The relationship between superior attachment of the uncinate process of the ethmoid and varying paranasal sinus anatomy: an analysis using computerised tomography

Abstract

Objective: The purpose of this research was to examine how attachment of the uncinate process superiorly (SAUP) relates to possession of an agger nasi cell, pneumatisation of the middle turbinate and the measurements of the base of the skull anteriorly. The study was carried out using computerised tomography (CT).

Methods: The study involved CT imaging captured from 727 individuals with persistent sinusitis- 1454 images in total, featuring coronal section of the paranasal sinus. The frequency of SAUP, existence of an agger nasi cell, pneumatisation of the middle turbinate and how high the lamella measured laterally, were all noted. Landsberg and Friedman’s classification scheme for SAUP was utilised. Statistical analysis used the chisquared test.

Results: In 1.65% of cases, SAUP was not identifiable. With regard to class of SAUP, the most frequent was type 2, then, in descending order of frequency, types 1, 4, 3, 5 and 6. The frequencies noted were 27.6%, 19.8%, 15.4%, 14.5%, 12.0% and 9.0%, respectively. An agger nasi cell was visualised in 894 images (61.07%). There was pneumatisation of the middle turbinate in 395 images (27.17%). The lamina cribrosa measured 5.58mm on average.

Conclusion: There were significant correlations between the type of SAUP and the existence of agger nasi cells or of concha bullosa. However, the type of SAUP was not statistically significant in predicting the height of the lamina cribrosa.

Keywords

• Paranasal sinuses,uncinate process,turbinates,skull base,multidetector computed tomography

Kaynakça

1. 1. Başak S, Akdilli A, Karaman CZ, Kunt T. Assessment of some important anatomical variations and dangerous areas of the paranasal sinuses by computed tomography in children. Int J Pediatr Otorhinolaryngol 2000;55:81-9.
2. 2. Wormald PJ. The agger nasi cell: the key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg 2003;129:497-507.
3. 3. Netto B, Piltcher OB, Meotti CD, Lemieszek J, Isolan GR. Computed tomography imaging study of the superior attachment of the uncinate process. Rhinology 2015;53:187-91.
4. 4. Tuli IP, Sengupta S, Munjal S, Kesari SP, Chakraborty S. Anatomical variations of uncinate process observed in chronic sinusitis. Indian J Otolaryngol Head Neck Surg 2013;65:157-61.
5. 5. Mahmutoğlu AS, Çelebi I, Akdana B, et al. Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis. J Craniofac Surg 2015;26:87-90.
6. 6. Landsberg R, Friedman M. A computer assisted anatomical study of the nasofrontal region. Laryngoscope 2001;111:2125-30.
7. 7. Srivastava M, Sushant T. Role of anatomic variations of uncinate process in frontal sinusitis. Indian J Otolaryngol Head Neck Surg 2016;68:441-4.
8. 8. Stammberger H, Hawke M. Functional endoscopic sinus surgery: the Messerklinger technique. Decker, Philadelphia, 1999 pp. 61-90.

9. 9. Badia L, Lund VJ, Wei W, Ho WK. Ethnic variation in sinonasal anatomy on CT-scanning. Rhinology 2005;43:210-4.
10. 10. Güldner C, Zimmermann AP, Diogo I, Werner JA, Teymoortash A. Age dependent difference of the anterior skull base Int J Pediatr Otorhinolaryngol 2012;76:822-8.
11. 11. Keros P. Uber die praktische bedeutung der niveauunterschiede der lamina cribrosa des etmoids. [Article in Germany] Z Lar Rhin Otol 1965;41:808-10.
12. 12. Bingham B, Wang RG, Hawke M, Kwok P. The embryonic development of the lateral nasal wall from 8 to 24 weeks. Laryngoscope 1991;101:992-7.
13. 13. Nayak DR, Balakrishnan R, Murty KD. Functional anatomy of the uncinate process and its role in endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg 2001;53:27-31.
14. 14. Lund VJ, Stammberger H, Fokkens WJ, et al. European position paper on the anatomical terminology of the internal nose and paranasal sinuses. Rhinol Suppl 2014;24:1-34.
15. 15. Wake M, Takeno S, Hawke M. The uncinate process: a histological and morphological study. Laryngoscope 1994;104:364-9.
16. 16. Cheng SY, Yang CJ, Lee CH, et al. The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis. Eur Arch Otorhinolaryngol 2017; 274: 1905-10.
17. 17. Liu SC, Wang CH, Wang HW. Prevalence of the uncinate process, agger nasi cell and relationship in a Taiwanese population. Rhinology 2010;48:239-44.
18. 18. Ercan I, Cakır BO, Sayın I, Başak M, Turgut S. Relationship between the superior attachments type of uncinate process and presence of agger nasi cell: a computer-assisted anatomic study. Otolaryngol Head Neck Surg 2006;134:1010-4.
19. 19. Messerklinger W. On the drainage of the normal frontal sinus of man. Acta Otolaryngol (Stockh) 1967; 63:176-81.
20. 20. Kantarci M, Karasen RM, Alper F, Onbas O, Okur A, Karaman A. Remarkable anatomic variations in paranasal sinus region and their clinical importance. Eur J Radiol 2004;50:296-302.
21. 21. Fadda GL, Rosso S, Aversa S, Petrelli A, Ondolo C, Succo G. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis. Acta Otorhinolaryngol Ital 2012;32:244-51.
22. 22. Krzeski A, Tomaszewska E, Jakubczyk I, Galewicz-Zielinska A. Anatomic variations of the lateral nasal wall in the computed tomography scans of patients with chronic rhinosinusitis. Am J Rhinol 2001;15:371-5.
23. 23. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variation and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991;101:56-64.
24. 24. Zhang L, Han D, Ge W, et al. Anatomical and computed tomographic analysis of the interaction between the uncinate process and the agger nasi cell. Acta Otolaryngol 2006;126:845-52.
25. 25. Ozcan KM, Selcuk A, Ozcan I, Akdogan O, Dere H. Anatomical variations of nasal turbinates. J Craniofac Surg 2008;19:1678-82.
26. 26. Gun R, Yorgancilar E, Bakir S, et al. The relationship between pneumatized middle turbinate and the anterior ethmoid roof dimensions: a radiologic study. Eur Arch Otorhinolaryngol 2013;270:1365-71.
27. 27. Şahin C, Yılmaz YF, Titiz A, Ozcan M, Ozlügedik S, Unal A. Analysis of Ethmoid Roof and Cranial Base in Turkish Population. [Article in Turkish] KBBve BBC Derg 2007;15:1-6.
28. 28. Gauba V, Saleh GM, Dua G, Agarwal S, Ell S, Vize C. Radiological classification of anterior skull base anatomy prior to performing medial orbital wall decompression. Orbit 2006;25:93-6.
29. 29. Adeel M, Ikram M, Rajput MS, Arain A, Khattak YJ. Asymmetry of lateral lamella of the cribriform plate: a software-based analysis of coronal computed tomography and its clinical relevance in endoscopic sinus surgery. Surg Radiol Anat 201335:843-7.