Remarkable anatomic variations in paranasal sinus region and their clinical importance

Department of Radiology, Medical School, Atatürk University, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum, Turkey.
European Journal of Radiology (Impact Factor: 2.37). 07/2004; 50(3):296-302. DOI: 10.1016/j.ejrad.2003.08.012
Source: PubMed


With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed 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 preoperative work-up. To be in the known anatomical variants with some accompanying pathologies, directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. A review of 512 (1024 sides) paranasal sinus tomographic scans was carried out to expose remarkable anatomic variations of this region. We used only coronal sections, but for some cases to clear exact diagnosis, additional axial CT scan, magnetic resonance imaging (MRI) and nasal endoscopy were also performed. In this pictorial essay, rates of remarkable anatomic variations in paranasal region were displayed. The images of some interesting cases were illustrated, such as the Onodi cell in which isolated mucocele caused loss of visual acuity, agger nasi cell, Haller's cell, uncinate bulla, giant superior concha bullosa, inferior concha bullosa, bilateral carotid artery protrusion into sphenoid sinus, maxillary sinus agenesis, bilateral secondary middle turbinate (SMT) and sphenomaxillary plate. The clinical importance of all these variations were discussed under the light of the literature. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in the preoperative evaluation.

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Available from: Adem Karaman, Nov 02, 2015
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    • "Collet S, et al. reported a literature review that cannot establish a definite role to the nasal septum neither as the pathogenesis of chronic sinusitis nor as a contributing factor [13]. In our study, we selected these three anatomic variations because they commonly studied for their influence on alteration in maxillary sinus [6] [8]. "
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    ABSTRACT: Purpose: Maxillary sinus's inferior pneumatization is a physiological process, which increase with time and accelerates following extraction. The aim of this study was to determine the prevalence of nasal septal deviation (NSD), concha bullosa (CB), and Haller's cells (HC) and to examine the correlation of maxillary sinus inferior pneumatization (MSIP) with these anatomical variations. Material and Methods : 300 (150 m, 150 f) CBCT scans taken at the Marmara University School of Dentistry from 2011 to 2014 were retrospectively reviewed for the presence of CB, NSD, HC and MSIP. The correlation between pneumatization to the anatomic variants was then compared. Data were analyzed with a Chi-square test. Results : Of the 300 CBCT scans, 44.3% have CB, 37.3% NSD, 19.3% HC and 27.7% MSIP. There was no statistical significancewhen comparing the relationship of patients with CB, NSD, HC and pneumatization. Conclusion : NSD, CB and HC do not have a definite role on sinus's inferior pneumatization. Further studies should be conducted including potential factors related pneumatization with more sample size for further correlation with NSD, CB,HC.
    The Open Dentistry Journal 07/2015; 9(Suppl 2: M5):282-286. DOI:10.2174/1874210601509010282
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    • "The nasal septum is easily identified on both axial and coronal CT (Laine & Smoker). It is impossible to differentiate the pneumatisation and hypertrophy of the INC without CT (Kantarci et al., 2004; Yang et al.; Dogru et al.; Aydin et al.). CB and SD are frequently present together and there is a relationship between these two issues (Stallman et al., 2004; Keles et al., 2010; Lloyd, 1990; Zinreich et al., 1988; Bolger et al.; 1991; Uygur et al., 2003; Blaugrund, 1989). "
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    ABSTRACT: The objective of this study was to evaluate the relationship between variations of the lateral wall of the nasal cavity and septal deviation (SD). Coronal and axial paranasal sinus CT images of 115 individuals (65 females, 50 males) were reviewed and the presence of pneumatisation and hypertrophy of the conchae was evaluated. Pneumatisation of the concha was classified as lamellar concha bullosa (LCB), bulbous concha bullosa (BCB), or extensive concha bullosa (ECB). If bulbous and extensive conchae and hypertrophic conchae were bilateral the side on which it was greatest was accepted as the dominant concha. The relationship between these variations and nasal septum deviation was also taken into account. Eighty-six (74.8%) of the 115 subjects had SD. Of these, 20 were not affected by the size of the middle nasal concha (MNC) or inferior nasal concha (INC). Thirty-four cases had dominant MNC, 20 had dominant INC, and 11 had both dominant MNC and dominant INC, and all of which had SD towards the opposite side. In one case there was SD towards the side in which the MNC was dominant. Our data indicate that coexistence of pneumatisation or hypertrophy of the conchae and SD was more common in adults compared to the results of similar studies conducted with a wide range of age groups, including children. Thus the presence of SD together with a large concha increases with age. A prospective study, which will include infants, will elucidate the relationship between conchae and SD.
    International Journal of Morphology 06/2013; 31(2):438-443. DOI:10.4067/S0717-95022013000200012 · 0.32 Impact Factor
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    • "However, there is controversy regarding the incidence of this variation and more importantly the clinical symptoms associated with it. It has been estimated that the incidence of secondary middle turbinate ranges from 0.8% to 14.3% (Khanobthamchai et al., 1991a; Aykut et al., 1994; Kantarci et al., 2004; Ozcan et al., 2008). This is a bony structure covered by mucosa and originating from the lateral wall of the middle meatus as illustrated in Figure 1C. "
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    ABSTRACT: The aim of the current anatomical and clinical study was to audit our cases of patients who presented with secondary and/or accessory middle turbinates during a two-year period. We investigated the incidence and the clinical impact of these variations. Twenty-eight patients, 19 males and 9 females with a mean age of 41.5 years, representing different ethnic origins, were diagnosed with double middle turbinates based on endoscopic examination. Of those, 92.8% had a main symptom of refractory frontal headache. A secondary nasal symptom was sensation of blocked nose. Patients who underwent endoscopic surgery (n = 13) for reduction of the extra turbinate, reported significant symptom scores improvement (P < 0.0001) of frontal headache and blocked nose, from means of 9.07 ± 0.26 and 8.57 ± 1.39 to 1 ± 0.31, and 1.42 ± 0.35, respectively. Our results indicate that double middle turbinates may be encountered in rhinology practice (2%). Clinically they may present with refractory headache and blocked nose. Endoscopic surgical approach seems to be an effective way of improving the symptoms.
    Clinical Anatomy 04/2012; 25(3):340-6. DOI:10.1002/ca.21208 · 1.33 Impact Factor
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