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Geamănu A, Rusu MC, Mureşan AN, Vrapciu AD. The Ethmomaxillary Sinus-A False Duplicate Maxillary Sinus. J Craniofac Surg 2024; 35:e458-e461. [PMID: 39042059 DOI: 10.1097/scs.0000000000010195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/07/2024] [Indexed: 07/24/2024] Open
Abstract
Functional endoscopic sinus surgery consistently benefits from good anatomical knowledge and modern imaging techniques. Ethmoid air cells migrate in specific topographical sites near the ethmoid. Posterior ethmoid air cells that descend into the maxillary sinus (MS) are ethmomaxillary sinuses (EMSs) that into the superior nasal meatus. Few previous studies found EMSs in 0.68% to 16.48% of cases. An EMS differs from a Haller's infraorbital cell nearing the ethmoidal infundibulum. A posterior ethmoid air cell intercalated between the ethmoid, MS and sphenoidal sinus is a Sieur's cell, but it could also be regarded as an EMS. An EMS should be discriminated from a maxillary recess of the sphenoidal sinus. An EMS could determine Onodi's maxillary bulla into the MS. The false duplicate MS described by Zuckerkandl consists of a MS draining into the middle nasal meatus adjoined by an EMS draining into the superior nasal meatus. These are separated by the ethmomaxillary septum. The latter may be confused with an intrasinus septum of the MS if the drainage pathways are not adequately documented. Therefore, a case-by-case anatomic identification of the pneumatic spaces nearing the MS should be performed before surgical endoscopic approaches of the nose and sinuses.
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Affiliation(s)
- Aida Geamănu
- Division of Ophthalmology, Department 12 - University Emergency Hospital, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy
| | - Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy
| | - Alexandru Nicolae Mureşan
- Division of Anatomy, Department 1, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy
| | - Alexandra Diana Vrapciu
- Division of Anatomy, Department 1, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy
- Clinic of Ophthalmology, University Emergency Hospital, Bucharest, Romania
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Abstract
BACKGROUND Improved understanding of the microanatomy of the paranasal sinuses, including its individual variations, makes a substantial contribution to current progress in endonasal endoscopic microsurgery. Microanatomy of the sinuses is an active field of present scientific investitations. MATERIALS AND METHODS A comprehensive review on microanatomy of the maxillary sinus is presented from the perspective of contemporary endonasal endoscopic microsurgery. RESULTS The range of variation of the individual microanatomy of all sections of the maxillary sinus is presented, in particular to minimize secondary sugical tissue trauma, to avoid complications (e.g. on orbital tissues) and as a basis for the prelacrimal access to the maxillary sinus. CONCLUSION Improved understanding of the range of microanatomical variations reduced the burden on the patient while opimizing the effectiveness of the necessary surgical manipulations.
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Affiliation(s)
- W Hosemann
- Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf- und Hals-Chirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Deutschland.
| | - A Grimm
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Semmelweis Universität, Budapest, Ungarn.,Anatomisches, Histologisches und Embryologisches Institut, Semmelweis Universität, Budapest, Ungarn
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Akbulut A, Dilaver E. Correlation between prevelance of Haller cells and postoperative maxillary sinusitis after sinus lifting Procedure. Br J Oral Maxillofac Surg 2019; 57:473-476. [PMID: 31085018 DOI: 10.1016/j.bjoms.2019.04.013] [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: 11/22/2018] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Abstract
Our aim was to investigate the prevalence of Haller cells in a group of patients listed for sinus lifting, and to assess the correlation between postoperative maxillary sinusitis and their presence. A total of 102 patients (150 sides) were evaluated retrospectively on cone-beam computed tomography (CT). The presence and dimensions of Haller cells were noted on the scans. The development of postoperative maxillary sinusitis was recorded. Fisher's exact test was used for statistical evaluation and probabilities of less than 0.05 were considered significant. Maxillary sinusitis developed after sinus lifting in five patients, and Haller cells were found in three of them. However, there was no correlation between the presence of Haller cells and postoperative maxillary sinusitis (p=0.638). The cells were larger in patients with postoperative maxillary sinusitis, and the greater dimensions may be a potential risk factor for developing it after a sinus lift.
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Affiliation(s)
- A Akbulut
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul Medipol University, 00 90 212 453 49 52, Istanbul, Turkey.
| | - E Dilaver
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul Medipol University, 00 90 212 453 49 42, Istanbul, Turkey.
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Orhan K, Aksoy S, Avsever IH, Gündüz K. Incidental Findings in TMJ Imaging. IMAGING OF THE TEMPOROMANDIBULAR JOINT 2019. [PMCID: PMC7115005 DOI: 10.1007/978-3-319-99468-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For years, the conventional imaging modalities are generally used in dental practice routine. They provide precious information about dentomaxillofacial region; they also have some limitations such as superimpositions, magnifications, distortions, and low-image quality. Because of these limitations, some pathologies, calcifications, and anatomical variations may be missed. Any findings on a radiographic image which are not related to the research areas of interest could be a description of “incidental findings.” Calcifications are one of these incidental findings. They are asymptomatic and also common in TMJ images. Although most of the calcifications require no treatment, correct identification will reduce further diagnostic assessments. Incidental findings on TMJ images were rare, while examining images for temporomandibular disorders and associated issues, it is important not only to examine the TMJ structures but also to look at the nearby anatomical features to check for evidence of incidental findings pathologies that may have mimicked signs and symptoms of TMJ disorders.
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Khojastepour L, Haghnegahdar A, Khosravifard N. Role of Sinonasal Anatomic Variations in the Development of Maxillary Sinusitis: A Cone Beam CT Analysis. Open Dent J 2017; 11:367-374. [PMID: 28839485 PMCID: PMC5543612 DOI: 10.2174/1874210601711010367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/07/2016] [Accepted: 12/14/2016] [Indexed: 12/26/2022] Open
Abstract
Background: Several anatomical variations can lead to the inflammation of the paranasal sinuses; therefore, surgeons should be familiar with these variations and their impacts on the status of the paranasal sinuses. Objectives: The present study aimed to determine the prevalence of Haller cells and its association with patients’ sex and age. Furthermore, the relationships between the presence and size of Haller cells, deviation of the uncinate process and size of the maxillary sinus ostium with the occurrence of maxillary sinusitis were investigated. Materials/ Patients and Methods: 120 coronal CBCT images were retrieved and analyzed. Statistical analysis of the data was performed by means of Mann - Whitney, χ2 and T tests. Results: There were statistically significant associations between the presence and surface area of Haller cells and the occurrence of ipsilateral maxillary sinusitis. Neither the angulation of the uncinate process nor the size of the maxillary sinus ostium significantly correlates with the formation of maxillary sinusitis. Conclusion: Haller cells can interfere with the normal drainage of the maxillary sinus and result in sinusitis. In contrast, diameter of the sinus ostium and deviation of the uncinate process do not influence the inflammatory status of the maxillary sinus significantly.
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Affiliation(s)
- Leila Khojastepour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical sciences, Shiraz, Iran
| | - Abdolaziz Haghnegahdar
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical sciences, Shiraz, Iran
| | - Negar Khosravifard
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Guilan University of Medical sciences, Rasht, Iran
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Friedrich RE, Fraederich M, Schoen G. Frequency and volumetry of infraorbital ethmoid cells (Haller cells) on cone-beam computed tomograms (CBCT) of the mid-face. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2017; 6:Doc07. [PMID: 28446994 PMCID: PMC5390117 DOI: 10.3205/iprs000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective: The aim of this study was to determine the frequency and morphology of Haller cells using a new radiological technique that allows examination of the facial skull. Material and methods: In a single center retrospective cohort study the cone-beam computed tomography (CBCT) volume data of the maxillary sinus of 199 patients were analysed (398 paranasal sinuses). If Haller cells were found, their capacity was determined. If orthopantomograms (OPG) were taken in a narrow time frame around the CBCT investigation, the rate of correspondence of the radiological findings was determined. The correlation between frequency of Haller cells and age and gender was calculated. Results: Out of 199 patients 47 showed at least one Haller cell (23.62%). The total number of Haller cells was 64. Correspondence was rare in the same case between the results from different examination procedures with respect to the target object. Conclusions: Bony variants of paranasal sinuses can be analysed using CBCT as an alternative to computed tomography (CT), whereas OPG images do not reliably detect Haller cells.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Cranio-Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Fraederich
- Department of Oral and Cranio-Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Craiu C, Rusu MC, Hostiuc S, Săndulescu M, Derjac-Aramă AI. Anatomic variation in the pterygopalatine angle of the maxillary sinus and the maxillary bulla. Anat Sci Int 2015; 92:98-106. [PMID: 26663153 DOI: 10.1007/s12565-015-0320-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/29/2015] [Indexed: 11/25/2022]
Abstract
Bulges of the most posterior ethmoid air cells into the maxillary sinus were termed maxillary bullæ by Onodi. With few exceptions, they have since been ignored by anatomists through time. Likewise, Sieur cells-the spheno-ethmoido-maxillary air cells-are uncommonly found in anatomical texts. We therefore aimed to perform a retrospective cone beam computed tomography study on 50 patients to document the possibilities of anatomic variation in the situs of the orbital process of palatine bone-a variation related anatomically with the pterygopalatine fossa (PPF) and the respective angle of the maxillary sinus. Commonly occurring pneumatizations in this situs were the Sieur cell (58 %/64 % right/left side), and the maxillary recess of the sphenoidal sinus (20 %/22 % right/left side). Alone or in combination, these determined, but not exclusively, the maxillary bullæ. Uncommon pneumatizations in the anterior wall of the PPF were also found, such as a sphenoidal recess of the maxillary sinus, and lateral (maxillary, or pterygopalatine) recesses of the middle and superior, respectively, nasal meatuses. In two different cases, non-Haller, and non-Sieur posterior ethmoid air cells were found extruded posterior to the maxillary sinus. Significant statistical association indicated bilateral symmetry of Sieur's cell and of the maxillary recess of the sphenoidal sinus. It is important to identify such variant pneumatizations on a case-by-case basis in different surgical procedures and endoscopic corridors.
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Affiliation(s)
- C Craiu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 8 Bd. Eroilor Sanitari, 050474, Bucharest, Romania
| | - M C Rusu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 8 Bd. Eroilor Sanitari, 050474, Bucharest, Romania.
| | - S Hostiuc
- Department of Legal Medicine and Bioethics, Department 2 Morphological Sciences, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - M Săndulescu
- Division of Oral Implantology, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - A I Derjac-Aramă
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 8 Bd. Eroilor Sanitari, 050474, Bucharest, Romania
- INTERMEDICA HIGH CARE RO Clinic, Bucharest, Romania
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9
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Mathew R, Omami G, Hand A, Fellows D, Lurie A. Cone beam CT analysis of Haller cells: prevalence and clinical significance. Dentomaxillofac Radiol 2013; 42:20130055. [PMID: 23975112 DOI: 10.1259/dmfr.20130055] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Haller cells are anterior ethmoid air cells located in the medial orbital floor immediately lateral to the maxillary infundibulum. The purpose of this study was to demonstrate the prevalence and relationship between the existence and size of these cells with ipsilateral maxillary sinusitis and orbital floor dehiscence as visualized on cone beam CT (CBCT) images. METHODS CBCT image volumes of 50 patients were retrieved and analysed. All CBCT images were acquired with a 9-inch field of view scan. χ(2) and Cochran-Mantel-Haenszel tests were used for statistical analysis of the obtained data, and p-values of <0.05 were considered to be statistically significant. RESULTS There was no statistically significant association between the existence and size of Haller cells and maxillary sinusitis. There was a significant association between Haller cells and orbital floor dehiscence. CONCLUSIONS The explanation of maxillary sinusitis on the basis of mechanical obstruction is unlikely. This study provides evidence for the usefulness of CBCT scan in delineation of the sinonasal anatomy.
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Affiliation(s)
- R Mathew
- Department of Oral and Maxillofacial Radiology, Midwestern University College of Dental Medicine-Illinois (CDMI), Downers Grove, IL, USA
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Caversaccio M, Boschung U, Mudry A. Historical review of Haller's cells. Ann Anat 2011; 193:185-90. [PMID: 21454060 DOI: 10.1016/j.aanat.2011.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 01/24/2011] [Accepted: 02/05/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Albrecht von Haller (1708-1777) discovered the infraorbital ethmoid cells, also known as Haller's cells, in 1743. The aim of this historical study is to trace both the different terminology used to name them from the time they were first described anatomically, and the progressive understanding of the role they play in the development of acute rhinosinusitis, and finally to suggest a clear modern definition of Haller's cells based on this history. METHODS A Pubmed search was conducted to find relevant original publications dealing with this subject, and the secondary literature was also reviewed. RESULTS Three historical periods can be distinguished in the study of Haller's cells: their initial description in the mid 18th century, followed by a period of obscurity from the mid 18th to the mid 20th century, and finally the modern period starting in the mid 20th century when their clear pathological influence was realized. Haller's cells are thought to contribute to the narrowing of the entrance of the ethmoidal infundibulum and obstruction of the ostium of the maxillary sinus, which could explain the development of rhinosinusitis where inflammation is present. CONCLUSION On the basis of its history, we suggest that the term "Haller's cell" should be restricted to the most inferior infraorbital ethmoid cell, that nearest the ostium of the maxillary sinus.
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Affiliation(s)
- Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland.
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Polavaram R, Devaiah AK, Sakai O, Shapshay SM. Anatomic variants and pearls--functional endoscopic sinus surgery. Otolaryngol Clin North Am 2004; 37:221-42. [PMID: 15064059 DOI: 10.1016/s0030-6665(03)00161-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For successful endoscopic sinus surgery. a clear understanding of the anatomy is vital. Knowledge of the anatomic relationships and variations helps surgeons avoid complications. By applying anatomic knowledge with careful surgical technique, one can maximize patient safety. Basic tenets for endoscopic sinus surgery can be applied to a variety of patients with confidence.
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Affiliation(s)
- Raju Polavaram
- Department of General Surgery, Boston University School of Medicine, Boston, MA 02118, USA
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Affiliation(s)
- Ian J Witterick
- Division of Otolaryngology, Saint Joseph's Health Centre, 30 The Queensway, Toronto, ON, Canada M6R 1B5.
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Abstract
OBJECTIVES To present unusual computed tomography (CT) findings concerning huge pneumatization of turbinates and paranasal sinuses in one patient. In current world literature the authors only found nine reports of pneumatization of inferior turbinates, which, therefore, must be considered an extremely rare anatomical finding. STUDY DESIGN Case report and literature review. METHODS Computed tomography findings in a 35-year-old white woman with nasal obstruction are presented; and the authors describe this additional case of pneumatization of an inferior turbinate, as well as other variants. The literature and nomenclature are reviewed. RESULTS Besides the rare anatomical finding of a pneumatized inferior turbinate, in addition, both patient middle and superior turbinates were pneumatized bilaterally. Frontal and sphenoid sinuses were huge, with pneumatization of the crista galli and the posterior parts of the septum. The floor of the orbit presented with an orbitoethmoid (Haller) cell on one side. Thus, five of the six turbinates present were pneumatized. To the authors' knowledge, no other case of such extreme pneumatization has been published in world literature to date. CONCLUSIONS Whereas pneumatization of the ethmoturbinals is a frequent finding on sinus computed tomography scans, pneumatization of the maxilloturbinal remains an extremely rare anatomical variant. Pneumatization of ethmoid cells and secondary sinuses is considered an active achievement of nasal and sinus mucosa during fetal development and adolescence. The underlying mechanisms of this process are not yet understood. The inferior turbinate is the least likely to present with pneumatization. In clinical practice, the pneumatization status should well be studied on the scans before any sinus and turbinate surgery is undertaken.
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Sabaté J, Carmona A, Catalina-Herrera CJ, Jiménez-Castellanos J. Anatomical variations in the human paranasal sinus region studied by CT. J Anat 2000; 197 ( Pt 2):221-7. [PMID: 11005714 PMCID: PMC1468121 DOI: 10.1046/j.1469-7580.2000.19720221.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A precise knowledge of the anatomy of the paranasal sinuses is essential for the clinician. Conventional radiology does not permit a detailed study of the nasal cavity and paranasal sinuses, and has now largely been replaced by computerised tomographic (CT) imaging. This gives an applied anatomical view of the region and the anatomical variants that are very often found. The detection of these variants to prevent potential hazards is essential for the use of current of endoscopic surgery on the sinuses. In the present work, we have studied the anatomical variants observed in the nasal fossae and paranasal sinuses in 110 Spanish subjects, using CT in the coronal plane, complemented by horizontal views. We have concentrated on the variants of the nasal septum, middle nasal concha, ethmoid unciform process and ethmoid bulla, together with others of lesser frequency. The population studied showed great anatomical variability, and a high percentage (67%) presented one or more anatomical variants. Discounting agger nasi air cells and asymmetry of both cavities of the sphenoidal sinus, which were present in all our cases, the variations most often observed were, in order, deviation of the nasal septum, the presence of a concha bullosa, bony spurs of the nasal septum and Onodi air cells.
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