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Taş BM, Bekin Sarıkaya PZ, Şencan Z, Cömert E, Bayar Muluk N. Radiological Evaluation of the Effect of Laryngopharyngeal Reflux on the Thickness of Inferior Turbinate, Maxillary Sinus Mucosa and Nasal Septal Body. Indian J Otolaryngol Head Neck Surg 2024; 76:530-535. [PMID: 38440497 PMCID: PMC10908712 DOI: 10.1007/s12070-023-04204-3] [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: 05/30/2023] [Accepted: 08/28/2023] [Indexed: 03/06/2024] Open
Abstract
Background We investigated the relationship between Laryngopharyngeal Reflux (LPR) and maxillary sinus mucosal thickness (MSMT), inferior turbinate mucosal thickness (ITMT), inferior turbinate width (ITW) and nasal septal body thickness (NSBT), which can be signs of chronic rhinosinusitis and allergic rhinitis. Methods The study, which included 87 patients, was designed as two groups. While 42 of the patients were included in the Laryngopharyngeal Reflux group, 45 were included in the control group. Age and gender information of the patients were noted. MSMT, ITMT, ITW and NSBT values were measured in patients who had Paranasal Sinus Computed Tomography. MSMT, ITMT and ITW were measured as right and left. Both groups were evaluated in terms of these values. Results Right ITMT, bilateral ITW and MSMT values were found to be significantly higher in the LPR group than in the control group (p < 0.05). MSMT values were higher in males (p < 0.05). The left-ITT and NSBT values were not significantly different between the LPR group and the control group, but both values were higher in the LPR group than in the control group (p > 0.05). In the LPR group, there were positive correlations between ITMT and ITW values of the right side; and left side separately (p < 0.05). Conclusion It has been shown that Laryngopharyngeal Reflux increases maxillary sinus mucosal thickness, inferior turbinate thickness and width, and nasal septal body thickness, which can be signs of chronic rhinosinusitis and allergic rhinitis. The negative effects of LPR on nasal and paranasal mucosa and structures were demonstrated in this study.
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Affiliation(s)
- Burak Mustafa Taş
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | | | - Ziya Şencan
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Ela Cömert
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
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Akbulut N, Akbulut S, Bayrak S, Şen E, Altan A, Kaymaz G, Çolak S. Effects of modified step Le Fort I advancement surgery on nostril area and inferior nasal structures volume in class III patients: a retrospective clinical study. Clin Oral Investig 2023; 27:807-815. [PMID: 36648584 DOI: 10.1007/s00784-023-04860-3] [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: 02/07/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The effect of the modified step Le Fort I osteotomy on the inferior nasal structures and the nostril area was evaluated. MATERIALS AND METHODS This study included 24 patients who had modified step Le Fort I osteotomy. Inferior nasal concha volume (INCV), meatus nasi inferior volume (MNIV), the sum of both structures volume (TV), and nostril area (NA) were evaluated in pre- (T0) and postoperative (T1) periods. RESULTS For all patients, NA increased both on the right side (p = 0.011) and left side (p = 0.050) after surgery. The INCV and TV values were lower in T1 than those in T0; however, a statistically significant decrease of INCV and TV was found only in the right side of males (p = 0.039 and p = 0.050, respectively). No significant difference was found in MNIV between T0 and T1 measurements (p > 0.05). CONCLUSION Maxillary advancement with the modified step Le Fort I osteotomy technique increased the NA, which may have a positive effect on breathing function. On the other hand, although TV tended to decrease, MNIV did not change after surgery as the same decreasing tendency also existed in INCV. CLINICAL RELEVANCE Step Le Fort I advancement surgery technique usually affects nasal structures positively regarding the nasal airway.
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Affiliation(s)
- Nihat Akbulut
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Sibel Akbulut
- Orthodontics Department, Dentistry Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Seval Bayrak
- Oral and Maxillofacial Radiology Department, Dentistry Faculty, Bolu Abant Izzet Baysal University, Golkoy, Bolu, Turkey.
| | - Esengül Şen
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Ahmet Altan
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Gizemnur Kaymaz
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Sefa Çolak
- Oral and Maxillofacial Surgery Department, Dentistry Faculty, Tokat Gaziosmanpaşa University, Tokat, Turkey
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Shetty S, Al-Bayatti S, Alam MK, Al-Rawi NH, Kamath V, Tippu SR, Narasimhan S, Al Kawas S, Elsayed W, Rao K, Castelino R. Analysis of inferior nasal turbinate volume in subjects with nasal septum deviation: a retrospective cone beam tomography study. PeerJ 2022; 10:e14032. [PMID: 36172494 PMCID: PMC9511997 DOI: 10.7717/peerj.14032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background The association of the linear dimensions of the inferior turbinate hypertrophy with nasal septal deviation has been studied recently. However, the volumetric dimensions provide a more accurate status of the turbinate hypertrophy compared to linear measurements. The aim of this study was to analyze the association of inferior nasal turbinate volume with the degree of nasal septal deviation (NSD). Methods A retrospective evaluation of the cone beam computed tomography (CBCT) scans of 412 patients was carried out to obtain 150 scans which were included in the study. The scans were categorized into three groups. Group 1 comprised of 50 scans of patients with no inferior turbinate hypertrophy (ITH) and no nasal septal deviation. Group 2 comprised of 50 scans of patients with ITH and no NSD; whereas Group 3 included 50 scans of patients with ITH and NSD. The total turbinate volume of inferior turbinates (bilateral) were determined by using Vesalius 3D software (PS-Medtech, Amsterdam, Netherlands). Results The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologists was 0.82. There were no significant age and gender related changes in the total turbinate volume. Patients in Group 3 had significantly higher (p = 0.001) total turbinate volume compared to Group 2 and Group 1. There was a positive and significant correlation (r = 0.52, p = 0.002) between the degree of septal deviation and total turbinate volume. When the total turbinate volume of the patients with different types of septal deviation was compared in Group 3, a statistically significant difference (p = 0.001) was observed. Regression analysis revealed that the septal deviation angle (SDA) (p = 0.001) had a relationship with total turbinate volume. From the results of the study we can conclude that the total turbinate volume is higher in patients with nasal septal deviation. It can also be concluded that the septal deviation angle has a positive correlation with total turbinate volume. The data obtained from the study can be useful in post-surgical follow up and evaluation of patients with nasal septal deviation and hypertrophied inferior nasal turbinate.
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Affiliation(s)
- Shishir Shetty
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Saad Al-Bayatti
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Natheer H. Al-Rawi
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Vinayak Kamath
- Department of Public Health Dentistry, Goa Dental College, Goa, India
| | - Shoaib Rahman Tippu
- Department of Diagnostic and Surgical Dental Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Sangeetha Narasimhan
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Sausan Al Kawas
- Department of Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Walid Elsayed
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | - Kumuda Rao
- Department of Oral Medicine and Radiology, Nitte (Deemed to be University), Mangalore, India
| | - Renita Castelino
- Department of Oral Medicine and Radiology, Nitte (Deemed to be University), Mangalore, India
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Shetty SR, Al-Bayatti SW, Al Kawas S, Al-Rawi NH, Kamath V, Shetty R, Shetty S, Desai V, David L. A study on the association between the inferior nasal turbinate volume and the maxillary sinus mucosal lining using cone beam tomography. Heliyon 2022; 8:e09190. [PMID: 35368549 PMCID: PMC8968633 DOI: 10.1016/j.heliyon.2022.e09190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/12/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives The volume of the inferior turbinates (IT) and the lining of the maxillary sinuses are important parameters when assessing sino-nasal diseases. However, no radiographic studies have investigated the correlation between these parameters. The present study was conducted to analyze the association between IT volumes and thickness of maxillary sinus mucosal lining. Materials and methods A retrospective evaluation of the cone-beam computed tomography (CBCT) scans of 100 adult subjects was carried out by two radiologists. The scans were assigned to two groups (Group 1 & 2) based on the radiographic evidence of maxillary sinus lining in the CBCT scans. Group 1 consisted of 50 CBCT scans of subjects with no evidence of maxillary sinus mucosal lining, whereas Group 2 consisted of 50 subjects with evidence of maxillary sinus mucosal lining. The scans in the Group 2 were further sub-classified into five categories, based on the thickness of the maxillary sinus mucosal lining. Vesalius 3D software was used to evaluate the total volume of inferior nasal turbinates by the two radiologists and a mean volume was obtained for each study subject. Results The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologist was 0.87. Analysis of the results revealed that there was no significant gender-based difference (Group 1, P = 0.67 and Group 2, P = 0.95) in the total turbinate volume in either of the study groups. The total turbinate volume did not show any significant correlation (Group 1, r = 0.24 and Group 2, r = 0.12) with the age. There was a significant increase (P = 0.001) in the total turbinate volume of the subjects in Group 2 compared to Group 1. Regression analysis revealed that the thickness of sinus lining correlated significantly (P = 0.001) with the total turbinate volume. Conclusion An increase in the total turbinate volume has been associated with an increase in the thickness of the maxillary sinus mucosal lining. The data from this study will be useful for post-operative follow-up of inferior turbinates and maxillary sinus lining after the turbinate volume reduction procedures.
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Affiliation(s)
- Shishir Ram Shetty
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Corresponding author.
| | | | - Sausan Al Kawas
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | | | - Sunaina Shetty
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Vijay Desai
- College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Leena David
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Baddam P, Thereza-Bussolaro C, Flores-Mir C, Graf D. Nasal cavity structural anomalies in children and adolescents at high risk of sleep-disordered breathing: An exploratory cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2021; 160:533-543.e2. [PMID: 34334271 DOI: 10.1016/j.ajodo.2020.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In this study, we investigated the presence of structural anomalies in the nasal cavity (deviated nasal septum [DNS] and turbinate hypertrophy [TH]) in patients at high risk or not of sleep-disordered breathing (SDB). METHODS A retrospective study considering available cone-beam computed tomography scans of 99 patients was conducted. Dolphin Imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif) was used to process the craniofacial scans. A pediatric sleep questionnaire (PSQ) was used to suggest a high risk of SDB. Subjective and objective assessments of DNS and TH were considered. RESULTS Good to excellent intrareliability and interreliability were attained. The prevalence of a PSQ score suggestive of a high risk of SDB in this sample was 59%. The prevalence of subjective DNS and TH assessment was 64% and 70%, respectively. In contrast, on the basis of objective assessments, 27% of patients presented with DNS and 25% with TH. Cross-tabulation of DNS and TH with PSQ score indicated a statistically significant association between subjective DNS and subjective TH and subjective TH and positive PSQ. A positive correlation between age and subjective and objective DNS assessments was also observed. CONCLUSIONS Older patients are more likely to present with DNS. Only the presence of subjectively determined TH in patients is associated with a high risk for SDB. The study reveals that assessment of DNS and TH using cone-beam computed tomography imaging is not likely suitable to strongly suggest patients at high risk for SDB. DNS subjective assessments were capable of identifying less than 5% of deviation.
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Affiliation(s)
- Pranidhi Baddam
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Carlos Flores-Mir
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel Graf
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Shetty SR, Al Bayatti SW, Al-Rawi NH, Marei H, Reddy S, Abdelmagyd HA, Narasimhan S, Al Kawas S, Mathew A. Analysis of inferior nasal turbinate width and concha bullosa in subjects with nasal septum deviation: a cone beam tomography study. BMC Oral Health 2021; 21:206. [PMID: 33894757 PMCID: PMC8066481 DOI: 10.1186/s12903-021-01576-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background In individuals with nasal septal deviation (NSD), compensatory hypertrophy of the nasal turbinates occurs as a protective mechanism of the nasal passage from dry and cold air. NSD associated nasal turbinate hypertrophy is usually recurrent, requiring repetitive imaging. Therefore, a multiplanar imaging modality with a low radiation dose is best suited for long-term follow-up of this condition. This study aimed to evaluate the association of width of inferior turbinates and presence of concha bullosa with the degree of NSD using Cone beam computed tomography (CT). Methods The CBCT scans of 100 patients with NSD were selected as per convenience sampling and were evaluated by two maxillofacial radiologists. The width of the non-hypertrophied inferior turbinate (NHT) on the convex side of the NSD, and hypertrophic inferior turbinates (HT) on the concave side of the NSD were measured at three locations. The septal deviation angle (SDA) and the presence of concha bullosa (CB) were determined. Results A significant difference was observed in the anterior, middle, posterior, and mean widths between HT and NHT (p < 0.001). There was a significant difference in the widths of the HT and NHT among different types of NSD. A strong positive correlation (r = 0.71, p < 0.001) was found between SDA and the mean width of the HT. Age (P = 0.71) and gender (P = 0.65) had no significant difference among different types of NSD. Regression analysis revealed that the presence of CB (p = 0.01) and middle width of the HT (p < 0.001) are significant predictors of SDA and type of NSD. Conclusion The results of the present study reveal that the middle width of the HT and the presence of CB influence the degree of NSD. The present study results recommend the use of CBCT as a substitutive low radiation dose imaging modality for evaluation of NSD, CB, and associated inferior turbinate hypertrophy.
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Affiliation(s)
- Shishir Ram Shetty
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates. .,Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.
| | | | | | - Hesham Marei
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | - Sesha Reddy
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | | | - Sangeetha Narasimhan
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sausan Al Kawas
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Asok Mathew
- University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
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Endoscopic maxillectomy: anatomo-radiological description of the "double" maxillary sinus window. Eur Arch Otorhinolaryngol 2021; 278:3813-3820. [PMID: 33481079 DOI: 10.1007/s00405-021-06604-z] [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: 12/01/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present a modified endoscopic medial maxillectomy (MEMM) approach to control maxillary sinus pathologies. METHODS MEMM was completed in 13 fresh-frozen specimens. An MEMM includes cutting the nasolacrimal duct, inferior meatus flap, and repositioning the inferior turbinate (IT). The following measurements were obtained: length of IT, height from the nasal floor to valve of Hasner, height of the IT at the level of valve of Hasner, height of the IT at the insertion of the middle turbinate, and distance from the piriform aperture to the posterior wall of maxillary sinus and to the posterior border of palatine bone. Similar measurements were also performed on craniofacial computed tomography (CT) scans (n = 50). The surgical technique was performed in a case series (n = 8). RESULTS The mean of the specimens was 82 (range 70-95) years old. The average area of the harvested inferior meatus flap area was 9.6 ± 1.0 cm2. In the radiologic study, the mean maximum antrostomy area was 8.8 ± 1.7 cm2 and the IT area overlapping the antral window was 5.8 ± 1.1 cm2, the area allowing a double window control was 3.1 ± 1.9 cm2, the posterior IT insertion length was 0.7 ± 0.4 cm, and the inferior meatus flap covering the inferior meatotomy had an area measuring 6.7 ± 1.7 cm2. Eight patients underwent MEMM for various benign conditions showing no recurrence after 26 month follow-up. CONCLUSION The proposed modifications of MEMM provide a "double" window maxillary sinus control with access to all maxillary walls and preservation of the IT.
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van der Elst LA, Gokce Kurtoglu M, Leffel T, Zheng M, Gumennik A. Rapid Fabrication of Sterile Medical Nasopharyngeal Swabs by Stereolithography for Widespread Testing in a Pandemic. ADVANCED ENGINEERING MATERIALS 2020; 22:2000759. [PMID: 33173409 PMCID: PMC7645949 DOI: 10.1002/adem.202000759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/27/2020] [Indexed: 05/04/2023]
Abstract
The 3D printing of nasopharyngeal swabs during the COVID-19 pandemic presents a central case of how to efficiently address a break in the global supply chain of medical equipment. Herein a comprehensive study of swab design considerations for mass production by stereolithography is presented. The retention and comfort performance of a range of novel designs of 3D-printed swabs are compared with the standard flocked-head swab used in clinical environments. Sample retention of the 3D swab is governed by the volume, porosity density, and void fraction of the head as well as by the pore geometry. 3D-printed swabs outperform conventional flock-head swabs in terms of sample retention. It is argued that mechanically functional designs of the swab head, such as corkscrew-shaped heads and negative Poisson ratio heads, maximize sample retention and improve patient comfort. In addition, available designs of swab shafts for an optimized sample collection procedure are characterized. The study is conducted in vitro, using artificial mucus, covering the full range of human mucus viscosities in a 3D-printed model of a nasal cavity. The work sets the path for the resilient supply of widespread sterile testing equipment as a rapid response to the current and future pandemics.
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Affiliation(s)
- Louis A. van der Elst
- Fibers and Additive Manufacturing Enabled Systems LaboratoryDepartment of Intelligent Systems EngineeringIndiana UniversityMultidisciplinary Engineering & Sciences Hall, 2425 North Milo B. Sampson LaneBloomingtonIN47408USA
| | - Merve Gokce Kurtoglu
- Fibers and Additive Manufacturing Enabled Systems LaboratoryDepartment of Intelligent Systems EngineeringIndiana UniversityMultidisciplinary Engineering & Sciences Hall, 2425 North Milo B. Sampson LaneBloomingtonIN47408USA
| | - Troy Leffel
- Fibers and Additive Manufacturing Enabled Systems LaboratoryDepartment of Intelligent Systems EngineeringIndiana UniversityMultidisciplinary Engineering & Sciences Hall, 2425 North Milo B. Sampson LaneBloomingtonIN47408USA
| | - Mengxin Zheng
- Fibers and Additive Manufacturing Enabled Systems LaboratoryDepartment of Intelligent Systems EngineeringIndiana UniversityMultidisciplinary Engineering & Sciences Hall, 2425 North Milo B. Sampson LaneBloomingtonIN47408USA
| | - Alexander Gumennik
- Fibers and Additive Manufacturing Enabled Systems LaboratoryDepartment of Intelligent Systems EngineeringIndiana UniversityMultidisciplinary Engineering & Sciences Hall, 2425 North Milo B. Sampson LaneBloomingtonIN47408USA
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Abstract
OBJECTIVE The aim of the study was to assess different radiologic bony landmarks for endoscopic localization of the sphenopalatine foramen (SPF). METHODS Paranasal computed tomography (CT) scans of adults without sinonasal pathology were included. On axial cuts, the anteroposterior distances from the SPF to maxillary line, anterior head of the middle turbinate, basal lamella of the middle turbinate, choanal arch, and posterior fontanel of the maxillary sinus ostium were measured. While on coronal cuts, the vertical distances from the SPF to the nasal floor was measured. The registered measurements were then studied and statistically analyzed. RESULTS In 70 patients (140 sides, 840 measurements), the mean distances from the SPF to nasal floor, choanal arch, maxillary line, anterior head of the middle turbinate, basal lamella, and posterior fontanel were 25.6 ± 2.4, 8.5 ± 1.38, 36.4 ± 2.6, 34.6 ± 4.26, 8.1 ± 1.27, and 13.7 ± 1.7 mm, respectively, without significant differences between right and left sides. Females showed significantly shorter mean distances between SPF and the nasal floor (P = 0.0011), choanal arch (P = 0.0459), and posterior fontanel (P < 0.0001) than males. While no significant differences were detected between both sexes as regard distances from SPF to maxillary line (P = 0.5579), anterior head of middle turbinate (P = 0.8581), and basal lamella (P = 0.0638). CONCLUSION Preoperative CT can provide multiple easily detected, reliable, and simple bony landmarks that can help SPF endoscopic localization. Thus the authors recommend adding these measurements to the preoperative CT checklist for patients scheduled for sphenopalatine artery ligation and/or excision of vascular lesions.
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