Ethmoid roof morphometric measurements of a pediatric population using computed tomography

The Morphometric Analysis of the Ethmoid Roof for Endoscopic Sinus Surgery With Multidetector Computed Tomography

Most potential major complications in endoscopic sinus surgery are related to the ethmoid bone. To prevent complications, it is necessary to define the concept of a "dangerous ethmoid." The coronal multidetector computed tomography (MDCT) scans of a total of 271 patients, including 101 patients under 18 years old and 170 patients over 18 years old, were examined. For each patient, the depth of the olfactory fossa (DOF), the width of the olfactory fossa (WOF), the angle between the lateral lamella and the cribriform plate (LLCPA), the length of the lateral lamella (LLL), the distance between the nasal floor and the ethmoid roof (NFERL), and the width of the olfactory cleft (WOC) were recorded. The Keros and Gera types were determined. NFERL was found to be significantly higher in males across all age groups. WOC was significantly higher in males only under 18 years old. Only LLCPA was found to be significantly higher on the right side in both sexes. It was determined that NFERL increased with age, while WOC increased with age until 18. Keros type III and Gera type C, which are called dangerous types, were detected in 28 and 24 cases in total, respectively. The data obtained from significant anatomical landmarks in pediatric and adult cases provide useful information about the region in preoperative planning. The analysis results of the prevalence of Keros and Gera classifications allow the identification of high-risk anatomical conditions within the ethmoid.

Correlation of maximal nasal septal deviation with deviation at the maxillary insertion

PURPOSE

It is unclear if septal deviation at the insertion points to the nasal cavity is associated with the overall septal deviation. This study aimed to assess septal deviation at the cribriform plate (CP) and maxillary crest (MC) using CT scans and to see if there was any correlation with overall septal deviation.

METHODS

All consecutive CT sinus scans between January 2020 and December 2021 were retrospectively reviewed. Patients were excluded if they had a history of head, nasal or facial trauma, or any previous nasal surgical procedure. Angles between the septum and MC and the septum and CP as well as maximal angle of septal deviation (MSD) were measured.

RESULTS

A total of 70 scans were included in the final analysis. The mean MSD was 8.14°. The mean septal deviation was 0.89° at the CP and 2.02° at the MC. The correlation coefficient between the deviation at the CP and MSD was 0.025 and between the deviation at the MC and MSD was 0.321.

CONCLUSION

Our data reveal a positive correlation between septal deviation at the floor of the nose and overall septal deviation; this was not observed at the septal deviation at the roof. This could be explained due to the inherent tilt in the cribriform plate or by earlier ossification and fixation of the septum during its development at its insertion to the roof, thereby allowing further growth and potential for deviation of the lower part of the septum and its insertion to the floor.