Remarkable anatomic variations in paranasal sinus region and their clinical importance

Ataturk University, Kalikala, 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.

Download full-text


Available from: Adem Karaman, Nov 02, 2015
  • Source
    • "A concha bullosa is generally defined as the pneumatization of the middle turbinate [2] [3]. However, superior and inferior concha bullosa are also encountered, these being pneumatizations of the superior and inferior turbinates , respectively [3] [4] [5] [6] [7]. This is the reason why concha bullosa is better defined as " the presence of air cells in turbinates " [8]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Multiple anatomical variants were encountered during a cone beam computed tomography (CBCT) study of the nasal cavity of a 43-year-old male patient. These were mostly related to the nasal turbinates, suggestive for an unusual development of ethmoturbinals. Pneumatized turbinates were observed: bilateral supreme, superior, and middle concha bullosa. There were bilateral paradoxically curved superior turbinates, as well as a unilateral paradoxically curved inferior turbinate. There was also found a unilateral accessory middle turbinate, presenting as a medially bent uncinate process. Due to the presence of the Santorini's concha, the natural ostium of the sphenoidal sinus was medial to it, and was not directly related to the superior turbinate. Such variants, alone or in combination, should be documented prior to surgical procedures, endoscopic or microscopic, by rhinologists and neurosurgeons, prior to various sinonasal or skull base approaches. Patients should be evaluated on a case-by-case basis, as the Vesalian anatomy could not apply to all.
    Full-text · Article · Dec 2015 · Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jul 2015 · The Open Dentistry Journal
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jun 2013 · International Journal of Morphology
Show more