upper, middle, and lower points of the posterior wall of the maxillary sinus. This study used 60 cadavers aged over 17 years, and evaluated these bodies with respect to age, height, BMI, weight, gender, and ethnicity, comparing measurements of right and left sides.ResultsThe measurements were >1.5cm in all cadavers and did not vary with age, height, weight, gender, and ethnicity on their right and left sides. The lack of association between the measurement from Δ90° to the upper, middle, and lower posterior walls of the maxillary sinus (categorical or quantitative) is noteworthy, considering the characteristics studied.ConclusionThe methodology defined the nasal point of reference, considering an absence of variation in the cadavers’ characteristics

Protrusion of the carotid canal into the sphenoid sinuses: evaluation before endonasal endoscopic sinus surgery

Background: Many reports have previously indicated the vast number of anatomical variations of the sphenoid sinuses, e.g. presence of the recesses. Notwithstanding, there are a few crucial neurovascular structures directly neighbouring with the sinuses. The following research aimed to evaluate frequency prevalence of the carotid canal’s protrusion into the sphenoid sinuses in adult population.Materials and methods: Computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females, 149 males) were analysed in this retrospective study. The patients did not present any pathology in the sinuses. Spiral CT scanner Siemens Somatom Sensation 16 was used in the standard procedure in the option Siemens CARE Dose 4D.Results: Protrusion of the carotid canal was found in the majority of the patients — 55.74%, more frequently in males (65.1% of the patients) than in females (46.26% of the patients). The said variant — regardless of gender — was noted more often bilaterally (41.55% of the cases: 29.93% females, 53.02% males) than unilaterally (14.19% of the cases: 16.33% females, 12.08% males). In the unilateral type (regardless of gender), the protrusion was more common for the left sphenoid sinus — 10.81% of the patients (12.24% females, 9.4% males) than for the right — 3.38% of the patients (4.08% females, 2.68% males).Conclusions: Complicated structure of the paranasal sinuses, derived from the high prevalence of their anatomical variations, may perplex routine surgical interventions. Henceforth, referral for a CT scan is imperative in order to abate the risks associated with an invasive procedure in the said region

Determination the effect of nasal septum deviation with pneumatization of mastoid cells and its Its feasible relationship with chronic otitis media using computed tomography (CT) scan

BACKGROUND: The nasal septum deviation is the most common deformity of the nasal, and that can be congenital or acquired. Despite many studies exist about the impact of nasal septum deviation on chronic sinusitis and also association between chronic otitis and mastoid pneumatization; few studies exist about the impact of nasal septum deviation on chronic otitis and mastoid pneumatization. AIM: The aim of this study was to evaluate the associations of nasal septum deviation and mastoid pneumatization and chronic otitis. METHODS: In this study review, all CT scans of PNS and Mastoid View in the imaging section from Imam Ali hospital in 2016-2017 years and cases of nasal septum deviation were enrolled. The nasal septum deviation was recorded, and the degree of nasal septum deviation in the coronal plane that showed the maximum deviation of the nasal septum was recorded. The volume of the mastoid cells automatically and directly was calculated using three diameter measurements (2 coronal diameters and 1 axial diameter) by the program. The software of SPSS 22 was used for statistical analysis. RESULTS: There was no relationship between nasal septum deviation severity and incidence of mastoid pneumatization in patients with nasal septum deviation (P > 0.05). There was relationship between nasal septum deviation severity and chronic otitis in patients with nasal septum deviation (P < 0.05). In patients with moderate and severe intensity of nasal septum deviation, the volume of mastoid air cells in deviation side was lower than the front side (P < 0.05). CONCLUSION: Based on the results of the CT scan, in patients with moderate and severe nasal septum deviation intensity, the volume of mastoid air cells in deviation side was lower than the front side. Also, there was a relationship between nasal septum deviation severity and chronic otitis

Paranasal Sinuses Anatomy and Conditions

This book discusses selected topics on the anatomy of paranasal sinuses and related conditions, providing insight into advancements in the field. The first section covers morphological aspects of the maxillary sinus, infectious causes of acute and chronic sinusitis, posterior ethmoidal artery, and paranasal sinuses anatomy and anatomical variations. The second section covers sinonasal-associated midfacial expansion and maxillary sinus in dental implantology. Chapters present new clinical and research developments as well as future perspectives on ever-expanding upper airway and jaw problems

Relation between Metopic Suture Persistence and Frontal Sinus Development

The frontal bone develops as two halves, which further unite in a single bone by the closure of the mid-sagittal metopic suture, typically by the end of the first postnatal year. The frontal sinus begins to expand into the orbital and vertical plates of the frontal bone postnatally and reaches the level of the nasion by the fourth year of age. At this time, the metopic suture is usually entirely closed. However, in the cases of failed closure of the metopic suture, its relationship to the frontal sinus development is still obscure. Here, we review the relevant literature and discuss the frontal bone development and maturation, from the viewpoint of the frontal sinus pneumatization in relation to the metopic craniosynostosis and failed closure of the metopic suture. The peculiar to the metopic skulls frontal bone configuration is rather an expression of the underlying neural mass demands than a consequence of the metopic suture persistence. Furthermore, the persistent metopic suture is frequently associated with a frontal sinus underdevelopment. It seems that the metopic suture does not inhibit the frontal sinus pneumatization itself, but rather both traits are an expression or an aftereffect of a certain condition during the early development

Dimensional relationship between maxillary sinuses, frontal sinusess, and craniofacial parameters using CT in Hospital Universiti Sains Malaysia

The importance of paranasal sinuses cannot be denied as they have close relationships with vital organs such as the brain, eye, nose, and mouth. They grow deep within several facial skeletons and play many functions, such as increasing the voice resonance and acting as a crumpling zone in case of facial trauma skeletons. Nowadays, the advanced medical images database, such as the CT scan database facilitates the study of the paranasal sinuses and their relationships with other structures. Therefore, this study aimed to investigate the correlation between the maxillary and frontal sinuses dimensions and craniofacial parameters in CT scan and to identify the differences between gender in these structures. This was performed by using the head CT scan images, retrospectively analyzed from the database accessible in the Hospital Universiti Sains Malaysia. There were 120 subjects, which consisted of 60 males and 60 females. These subjects were divided into three groups; the first group with age between 5 to 10 years old, the second group, between 11 to 20 years old and the third group, between 21 till 40 years old. The measurements of maxillary sinus dimensions, frontal sinus dimensions and craniofacial parameters on the CT images were obtained by using computer software. The result of this study showed a statistically significant correlation between maxillary dimensions with all craniofacial parameters observed within the age of 5 to 10 years old. This correlation lasted till age 20 but became weak between age 21 till 40 years old. Also, there was a significant correlation between midfacial parameters with frontal sinuses dimensions. This correlation was more significant with the nasal structure. The correlation between maxillary and frontal sinuses dimensions was not significant. On the other hand, gender determination showed significant results towards the maxillary sinus, frontal sinus and midfacial structures. In conclusion, dimensional correlations exist between the maxillary and frontal sinuses with craniomaxillofacial parameters. These correlations constantly change with ageing. Also, this study showed significant variations between males and females in the maxillary sinus, frontal sinus and midfacial parameters

Rhinosinusitis

This book highlights five different sections of rhinosinusitis, namely allergic rhinitis, sinusitis, dental-related sinusitis, one airway disease, and surgical techniques in sino-nasal diseases. It incorporates new clinical and research developments as well as future perspectives in the ever-expanding upper and lower airway problems. I dedicate this book to those who provide continued research, high-quality clinical observations, and care, as well as selfless teaching and publications to advance knowledge in airway problems. ENT surgeons, rhinologists, allergologists, immunologists, pulmonologists, postgraduates, researches, trainees, and general practitioners with special interest in one airway disease will find this book useful and interesting

Pneumatization of the sphenoid sinus, dorsum sellae and posterior clinoid processes in computed tomography

Purpose: Assessment of sphenoid sinus (SS), posterior clinoid process (PCP), and dorsum sellae (DS) pneumatisation is significant when planning surgical approaches both to intra- and extrasellar pathologies. The authors analysed pneumatisation of the SS, with particular attention paid to pneumatisation of the PCP and DS. Material and methods: The study was based on 100 computed tomography angiography examinations. SS, PCP, and DS pneumatisation grades were assessed using the classification system proposed by Hardy. The analyses were conducted in sagittal planes: midline plane (MP), sagittal posterior clinoid plane right (SPCP-R), and sagittal posterior clinoid plane left (SPCP-L). The occurrence of the highest pneumatisation grade (IVB according to Hardy), which encompasses DS and PCP, prompted the authors to conduct a further analysis in the coronal plane. In this way, seven DS and PCP pneumatisation symmetry types were identified. Results: In the MP and SPCP-R, the most frequent pneumatisation grade was grade III (41% and 38%, respectively). In the SPCP-L, grade IVA prevailed (41%). Grade IVB was found in 12% of the SPCP-R images, 10% of the SPCP-L images, and in 12% of the MP images. Consistent pneumatisation grades in all analysed planes were found for 64% of cases. This was usually grade III noted in 28% of cases. Conclusions: SS pneumatisation is characterised by considerable individual variability. There are a number of SS pneumatisation classification systems, but the system proposed by Hardy is the most useful for assessment of DS and PCP pneumatisation. Grade III of SS pneumatisation is the most common. Pneumatisation encompassing DS and PCP was found in 10-12% of cases