Remarkable anatomic variations in paranasal sinus region and their clinical importance.
ABSTRACT 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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ABSTRACT: Coronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the "background" prevalence of these findings are needed to determine their clinical relevance. A detailed analysis of coronal plane CT scans of the paranasal sinuses obtained in 202 consecutively imaged patients was conducted. Special attention was directed toward identifying bony anatomic variations and mucosal abnormalities. Anatomic variations studied included pneumatization of the middle turbinate, paradoxical curvature of the middle turbinate, Haller's cells, and pneumatization of the uncinate process. Such bony anatomic variations were detected in 131 (64.9%) of 202 patients and were found with a similar frequency in patients scanned for sinus complaints and in those scanned for nonsinus reasons. Mucosal abnormalities were detected in 168 (83.2%) of 202 patients. For those patients scanned during the evaluation of sinus-like complaints, mucosal abnormalities were noted in 153 (92.2%) of 166 cases, and were predominantly detected in the anterior ethmoid region. For patients scanned during nonsinus evaluations, mucosal abnormalities were detected in 15 (41.7%) of 36 cases, without predilection for the anterior ethmoid region. Discussion regarding the prevalence and clinical significance of paranasal sinus bony anatomic variations and mucosal abnormalities is included as a guide to assist the otolaryngologist and/or radiologist in the evaluation of coronal sinus CT scans.The Laryngoscope 02/1991; 101(1 Pt 1):56-64. · 1.98 Impact Factor
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ABSTRACT: Normally, there are three pairs of nasal turbinates in the nasal cavity. Coronal computed tomographies of 253 cases of sinusitis were examined for the presence of additional turbinates and bilateral secondary middle turbinates were detected in two cases. Also, we describe another accessory turbinate, 'bifid inferior turbinate', in one of these cases. Existence of these accessory turbinates may occur during embryologic development of lateral nasal wall.European Journal of Radiology 10/1999; 31(3):174-6. · 2.51 Impact Factor
Article: Concha bullosa: CT evaluation.[show abstract] [hide abstract]
ABSTRACT: Aeration of the middle turbinate, termed "concha bullosa," is a common anatomical variant of intranasal anatomy. Of 320 patients evaluated for sinus disease with coronal CT, 34% had concha bullosa on at least one side. The overall incidence of inflammatory disease in the ostiomeatal complex in these symptomatic patients was not different between those with and without concha bullosa. However, there were many cases in which an abnormally large middle turbinate appeared to obstruct the ostiomeatal complex causing secondary infection of the ethmoid, frontal, and maxillary sinuses. Obstruction of drainage of the concha bullosa itself can lead to mucocele formation. Furthermore, the presence of a concha bullosa has important implications for the technique of endoscopic surgery used in the management of the sinus disease. The anatomy, pathophysiology, and CT findings in patients with concha bullosa are reviewed.Journal of Computer Assisted Tomography 01/1988; 12(5):778-84. · 1.58 Impact Factor