Sinus CT scans and mediator release in nasal secretions after nasal challenge with cypress pollens

BACKGROUND: Involvement of paranasal sinuses has been suggested in allergic rhinitis but not clearly demonstrated. AIMS: To investigate the relationship between intermittent allergic rhinitis and computerized tomography (CT). METHODS: Twenty patients with intermittent rhinitis and sensitized to cypress pollens underwent unilateral nasal provocation tests (NPTs) using increasing concentrations of cypress pollens out of the pollen season. Sinus CT-scans were carried out just before a NPT and 24 h later. Nasal lavage was carried out just before a NPT, 30 min after a positive challenge and again 24 h later. Leucotriene C4/D4, intracellular adhesion molecule-1 and eosinophil cationic protein were measured in nasal secretions. RESULTS: Thirteen patients (65%) showed an alteration in their CT-scans after allergen challenge. Ten of them showed sinus changes controlateral to their allergenic provocation. Radiological changes mainly affected the osteomeatal complex and the ethmoid sinuses. Pre-existing abnormalities (13 of 20 cases) mainly concerned the maxillary sinuses. There was no correlation between CT-scan abnormalities and levels of mediators released in nasal secretions. CONCLUSIONS: We have shown that nasal allergen challenge can produce radiological changes in the paranasal sinuses. This mainly concerned the ethmoid sinuses.     

Comparison between transillumination and the roentgenogram in diagnosing paranasal sinus disease

The reliability of transillumination versus roentgenogram to diagnose maxillary and frontal paranasal sinus disease was assessed in 52 subjects with rhinitis and/or asthma. Two different otolaryngologists transilluminated the sinuses while the roentgenograms were evaluated by a radiologist and a third otolaryngologist. Patients filled in questionnaires of symptoms. There was excellent agreement (p < 0.001) between otolaryngologists regarding transillumination of the frontal sinuses but not the maxillary sinuses. Similarly, transillumination of the frontal sinuses correlated well with the roentgenograms. This was not true for transillumination of the maxillary sinuses. Although pain in the upper teeth related well to the presence of frontal disease, sinus headache was a frequent complaint but not useful as a predictor of sinus disease. Even though transillumination of the frontal paranasal sinus has some predictive value, the technique of transillumination has limited usefulness as a diagnostic tool and is not an adequate substitute for roentgenogram.     

Growth pattern of the maxillary sinus in the Japanese macaque (Macaca fuscata): reflections on the structural role of the paranasal sinuses

To investigate the claim that the primate paranasal sinuses possess not a functional but a structural role associated with the skull architecture (Blaney, 1990), the relationship between the maxillary sinus and the skull architecture was studied ontogenetically in 30 skulls of male and female Japanese macaques ( Macaca fuscata ). Coronal CT scan series and computerised 3-dimensional images served to evaluate the maxillary sinus. The definitive hemispherical shape of the sinus was already achieved after the completion of the primary dentition. Sinus volume increased with a trend indicating positive allometry. When compared with an ontogenetic data set of orang-utan (Koppe et al. 1995), however, the growth rate of the maxillary sinus of M. fuscata was significantly less. The maxillary sinus both of male and female macaques enlarged according to a common growth pattern. However, no sexual dimorphism could be established for the maxillary sinus size. Although the volume of the right maxillary sinus was normally bigger than that of the left side, the results suggested that asymmetry in maxillary sinus volume is related neither to skull size nor sex. Whereas a correlation analysis showed close relationships between the maxillary sinus volume and external cranial dimensions, the partial correlation coefficients revealed that these relationships were highly influenced by skull size. Although it cannot be ruled out that the paranasal sinuses are to some extent linked to the skull architecture, this study does not support a solely structural role for these air cavities.     

Growth pattern of the maxillary sinus in the miniature pig (Sus scrofa)

The biological role of the paranasal sinuses is obscure, can be elucidated through a cross-sectional growth study of the maxillary sinus in miniature pigs. The maxillary sinus area was obtained from lateral cephalograms of left skull halves of 103 female miniature pigs of known ages, from newborn to 24 months. Out of several nonlinear models, the growth of the maxillary sinus was best described with the Gompertz model. The first derivative of the Gompertz curve revealed an increase in the growth rates of the maxillary sinus until 4 months, after which sinus growth slowed down. The eruption of the permanent molars did not seem to have a significant influence on this growth pattern. Furthermore, growth in maxillary sinus size in the miniature pig does not follow growth in skull size closely, which showed the highest growth rates in newborn animals. In addition, a correlation analysis revealed that the relationship between maxillary sinus area and different characteristics of the masticatory apparatus (including linear cranial dimensions, and the dry weight of the masseter and zygomatico-mandibularis muscles) were influenced greatly by skull size. These results suggest that the existence of pneumatic cavities within the mammalian skull is not satisfactorily explained solely by an architectural theory. Epigenetic factors are likely to influence the final shape of the maxillary sinus.     

Changes in paranasal sinuses during postnatal ontogenesis of inhabitants of Karelia

Roentgenographs of 1566 maxillary, 1404 frontal and 131 sphenoid sinuses (a total of 3101 sinuses) belonging to the practically healthy individuals of both sexes aged 3-85 years were studied to reveal the regularities of growth of paranasal sinuses in inhabitants of Karelya. It was established that the dimensions of paranasal sinuses depended upon person's age and gender. The growth of paranasal sinuses in women was completed 1.5-2.0 years earlier than in men. In persons of elderly and senile age there was a secondary increase in sinuses' dimensions, associated with osteoporosis phenomena. In women this secondary increase was more pronounced than in men and started on average 5 years earlier.     

Human paranasal sinuses and selective brain cooling: a ventilation system activated by yawning?

The function of the paranasal sinuses has been a controversial subject since the time of Galen, with many different theories advanced about their biological significance. For one, the paranasal sinuses have been regarded as warmers of respiratory air, when in actuality these structures appear to function in cooling the blood. In fact, human paranasal sinuses have been shown to have higher volumes in individuals living in warmer climates, and thus may be considered radiators of the brain. The literature suggests that the transfer of cool venous blood from the paranasal sinuses to the dura mater may provide a mechanism for the convection process of cooling produced by the evaporation of mucus within human sinuses. In turn, the dura mater may transmit these temperature changes, initiated by the cool venous blood from the heat-dissipating surfaces of the sinuses, to the cerebrospinal fluid compartments. Furthermore, it has recently been demonstrated in cadaveric dissections that the thin bony posterior wall of the maxillary sinus serves as an origin for both medial and lateral pterygoid muscle segments, an anatomic finding that had been previously underappreciated in the literature. The present authors hypothesize that the thin posterior wall of the maxillary sinus may flex during yawning, operating like a bellows pump, actively ventilating the sinus system, and thus facilitating brain cooling. Such a powered ventilation system has not previously been described in humans, although an analogous system has been reported in birds.     

Study of the degree of pneumatization of the viscerocranium in man and pongidae]

The volumes of the paranasal sinuses of 41 adult skulls of humans, gorillas, chimpanzees and orangutans, were examined with use of a Computertomograph type SOMATOM DR. The percentage distribution of the volumes of the different paranasal sinuses showed that the maxillary sinus always had the greatest volume. The maxillary sinus of the humans showed the smallest volume percentage in comparison with the pongids. The typical differences between humans and pongids were observed in the ethmoidal cells and the sphenoidal sinus. The ethmoidal cells of the gorilla and the orangutan have to be defined as rudimentary. Those of the humans come to more than 20% of the total volume of the paranasal sinuses of all hominoids. Differing from the humans, the sphenoidal sinus of the pongids pneumatizes almost the whole sphenoid bone. This volume percentage of the pongids is twice as high as that of the humans. In addition, an index was calculated from the volume of the facial skeleton volume and the total volume of the paranasal sinuses and defined as the degree of pneumatization. We found that the gorilla has the highest degree of pneumatization followed by the chimpanzee, the orangutan, and the humans. The lowest degree of pneumatization of the humans may be related to the reduction of the jaws.     

Maxillary and sphenoid sinus aplasia in Turkish individuals: a retrospective review using computed tomography

The absence of a maxillary or sphenoid sinus in an adult is an extremely rare condition. We investigated maxillary and sphenoid sinus aplasia in adult Turkish individuals using computed tomography (CT). We examined CT scans in the axial and coronal planes of the paranasal sinuses in 1,526 patients. The CT scans of a 21-year-old male were notable for bilateral maxillary sinus aplasia. Another patient, a 20-year-old female, had CT scans that showed the unilateral absence of a maxillary sinus. Two additional cases showed the unilateral absence of one sphenoid sinus. Bilateral absence of the sphenoid sinuses was not observed in our study. The clinical implications of maxillary and sphenoid sinus aplasia will be further discussed.     

Aplasia and agenesis of the frontal sinus in Turkish individuals: a retrospective study using dental volumetric tomography

Agenesis of the paranasal sinuses is an uncommon clinical condition that appears mainly in the frontal (12%) and maxillary (5-6%) sinuses; in some populations, it appears at a higher proportion. This study investigated the prevalence of agenesis of the frontal sinuses using dental volumetric tomography (DVT) in Turkish individuals. The frontal sinuses of 410 patients were examined by DVT scans in the coronal planes for evidence of the absence of the frontal sinuses. A bilateral and unilateral absence of the frontal sinuses was seen in 0.73% and 1.22% of cases, respectively. In one case, both agenesis and aplasia of the frontal sinus was seen (0.24%). The low percentage of frontal sinus agenesis must be considered during pre-surgical planning related to the sinuses. DVT may be used as a diagnostic tool for the examination of frontal sinus aplasia.     

鼻旁窦的年龄断面解剖学研究

目的：为影像学诊断和鼻旁窦手术的最佳年龄提供解剖学依据。方法：采用三组年龄的国人头部标本２９例，各组标本均按等比例分别切割为横切面、矢状切面和冠状切面。结果：各组标本均可见明显的上颌窦和筛窦；幼儿组未见显著的额窦和蝶窦。学龄组５０％未见明显的额窦和筛窦，余组标本可见额窦和蝶窦。成人上颌窦开口的长轴呈水平状，儿童上颌窦开口为向外下方的斜形管道。结论：鼻旁窦的形态有明显的年龄变化，窦额窦和蝶窦的最初气     

The morphogenesis of the lateral nasal wall in the early prenatal life of man

To study the fetal morphogenesis of the lateral nasal wall and nasal conchae as well as the initial development of the paranasal sinuses, 15 specimens were investigated. Their crown-rump lengths ranged from 25 to 263 mm. The specimens were fixed in Bouin's solution. Serial sections were stained with hematoxylin and eosin, and Mallory's trichrome stain. The objectives were to ascertain the time and course of development of: (1) ossification in the maxilla and palate, (2) formation of the nasal capsule and the conchae, (3) chondrification and ossification in the nasal capsule and conchae, (4) the maxillary sinus and ethmoidal cells, and (5) glands in the respiratory mucosa. The earliest appearance of the conchae was observed in a 25 mm CR fetus. In a 32 mm CR fetus, ossification in the maxilla and palate was begun and the first maxillary sinus primordium was observed. The glands associated with the maxillary sinus and the inferior concha developed in a 49 mm and in a 90 mm CR fetus, respectively. The ethmoid and three conchae started to ossify in a 160 mm CR fetus. It was concluded that the transformation of mesenchyme into the bony skeleton was accomplished in a 263 mm CR fetus. Both groups of paranasal sinuses and the respiratory glands in the 263 mm CR fetus were morphologically well differentiated. In addition to an extensive survey of the literature, the possible role of the mucosal glands in development of the paranasal system was discussed.     

The Maxillary Sinus in Three Genera of New World Monkeys: Factors That Constrain Secondary Pneumatization

The air filled cavities of paranasal sinuses are thought by some to appear opportunistically in spatial “gaps” within the craniofacial complex. Anthropoid primates provide excellent natural experiments for testing this model, since not all species possess a full complement of paranasal sinuses. In this study, two genera of monkeys (Saguinus and Cebuella) which form maxillary sinuses (MS) as adults were compared to squirrel monkeys (Saimiri spp.), in which a MS does not form. Using microCT and histomorphometric methods, the spatial position of paranasal spaces was assessed and size of the adjacent dental sacs was measured. In Saguinus, secondary pneumatization is underway perinatally, and the sinus extends alongside deciduous premolars (dp). The MS overlaps all permanent molars in the adult. In Saimiri, the homologous space (maxillary recess) extends no farther posterior than the first deciduous premolar at birth and extends no farther than the last premolar in the adult. Differences in dental size and position may account for this finding. For example, Saimiri has significantly larger relative dp volumes, and enlarged orbits, which encroach on the internasal space to a greater degree when compared to Saguinus. These factors limit space for posterior expansion of the maxillary recess. These findings support the hypothesis that secondary pneumatization is a novel, opportunistic growth mechanism that removes “unneeded” bone. Moreover, paranasal spaces occur in association with semiautonomous skeletal elements that border more than one functional matrix, and the spatial dynamics of these units can act as a constraint on pneumatic expansion of paranasal spaces. Anat Rec, 2010. © 2009 Wiley‐Liss, Inc.     

藏酋猴上颌窦的应用解剖

目的 通过对藏酋猴上颌窦的应用解剖,为上颌窦的临床应用提供形态学依据。方法 对6只藏酋猴的12侧上颌窦进行大体解剖,从整体和局部对上颌窦的位置、形态,窦腔与眶、鼻腔和口腔的结构进行观察和测量。结果 藏酋猴的上颌窦位于上颌骨体内,由前、后窦构成。后窦位于前窦的后方,窦腔较小。前窦和人的上颌窦类似,位于第1前臼齿至第2臼齿及相应骨腭的上方,毗邻眶、鼻腔、口腔,窦腔较大且形态无异常;窦腔与眶间骨质较薄,有鼻泪管连通,其管径为(4.31±0.10)mm、长度为(15.89±0.31)mm;窦腔底与鼻腔间有大且恒定的上颌窦裂孔,自然状态下裂孔长度(12.59±0.46)mm、高度(1.01±0.12)mm;向上牵拉海绵状血管球可使裂孔高度增大到(11.14±1.44)mm;窦腔与口腔间骨质最厚处位于第1前臼齿根尖的上方,厚度为(6.20±0.20)mm,最薄处位于第2臼齿根尖的上方,厚度为(1.57±0.23)mm,窦底最低处位于第1、2臼齿间。同一个体双侧对比,差异无统计学意义。结论 藏酋猴上颌窦的形态结构特点,适合于作为动物模型,应用于人类上颌窦病变、上颌窦提升及种植牙的相关研究;其上颌窦裂孔是上颌窦底非开窗手术入路的最佳部位。     

Radiologic anatomy of the paranasal sinuses in the child

Summary The development of the paranasal or accessory sinuses begins very early in utero. In the newborn the ethmoidal sinus, which gives rise to all the other sinuses, as well as the maxillary sinus, can already be identified on x-rays. The frontal sinus appears as a triangle at the age of four and oversteps the supraorbital margin at the age of six. The sphenoidal sinus begins to excavate the concha sphenoidalis at the age of four and can be seen on x-rays at the age of eight, when it extends to the hypophyseal fossa. In the twelve-year-old child all sinuses almost reach their final sizes. However, the size and shape of all sinuses, particularly of the frontal and the sphenoidal sinuses are very different.

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Anatomie radiologique des sinus para-nasaux chez l'enfant

Résumé Le développement des sinus para-nasaux ou sinus accessoires commence très précocement dans la vie in-utéro. Chez le nouveau-né le sinus ethmoïdal, qui contrôle l'apparition de tous les autres sinus, et le sinus maxillaire peuvent déjà être identifiés à la radio. Le sinus frontal a la forme d'un triangle a l'âge de 4 ans et franchit la ligne supra-orbitaire à 6 ans. Le sinus sphénoïdal commence à creuser le cornet sphénoïdal dès l'âge de 4 ans et devient visible à la radio à 8 ans lorsqu'il s'étend jusqu'à la fosse hypophysaire. Chez l'enfant de 12 ans tous les sinus ont pratiquement atteint leur taille adulte. Cependant la taille et la forme de ces sinus et spécialement les sinus frontaux et sphénoïdaux sont très différentes.

     

Orbitomaxillary mucormycosis (zygomycosis) and the surgical approach to treatment: perspectives from a maxillofacial surgeon

Rhinocerebral or rhino-orbitocerebral (mucormycosis) zygomycosis (ROCZ) usually occurs among patients with poorly controlled diabetes mellitus (especially those with ketoacidosis), solid malignancies, iron overload or extensive burns, in patients undergoing treatment with glucocorticosteroid agents, or in patients with neutropenia related to haematologic malignancies. The disease process starts with inhalation of the fungus into the paranasal sinuses. The fungus may spread to invade the palate, sphenoid sinus, cavernous sinus, orbits or cranially to invade the brain. Pain and swelling precede oral ulceration and the resulting tissue necrosis can result in palatal perforation. Infection can sometimes extend from the sinuses into the mouth and produce painful, necrotic ulcerations of the hard palate. If untreated, infection usually spreads from the ethmoid sinus to the orbit, resulting in the loss of extraocular muscle function and proptosis. Surgical treatment includes the resection of involved tissues of the face, including skin and muscle, any skin of the nose that is involved, maxillary and ethmoid sinuses, necrotic tissue of the temporal area and infratemporal fossa, and orbital exenteration. The keys to successful therapy include suspicion of the diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders such as ketoacidosis, and aggressive medical and surgical intervention.     

Anatomic variations of paranasal sinuses—clinical case report

This article describes the clinical case of an 86-year-old female patient with an asymptomatic clinical condition, without presenting a history of previous traumatisms. When routine radiographic exam—panoramic radiograph—was performed, the following extensions of the paranasal sinuses were found: maxillary sinus (palate), sphenoid sinus (pterygoid process, major wing, and anterior clinoid process), and supraorbital portion of the frontal sinus. Thus computerized tomography was performed to confirm the diagnosis.     

术前鼻窦CT Lund-Mackay评分对功能性内镜鼻窦手术后鼻腔填塞物选取的预测价值

目的 探讨功能性内镜鼻窦手术(FESS)术前鼻窦CT Lund-Mackay评分对术后鼻腔填塞物选取的预测作用。方法 回顾性队列研究。纳入2015年5月—2020年1月蚌埠市第一人民医院耳鼻咽喉科鼻窦炎患者50例,其中男27例、女23例,年龄4~70(32.2±4.0)岁。50例患者均采用Messerklinger术式行FESS治疗,术后予以鼻腔填塞止血。根据鼻腔填塞材料的不同将患者分为凡士林填塞组和明胶海绵填塞组,每组25例。分别于手术前24 h和术后48 h行主观感受视觉模拟评分法(VAS)评分、鼻窦CT Lund-Mackay评分以及术后鼻腔填塞止血效果评价(以填塞期间出血＜5 mL为填塞止血满意)。对影响明胶海绵填塞效果的因素进行logistic回归分析。根据鼻窦CT Lund-Mackay评分绘制预测适合明胶海绵填塞效果的受试者操作特征(ROC)曲线,以最佳截断值预测明胶海绵填塞的效果。结果 两组患者性别构成、病变侧别、术前各项VAS评分比较差异均无统计学意义(P值均＞0.05)。止血满意率凡士林组100%(25/25)、明胶海绵组92%(23/25),两组差异无统计学意义(χ²=3.615, P＞0.05)。两组患者术后填塞期总出血量及术后流涕VAS评分比较差异均无统计学意义(P值均＞0.05);明胶海绵组术后鼻塞、头面部胀痛及嗅觉障碍VAS评分均低于凡士林组,差异均有统计学意义(t=4.324、4.861、5.207, P值均＜0.05)。明胶海绵组患者术前鼻窦CT总评分以及筛窦CT总评分[(8.2±3.1)分、(3.1±1.9)分]均较凡士林组分值[(15.0±4.4)分、(6.5±1.4)分]更小,差异均有统计学意义(t=6.383、7.171, P值均＜0.05)。logistic回归分析结果提示,鼻窦CT总分[比值比(OR)=1.366(95% CI 1.004~1.860)]及筛窦CT总分[OR=2.155(95% CI 1.155~4.021)]是明胶海绵填塞止血满意的危险因素(P值均＜0.05),两者对于明胶海绵填塞止血满意均具有高度预测价值(AUC值分别为0.91、0.92,P值均＜0.05)。当鼻窦CT总分＜9.5分时,约登指数为0.80,预测适合明胶海绵填塞止血满意的敏感度为84.0%,特异度为96.0%;当筛窦总分＜4.5分时,约登指数为0.68,预测适合明胶海绵填塞止血满意的敏感度为76.0%、特异度为92.0%。结论 术前鼻窦CT Lund-Mackay评分,对于FESS术后鼻腔填塞物种类的恰当选择具有一定意义;鼻窦CT Lund-Mackay总分及筛窦CT总分较低时,选择明胶海绵进行术腔填塞,既能有效止血,又能提高患者舒适度。     

The pterygopalatine recess of the superior nasal meatus

The pneumatizations surrounding the pterygopalatine fossa (PPF) and closely related to the sphenopalatine foramen are anatomically variable. During the assessment of a cone beam computed tomography of a 64-year-old male patient, we found bilaterally a previously unreported anatomic variant. This was represented by a lateral or pterygopalatine recess (PPR) of the superior nasal meatus which extended in the anterior wall of the PPF and protruded within the maxillary sinus to determine a maxillary bulla. The PPR was antero-superior to the sphenopalatine foramen. Additionally were found a right nasal septal deviation, seemingly compensated by a left middle concha bullosa and a left prominent ethmoidal bulla. The superior turbinates were also pneumatized. Such anatomic variants related to the pterygopalatine angle of the maxillary sinus should be explored prior to surgical or endoscopic procedures which target the maxillary sinus, the pterygopalatine fossa, or the skull base.