The evaluation of paranasal sinuses and anatomical variations with dental volumetric tomography

Abstract

Paranasal sinus region has a very complex and variable anatomy. There are many anatomical variations on sinonasal region and detection of these variations becomes important to avoid complications when endoscopic surgery was planned. Variations of paranasal sinuses includes concha bullosa, septum deviation, agger nasi cell, kuhn cells, haller cell, onodi cell, paradoxical middle concha, unsinate prosess variations and maxillary sinuse hypoplasia. Some of these variations can be detected with plain extraoral radiographs. However plain radiographies is not always sufficient to demonstrate complex anatomy of this area. CT is an excellent means of providing anatomical information of this region and routinely used for pre-operative planning prior to functional endoscopic sinus surgery. On the other hand cone-beam computed tomography CBCT has more advantages than CT with its compact design, short scanning times, low cost and low radiation dose. In this review, we aim to demonstrate the complex anatomy of paranasal sinus area. The wide spectrum of variations affecting paranasal region will be described and illustrated with useful CBCT imaging features

Keywords

• Paranasal sinuses, anatomical variations, haller cell, concha bullosa, cone-beam computed tomography

Paranasal sinüs anatomik yapıları ve varyasyonlarının dental volumetrik tomografi ile incelenmesi

Abstract

Paranasal sinüs bölgesinde oldukça kompleks ve değişken yapılar görülür ve bu bölgede bir çok anatomik varyasyon bulunmaktadır. Endoskopik cerrahi planlanan hastalarda olası komplikasyonların önüne geçebilmek için varyasyonlarınönceden tespiti önem taşımaktadır. Paranasal sinüslerde görülen varyasyonlar; konka bülloza, septum deviasyonu, ager nazi hücresi, kuhn hücreleri, haller hücresi, onodi hücresi, paradoksal orta konka, unsinat proses varyasyonları ve maksiller sinüs hipoplazisi’dir. Bu varyasyonların bir kısmı direkt ekstraoral radyograflarla tespit edilebilir. Ancak direkt radyografiler bölgenin kompleks anatomisini göstermekte çoğu zaman yeterli olmamaktadır. Bilgisayarlı tomografi BT ise bölge hakkında detaylı anatomik bilgi sağlayan üstün görüntüleme yöntemlerinden biridir ve fonksiyonel sinüs cerrahisi öncesi planlamada rutin olarak kullanılmaktadır. Diğer taraftan cone-beam bilgisayarlı tomografi CBCT ise kompakt dizaynı, hızlı görüntüleme zamanı, düşük maliyet ve düşük radyasyon dozu yönünden BT’ye üstünlük sağlamaktadır.Bu derlemede paranasal sinüs bölgesinin kompleks anatomisi gösterilirken, bölgeyi etkileyen geniş spektrumdaki anatomik varyasyonlar CBCT görüntüleri kullanılarak değerlendirilecektir

Keywords

• Paranasal sinüsler, anatomik varyasyonlar, haller hücresi, konka bülloza, cone-beam bilgisayarlı tomografi

References

1. Cerrah YSS, Altuntaş EE, Uysal IO, Mısır M, ùalk I, Müderris S. Anatomical varia- tions of paranasal sinus detected by computed tomography. Cumhuriyet Med J 2011; 33: 70- 9.
2. Keast A, Sofie Y, Dawes P, Lyons B. Anatomical variations of the paranasal sinuses in Polynesian and New Zealand European; Computerized tomography scans. Otolaryngo- logy 2008; 139: 216.
3. Dursun E. Kronik Paranazal sinüs has- talıklarının preoperatif değerlendirilmesi ve fonksiyonel endoskopik sinüs cerrahisinin te- davideki yeri. Uzmanlık tezi. S.B. Ankara Eği- tim ve Araştırma Hastanesi K.B.B. Kliniği. 1995.
4. Sirikci A, Bayazit Y, Bayram M. Pos- terior etmoidal hücrelerin özel bir varyasyonu: etmomaksiller sinüs. Tanısal ve Girişimsel Radyoloji 2000; 6: 299-302.
5. Akan H. Baş Boyun Radyolojisi. An- kara, MN Medikal & Nobel Tıp Kitabevi. 2008; p: 179-89.
6. Yücel A, Dereköy FS, Yılmaz MD, Altuntaş A. Effects of Sinonasal Anatomical Variations on Paranasal Sinus Infections. The Medical Journal of Kocatepe 2004; 5: 43-7.
7. Pauwels R, Beinsberger J, Stamatakis H, Tsiklakis K, Walker A, Bosmans H, et al. Comparison of spatial and contrast resolution for cone-beam computed tomography scan- ners. Oral Surg Oral Med Oral Pathol Oral Ra- diol 2012; 114: 127-35.
8. Demir K. Nazal Polipozis Tanılı Has- talarda Endonazal Anatomik Varyasyonların Görülme Sıklığının Tespiti Ve Toplum İle Karşılaştırılması. Uzmanlık tezi. İstanbul Eği- tim ve Araştırma Hastanesi K.B.B. Kliniği. 2006.

9. Tezel I. Paranasal Sinüslerin Embriyo- lojisi ve Anatomisi. Paranasal Sinüs Cerrahisi. Bursa, Uludağ Üniversitesi Basımevi. 1994; p:1-9.
10. Anyürek OM. Paranasal Sinüslerin Radyolojisi. Rad 95 Konferans Kitapçığı An- kara 1995; p: 52-4.
11. Bingham B, Shankar I. Havke M. Pit- falls. Computed Tomography of The Paranasal Sinuses. J Otoloryngol 1991; 20: 414-8.
12. Karcı B, Günhan Ö. Endoskopik Sinüs Cerrahisi. I. Baskı Özen Ofset, İzmir. 1999; p: 1-3.
13. Connor SEJ, Hussain S, Woo EK-F. Sinonasal imaging. Imaging 2007; 19: 39–54.
14. Kantarci M, Karasen RM, Alper F, Onbas O, Okur A, Karaman A. Remarkable anatomic variations in paranasal sinus region and their clinical importance. European Journal of Radiology 2004; 50: 296–302.
15. Hatipoğlu H G, Çetin M A,Yüksel E. Concha bullosa types: their relationship with sinusitis, ostiomeatal and frontal recess disea- se. Diagn Intervent Radiol 2005; 11: 145-9.
16. Arslan H, Aydinlioglu A, Bozkurt M, Egeli E. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx 1999; 26: 39-48.
17. Sazgar AA, Massah J, Sadeghi M, Bagheri A, Rasool F. The incidence of concha bullosa and the correlation with nasal septal deviation. B-ENT 2008; 4: 87-91.
18. Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. American Journal of Neuroradiology 2004; 25: 1613-8.
19. Aktas D, Kalcioglu MT, Kutlu R, Oz- turan O, Oncel S. The relationship between the concha bullosa, nasal septal deviation and si- nusitis. Rhinology 2003; 41: 103-6.
20. Calhoun KH, Waggenspack GA, Simpson CB, et al. CT evaluation of the para- nasal sinuses in symptomatic and asymptoma- tic populations. Otolaryngol Head Neck Surg 1991; 104: 480–3
21. Smith KD, Edwards PC,Saini TS, Nor- ton NS. The Prevalence of Concha Bullosa and Nasal Septal Deviation and Their Relationship to Maxillary Sinusitis by Volumetric Tomog- raphy. International Journal of Dentistry doi:10.1155/2010/404982
22. Hamdan AL, Bizri AR, Jaber M, et al. Nasoseptal variation in relation to sinusitis: a computerized tomographic evaluation. J Med Liban 2001; 49: 2–5
23. Pittore B, Safi WA , Jarvis SJ. Concha bullosa of the inferior turbinate: an unusual ca- use of nasal obstruction. ACTA Otorhino- laryngologica Italica 2011; 31: 47-9
24. Ariyurek OM, Balkanci F, Aydingoz U, Onerci M. Pneumatized superior turbinate: a common anatomic variation. Surg Radiol Anat 1996; 18: 137–9.
25. Clerico DM. Pneumatized superior turbinate as a cause of referred migraine hea- dache. Laryngoscope 1996; 106: 874–9.
26. Dogru H, Doner F, Uygur K, Gedikli O, Cetin M. Pneumatized inferior turbinate. Am J Otolaryngol 1999; 20: 139–41.
27. Unlu HH, Akyar S, Caylan R, Nalca Y. Concha bullosa. J Otolaryngol 1994; 23: 23-7.
28. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endos- copic sinus surgery. Laryngoscope 1991; 101: 56-64.
29. Nguyen KL, Corbett ML, Garcia DP, Eberly SM, Massey EN, Le HT et al. Chronic sinusitis among pediatric patients with chronic respiratory complaints. J Allergy Clin Immu- nol 1993; 92: 824-30.
30. Yousem DM. Imaging of sinonasal inflammatory disease. Radiology. 1993; 188: 303-14.
31. Laine FJ, Smoker WR. The ostiomea- tal unit and endoscopic surgery: anatomy, vari- ations, and imaging findings in inflammatory diseases. AJR Am J Roentgenol. 1992; 159: 849-5.
32. Shruti D, Agarwal AK, JC, Kaul JM. Anatomical Analysis of the Fron- tal Recess Cells in Endoscopic Sinus Surgery. An Indian Perspective. Clinical Rhinology 2009; 2: 15-9. Passey
33. F.A. Kuhn Chronic frontal sinusitisThe endoscopic frontal recess approach Otolaryn- gol Head Neck Surg 1996; 7: 222–9.
34. Wormald JP. The agger nasi cell: the key to understanding the anatomy of the fron- tal recess. Otolaryngol Head Neck Surg 2003; 129: 497-507.
35. Beale TJ, Madani G, Morley SJ. Ima- ging of the Paranasal Sinuses and Nasal Ca- vity: Normal Anatomy and Clinically Relevant Anatomical Variants. Seminars in Ultrasound, CT and MRI 2009; 30: 2–16.
36. Wormald JP. Three-dimensional buil- ding block approach to understanding the ana- tomy of the frontal recess and frontal sinus. Operative Techniques in Otolaryngology 2006; 17: 2-5.
37. Stammberger H. Functional Endosco- pic Sinüs Surgery. Publisher BC Decker. Fırs- tEdit. Philadeiphia, 1991.
38. Rice DH, Schaefer SD; with illustrati- ons by Calver LE, Barrows ST, Ensor E. En- doscopic paranasal sinus surgery. Lippincott Williams & Wilkins. Philadelphia, 2004.
39. Kainz, J, Braun, H, Genser, P.Haller’s cells: morphologic evaluation and clinico- surgical relevance. Laryngorhinootologie 1993; 72: 599–604
40. Stammberger HR, Kennedy DW. Pa- ranasal sinuses: anatomical terminology and nomemclature. Ann Otol Rhinol Laryngol Suppl 1995; 167: 7–16.
41. Caversaccioa M, Boschung U, A Mudry. Historical review of Haller’s cells. An- nals of Anatomy 2011; 193: 85–90
42. Kayalioglu G, Oyar O, Govsa F. Nasal cavity and paranasal sinus bony variations: a computed tomography study. Rhinology 2000; 38: 108–113.
43. ùerbetçi E. Endoskopik Sinüs Cerrahi- si. İstanbul; Güzel Sanatlar Matbaası A. ù. 1999; p: 4-18.
44. Lang J. Paranasal sinuses. In: Lang J, editor. Clinical Anatomy of the Nose, Nasal Cavity and Paranasal Sinuses. New York: Thi- eme, 1989; p: 88–9.
45. Kantarci M, Alper F, Karasen RM, Okur A, Onbas O. Quiz case (acute visual loss caused by an isolated mucocele of an Onodi cell). Eur. J. Radiol. Extra 2003; 47: 88–90.
46. Perez-Pinas I, Sabate J, Carmona A, et al. Anatomical variations in the human parana- sal sinus region studied by CT. J Anat 2000; 197: 221–7.
47. Tonai A, Baba S. Anatomic variations of the bone in sinonasal CT. Acta Otolaryngol Suppl 1996; 525: 9 –13.
48. Riello APFL, Boasquevisque EM. Anatomical variants of the ostiomeatal comp- lex: tomographic findings in 200 patients. Ra- diol Bras 2008; 41: 3
49. Stammberger H. Wolf G. Headaches and Sinüs Disease : The Endoscopic Approach. Ann Otol Rhinol Laryngol Suppi 1988; 97: 3- 23
50. Bolger W, Woodruff W, Morehead J, et al. Maxillary sinus hypoplasia: classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg 1990; 103: 759–65.
51. Stammberger H. Endoscopic sinus surgery-concepts in treatment of recurring rhi- nosinusitis. Part II. Surgical technique. Oto- laryngol Head Neck Surg 1986; 94: 147–56.
52. Meyers RM, Valvassori G. Interpreta- tion of anatomic variations of computer tomog- raphy scans of the sinuses: a surgeon’s pers- pective. Laryngoscope 1998; 108: 422–5. Sorumlu Yazar Mehmet Zahit Adışen Kırıkkale Üniversitesi, Diş Hekimliği Fakültesi, Ağız Diş ve Çene Radyolojisi Anabilim Dalı. Kırıkkale, Turkiye Telefon: [phone] Fax: [phone] E-mail: [e-mail]