Background: Studies evaluating the mean volumes of nasal cavity and concha
are very rare. Since there is little date on the mentioned topic, we aimed to
carry out the presented study to obtain a volumetric index showing the relation
between the nasal cavity and concha.
Material and methods: The volumes of the nasal cavity and concha were
measured in 30 males and 30 females (18&#8211;40 years old) on computed tomography
images using stereological methods.
Results: The mean volumes of nasal cavity, concha nasalis media, and concha
nasalis inferior were 5.95 &#177; 0.10 cm3, 0.56 &#177; 0.22 cm3, and 1.45 &#177; 0.68 cm3;
7.01 &#177; 0.18 cm3, 0.67 &#177; 0.31 cm3 and 1.59 &#177; 0.98 cm3 in females and males,
respectively. There were statistically significant differences in the volume of the
nasal cavity and concha nasalis media (p < 0.05) between males and females,
except for concha nasalis inferior (p > 0.05).
Conclusions: Our results could provide volumetric indexes for the nasal cavity
and concha, which could help the physician to manage surgical procedures
related to the nasal cavity and concha

Bilgic, S.

Celebi, M.

Emirzeoglu, M.

Sahin, B.

Tontus, H.O.

Uzun, A.

English

Via Medica Journals

Folia Morphol. Vol. 71, No. 2, pp. 105–108Copyright © 2012 Via MedicaISSN 0015–5659www.fm.viamedica.plO R I G I N A L   A R T I C L E105Address for correspondence: Prof. M. Emirzeoglu, Anatomy Department, Medical Faculty, Ondokuz Mayis University, Samsun, OndokuzMayis Uni. TIP FAK, Atakum, 55000 Samsun, Turkey, e-mail: memirze@omu.edu.trEstimation of nasal cavity and conchaevolumes by stereological methodM. Emirzeoglu1, B. Sahin1, M. Celebi2, A. Uzun1, S. Bilgic1, H.O. Tontus31Anatomy Department, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey2ENT Department, Mehmet Aydin Research Hospital, Samsun, Turkey3Medical Education Department, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey[Received 16 February 2012; Accepted 23 February 2012]Background: Studies evaluating the mean volumes of nasal cavity and conchaare very rare. Since there is little date on the mentioned topic, we aimed tocarry out the presented study to obtain a volumetric index showing the relationbetween the nasal cavity and concha.Material and methods: The volumes of the nasal cavity and concha weremeasured in 30 males and 30 females (18–40 years old) on computed tomo-graphy images using stereological methods.Results: The mean volumes of nasal cavity, concha nasalis media, and conchanasalis inferior were 5.95 ± 0.10 cm3, 0.56 ± 0.22 cm3, and 1.45 ± 0.68 cm3;7.01 ± 0.18 cm3, 0.67 ± 0.31 cm3 and 1.59 ± 0.98 cm3 in females and males,respectively. There were statistically significant differences in the volume of thenasal cavity and concha nasalis media (p < 0.05) between males and females,except for concha nasalis inferior (p > 0.05).Conclusions: Our results could provide volumetric indexes for the nasal cavityand concha, which could help the physician to manage surgical proceduresrelated to the nasal cavity and concha. (Folia Morphol 2012; 71, 2: 105–108)Key words: stereology, nasal cavity, volumeINTRODUCTIONNasal cavity is the first part of the respiratorytract. It not only moisturises, cleans and adjuststhe temperature of the air inhaled, but it also servesthe smell function. Thanks to these features, it helpsus to adjust ourselves to the environment. The dy-namic execution of these functions by the nasalcavity depends heavily on the structure of the con-chae adherent to the exterior wall of the cavity. Con-chae have a dynamic structure. This enables themto adjust the flow rate and volume of the air in-haled. Conchae increase the surface area that theair comes into contact with to achieve this func-tion. The middle and inferior nasal conchae areimportant points in the exterior nasal wall. Theformer forms the medial wall of the ethmoid cham-bers. This area is of crucial importance for endo-scopic sinus surgery. Clinicians have encounterednumerous variations of the medial concha. How-ever, previous studies conducted on medial con-chae focused on size and structure [9].Nasal obstruction is known to be a common com-plaint of people with a long history, and studies havebeen conducted to determine an ideal treatment.Potential complications of the treatment techniquesapplied are still on the agenda [12].Hypertrophy of inferior nasal concha is oneof the causes of nasal air passage obstruction.The most common causes for hypertrophy includelong-term septal deviation and allergy and nasal106Folia Morphol., 2012, Vol. 71, No. 2mucosal diseases such as vasomotor rhinitis [5].Age-related changes of nasal cavity structureshould be determined before planning medicalor surgical treatment modalities. These changesprobably lead medical professionals to choosedifferent options when managing their patients’symptoms or diseases [6]. Although many re-searchers have studied the anatomy of the la-teral nasal wall “to resolve the problem of pa-tients with nasal air passage obstruction”, wecould not find any study specifically addressingthe volume of the nasal cavity, middle nasal con-cha, and inferior nasal concha [7, 8, 13, 14].The volumes of the mentioned structures canbe calculated with cross sectional tomographyimages by using the stereological method (SM).There is no published study about calculatingthe volumes of the nasal cavity and conchaeusing computed tomography (CT) images andSM. In this study, we aimed to calculate thenasal cavity and conchae volumes using CT ima-ges and SM.MATERIAL AND METHODSThis study was conducted on the CT ima-ges of 60 volunteers (30 male, 30 female). CTimages of nasal cavities and conchae were ob-tained by coronal cross sections. From vesti-bulum nasi to choanae, CT images with 3-mmcross section thickness were used to collect thevolunteers’ image data. The images were print-ed onto X-ray films, which were placed ontoa negatoscope. Point counting grids (d = 0.25//1.25 and d = 0.3/1.5 cm) of 1/4 proportion were ran-domly allocated onto CT image printouts in order tocalculate the nasal cavity and conchae volumes. First-ly, the point counting grid was randomly located ontosections. Then we counted how many points werefound within the region of interest, and we kepta record of how many points hit each section. Finally,the results are used to compute the volumes. All theintersections of the nasal cavity, including the spotsin circles found on the point counting grid, and theconchae were counted. Afterwards, we counted theintersections between the spots, whether in circlesor not, and the conchae (Fig. 1). The number of thespots counted was put in the following formula tocalculate the volume of the nasal cavity and those ofthe conchae.V = t × [((SU)×d)/SL]2 × SPIn this formula, (t) stands for the mean cross sec-tional thickness, (SU) the length represented by the scaleshowing image magnification, (d) the distance betweentwo spots on the point counting grid, (SL) the lengthof the scale on the image measured either by a ruler ora calliper, and (SP) the total number of spots of thestructure in question on cross sectional surface area.Superior nasal concha volume estimation is exclud-ed from this study because it is not possible to distin-guish it on the cross sectional images. The volumes ofthe nasal cavity and inferior and middle nasal conchaewere calculated for the right and left parts separately.Microsoft Excel® was used for the calculations. The num-ber of spots and related data were entered and vo-lumes were automatically calculated.Figure 1. Magnetic resonance image of the nasal cavity and the conchae shaded with point grid.107M. Emirzeoglu et al., Estimation of nasal cavity volumesresearchers have indicated that hypertrophy of in-ferior conchae is the cause of the nasal obstructionin 20% of cases [1].Many studies have been conducted on the struc-ture, function, and volume of the nasal cavity [5].One of the methods recently used in calculating thevolume of the nasal cavity is acoustic rhinometry.Although acoustic rhinometry is reported to be anRESULTSTable 1 represents the mean volumes of the nasalcavity and the conchae in male and female volun-teers. The nasal cavities of the males were larger thanthose of the females (p < 0.001). The volume of themiddle nasal concha was also larger in males com-pared with females (p < 0.01). On the other hand,there was no significant difference between the maleand the female inferior nasal concha volumes (p > 0.05).Also, there was no significant difference between thetwo genders with regard to right and left nasal cav-ity and the conchae volumes (p > 0.05).The correlation values of the nasal cavity andthe conchae are given in Figures 2–4. These va-lues indicate high correlation values between thenasal cavity and the conchae and the conchaethemselves.DISCUSSIONNasal cavity is the entrance point of the respira-tory system and olfactory tracts. Many clinicians havebeen interested in this region’s anatomical structure,structural changes, mucosal diseases, and otherpathological and physiological changes because ofthe great importance in regard of upper and lowerrespiratory diseases.One of the main causes of chronic nasal obstruc-tion is turbinate (conchae) hypertrophy. The aimof medical and surgical treatments of turbinate hy-pertrophy is to decrease the volume of the con-chae. Medical professionals have applied severaltechniques in order to eliminate the nasal obstruc-tion. The ideal technique is to achieve volumetricreductions of the conchae volumes without inter-rupting the normal function [2]. In many studiesTable 1. Mean nasal cavity and conchae volumes inmales and femalesMin–Max Mean ± SDNasal cavity in females 4.13–8.10 5.95 ± 0.10Middle nasal concha 0.25–1.03 0.56 ± 0.02in femalesInferior nasal concha 0.41–2.94 1.45 ± 0.07in femalesNasal cavity in males 4.10–12.71 7.61 ± 0.18Middle nasal concha 0.22–1.29 0.67 ± 0.03in malesInferior nasal concha 0.59–3.94 1.59 ± 0.09in malesFigure 3. The relationship between the volume of the nasal cavityand that of the inferior nasal concha.Figure 2. The relationship between the volume of the nasal cavityand that of the middle nasal concha.Figure 4. The volume of the middle nasal concha and inferiornasal concha.108Folia Morphol., 2012, Vol. 71, No. 2effective method for predicting the volume of thenasal cavity, it is insufficient for estimating the vo-lume of the posterior part of the nasal cavity [4, 10].The Cavalieri method is the one of the modern ste-reological methods enabling secure and effective eva-luation of the organs and the volumes of the struc-tures. In this method, the two-dimensional imagesacquired with CT and/or magnetic resonance are usedfor three-dimensional volume calculation. The volumecalculation can be made with the software of the CT(or magnetic resonance) device that is used to acquirethe image. However, in the Cavalieri method, pointgrid scales are used to calculate the volumes in rou-tine image series. Point grid scales can also be helpfulfor on-screen studies. This method is an important toolfor prospective and retrospective studies [3, 11].In this study, we calculated the volumes of the nasalcavities and each of the conchae with both the CT tech-nique and the Cavalieri method. According to the dataobtained, there was no significant difference in sizebetween the right and left parts of the nasal cavityand the conchae. As expected, the nasal cavity waslarger in men than women. Conversely, there was nosignificant difference between the volumes of the mid-dle nasal concha, which had not been expected.This study revealed that the volumes of the nasalcavity and the conchae can be calculated on routinecoronal CT images without any additional costs. Thevolume of the studied structure can be calculated inminutes with point grid scales placed on the printedimages. Moreover, we believe that the data obtainedin this study can help clinicians in the evaluation andplanning of treatment of pathological cases.REFERENCES1. Cavaliere M, Mottola G, Lemma M (2005) Comparisonof the effectiveness and safety of radiofrequencyturbinoplasty and traditional surgical technique in treat-ment of inferior turbinate hypertrophy. OtolatyngolHead Neck Surg, 133: 972–978.2. Cavaliere M, Mottola G, Lemma M (2007) Monopolarand bipolar radiofrequency thermal ablation of inferi-or turbinates:20-month follow-up. Otolaryngol HeadNeck Surg, 137: 256–263.3. Emirzeoglu M, Sahin B, Selcuk MB, Kaplan S (2005)The effects of section thickness on the estimation oflive volume by the Cavalieri principle using computedtomograhpy images. Eur J Radiol, 56: 391–397.4. Kalmovich LM, Elad D, Zaretsky U, Adunsky A, Chetrit A,Sadetzki S, Segal S, Wolf M (2005) Endonasal geome-try changes in elderly people: acoustic rhinometry mea-surements. J Gerontol, 60A: 396–398.5. Kasev KL, Nelson BP, Robert WR, Robert JT, Christian G(1998) Radiofrequency volumetric tissue reduction fortreatment of turbinate hypertrophy: a pilot study. 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Estimation of nasal cavity and conchae volumes by stereological method

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Estimation of nasal cavity and conchae volumes by stereological method

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