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ABSTRACT: This study aimed to investigate the anatomy of the intraorbital structures regarding to endoscopic sinus surgery and external frontal sinus surgery analyzing computer tomography (CT) scans.
The CT scans of 100 patients were retrospectively evaluated. The anatomic relationships between the intraorbital structures and paranasal structures were measured using multiplanar reconstruction of the CT scan.
The mean distances from the medial orbital floor (MOF) to the intraorbital structures were measured at the depth of the anterior ethmoid (AE), basal lamella (BL), and midportion of posterior ethmoid (PE) in the coronal planes respectively. The mean distances from the MOF to the medial rectus muscle and inferior rectus muscle at the depth of AE were approximately 8 mm and those distances in the BL and PE decreased rapidly. The mean distances from the MOF to the infraorbital nerve at the depth of the AE and BL were approximately more than 10 mm. The mean distances from the vertical axis, which passed through the MOF, to the superior oblique muscle and optic nerve at the depth of the PE were approximately 5 mm medially and 1 mm laterally. In addition, the mean distance from the midline to the trochlea of the superior oblique muscle was approximately 15 mm.
Those measurements provide spatial information on the placements of the extraocular muscles within the orbit. The measurements will contribute to the avoidance of orbital complications during sinus surgery.
Clinical and Experimental Otorhinolaryngology 03/2013; 6(1):23-9. · 0.92 Impact Factor
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ABSTRACT: PURPOSE: This study aimed to investigate the anatomy of the infraorbital foramen (IOF), infraorbital canal (IOC), and infraorbital groove (IOG) with regard to surgical and invasive procedures using three-dimensional reconstruction of CT scans. METHODS: The CT scans of 100 patients were evaluated retrospectively. The morphology of the IOF, IOC, and IOG as well as their relationships to different anatomic landmarks was assessed in a three-dimensional model. RESULTS: The mean length of the IOC and IOG and the angle of the IOC relative to IOG were 11.7 ± 1.9, 16.7 ± 2.4 mm, and 145.5° ± 8.5°, respectively. The mean angles of the IOC relative to vertical and horizontal planes were 13.2° ± 6.4° and 46.7° ± 7.6°, respectively. In the relationships between the IOF and different anatomic landmarks, the mean distances from the IOF to supraorbital notch/foramen, facial midline, and infraorbital rim were 5.6 ± 3.1 mm laterally, 26.5 ± 1.9 mm laterally, and 9.6 ± 1.7 mm inferiorly, respectively. The mean distance from the IOF to anterior nasal spine (ANS) was 35.0 ± 2.6 mm, and the mean angle of the axis that passed the IOF and ANS relative to horizontal plane was 28.8° ± 4.1°. In addition, the mean soft tissue thickness overlying the IOF was 11.4 ± 1.9 mm. CONCLUSIONS: These results provide detailed knowledge of the anatomical characteristics and clinical importance of the IOF. Such knowledge is of paramount importance for surgeons when performing maxillofacial surgery and regional block anesthesia.
Anatomia Clinica 02/2013; · 0.93 Impact Factor
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ABSTRACT: OBJECTIVES: Limited information is available regarding the characteristics of histiocytic necrotizing lymphadenitis (HNL) in children. This study compares the clinical and laboratory features as well as the immunohistochemical findings of HNL in children with those of adults. STUDY DESIGN: Retrospective analysis. METHODS: Thirty patients who underwent a biopsy of a cervical lymph node and were histologically proven to have HNL were enrolled in this study. There were 13 children and 17 adults. CD68, CD163 and myeloperoxidase expression were analyzed by immunohistochemical staining. RESULTS: Children had more bilateral lymphadenopathy (P=0.045) and a higher expression of CD68 (P=0.043) than did the adult patients. However, there was no significant difference between the groups in the following variables: patient gender, presence of fever, size and necrosis of enlarged lymph node, multiplicity of lymphadenopathy, WBC count, ESR, CRP, recurrence, and expression of myeloperoxidase and CD163. CONCLUSIONS: The clinical and immunohistological characteristics of HNL in pediatric patients are similar to those of adults. Bilateral involvement of lymph nodes and a high expression of CD68 were the only features significantly associated with children with HNL.
International journal of pediatric otorhinolaryngology 12/2012; · 0.85 Impact Factor
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ABSTRACT: Although the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB.
We enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images.
The relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups.
The middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.
Clinical and Experimental Otorhinolaryngology 12/2012; 5(4):213-7. · 0.92 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of this study was to investigate the relationship between the radial forearm free flap (RFFF) volume changes and speech and swallowing outcomes. METHODS: The study included 18 subjects with squamous cell carcinoma of the oral tongue. RESULTS: Average percentage changes in flap volume between 3 and 12months was 19.2%. Postoperative free flap volume changes were significantly and negatively correlated with the word and sentence intelligibility (Y=-0.338X+43.641, r(2)=0.383, p=0.006 and Y=-0.246X+34.322, r(2)=0.321, p=0.014, respectively). A significant positive correlation was also found between word and sentence intelligibility and floor of mouth resected, postoperative irradiation. Postoperative flap volume changes between 3 and 12months were correlated with reduced posterior bolus movement by tongue (p=0.002), reduced tongue base to posterior pharyngeal wall contact (p=0.002), reduced laryngeal elevation (p=0.005), increased aspiration (p=0.005), delayed oral (p=0.010) and pharyngeal transit time (p=0.011). Floor of mouth resected, tongue base resected, and postoperative irradiation also influenced the swallowing outcomes. CONCLUSIONS: This study shows that postoperative flap volume changes are significantly related to speech and swallowing outcomes in patients undergoing partial glossectomy reconstructed with RFFF.
Auris, nasus, larynx 08/2012; · 0.58 Impact Factor
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ABSTRACT: This study aimed to investigate the anatomy of the optic nerve (ON), extraocular muscles (EOMs), and paranasal structures with regard to an endoscopic endonasal approach to the orbit using multiplanar reconstruction of computed tomographic (CT) scans.
The CT scans of 125 patients were retrospectively evaluated. The anatomic relationships between the ON, EOMs, and medial orbital floor (MOF) were measured on a coronal plane using multiplanar reconstruction of the CT scan.
The mean distances from MOF to medial rectus (MR) and inferior rectus (IR) muscles and distance from MR to IR at the depth of the basal lamella (BL) and midportion of posterior ethmoid (PE) were measured on the coronal planes, respectively. The mean distances at the depth of PE were approximately less than 2 mm and half of those were at the depth of BL. The mean distances from ON to MOF, lamina papyracea, and EOMs at the depth of BL, PE, and sphenoid sinus anterior wall were measured, respectively. The distances from the ON to surrounding structures at the depth of PE were approximately half of those at the depth of BL and the distances from the ON to surrounding structures at the depth of sphenoid sinus anterior wall were less than 2 mm except the distance from the ON to MOF.
The MOF and EOMs could be the most important and safe anatomic landmarks for an endoscopic approach to the orbit. These results could be used as a reference to minimize ON and EOM injury.
The Journal of craniofacial surgery 07/2012; 23(4):966-9. · 0.81 Impact Factor
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ABSTRACT: The objective of this study was to investigate the feasibility of computerized segmentation of lymph nodes to evaluate the relationship of treatment outcomes in tuberculous cervical lymphadenitis (TCL).
The study included 52 subjects with TCL that had CT before standard medical treatment. The relationship between the medication treatment response, volume and ratio of necrotic area of the largest lymph node in patients with TCL was evaluated. The treatment outcome was defined as the 'responder' (n=35) and 'non-responder' (n=17) groups. Seventeen non-responder patients required surgery.
The average lymph node volumes and ratio of necrotic area were 58.59cm(3) (range, 4.96-249.48cm(3)) and 0.30 (range, 0-0.59), respectively. There was a significant difference in the lymph node volumes (34.91±24.00cm(3) vs. 107.04±69.12cm(3), p<0.001) and ratio of necrotic area (0.26±0.12 vs. 0.40±0.14, p=0.001) between responders and non-responders. The receiver-operating-characteristic (ROC) curve analysis was used for differentiating responders from non-responders; it showed that the area under the curve for the lymph node volumes and ratio of necrotic area was 0.845 and 0.759, respectively. The cut-off value for the lymph node volumes and ratio of necrotic area was 44.15cm(3) and 0.36 based on the ROC curve.
A large lymph node volume and high ratio of necrotic area on the 3D reconstruction of CT images were associated with the response to medical treatment for TB. These findings might be useful for assessing treatment outcomes.
Auris, nasus, larynx 08/2011; 39(4):402-6. · 0.58 Impact Factor
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ABSTRACT: The pterygopalatine fossa (PPF) is accessed via the greater palatine canal (GPC) in an attempt to reduce bleeding during paranasal sinus surgery. This study aims to investigate the anatomy of the greater palatine foramen (GPF), GPC, and the PPF, with reference to PPF infiltration using three-dimensional reconstruction of computer tomographic (CT) scan measurements. The CT scans of 50 patients were retrospectively evaluated. The morphology of the GPF, GPC, and the PPF was assessed in a three-dimensional model. The thickness of the mucosa over the GPF was evaluated in the parasagittal plane. The mean length of the GPC was 13.8 ± 2.0 mm, and the mean height of the PPF was 21.0 ± 3.4 mm. The mean angles of the GPC in relation to the hard palate and the PPF were 67.4° ± 6.9° and 159.8° ± 7.1°, respectively. The GPF was 16.2 ± 1.3 mm lateral to the sagittal plane of the posterior nasal spine (PNS) and 6.1 ± 1.7 mm anterior to the coronal plane of the PNS. The mean volume of the PPF was 1039.9 ± 280.0 mm(3) . The mean thickness of the mucosa overlying the GPF was 10.7 ± 1.8 mm. We recommend that the PNS may be used as the bony landmark to locate the position of the GPF during PPF infiltration. The needle delivering the anesthetic should be bent 25 mm from the tip at a 45° angle, and a 1-ml injection of anesthetic should be administered in adults.
Clinical Anatomy 03/2011; 24(5):576-82. · 1.29 Impact Factor
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ABSTRACT: The goal of this study was to evaluate changes in radial forearm free flap (RFFF) volumes after 5 years of follow-up after ablative tumor surgery in the head and neck. Eighteen patients underwent RFFF reconstruction. Flap volumes were measured by computerized segmentation of CT or MR images. Average postoperative 3 months, and 1, 3, and 5 years flap volumes were 167.4, 129.0, 104.9, and 88.7 cm³, respectively. Average percentage changes between 3 months and 1-year, 3 months and 3-years, and 3 months and 5-years scans were 20.4, 30.3, and 42.7%, respectively. A significant relation was found between postoperative irradiation and RFFF volume changes from 3 months to 5 years (p=0.046). Overcorrection with a 40% greater RFFF volume is recommended for the reconstruction of tumor-related defects in the head and neck.
Oral Oncology 01/2011; 47(1):72-5. · 2.86 Impact Factor
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ABSTRACT: The pterygopalatine fossa (PPF) can be entered endoscopically, but the endoscopic landmarks to localize the bony structures in the PPF are not well described. This study aimed to investigate the anatomy of the sphenopalatine foramen (SPF), vidian canal (VC), and foramen rotundum (FR) with regard to an endoscopic endonasal approach to the PPF using three-dimensional reconstruction of computed tomography (CT) scans.
The CT scans of 98 patients were retrospectively evaluated. The morphology of the SPF, VC, and FR as well as the spatial relationship between the SPF and VC were measured on a three-dimensional model.
The mean diameters of the SPF, VC, and FR were 5.3 ± 1.3 mm, 2.4 ± 0.7 mm, and 2.8 ± 0.5 mm, respectively. The mean distance between the VC and posteroinferior margin of SPF was 3.8 ± 1.0 mm. The mean vertical and horizontal distances on the surface plane of sphenoid bone between the VC and FR were 5.8 ± 1.9 mm and 8.5 ± 1.9 mm, respectively. The whole or partial margin of the VC was above the inferior margin of the SPF in 92% (180/196) of the VC and lateral to the posterior margin of the SPF in 98% (195/196) of the VC. The distance between the VC and SPF had a positive correlation with the distances between the VC and FR.
The endoscopic endonasal approach to the PPF will be performed with greater accuracy and safety through comprehension of the spatial relationships between the SPF, VC, and FR.
American Journal of Rhinology and Allergy 25(5):346-50.
