Assessment of Bony Anatomical Variations of Paranasal Sinuses and Nasal Cavity: A Cone Beam Computed Tomography Study

Abstract

Purpose: Air-filled and bony surrounded structures around the nasal cavity are defined as paranasal sinuses and are effective in the development of facial structures, jaws and airway. Although these structures are separated from each other by thin bone lamina, they are connected via ostiums. Paranasal sinuses are associated with other anatomical structures such as internal carotid artery, orbit, cavernous sinus, optic nerve. Knowledge of the anatomy and variations of the paranasal sinuses is very important in terms of applications such as functional endoscopic sinus surgery, implant surgery involving posterior maxilla and complications that may occur. Methods: In our study, a total of 180 cone beam computed tomography (CBCT) images containing all of the paranasal sinuses were evaluated retrospectively in terms of anatomical variation presence or absence. Results: The most common anatomic variations in our study were agger nasi cell (80.6%), concha bullosa (65.6%) and septum pneumatization (60.3%), while the least observed variations were sphenomaxillary plate (2.1%), second middle turbinate (1.8%) and concha bullosa of the inferior turbinate. (1.7%). Conclusion: Anatomical variations of paranasal sinuses particularly in the osteomeatal complex (OMC), can obstruct sinus drainage, leading to chronic inflammation. Due to their proximity to dental structures, preoperative imaging is crucial to avoid surgical complications. While computed tomography (CT) scans provide the best diagnostic accuracy for paranasal sinuses evaluation, high radiation exposure doses risks to sensitive tissues. In 3-dimensional radiological examination of the paranasal sinuses, CBCT stands out as a good option due to its lower radiation dose and cost effectiveness.

Keywords

• Anatomical variation
• cone beam computed tomography
• paranasal sinus

Paranazal Sinüsler ve Nazal Kavitenin Anatomik Varyasyonlarının Değerlendirilmesi: Konik Işınlı Bilgisayarlı Tomografi Çalışması

Abstract

Amaç: Burun boşluğunun çevresinde bulunan hava dolu ve kemikle çevrili yapılar paranasal sinüsler olarak tanımlanır ve yüz yapılarının, çenelerin ve hava yolunun gelişiminde etkilidir. Bu yapılar ince kemik tabakalarıyla birbirlerinden ayrılsa da, ostiumlar aracılığıyla birbirlerine bağlıdırlar. Paranasal sinüsler, internal karotid arter, orbita, kavernöz sinüs, optik sinir gibi diğer anatomik yapılarla ilişkilidir. Paranazal sinüslerin anatomisi ve varyasyonları hakkında bilgi sahibi olmak, fonksiyonel endoskopik sinüs cerrahisi, posterior maksillayı içeren implant cerrahisi ve ortaya çıkabilecek komplikasyonlar açısından çok önemlidir. Yöntemler: Çalışmamızda, tüm paranazal sinüsleri içeren toplam 180 konik ışınlı bilgisayarlı tomografi (CBCT) görüntüsü, anatomik varyasyonların varlığı veya yokluğu açısından retrospektif olarak değerlendirilmiştir. Sonuçlar: Çalışmamızda en sık görülen anatomik varyasyonlar agger nasi hücresi (%80,6), konka bullosa (%65,6) ve septum pnömotizasyonu (%60,3) iken, en az görülen varyasyonlar sfenomaksiller plaka (%2,1), ikinci orta konka (%1,8) ve inferior konkanın konka bullosa'sı (%1,7) idi. (1,7%). Sonuç: Paranazal sinüslerin, özellikle osteomeatal kompleks (OMC) içindeki anatomik varyasyonları, sinüs drenajını engelleyerek kronik inflamasyona yol açabilir. Diş yapılarına yakınlıkları nedeniyle, cerrahi komplikasyonları önlemek için ameliyat öncesi görüntüleme çok önemlidir. Bilgisayarlı tomografi (BT) taramaları paranazal sinüslerin değerlendirilmesinde en iyi tanı doğruluğunu sağlarken, yüksek radyasyon maruziyeti hassas dokular için risk oluşturur. Paranazal sinüslerin 3 boyutlu radyolojik incelemesinde, CBCT, daha düşük radyasyon dozu ve maliyet etkinliği nedeniyle iyi bir seçenek olarak öne çıkmaktadır.

Keywords

• Anatomik varyasyon
• konik ışınlı bilgisayarlı tomografi
• paranazal sinüs

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