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Greening VA, Hernandez E, Mongle CS, Billings BK, Mngomezulu V, Wallace IJ, Grine FE. Variation, sexual dimorphism, and enlargement of the frontal sinus with age in adult South Africans. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:e24899. [PMID: 38269496 DOI: 10.1002/ajpa.24899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To document frontal sinus volume (FSV) in a sample of sub-Saharan Africans with a view to evaluating claims that such populations exhibit comparatively small sinuses. This study also addresses questions related to sexual dimorphism, incidence of sinus aplasia, and the possibility that FSV continues to increase through adulthood. MATERIALS AND METHODS FSV was measured from CT scans of adult crania from the Dart Collection. Sex and age were known for each individual. Linear cranial dimensions were used to compute a geometric mean from which a scaled FSV was computed for each cranium. RESULTS FSV does not differ significantly between sexes, but females exhibit a higher incidence of aplasia. There is considerable variation in FSV in this sample, with the average ranking among the higher means reported for other population samples. The incidence of FS aplasia falls within the range of values recorded for other population samples. Although our study is cross-sectional rather than longitudinal, there is strong evidence that FSV continues to increase with age throughout adulthood. DISCUSSION The FSV mean of our sample contradicts the notion that sub-Saharan Africans possess small sinuses. In a global context, geography (climate and altitude) does not appear to be related to FSV. The absence of sexual dimorphism in our sample is unexpected, as significant dimorphism has been reported for most other population samples. Our results support other indications that the frontal sinus continues to expand throughout adulthood, especially in females, and that it is likely due to bone resorption.
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Affiliation(s)
- Victoria A Greening
- Department of Anthropology, Stony Brook University, Stony Brook, New York, USA
| | - Emily Hernandez
- Department of Anthropology, Stony Brook University, Stony Brook, New York, USA
| | - Carrie S Mongle
- Department of Anthropology, Stony Brook University, Stony Brook, New York, USA
- Turkana Basin Institute, Stony Brook University, Stony Brook, New York, USA
| | - Brendon K Billings
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Mngomezulu
- Department of Diagnostic Radiology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Ian J Wallace
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Frederick E Grine
- Department of Anthropology, Stony Brook University, Stony Brook, New York, USA
- Department of Anatomical Sciences, School of Medicine, Stony Brook University, Stony Brook, New York, USA
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Nizzola M, Leonel LCPC, Peris-Celda M. Neurosurgery for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:40-49. [PMID: 38193519 DOI: 10.1097/moo.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a comprehensive anatomical appraisal of the neurosurgical anatomy exposed through the endonasal and paranasal sinuses routes, focusing on the most common expanded endonasal approaches (EEAs) as well as recent advances in this surgical field. RECENT FINDINGS The EEAs are redefining the management of skull base pathology. Neurovascular structures previously considered a limitation, can be now approached through these surgical corridors. Advances in this field include the development of new surgical techniques and routes that allow better visualization and access to pathologies located in the ventral skull base. Understanding the surgical anatomy related to EEAs is essential not only for neurosurgeons but also for rhinologists. SUMMARY Knowledge of the surgical anatomy of the most common EEAs that utilize paranasal sinuses as a surgical corridor enables more effective management of complex skull base pathologies. Comprehensive anatomical knowledge of these corridors and the surrounding neurovascular structures is crucial to maximize benefits of EEAs and improve outcomes.
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Affiliation(s)
- Mariagrazia Nizzola
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Gamma Knife radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C P C Leonel
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Jannelli G, Calvanese F, Jouanneau E, Jacquesson T. Frontal trans-sinusal approach: how I do it. Acta Neurochir (Wien) 2023; 165:2963-2968. [PMID: 37672096 DOI: 10.1007/s00701-023-05785-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/26/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Anterior skull base lesions could be reached by different approaches (subfrontal, pterional, interhemispheric, etc.). In selected cases, the frontal trans-sinusal approach is an effective alternative to conventional techniques. METHODS We present our technique to perform a frontal trans-sinusal approach in a patient affected by a large olfactory groove meningioma. DISCUSSION-CONCLUSION The frontal trans-sinusal approach allows to approach safely lesions of the median anterior cranial fossa. This approach provides lower brain retraction, easier access to olfactory grooves, and earlier tumor devascularization. However, it remains limited to patients with large-sized frontal sinuses and entails some postoperative risks such as mucocele or CSF leak.
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Affiliation(s)
- Gianpaolo Jannelli
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano, Lugano, Switzerland
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France
| | - Francesco Calvanese
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France.
- Department of Neurosurgery, Helsinki University Central Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Emmanuel Jouanneau
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France
- Lyon 1 University, Lyon, France
| | - Timothée Jacquesson
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France
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Algahefi AL, Zheng B, Almashraqi AA, Alhashimi N, Liu Y, Alhammadi MS. The dimensional and morphological assessment of frontal air sinus in different ages, genders and ethnicities (Arabian-Caucasian and Han-Chinese sub-populations). Oral Radiol 2023; 39:341-348. [PMID: 35927529 DOI: 10.1007/s11282-022-00642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to assess the dimensional and morphological measurements of the frontal air sinuses in different ages and genders in the two ethnicities. MATERIALS AND METHODS This retrospective study included 360 subjects (160 males and 200 females) of both ethnicities. Subjects were divided based on age and gender into four groups, including an equal number of both males and females, for each age and ethnic group. The frontal air sinus dimensions were measured utilizing lateral cephalometric radiographs and computed using Winceph version 9.0 software. The frontal air sinus dimensions were compared between age groups in both genders and between ethnicity using an independent sample t test. The relationship between the frontal air sinus dimensions and subjects' age was evaluated using Pearson's correlation coefficient. RESULT The frontal air sinuses measurements were larger in males than females in both ethnicities, except for the frontal sinus index, which was found to be larger in females than males. The frontal air sinus surface area and height showed statistically significant differences between the two age groups in both ethnicities (P < 0.05). The Arabian-Caucasian patients had a larger frontal sinus surface area, height, and depth than the Han-Chinese patients in both age groups. CONCLUSION The size of the frontal air sinus increases with age; and continues to expand after the age of 20 years. Based on the Arabian-Caucasian and Han-Chinese sub-population findings, the frontal sinus is an effective tool for determining gender and appears to have potential in ethnicity identification.
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Affiliation(s)
- Ahmed Lotf Algahefi
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, People's Republic of China.,Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen
| | - Bowen Zheng
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, People's Republic of China
| | - Abeer A Almashraqi
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - Najah Alhashimi
- Unit and Divisional Chief Orthodontics at Hamad Medical Corporation, College of Dental Medicine, Qatar University, Doha, Qatar
| | - Yi Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Nanjing North Street #117, He-Ping District, Shenyang, 110002, People's Republic of China.
| | - Maged S Alhammadi
- Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Estrela CRA, Bueno MR, Estrela MRA, Estrela LRA, Guedes OA, Azevedo BC, Cintra LTA, Estrela C. Frequency and Risk Factors of Maxillary Sinusitis of Endodontic Origin evaluated by a Dynamic Navigation and a New Filter of Cone-Beam Computed Tomography. J Endod 2022; 48:1263-1272. [DOI: 10.1016/j.joen.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
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Park JA, Lee YJ, Yeo IS, Koh KS, Song WC. Three-dimensional linear and volumetric computed tomography analysis of the frontal sinus. Anat Cell Biol 2022; 55:142-147. [PMID: 35773217 PMCID: PMC9256494 DOI: 10.5115/acb.22.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/25/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022] Open
Abstract
The frontal sinus is one of the four paranasal sinuses in humans, and knowledge of its anatomy is important when performing surgery involving the frontal bone or sinus. Although many studies have measured the frontal sinus using radiography and computed tomography (CT), few studies have evaluated by using three-dimensional (3D) analysis. The purpose of this study was to analyze the frontal sinus using 3D reconstruction analysis and determine the differences in linear and volumetric measurements between sexes, sides, and ages. The sample comprised 281 facial CT scans: 173 and 108 from males and females, respectively. The width, height, and length of each frontal sinus and total volume were all larger in males than in females. Almost all linear and volumetric measurements were larger in young adults than in older for both sexes, but not all of the differences were statistically significant. Linear and volumetric measurements were larger for males than females regardless of age group. There were no statistically significant differences between the right and left sides except the width in males. The size of the frontal sinus was strongly influenced by sex and age. The measurements reported here might be useful for improving surgical procedures involving the frontal sinus.
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Affiliation(s)
- Jung-Ah Park
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Yeon-Ju Lee
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - In-Seung Yeo
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Ki-Seok Koh
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Wu-Chul Song
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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Relationship between the Superior Attachment of the Uncinate Process and Pneumatization of the Middle Turbinate—A Radiological Study. SURGERIES 2022. [DOI: 10.3390/surgeries3020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: the superior attachment of the uncinate process (SAUP) is highly variable. Lateral types of SAUP are associated with frontal rhinosinusitis. SAUP in the middle turbinate is more common when the middle turbinate is aerated. We aim to refine these findings by studying the relationship between the SAUP type and the different subtypes of pneumatization of the middle turbinate. Methods: 200 CT sinonasal scans were analyzed by an otolaryngologist and a radiologist. All CT scans were analyzed to study the type of the middle turbinate concha bullosa and lamellar cell and the type of SAUP. Results: 379 sides were analyzed. The prevalence of the various types of SAUP were: Type I: 43.80%, Type II: 22.16%, Type III: 16.36%, Type IV: 3.69%, Type V: 9.76%, and Type VI: 4.22%. When studying the pneumatization of the middle turbinate and the SAUP types, we only found a statistically significant association between the lateral attachment of the uncinate process and the presence of a lamellar cell (p = 0.029). Conclusion: lateral types of SAUP are more likely in the presence of a lamellar cell. This finding, therefore, renders checking for lateral SAUP types in the presence of a lamellar cell even more relevant than when studying the pre-surgical CT scan. In those cases, it is advisable to perform a careful and complete uncinectomy.
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Butaric LN, Campbell JL, Fischer KM, Garvin HM. Ontogenetic patterns in human frontal sinus shape: A longitudinal study using elliptical Fourier analysis. J Anat 2022; 241:195-210. [DOI: 10.1111/joa.13687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 03/26/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Lauren N. Butaric
- College of Osteopathic Medicine, Department of Anatomy Des Moines University Des Moines Iowa USA
| | - Jessica L. Campbell
- College of Osteopathic Medicine, Department of Anatomy Des Moines University Des Moines Iowa USA
| | - Kristine M. Fischer
- College of Osteopathic Medicine, Department of Anatomy Des Moines University Des Moines Iowa USA
| | - Heather M. Garvin
- College of Osteopathic Medicine, Department of Anatomy Des Moines University Des Moines Iowa USA
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Lee S, Fernandez J, Mirjalili SA, Kirkpatrick J. Pediatric Paranasal Sinuses- Development, Growth, Pathology & Functional Endoscopic Sinus Surgery. Clin Anat 2022; 35:745-761. [PMID: 35437820 PMCID: PMC9544638 DOI: 10.1002/ca.23888] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 11/27/2022]
Abstract
The paranasal sinuses (maxillary, frontal, ethmoid, and sphenoid sinuses) are complex anatomical structures. The development and growth of these have been investigated utilizing a number of different methods ranging from cadaveric analysis to modern cross sectional imaging with 3D modeling. An understanding of normal pediatric paranasal sinus embryology and development enables us to better determine when pathology may be affecting the normal developmental process. Cystic fibrosis, chronic sinusitis, deviated nasal septum and cleft lip and palate are some of the conditions which have been shown to effect paranasal sinus development to varying degrees. Functional endoscopic sinus surgery (FESS) is becoming increasingly common and an understanding of sinus anatomy together with when periods of rapid growth occur during childhood is important clinically. Although concerns have been raised regarding the impact of FESS on facial growth, there is limited evidence of this in regards to either changes in anthropomorphic measurements or clinical assessments of symmetry post operatively.
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Affiliation(s)
- Sophie Lee
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joshua Kirkpatrick
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Zinreich S, Kuhn F, Kennedy D, Solaiyappan M, Lane A, London Jr. N, Hosemann W. Supplements and refinements to current classifications and nomenclature of the fronto-ethmoidal transition region by systematic analysis with 3D CT microanatomy. RHINOLOGY ONLINE 2021. [DOI: 10.4193/rhinol/21.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: The microanatomy of the fronto-ethmoidal transition region has been addressed in several classifications. CT stereoscopic imaging (3DCTSI) provides improved display and delineates three defined complex “spaces”, the Frontal Sinus/Frontal Recess Space, the Infundibular Space of the Ethmoid Uncinate Process, and the Ethmoid Bulla Space (FSRS, IS-EUP, EB), none of which were adequately described with the “cell” terminology. We present details on the 3D microanatomy, variability, and prevalence of these spaces. Methods: 3D stereoscopic imaging displays (3DCTSI) were created from 200 datasets. The images were analyzed and categorized by a radiologist (SJZ), and consultant otolaryngologists, focusing on 3D microanatomy of the fronto-ethmoidal transition, the frontal recess/frontal sinus, and drainage pathways, in comparison to established anatomical classification systems. Results: The anterior ethmoid is subdivided into seven groups with the following core properties and prevalence: 1. The horizontal roof of the IS-EUP is attached to the superior half of the frontal process of the maxilla (19%); 2. The IS-EUP extends into the frontal recess (6.5%); 3. The IS-EUP extends into the frontal recess and the frontal sinus (18.5%); 4. A bulla is seen in the medial frontal sinus (3%); 5. The ethmoid bulla and supra bullar space extend into the frontal sinus (7%); 6. Lamellae extend into the FSRS antero-superiorly (25%); 7. FSRS expansion expands below the upper half of the frontal process of the maxilla (FSRS) (21%). Conclusion: 3-D analysis of the detailed anatomy provides important new anatomic information with the increased focus on precision surgery in the region.
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Frontal Sinus Fractures: A Review on Etiology and Management Emphasizing Minimally Invasive and Endoscopic Techniques. J Craniofac Surg 2021; 32:1246-1250. [PMID: 33770048 DOI: 10.1097/scs.0000000000007623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In spite of a long and tortuous history of the acute management of frontal sinus fractures, current optimal management remains steeped in controversy. These fractures are frequently produced by excessive forces and are often accompanied with other injuries. However, disruption of the nasofrontal duct persists as essential to maintain proper sinus function and should guide current management. Although there has never been any distinct procedure defining optimal outcomes, proper treatment is contingent on precise diagnosis culled from a complete history, physical examination, and imaging studies. This is further augmented by the surgeon's intraoperative findings. Reconstruction will ultimately rest on the degree of disruption of the anterior and posterior sinus walls, as well as the status and function of the nasofrontal ducts. For these reasons, current management continues to be challenging and evolving. Thus, this review will discuss the etiology and clinical presentation of frontal sinus fractures, the current complications arising in the subject, and the evolution of treatment options towards a more conservative and endoscopic approach to care.
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Frontal Sinus Fractures: 10-Year Contemporary Experience at a Level 1 Urban Trauma Center. J Craniofac Surg 2021; 32:1376-1380. [PMID: 33645957 DOI: 10.1097/scs.0000000000007426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Frontal sinus fractures account for 5% to 15% of all facial fractures, and have traditionally been associated with high kinetic energy blunt injury. Surgical management is largely focused on minimizing potentially serious sequelae including frontal sinus dysfunction, CSF leak, and significant cosmetic deformity. An institutional database of 1944 patients presenting with maxillofacial fractures over a 10-year period was queried. Demographics, mechanism of injury, yearly trends, surgical approaches, and follow-up data were examined. A total of 160 (8.3%) patients presented with at least 1 fracture of the frontal sinus anterior table, posterior table, or frontal sinus outflow tract during the study period. The average annual number of cases was 15.9 ± 5.7 per year with a peak of 21.5 ± 4.0 cases during the 2014 to 2015 period and a decline to 8.5 ± 1.5 cases/year from 2016 to 2017. Among those patients with falls, 61.5% (n = 40) were a result of tripping or fainting at a height of <6 ft. 55.6% of fracture types were isolated to the anterior table, but fracture location was not significantly associated with operative intervention. Cases of operative fracture type had a higher rate of both displacement and comminution compared to nonoperative fractures (P < 0.00001). Of all patients presenting with frontal sinus fractures, 75% of cases were managed nonoperatively. However, many patients presented with falls and other seemingly low energy injuries which are not traditionally associated with frontal sinus trauma. These results highlight the need for continued follow-up even in otherwise low-risk urban populations in order to avoid long term sinus dysfunction.
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Makihara S, Kariya S, Okano M, Naito T, Uraguchi K, Matsumoto J, Noda Y, Nishizaki K. The Relationship Between the Width of the Frontal Recess and the Frontal Recess Cells in Japanese Patients. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619884946. [PMID: 31700254 PMCID: PMC6823981 DOI: 10.1177/1179550619884946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/15/2022]
Abstract
Objective The agger nasi cell (ANC) is an easily identifiable landmark when approaching the frontal sinus. The success of endoscopic frontal sinus surgery may be influenced by the width of the frontal recess (FR). The aim of this study is to examine the relationship between the FR width and the ANC size in Japanese patients. In addition, the effect of various frontal recess cells (FRCs) on the development of frontal sinusitis has been examined. Materials and methods Multiplanar computed tomography (CT) scans of the nasal cavities and paranasal sinuses in 95 patients (190 sides) before endoscopic sinus surgery were reviewed. The presence of FRCs, the thickness of the frontal beak (FB), the ANC size, and the anterior-to-posterior (A-P) length of the frontal isthmus (FI) and FR were evaluated in patients with and without frontal sinusitis. Results The prevalence of the ANC, frontal cell types 1, 2, 3, and 4, frontal bullar cell (FBC), suprabullar cell, supraorbital ethmoid cell, and interfrontal sinus septal cell was 85.3%, 11.6%, 0%, 7.9%, 0%, 25.3%, 45.8%, 16.8%, and 15.3%, respectively. The ANC volume showed a significant positive correlation with the A-P length of the FI and FR. The incidence of frontal sinusitis in the patients with FBCs was significantly higher than that without FBCs. Conclusion A large ANC offers a greater potential to facilitating the approach to the frontal sinus because of the extensiveness of the FR in Japanese patients. The presence of FBCs may be related to a higher incidence of frontal sinusitis.
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Affiliation(s)
- Seiichiro Makihara
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Marugame, Japan
| | - Shin Kariya
- Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Mitsuhiro Okano
- Department of Otolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Tomoyuki Naito
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Marugame, Japan
| | - Kensuke Uraguchi
- Department of Otolaryngology-Head and Neck Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Junya Matsumoto
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Marugame, Japan
| | - Yohei Noda
- Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Jing XL, Luce E. Frontal Sinus Fractures: Management and Complications. Craniomaxillofac Trauma Reconstr 2019; 12:241-248. [PMID: 31428249 DOI: 10.1055/s-0038-1675560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/16/2018] [Indexed: 10/27/2022] Open
Abstract
Frontal sinus fractures are relatively rare maxillofacial injuries (only 5-15% of all facial fractures). The appropriate management of frontal sinus fracture and associated pathology is controversial. Diagnosis and treatment of frontal sinus fractures has improved with the advances of high-resolution computed tomography technology. Treatment of frontal sinus fractures depends on several factors, including contour deformity of anterior table; the presence of CSF leak or air-fluid level in the sinus, likelihood of nasofrontal duct obstruction, and degree of displacement of posterior table. Nasofrontal duct patency should be checked if fracture pattern is highly suspicious of ductal injury. Cranialization is performed in cases of severely comminuted posterior wall fracture. Long-term complication of frontal sinus fracture can occur up to 10 years after initial injury or intervention; so, judicious long-term follow-up is warranted. This article presents the management and complications of frontal sinus fractures.
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Affiliation(s)
- Xi Lin Jing
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Edward Luce
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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15
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Meyer TK, Kocak M, Smith MM, Smith TL. Coronal Computed Tomography Analysis of Frontal Cells. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240301700310] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Described by Schaefer in 1916, frontal cells have been implicated as a cause of frontal recess obstruction. In this cross-sectional study, we determine the prevalence of frontal cells and other anatomic variants and examine their relationships. Methods Coronal computed tomography scans of the sinuses performed from January 2000 to June 2001 were evaluated for frontal cells, other anatomic variants, and sinus disease. Of 1009 scans evaluated, 768 scans were included for data collection. Frontal cells were classified. Results In this population, 20.4% of individuals had frontal cells (14.9% had type I, 3.1% had type II, 1.7% had type III, and 2.1% had type IV). The presence of frontal cells was positively associated with hyperpneumatization of the frontal sinus (p = 0.01) and negatively associated with hypopneumatization of the frontal sinus (p < 0.01). Individuals with frontal cells had an increased prevalence of concha bullosa compared with individuals without frontal cells (41.4% versus 24.1%, p < 0.01). The prevalence of frontal mucosal thickening was increased in individuals with type III and type IV cells compared with individuals without frontal cells (38.5 and 69.0% versus 17.1%, p = 0.04 and p < 0.01). Conclusion The prevalence of frontal cells among a population undergoing sinus computed tomography is 20.4%. Frontal cells are associated with other variants of sinonasal pneumatization and should be suspected when these variants are noted. The presence of frontal cells does not invariably lead to frontal sinusitis but may contribute to the mechanical obstruction of the frontal recess and should be appropriately addressed during the surgical management of frontal sinusitis.
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Affiliation(s)
- Tanya K. Meyer
- Departments of Otolaryngology and Communication Sciences Milwaukee, Wisconsin
| | - Mehmet Kocak
- Departments of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michelle M. Smith
- Departments of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy L. Smith
- Departments of Otolaryngology and Communication Sciences Milwaukee, Wisconsin
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Kanowitz SJ, Shatzkes DR, Pramanik BK, Babb JS, Jacobs JB, Lebowitz RA. Utility of Sagittal Reformatted Computerized Tomographic Images in the Evaluation of the Frontal Sinus Outflow Tract. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Anatomic and mucosal obstruction of the frontal sinus outflow tract (FSOT) can result in frontal sinusitis often associated with frontal headache. Thorough evaluation of symptomatic patients requires axial and coronal computerized tomographic (CT) scans of the paranasal sinuses (PNS). With the advent of multichannel multidetector CT scanning, the availability of high-quality sagittal images has become increasingly widespread. However, the utility of these images in the assessment of FSOT patency has not yet been established. Methods A retrospective review of coronal and sagittal images from 25 PNS CT scans (50 sides) were randomized, blinded, and independently evaluated by two neuroradiologists. FSOT obstruction by agger nasi cells, the ethmoid bulla, and mucosal disease was assessed. A degree of confidence was rendered for each of these findings. The results were then compared against a consensus diagnosis, which was rendered based upon simultaneous reading of the coronal and sagittal images. Generalized estimating equations were used to assess the difference between sagittal and coronal images in terms of reader confidence and diagnostic concordance with the consensus. Results Review of sagittal images had a higher degree of concordance with the consensus than did coronal images, and was highest for mucosal disease. Both readers were more confident in rendering a diagnosis based upon the sagittal images. Conclusion Sagittal reformatted CT images of the PNS are helpful in the radiologic evaluation of the FSOT. Experienced neuroradiologists had a higher degree of confidence in the diagnosis of the obstruction of the FSOT using sagittal reformatted images.
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Affiliation(s)
| | - Deborah R. Shatzkes
- Departments of Radiology, New York University School of Medicine, New York, New York
| | - Bidyut K. Pramanik
- Departments of Radiology, New York University School of Medicine, New York, New York
| | - James S. Babb
- Departments of Radiology, New York University School of Medicine, New York, New York
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Shama SA. Frontal sinus outflow tract: Multi-detector CT assessment. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Tatlisumak E, Asirdizer M, Bora A, Hekimoglu Y, Etli Y, Gumus O, Keskin S. The effects of gender and age on forensic personal identification from frontal sinus in a Turkish population. Saudi Med J 2017; 38:41-47. [PMID: 28042629 PMCID: PMC5278064 DOI: 10.15537/smj.2017.1.16218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives: To define the dimensions of the frontal sinus in groups standardized for age and gender and to discuss the reasons and the effects of the variations. Methods: Frontal sinus measurements were obtained from paranasal CT scans of 180 males and 180 females in the Radiology Department of Dursun Odabas Medical Center of Yuzuncu Yil University, Van, which is located in Eastern Turkey, between February and March 2016. The width and height of sinuses were measured on a coronal plane, and the anteroposterior length was measured on an axial plane. Volumes were calculated using the Hospital Information Management Systems and Image Archiving and Management System program. The Statistical Package of the Social Science version 13 was used for statistical analyses. Results: We determined differences in the frontal sinus measurements of different age groups in a Turkish adult population. Frontal sinus dimensions were usually higher in females and lower in males after 40-49 years of age than their younger counterparts, but the measurements were lower in females and higher in males in 70≤ years of age group than 60-69 years of age. Left frontal sinus was dominant in young age groups but right frontal sinus was dominant in groups 40-49 years of age or older. Conclusion: We observed crossing of the measurements between the different age groups, which we could not find clear explanations. The results of such studies may affect forensic identification from frontal sinus measurements.
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Affiliation(s)
- Ertugrul Tatlisumak
- Department of Anatomy, Celal Bayar University, Faculty of Medicine, Manisa, Turkey. E-mail.
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Moore K, Ross A. Frontal Sinus Development and Juvenile Age Estimation. Anat Rec (Hoboken) 2017; 300:1609-1617. [PMID: 28524272 DOI: 10.1002/ar.23614] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 12/08/2016] [Accepted: 12/20/2016] [Indexed: 11/11/2022]
Abstract
Assessment of development is an important component of age estimation in juveniles. One area that has not been fully investigated as a possible aging method is the development of the frontal sinus. The frontal sinuses form when the ectocranial table of the frontal bone separates from the endocranial table forming an air pocket in the bone. The endocranial table ceases growth with the brain, while the ectocranial table is displaced anteriorly as the facial bones continue growth. In order to examine growth and the utility of the frontal sinuses for age estimation, 392 radiographs were examined (♀=159 and ♂=233) from the Juvenile Radiograph Database at North Carolina State University and the Patricia Database from Mercyhurst University. The sample included individuals who ranged in age from 0 to 18 years. Anterior view (or AP) radiographs were examined and were grouped based upon the presence or absence of the frontal sinus. Individuals were grouped into four age categories. A one-way ANOVA was performed to test whether developmental phase was related to age. Results from the ANOVA show that developmental phase is significantly related to age (P <.0001). An ordinal logistic regression was conducted to examine whether developmental phase could be used to predict age. The results of the logistic regression suggest that developmental phase is an accurate indicator of age (P <.0001, df = 1, Chi-Squared = 537.2428); however, the age ranges can be quite wide and should be utilized alongside other established methods of age estimation. Anat Rec, 300:1609-1617, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Kaitlin Moore
- Sociology & Anthropology, North Carolina State University, North Carolina
| | - Ann Ross
- Sociology & Anthropology, North Carolina State University, North Carolina
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20
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Computed Tomographic Analysis: The Effects of Frontal Recess Morphology and the Presence of Anatomical Variations on Frontal Sinus Pneumatization. J Craniofac Surg 2017; 28:256-261. [PMID: 27906846 DOI: 10.1097/scs.0000000000003222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to describe the morphology of frontal recess area with its anatomical variations and to reveal if frontal recess morphology and the anatomical variations related to that region have effects on the pneumatization of the frontal sinuses. The frontal sinus and recess morphometry of 136 sides of 68 dry skulls were evaluated on multislice high-resolution computed tomography. The relationships between frontal sinus and frontal recess measurements were analyzed by correlation and linear regression analysis. The variables between the groups of anatomical variations were analyzed by Mann-Whitney U test and χ test or Fisher exact test. A positive relationship between the sagittal length of spina nasalis interna and morphometric measurements of frontal sinus was revealed (P <0.05). Agger nasi cells were present in 64.2% of sides, supraorbital ethmoid cells (SOECs) in 19.6%, type 3 frontal cells (FCs) in 18.9%, suprabullar cells in 24.3%, and frontal bulla was noted in 5.4%. Intersinus septal cells were observed in 16.2% of the skulls. There were statistically different increases in the measurements of frontal sinus morphometry in the presences of SOECs and type 3 FCs (P <0.05). The diameter of frontal sinus ostium was decreased in the presences of AN, SOEC, type 3 FC, and supraorbital ethmoid cell statistically (P = 0.049, P = 0.029, P = 0.043, P <0.001 respectively). In conclusion, frontal sinus pneumatization was affected by the spina nasalis interna and the presence of anatomical variations related to frontal recess or ostium region instead of the morphology of that area.
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21
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Delaney SW. Treatment strategies for frontal sinus anterior table fractures and contour deformities. J Plast Reconstr Aesthet Surg 2016; 69:1037-45. [PMID: 27345471 DOI: 10.1016/j.bjps.2016.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 11/17/2022]
Abstract
Anterior table frontal sinus fractures can result in aesthetically displeasing contour deformities. Acute anterior table frontal sinus fractures that are depressed may be reduced with an open, closed, or endoscope-assisted approach. Delayed contour deformity camouflage can be achieved using bone grafts, titanium meshes, methyl methacrylate, hydroxyapatite cement, and polyether ether ketone implants. The selection of surgical approach to repair a frontal sinus contour deformity depends on the fracture severity, chronicity, complexity, patient comorbidities, and surgeon preference and experience. Advancement in endoscopic technology and expertise has created a paradigm shift toward a less invasive approach to the frontal region, with considerably less morbidity than conventional open techniques.
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Affiliation(s)
- Sean W Delaney
- Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar St, Suite 204Q, Los Angeles, CA 90033, USA.
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22
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Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base. Braz J Otorhinolaryngol 2016; 83:349-355. [PMID: 27320654 PMCID: PMC9444793 DOI: 10.1016/j.bjorl.2016.04.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/08/2016] [Accepted: 04/14/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination. Objective To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. Methods This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations. Results The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation. Conclusion The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.
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Güngör G, Okur N, Okur E. Uncinate Process Variations and Their Relationship with Ostiomeatal Complex: A Pictorial Essay of Multidedector Computed Tomography (MDCT) Findings. Pol J Radiol 2016; 81:173-80. [PMID: 27158282 PMCID: PMC4841358 DOI: 10.12659/pjr.895885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 10/02/2015] [Indexed: 12/29/2022] Open
Abstract
The ostiomeatal complex (OMC) is a key area for the drainage and ventilation of the paranasal sinuses. Stenosis created by inflammation and anatomic variations in this region causes an ideal ground for parasanal sinus infections, by preventing the drainage and ventilation of the sinuses. In today’s diagnostics of paranasal sinus infections, the role of evaluation of OMC anatomical variations and soft tissue pathology has increased.. Knowing the anatomical details is important in terms of directing both medical and surgical treatment. The uncinate process (UP) constitutes the most important structure of the ostiomeatal complex, playing a role in mucociliary activity. UP variations can cause mucociliary drainage and ventilation problems, causing complications during surgery. Therefore, knowing and identifying their appearances in multidetector computed tomography (MDCT), the most frequently used radiological imaging method for these variations, becomes a very important consideration.
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Affiliation(s)
- Gülay Güngör
- Department of Radiology, Kahramanmaraş Necip Fazıl Şehir Hastanesi, Kahramanmaraş, Turkey
| | - Nazan Okur
- Department of Radiology, Afyon Kocatepe Üniversitesi Tıp Fakültesi, Afyonkarahisar, Turkey
| | - Erdoğan Okur
- Department of Otorhinolaringology, Afyon Kocatepe Üniversitesi Tıp Fakültesi, Afyonkarahisar, Turkey
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Soman BA, Sujatha GP, Lingappa A. Morphometric evaluation of the frontal sinus in relation to age and gender in subjects residing in Davangere, Karnataka. J Forensic Dent Sci 2016; 8:57. [PMID: 27051227 PMCID: PMC4799523 DOI: 10.4103/0975-1475.176945] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The main objective of the study was morphometric evaluation of the frontal sinus in relation to age and gender and to establish its forensic importance and application. Materials and Method: The study group consisted of 200 subjects (100 males and 100 females) in the age groups 14-20 years, 21-30 years, 31-45 years, 45 years and above. Posteroanterior (PA) cephalogram radiographs were taken using standardized technique. The processed films were traced and frontal sinus pattern was established as per Yoshino's classification system. Results: The mean values for length, width, and area of the frontal sinus were found to be higher in males as compared to females and area of frontal sinuses increase with age except in males who were 45 years and above. The left width, left area, and bilateral asymmetry in relation to gender was found to be statistically significant. Conclusion: The morphologic evaluation of frontal sinus is a useful technique to determine gender and seems promising in personal identification.
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Affiliation(s)
- Bhakti A Soman
- Department of Oral Medicine and Radiology, YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - G P Sujatha
- Department of Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Ashok Lingappa
- Department of Bapuji Dental College and Hospital, Davangere, Karnataka, India
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Hashim N, Hemalatha N, Thangaraj K, Kareem A, Ahmed A, Hassan NFN, Jayaprakash PT. Practical relevance of prescribing superimposition for determining a frontal sinus pattern match. Forensic Sci Int 2015; 253:137.e1-7. [PMID: 26103928 DOI: 10.1016/j.forsciint.2015.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 02/04/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
A research that tested the methods suitable for comparing ante- and post-mortem radiographic patterns of frontal sinuses concluded that superimposition should be followed as a stringent method for establishing individual identification. We verified the practical relevance of prescribing superimposition by superimposing ante- and post-mortem frontal sinus patterns recorded in case situations as well as simulated ante- and post-mortem of frontal sinus patterns recorded using archived skulls. For superimposition, the wipe facility available in the vision mixer was employed in addition to the mix mode. Ante- and post-mortem radiographic patterns that were available in two earlier cases were not superimposable. Related simulated ante- and post-mortem radiographic patterns of frontal sinuses are superimposable only when the skull that is initially oriented for recording the ante-mortem radiograph is retained in the same posture for recording the post-mortem radiograph also. Once the skull has been removed from the X-ray table, after recording the simulated ante-mortem radiograph, and repositioned for the simulated post-mortem radiograph, even when the intervening time is 1min, the sinus patterns in these radiographs are not superimposable. Superimposition cannot be used as a conditional requirement for side-by-side comparison of radiographic patterns of frontal sinuses.
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Affiliation(s)
- Natassha Hashim
- Forensic Science, Chemistry Department of Malaysia, Kuala Lumpur, Malaysia
| | - Narayanasamy Hemalatha
- Forensic Medicine Department, SRM Medical College and Research Centre, Potheri, Kattangulathur (PO), Kanchipuram Dist., Tamil Nadu 603203, India
| | - Karuppaiah Thangaraj
- Forensic Medicine Department, SRM Medical College and Research Centre, Potheri, Kattangulathur (PO), Kanchipuram Dist., Tamil Nadu 603203, India
| | - Abdul Kareem
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Arefuddin Ahmed
- Medical Radiation Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Nik Fakhuruddin Nik Hassan
- Forensic Science Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Paul T Jayaprakash
- Forensic Science Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
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Cossellu G, De Luca S, Biagi R, Farronato G, Cingolani M, Ferrante L, Cameriere R. Reliability of frontal sinus by cone beam-computed tomography (CBCT) for individual identification. Radiol Med 2015; 120:1130-6. [PMID: 25981382 DOI: 10.1007/s11547-015-0552-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
Abstract
Analysis of the frontal sinus is an important tool in personal identification. Cone beam-computed tomography (CBCT) is also progressively replacing conventional radiography and multi-slice computed tomography (MSCT) in human identification. The aim of this study is to develop a reproducible technique and measurements from 3D reconstructions obtained with CBCT, for use in human identification. CBCT from 150 patients (91 female, 59 male), aged between 15 and 78 years, was analysed with the specific software program MIMICS 11.11 (Materialise N.V., Leuven, Belgium). Corresponding 3D volumes were generated and maximal dimensions along 3 directions (x, y, z), X M, Y M, Z M (in mm), total volume area (in mm(3)), V t, and total surface (in mm(2)), S t, were calculated. Correlation analysis showed that sinus surfaces were strongly correlated with their volume (r = 0.976). Frontal sinuses were separate in 21 subjects (14 %), fused in 67 (44.6 %) and found on only one side (unilateral) in 9 (6 %). A Prominent Middle of Fused Sinus (PMS) was found in 53 subjects (35.3 %). The intra- (0.963-0.999) and inter-observer variability (0.973-0.999) showed a great agreement and a substantial homogeneity of evaluation.
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Affiliation(s)
- Gianguido Cossellu
- Department of Biomedical, Surgical and Dental Sciences, Unit of Orthodontics and Pediatric Dentistry, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano De Luca
- AgEstimation Project, Institute of Legal Medicine, University of Macerata, Macerata, Italy. .,, Calle las moreras 77, 28971, Griñón, Madrid, Spain.
| | - Roberto Biagi
- Department of Biomedical, Surgical and Dental Sciences, Unit of Orthodontics and Pediatric Dentistry, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giampietro Farronato
- Department of Biomedical, Surgical and Dental Sciences, Unit of Orthodontics and Pediatric Dentistry, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariano Cingolani
- Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | - Luigi Ferrante
- Department of Biomedical Sciences and Public Health, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Roberto Cameriere
- AgEstimation Project, Institute of Legal Medicine, University of Macerata, Macerata, Italy
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Awad AJ, Mohyeldin A, El-Sayed IH, Aghi MK. Sinonasal morbidity following endoscopic endonasal skull base surgery. Clin Neurol Neurosurg 2015; 130:162-7. [PMID: 25621713 DOI: 10.1016/j.clineuro.2015.01.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/27/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
Open transcranial surgery has long served as the traditional approach for resecting tumors and other lesions in the skull base. However, endoscopic endonasal skull base surgery (EESBS) has emerged as a credible alternative. This paper provides insight on the sinonasal morbidity in patients undergoing EESBS. A literature review was performed by searches of MEDLINE database to provide further insight on sinonasal morbidity associated with EESBS, with a particular focus on published incidence rates and patterns of complication. We identified only articles that reported the incidence of sinonasal morbidity and complications as the major outcome of the studies. The most common sinonasal morbidity symptoms are nasal crusting (50.8%), nasal discharge (40.4%), nasal airflow blockage (40.1%) followed by disturbances in olfaction (26.7%). The incidence of mucocele formation is 8%, and this is significantly increased in pediatric patients up to 25% (range, 14-50%). Epistaxis appears to be a rare event, often times not found in some case series. Some studies suggested less morbidity if the middle turbinate can be preserved, a finding that must be balanced with the need for sufficient exposure on larger cases. Sinonasal morbidity following endoscopic endonasal skull base surgery has the potential to adversely impact patient quality of life, with nasal crusting and discharge being the two most common symptoms. Morbidity signs and symptoms usually resolve within 3-4 months, however symptoms can persist for longer with more complex surgeries. The rate of mucocele formation is higher in pediatric patients, with special attention required in graft positioning for this population in particular.
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Affiliation(s)
- Ahmed J Awad
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ahmed Mohyeldin
- Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, USA
| | - Manish K Aghi
- Department of Neurosurgery, University of California at San Francisco, San Francisco, USA.
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Fleischman GM, Miller JD, Kim GG, Zanation AM, Ebert CS. Treatment of chronic frontal sinusitis with difficult anatomy: A hybrid balloon technique in four cases. ALLERGY & RHINOLOGY 2015; 5:120-4. [PMID: 25565046 PMCID: PMC4275456 DOI: 10.2500/ar.2014.5.0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The presence of frontal cells poses unique challenges when using endoscopic approaches. This study describes the use of a balloon dilation system as an aid for functional endoscopic sinus surgery (FESS) to access the frontal sinus in cases that would traditionally require open approaches. We present a case series of four patients with chronic rhinosinusitis refractive to medical management who underwent FESS with the aid of a balloon dilation system at a tertiary referral center. All patients had variant forms of frontal sinus anatomy. Surgical techniques will be described and use of the balloon system will be reviewed. All patients (aged 13–68 years) successfully underwent fontal sinusotomies with the assistance of a balloon dilation system, which was used in a variety of ways: to dilate the narrow infundibulum of a high intersinus septal cell, to remove an anteriorly located type III frontal sinus cell, to expand the natural frontal ostium in the presence of excessive agger nasi pneumatization, and to remove a type IV frontal sinus cell. All patients were spared an osteoplastic flap or trephination, and there were no intraoperative complications. No postoperative bleeding, infection, or cerebral spinal fluid leaks were reported. Balloon dilation in combination with standard frontal sinus dissection techniques may be beneficial for a select group of patients with complex frontal anatomy. In this series of patients, the balloon dilation system was used as a tool during FESS and eliminated the need for open approaches.
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Affiliation(s)
- Gitanjali M Fleischman
- Division of Rhinology, Allergy and Endoscopic Skull Base Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
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Morrison AD, Gregoire CE. Management of fractures of the nasofrontal complex. Oral Maxillofac Surg Clin North Am 2014; 25:637-48. [PMID: 24183374 DOI: 10.1016/j.coms.2013.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Repair of fractures involving the nasofrontal region remains a mainstay of contemporary oral and maxillofacial surgery. This article discusses the epidemiology of these injuries, anatomy of the area, and management of these fractures with insight into potential complications. These include fractures of the frontal sinus, naso-orbital-ethmoidal region, root of the nose, and associated adjacent structures.
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Affiliation(s)
- Archibald D Morrison
- Department of Oral and Maxillofacial Surgery, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2Y9, Canada; Department of Oral and Maxillofacial Sciences, Faculty of Dentistry, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia B3H 4R2, Canada.
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Cranialization in a cohort of 154 consecutive patients with frontal sinus fractures (1987-2007): review and update of a compelling procedure in the selected patient. Ann Plast Surg 2014; 71:54-9. [PMID: 22918401 DOI: 10.1097/sap.0b013e3182468198] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Retrospective review of charts of 180 consecutive patients with frontal sinus fractures managed by plastic surgeons at the University of Kentucky between 1987 and 2007 was performed with institutional review board approval. Twenty-six charts did not meet the criteria. The remaining 154 records provided 1-to-20-year follow-up. The study included 34 patients who underwent cranialization and 120 patients who did not. A low-complication rate of 6% after cranialization is ascribed by the authors to meticulous sinus mucosal debridement; thorough obliteration of the frontal sinus outflow tract (with sterile gelatin sponge pledgets and bone chips from the outer cortex of the temporoparietal skull); and avoidance of avascular barriers, such as abdominal fat. As high-resolution computerized tomography with parasaggital views was introduced, an increasing ability to preoperatively define the extent of injury of the medial and lateral sinus floor was observed. The authors conclude selective use of cranialization is indicated.
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The Anatomical Relationship between the Anterior Ethmoid Artery, Frontal Sinus, and Intervening Air Cells; Can the Artery Be Useful Landmark? ACTA ACUST UNITED AC 2014. [DOI: 10.3342/kjorl-hns.2014.57.10.687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Angélico FV, Rapoport PB. Analysis of the Agger nasi cell and frontal sinus ostium sizes using computed tomography of the paranasal sinuses. Braz J Otorhinolaryngol 2013; 79:285-92. [PMID: 23743742 PMCID: PMC9443836 DOI: 10.5935/1808-8694.20130052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/14/2013] [Indexed: 11/20/2022] Open
Abstract
The Agger nasi cell (ANC) and the frontal sinus ostium (FO) are important structures that can influence the anatomy and physiology of the frontal recess. The aim of this study was to evaluate the presence and size of ANC and the FO and correlate them according to gender, race and among themselves. Method A prospective study with 40 patients who underwent CT of the paranasal sinuses with sagittal reconstruction. Measurements: ANC (APAN) anteroposterior diameter, ANC (CCAN) craniocaudal diameter, ANC (LLAN) side-to-side diameter, anteroposterior diameter of the FO (APFO) and side-to-side diameter of the FO (LLFO). Results Twenty-two patients were male and 18 females, mean age 33.7 years. Most patients were white (45%), followed by browns (32.5%), blacks (20%) and asians (2.5%). The ANC was present in 98.7% of patients. There was statistical difference for APAN on females and LLAN on females and on the total sample. There were no differences for all measurements regarding gender, as well as the race. ANC and FO measurements showed positive correlation, but poor or very poor. Conclusion The prevalence of ANC in our sample was high and did not show a statistically significant difference for most measurements. The correlation between measurements of ANC and the FO was poor or very poor.
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Husain Q, Sanghvi S, Kovalerchik O, Shukla PA, Choudhry OJ, Liu JK, Eloy JA. Assessment of mucocele formation after endoscopic nasoseptal flap reconstruction of skull base defects. ALLERGY & RHINOLOGY 2013; 4:e27-31. [PMID: 23772323 PMCID: PMC3679564 DOI: 10.2500/ar.2013.4.0050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Advances in endoscopic skull base (SB) surgery have led to the resection of increasingly larger cranial base lesions, resulting in large SB defects. These defects have initially led to increased postoperative cerebrospinal fluid (CSF) leaks. The development of the vascularized pedicled nasoseptal flap (PNSF) has successfully reduced postoperative CSF leaks. Mucocele formation, however, has been reported as a complication of this technique. In this study, we analyze the incidence of mucocele formation after repair of SB defects using a PNSF. A retrospective review was performed from December 2008 to December 2011 to identify patients who underwent PNSF reconstruction for large ventral SB defects. Demographic data, defect site, incidence of postoperative CSF leaks, and rate of mucocele formation were collected. Seventy patients undergoing PNSF repair of SB defects were identified. No postoperative mucocele formation was noted at an average radiological follow-up of 11.7 months (range, 3–36.9 months) and clinical follow-up of 13.8 months (range, 3–38.9 months), making the overall mucocele rate 0%. The postoperative CSF leak rate was 2.9%. Proper closure of SB defects is crucial to prevent CSF leaks. The PNSF is an efficient technique for these repairs. Although this flap may carry an inherent risk of mucocele formation when placed over mucosalized bone during repair, we found that meticulous and strategic removal of mucosa from the site of flap placement resulted in a 0% incidence of postoperative mucocele formation in our cohort.
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Affiliation(s)
- Qasim Husain
- Departments of Otolaryngology- Head and Neck Surgery and
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Five 'nontraditional' techniques for use in patients with recalcitrant sinusitis. Curr Opin Otolaryngol Head Neck Surg 2013; 21:39-44. [PMID: 23262744 DOI: 10.1097/moo.0b013e32835bf65b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Although endoscopic sinus surgery remains the mainstay of surgical approaches to treating paranasal sinus disease, some disease may require alternative approaches. We review here five techniques: endoscopic middle turbinectomy, maxillary sinoscopy, the Caldwell-Luc procedure, intranasal inflammatory polyp steroid injection, and frontal sinus trephine. RECENT FINDINGS Recent findings suggest that endoscopic sinus surgery is limited in certain cases to access particular anatomic sites that may contain disease. The anterior, inferior maxillary wall and the frontal sinus may be accessed externally with minimal morbidity, and this access may be critical to treating the disease. The middle turbinate can contribute to preoperative and postoperative obstruction of sinus drainage, and resection of it can benefit the patient in many ways. Finally, the management of intranasal inflammatory polyps remains a challenge. In both preoperative and postoperative patients, the polyps may not respond to standard and even aggressive topical therapies. Intrapolyp steroid injection can provide a substantial anti-inflammatory effect and may avoid surgery for some patients. SUMMARY This article will review five ancillary procedures that add to the rhinologist's skill set to treat difficult or recalcitrant paranasal sinus disease.
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El-Anwar MW, Almassry HN, Elfiki I, Abdulmonaem G. Frontal sinus outflow tract evaluation by sagittal computed tomography in frontal sinus fracture. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Polyps originating from accessory middle turbinate and secondary middle turbinate. The Journal of Laryngology & Otology 2012; 126:729-32. [PMID: 22613806 DOI: 10.1017/s0022215112000941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We report two extremely rare cases of polyps from unilateral accessory middle turbinates, one of which coexisted with a polyp from an inferomedially projecting, pneumatised, secondary middle turbinate. METHODS Case report and literature review concerning accessory middle turbinate and secondary middle turbinate. RESULTS Two patients presented with unilateral nasal obstruction. In both patients, nasal endoscopy revealed polypoid masses originating from the middle meatus. Paranasal sinus computed tomography and histopathological analysis confirmed the presence of polyps originating from an accessory middle turbinate and secondary middle turbinate, which were resected uneventfully via endoscopic sinus surgery. CONCLUSION To our knowledge, this is the first report in the world literature of polyps originating from a unilateral accessory middle turbinate and secondary middle turbinate. Pre-operative recognition of these rare anatomical variations is of particular importance in avoiding intra-operative complication.
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Doonquah L, Brown P, Mullings W. Management of frontal sinus fractures. Oral Maxillofac Surg Clin North Am 2012; 24:265-74, ix. [PMID: 22386855 DOI: 10.1016/j.coms.2012.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The traditional treatment of frontal sinus fractures is undergoing a review by many clinicians. This review will undoubtedly contribute to the existing controversy surrounding the management of patients with this condition. This article seeks to further the review and suggest the authors' perspective on a more appropriate approach to the care of patients with frontal sinus injuries.
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Affiliation(s)
- Ladi Doonquah
- Department of Surgery, University Hospital of the West Indies, Mona, Jamaica.
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Mucocele after transnasal endoscopic repair of traumatic anterior skull base fistula in children. Int J Pediatr Otorhinolaryngol 2011; 75:1137-42. [PMID: 21820187 DOI: 10.1016/j.ijporl.2011.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/09/2011] [Accepted: 06/11/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To report the long-term sinonasal complications after endoscopic repair of anterior skull base fractures in children. This study describes mucocele formation in 6 patients treated endoscopically for posttraumatic CSF fistulae. We aim to address possible etiologic factors, specific treatments and follow-up modalities. PATIENTS AND METHODS 12 children, mean age 5.8 years (3-10), treated endoscopically at our institution between 2004 and 2010 for an anterior cranial base fracture complicated by a CSF fistula. An iatrogenic mucocele was observed in 6 cases. A retrospective review of the files of these 6 patients was carried out demonstrating demographic characteristics, presenting signs/symptoms, site of skull base defect, repair technique, timing and onset of the mucoceles, their presentation and management. A systematic CT-scan and/or MRI was carried out at 3 months, 1 year and then annually. RESULTS 3 patients presented after cranial trauma with persistent CSF nasal leak, and 4 with meningitis. Posttraumatic defects reached the posterior wall of the frontal sinus and the junction of ethmoid and frontal bone in 3 cases, and the cribriform plate in 3 cases. Endoscopic closure was performed in all cases, with the middle turbinate as an overlay patch. No recurrence of a CSF leak was observed. After a mean period of 16 months, a single iatrogenic mucocele was observed in 4 patients (radiological detection only), and multiple mucoceles in 2 patients. Surgical treatment was advocated in cases of proptosis, quick expansion of the mucocele leading to sinus bony wall remodelling or erosion (2 cases), and meningitis related to an erosion of the cribriform plate by the mucocele. Three mucoceles were successfully treated endoscopically, and 1 required an external approach. CONCLUSION Mucocele incidence after endoscopic repair of skull base fractures in children is not insignificant (50% in our 12 patients series). Paediatric anatomical features, cranial trauma, and the transethmoidal approach may play a role in mucocele pathogenesis. Long-term clinical and radiological follow-up is therefore recommended. These mucoceles may be managed endoscopically with good outcomes.
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Lien CF, Weng HH, Chang YC, Lin YC, Wang WH. Computed tomographic analysis of frontal recess anatomy and its effect on the development of frontal sinusitis. Laryngoscope 2011; 120:2521-7. [PMID: 20949581 DOI: 10.1002/lary.20977] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES/HYPOTHESIS To use computed tomography to determine the association of frontal recess cells with the development of frontal sinusitis. STUDY DESIGN Retrospective analysis. METHODS We retrospectively analyzed various frontal recess cells on spiral computed tomographic images of sinuses between November 2007 and May 2009. Exclusion criteria included previous sinus surgery, sinonasal polyposis, age younger than 18 years, maxillofacial fracture, incomplete sections of computed tomography, and sinonasal malignancy. We used logistic regression analysis to compare the distribution of various frontal recess cells in patients with frontal sinusitis and those without frontal sinusitis. RESULTS A total of 192 patients met the criteria, and only 363 sides were distinguishable. The presence of suprabullar cells, supraorbital ethmoid cells, frontal bullar cells, and recessus terminalis was significantly associated with the development of frontal sinusitis by multiple logistic regression models. CONCLUSIONS The frequency of frontal recess cells analyzed in Taiwanese adult patients was similar to that analyzed in other Asian adult populations (Chinese and Korean). The frontoethmoid cells posterior and posterolateral to the frontal recess (suprabullar cells, frontal bullar cells, and supraorbital ethmoid cells) might reveal a more significant association with the development of frontal sinusitis than those anterior to the frontal recess (agger nasi cells, frontal cell types 1-3). The presence of supraorbital ethmoid cells on computed tomographic images might indicate the highest odds of frontal sinusitis, followed by the presence of suprabullar cells, frontal bullar cells, and recessus terminalis.
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Affiliation(s)
- Ching-Feng Lien
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Chiayi, Taiwan
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Stanwix MG, Nam AJ, Manson PN, Mirvis S, Rodriguez ED. Critical computed tomographic diagnostic criteria for frontal sinus fractures. J Oral Maxillofac Surg 2010; 68:2714-22. [PMID: 20727640 DOI: 10.1016/j.joms.2010.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 02/05/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Diagnosis and treatment of frontal sinus fractures (FSFs) have progressed over the previous 30 years. Despite advances in computed tomography, there is no current diagnostic uniformity with regard to classification and treatment. We developed a statistically valid treatment protocol for FSFs based on injury pattern, nasofrontal outflow tract (NFOT) injury, and complication(s). These data outlined predictable injury patterns based on specific computed tomographic findings critical to the diagnosis and ultimate treatment of this potentially fatal injury. MATERIALS AND METHODS A retrospective review was conducted on patients with FSF from 1979 to 2005 under institutional review board approval. All computed tomographic scans were reviewed by the authors and fractures categorized by location, displacement, comminution, and degree of NFOT injury. RESULTS One thousand ninety-seven patients with FSF were identified, 87 expired and 153 had inadequate data, leaving a group of 857 patients. Simultaneous displacement of anterior-posterior tables constituted the largest group (38.4%). NFOT injury occurred in most patients (70.7%) and was strongly associated with anterior (92%) and posterior (88%) table involvement (comminuted 98%). Sixty-seven percent of patients with NFOT injury had obstruction. Five hundred four patients (59.6%) had surgery with 10.4% complications and 353 patients were observed with 3.1% complications. All but 1 patient with complications had NFOT injury (98.5%). CONCLUSIONS Predictable patterns of injury based on specific computed tomographic data play a pivotal role in classification and surgical management of potentially fatal frontal sinus injuries. Radiologic diagnosis of NFOT injury in FSFs, particularly obstruction, plays a decisive role in surgical planning.
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Affiliation(s)
- Matthew G Stanwix
- Division of Plastic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Lee AS, Schaitkin BM, Gillman GS. Evaluating the safety of frontal sinus trephination. Laryngoscope 2010; 120:639-42. [PMID: 20131361 DOI: 10.1002/lary.20803] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The depth of the frontal sinus was measured using axial computed tomography (CT) images to examine the safety of frontal sinus trephination at selected distances from the midline. STUDY DESIGN Review of 200 sinus CT scans. METHODS Two hundred sinus CT scans (400 frontal sinuses) were reviewed to measure the frontal sinus depth at 5 mm, 10 mm, and 15 mm from midline. RESULTS Males had a significantly deeper frontal sinus than females at all measurements points (P < .001). The measurements revealed a considerable number of small but nonhypoplastic frontal sinuses, which were shallower than the length of standard frontal trephine instruments (7 mm) and would risk penetration of the posterior table of the sinus. Of all frontal sinuses studied, 9.54% were <7 mm deep at 5 mm from the midline, 10.12% at 10 mm, and 8.96% at 15 mm from the midline. Overall, 15.3% of all frontal sinuses studied had at least one point where the measured depth was <7 mm. CONCLUSIONS Although the majority of patients have frontal sinuses deep enough to accommodate standard trephine instruments, surgeons should recognize that up to 15% of nonhypoplastic frontal sinuses may not be sufficiently deep at a given point to allow safe trephination without risking unintentional transgression of the posterior table. This study suggests that trephination routinely carried out at a given predetermined distance from the midline may be an unsafe practice. Careful evaluation of the imaging is essential in every case to avoid inadvertent injury and to help select the safest distance from the midline for frontal sinus trephination.
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Affiliation(s)
- Annie S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Serafim IM, Vilani GNL, Siqueira VCVD. A relação entre o crescimento mandibular e a maturação esquelética em jovens brasileiras melanodermas. Dental Press J Orthod 2010. [DOI: 10.1590/s2176-94512010000200009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: avaliar o grau de correlação existente entre o crescimento mandibular e a maturação esquelética em jovens brasileiras melanodermas. MÉTODOS: examinou-se 140 telerradiografias, obtidas em norma lateral e 140 radiografias de mão e punho de jovens do gênero feminino, brasileiras, melanodermas, com 8 a 14 anos de idade, com oclusão normal ou má oclusão de Classe I, de Angle, não submetidas a tratamento ortodôntico prévio. Nas radiografias da mão e do punho, avaliou-se o desenvolvimento dos centros de ossificação da falange proximal do 3º dedo e da epífise distal do osso rádio, apoiando-se no método descrito por Eklöf e Ringertz; e nas telerradiografias, obtidas em norma lateral, analisou-se a pneumatização do seio frontal, de acordo com o método descrito por Rüf e Pancherz, e as medidas cefalométricas representativas do crescimento mandibular (Co-Go, Co-Gn, Go-Gn e Fg-Pg). Os dados obtidos foram submetidos à análise estatística, utilizando-se a Correlação de Pearson, para determinar o grau de relacionamento entre as variáveis. RESULTADOS E CONCLUSÃO: ocorreu uma correlação altamente significativa entre os centros de ossificação observados na radiografia de mão e punho e as medidas cefalométricas representativas do crescimento mandibular (r = 0,777). Apesar de estatisticamente significativa, ocorreu uma baixa correlação entre a pneumatização do seio frontal e os eventos da maturidade esquelética (r = 0,306), assim como a relação entre a pneumatização do seio frontal e as medidas cefalométricas representativas do crescimento mandibular (r = 0,218).
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Twenty-six-year experience treating frontal sinus fractures: a novel algorithm based on anatomical fracture pattern and failure of conventional techniques. Plast Reconstr Surg 2009; 122:1850-1866. [PMID: 19050539 DOI: 10.1097/prs.0b013e31818d58ba] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frontal sinus fracture treatment strategies lack statistical power. The authors propose statistically valid treatment protocols for frontal sinus fracture based on injury pattern, nasofrontal outflow tract injury, and complication(s). METHODS An institutional review board-approved retrospective review was conducted on frontal sinus fracture patients from 1979 to 2005. Fractures were categorized by location, displacement, comminution, and nasofrontal outflow tract injury. Demographic data, treatment, and complications were compiled. RESULTS One thousand ninety-seven frontal sinus fracture patients were identified; 87 died and 153 were excluded because of insufficient data, leaving a cohort of 857 patients. The most common injury was simultaneous displaced anteroposterior walls (38.4 percent). Nasofrontal outflow tract injury constituted the majority (70.7 percent), with 67 percent having a diagnosis of obstruction. Of the 857 patients, 504 (58.8 percent) underwent surgery, with a 10.4 percent complication rate; and 353 were observed, with a 3.1 percent complication rate. All complications except one involved nasofrontal outflow tract injury (98.5 percent). Nasofrontal outflow tract injuries with obstruction were best managed by obliteration or cranialization (complication rates: 9 and 10 percent, respectively). Fat obliteration and osteoneogenesis had the highest complication rates (22 and 42.9 percent, respectively). The authors' treatment algorithm provides a receiver operating characteristic area under the curve of 0.8621. CONCLUSIONS A frontal sinus fracture treatment algorithm is proposed and statistically validated. Nasofrontal outflow tract involvement with obstruction is best managed by obliteration or cranialization. Osteoneogenesis and fat obliteration are associated with unacceptable complication rates. Observation is safe when the nasofrontal outflow tract is intact.
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Huang BY, Lloyd KM, DelGaudio JM, Jablonowski E, Hudgins PA. Failed Endoscopic Sinus Surgery: Spectrum of CT Findings in the Frontal Recess. Radiographics 2009; 29:177-95. [DOI: 10.1148/rg.291085118] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Márquez S, Tessema B, Clement PA, Schaefer SD. Development of the Ethmoid Sinus and Extramural Migration: The Anatomical Basis of this Paranasal Sinus. Anat Rec (Hoboken) 2008; 291:1535-53. [DOI: 10.1002/ar.20775] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
PURPOSE OF REVIEW Many of the successes and controversies in endoscopic management of craniofacial trauma are exemplified in the management of frontal sinus trauma. RECENT FINDINGS The effort to reduce surgical morbidity and to optimize reconstruction of craniomaxillofacial injuries has resulted in the development of less invasive surgical approaches and in the use of computer image guidance in surgical planning and execution. Minimally invasive management of frontal sinus inflammatory disease has gained wide acceptance. The technology and techniques applied to surgery of the floor of the frontal sinus is now being applied to the management of frontal sinus trauma. A paradigm shift in the treatment of frontal sinus trauma may be underway. SUMMARY An increasing scope of less severe injuries is being managed expectantly with endoscopic frontal sinus surgery available for salvage. There may be an overall decrease in the most severe frontal sinus injuries owing to enforcement of seatbelt and airbag usage. And the most severe injuries are often best managed through cranialization with anterior skull base reconstruction. Thus, the role for frontal sinus obliteration purely to obviate fractures of the frontal sinus outflow tract may be vanishing.
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Som PM, Park EE, Naidich TP, Lawson W. Crista galli pneumatization is an extension of the adjacent frontal sinuses. AJNR Am J Neuroradiol 2008; 30:31-3. [PMID: 18768714 DOI: 10.3174/ajnr.a1291] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The crista galli is part of the ethmoid bone and, as such, it could be expected that aeration of the crista would come from ethmoid cells. After observing crista pneumatization from the frontal sinuses in several cases, we undertook this study to establish how often crista galli pneumatization came from the frontal sinuses rather than from the ethmoid complex. MATERIALS AND METHODS Two hundred consecutive CT scans of the paranasal sinuses were studied in adult patients to obtain the incidence of crista galli pneumatization and the cell of origin for this phenomenon. A second group of 132 children, 0-7 years of age, was studied to see if any crista galli pneumatization occurred before frontal sinus development. A third group of 79 children, 7-12 years of age, was also studied to see when crista pneumatization occurred in children whose frontal sinuses had already extended into the squamosal portion of the frontal bone. RESULTS Of the 200 adult cases, there were 26 patients (13%) with crista galli pneumatization, all from either the left or right frontal sinuses. In the second group of children 0-7 years of age, there were no cases of crista pneumatization. In the third group of children 7-12 years of age, there were 4 cases of crista galli pneumatization, all from well-developed frontal sinuses. CONCLUSIONS Our study indicates that crista galli pneumatization is virtually exclusively from either the left or right frontal sinuses and not from displaced ethmoid complex cells in the frontal recess. This finding may have surgical implications when disease is present in the crista galli.
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Affiliation(s)
- P M Som
- Department of Radiology, Mount Sinai School of Medicine of New York University, New York, NY 10029, USA.
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Tatlisumak E, Ovali GY, Asirdizer M, Aslan A, Ozyurt B, Bayindir P, Tarhan S. CT study on morphometry of frontal sinus. Clin Anat 2008; 21:287-93. [PMID: 18428994 DOI: 10.1002/ca.20617] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this study was to determine the prevalence and morphological characteristics of the frontal sinus in an adult population. This study was conducted retrospectively on paranasal CT scans in the axial and coronal planes of 300 cases (123 male and 177 female). The mean age was 40.74 +/- 13.34 (range 20-83). Measurements of the width, height and anteroposterior length for each sinus and total width were obtained from CT scans. Measurements were compared statistically with relation to side and sex. The cases were divided into subgroups according to age for each sex and each measurement parameter was also compared among the subgroups. All measurements tended to be larger on the left side and were significantly larger in males than females. There was a significant difference in the anteroposterior lengths of right and left sides in both males and females and height for males and width for females. In both sexes, the highest values of measurements were usually observed at the 31-40 age group and there was a tendency to decrease with aging. The larger diameters of the left frontal sinus imply that it may be more possibly violated during surgical interventions. Morphometric features differed significantly in the two sexes at different ages and comparison with previous studies presented great regional variability. The size of the frontal sinus was seen to be related to age and sex. The knowledge provided in the present study is useful for some surgical procedures and widens the anthropometric knowledge of humanity.
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Affiliation(s)
- Ertugrul Tatlisumak
- Department of Anatomy, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Riello APDFL, Boasquevisque EM. Variações anatômicas do complexo ostiomeatal: achados tomográficos em 200 pacientes. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000300004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: O objetivo deste trabalho foi verificar a freqüência e os tipos de variações anatômicas do complexo ostiomeatal. MATERIAIS E MÉTODOS: Foram revisadas 200 tomografias computadorizadas de pacientes com suspeita clínica de sinusopatia. RESULTADOS: Observamos um ou mais tipos de variações anatômicas em 83,5% dos pacientes, as mais freqüentes envolvendo o corneto médio (84%) e o septo nasal (34%). Outras variantes anatômicas comuns encontradas foram a presença de aeração do agger nasi e células etmoidais infra-orbitárias (células de Haller). CONCLUSÃO: As variações anatômicas do complexo ostiomeatal anterior são muito corriqueiras. As mais freqüentes envolvem o corneto médio e o septo nasal.
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