Differential Scaling Patterns in Maxillary Sinus Volume and Nasal Cavity Breadth Among Modern Humans

Among modern humans, nasal cavity size and shape reflect its vital role in air conditioning processes. The ability for the nasal cavity to augment its shape, particularly in inferior breadth, likely relates to the surrounding maxillary sinuses acting as zones of accommodation. However, much is still unknown regarding how nasal and sinus morphology relate to each other and to overall craniofacial form, particularly across diverse populations with varying respiratory demands. As such, this study uses computed tomographic (CT) scans of modern human crania (N = 171) from nine different localities to investigate ecogeographic differences in (1) the interaction between maxillary sinus volume (MSV) and nasal cavity breadth (NCB) and (2) scaling patterns of MSV and NCB in relation to craniofacial size. Reduced major axis (RMA) regression reveals that all samples exhibit an inverse relationship between MSV and NCB, but statistical significance and the strength of that relationship is sample dependent. Individuals from cold–dry climates have larger MSVs with narrower NCBs, while smaller MSVs are associated with wider NCBs in hot–humid climates. MSV and NCB each scale with positive allometry relative to overall craniofacial size. However, sample differences are evident in the both the interaction between MSV and NCB, as well as their correlation with craniofacial size. While these results provide further support that the maxillary sinus and nasal cavity are integrated among populations from opposite ends of the climatic spectrum, additional epigenetic factors are needed to explain variation of these structures among populations from more intermediate climates. Anat Rec, 298:1710–1721, 2015. © 2015 Wiley Periodicals, Inc.     

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.     

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。     

Micro and nanoparticle deposition in human nasal passage pre and post virtual maxillary sinus endoscopic surgery

Realistic 3-D models of the human nasal passages were developed pre and post virtual uncinectomy and Middle Meatal Antrostomy. A 3-D computational domain was constructed by a series of coronal CT scan images from a healthy subject. Then a virtual uncinectomy intervention and maxillary antrostomy were performed on the left nasal passage by removing the uncinate process and exposing the maxillary sinus antrum. For several breathing rates corresponding to low or moderate activities, the airflows in the nasal passages were simulated numerically pre and post virtual routine maxillary sinus endoscopic surgery. The airflow distribution in the nasal airway, maxillary and frontal sinuses were analyzed and compared between pre and post surgery cases. A Lagrangian trajectory analysis approach was used for evaluating the path and deposition of microparticles in the nasal passages and maxillary sinuses. A diffusion model was used for nanoparticle transport and deposition analysis. The deposition rate of the inhaled micro and nanoparticles in the sinuses were evaluated and compared for pre and post operation conditions. The results showed that after maxillary sinus endoscopic surgery, the inhaled nano and microparticles can easily enter this sinus due to penetration of the airflow into the sinus cavity. This was in contrast to the preoperative condition in which almost no particles entered the sinuses. These results could be of importance for a better understanding of the effect of sinus endoscopic surgery on patient exposure to particulate pollution and inhalation drug delivery. The significantly higher airflow rate and particle deposition in the sinus could be a reason for the discomfort reported by some patient after maxillary sinus endoscopic surgery.     

Respiratory diseases in the late middle ages

Respiratory diseases have beset humanity from the earliest times. The aim of this study was to evaluate the prevalence of respiratory diseases in the inhabitants of a large medieval city. We analyzed 110 skeletons, coming from 12 to 17th century of individuals of either gender. In order to assess pneumatisation of paranasal sinuses and nasal septum curvature, radiographs were performed in the PA projection. Nasal septum deviation was found in 50% of individuals, asymmetry of the frontal sinuses and their aplasia in 11% of individuals. There was no significant relationship between the curvature of the nasal septum and frontal sinus aplasia. One case of tuberculosis and one case of periradicular abscess causing perforation of the maxillary sinus were noted. Developmental variation of the sternum was present in two individuals. In another two individuals, rib fractures with bone union were observed.     

视神经与蝶窦解剖关系及其临床意义的CT研究

目的:通过CT观察并探讨视神经与蝶窦关系的变化规律,为视神经管减压术提供依据.方法:随机选择鼻窦无明显异常的成人头部CT扫描350例,观察视神经隆凸的出现率,根据蝶窦内有无隆凸,将其分为视神经隆凸组和非隆凸组,各组随机选择30例进行蝶窦体积测量,比较两组之间体积的差异.在计算机上用Mimics软件勾画蝶窦、视神经等结构的轮廓,软件自动给出蝶窦的体积和三维重建图.结果:蝶窦腔内有视神经隆凸56例(16%),其中24侧的视神经直接裸露在蝶窦内,35例伴前床突气化.后者中有21侧气化的前床突腔隙与蝶窦腔融合,视神经游离于蝶窦腔内;19侧气化的前床突腔隙与后筛窦融合,视神经行走于筛窦内.无视神经隆凸组的蝶窦体积为(15.26±11.22)cm3,有视神经隆凸的蝶窦体积为(26.72±5.77)cm3.两组比较差异有统计学意义(P＜0.05).通过蝶窦、视神经的三维立体重建模型的观察,其有48%的视神经主要与蝶窦相邻,有52%的视神经主要与后筛窦相邻.结论:视神经隆凸与蝶窦体积相关,体积越大,视神经隆凸的出现率就高,从而提示是否实施经蝶窦的视神经减压术等内镜手术蝶窦体积是其考虑的主要因素之一.部分受试者的视神经与蝶窦接触较少,如经蝶窦入路有可能难以寻找视神经.     

Maxillary Sinus Anatomy: A Cadaveric Study With Clinical Implications

This study measured maxillary sinus volume, evaluated the location of the semilunar hiatus in correlation to the nasal floor, and the incidence, location, and height of antral septa and discusses their clinical implications. Maxillary sinus volume was quantified in 65 cadavers (130 sinuses) by water application through the semilunar hiatus and measuring the used amount. The location of the semilunar hiatus was identified as distance from the nasal floor. The septa were counted, evaluated, and the size measured from the antral floor. The medium maxillary sinus volume was 12.5 mL (range, 5–22 mL). The medium location of the semilunar hiatus was 25.6 mm above the nasal floor (range, 18–35 mm). Thirty‐five septa were counted in 130 maxillary sinuses. This equals an incidence of 27%. The medium height of the septa was 5.4 mm (2.5–11 mm). The main location of the septa was the region of the first molar (29%), the second molar (23%), and the second premolar (23%). The height, location, and number of septa as well as the height of the semilunar hiatus and volume of the maxillary sinus have to be taken into consideration to correctly plan the procedure and amount of grafting material in maxillary sinus floor elevation operations. Anat Rec, 292:352–354, 2009. © 2009 Wiley‐Liss, Inc.     

The maxillary sinus: evolution and function in aging

The maxillary sinus, or Highmore's antrum, is located in the maxillary bone. The maxillary, above the buccal cavity, below the orbital cavity and outside the nasal fossa, is going to take a part in the formation of the three cavities which surround it. Although voluminous, it is consists of a light bone. This distinctive feature is essentially due to the fact that the maxillary has a cavity. The maxillary sinus occupies the upper 2/3s of this maxillary bone. It is the largest of the facial structure's cavities. Its volume is very variable, depending on the individual, the condition of their edentulousness and their age. We find small, average or large sinuses. This sinus communicates with the corresponding nasal fossa by a canal. It opens at the level of the nasofrontalis duct by a meatic ostium, an ostium located at the top of the meatus nasi medius, i.e. under the floor of the sinus. This highly positioned drainage location easily explains the problems that sinus pathologies can come up against. The sinus is lined with a mucous membrane and we can point out that in the normal condition this mucous membrane adheres weakly to the bone. It is more or less thick as a function of the pathologies to which the sinus has been subjected, or even as a function of the geographical location where the individual lives. The imaging of this sinus as a function of age is not obvious due to the fact that it is invisible throughout embryonic and foetal development, and that it only becomes visible to X-rays relatively late, at about 6 years old. Its role is important at the level of the growth of the facial structure because it is always easier to have growth around cavities. It also has a mechanical role concerning the transmission of shockwaves during traumas. In old individuals, due to the condition of the edentulousness, the volume of the sinus is larger; in fact one can note the resorption of the alveolar bone. The maxillary sinus is a cavity which plays a very important role throughout an individual's existence because of the previously mentioned reasons, and which could be used during surgical reconstructions, by the partial filling of this space, to increase the quantity of usable bone (grafts...).     

兔适合构建鼻窦炎动物模型

背景：以实验动物模拟人类相关疾病是研究疾病发生发生及治疗的基础,鼻腔、鼻窦疾病也需要恰当实验动物作为其模型。 目的：观察兔鼻腔、鼻窦的CT和局部解剖表现,探讨兔应用于鼻窦炎动物模型的可行性。 方法：利用CT使用常规鼻窦冠状位与水平位扫描新西兰兔,随后进行常规鼻腔、鼻窦解剖学观察。 结果与结论：兔鼻中隔将鼻腔分为左右两个腔,鼻腔外侧壁由上颌鼻甲、中间鼻甲、内侧鼻甲、下鼻甲组成,上颌窦窦腔最大,筛窦、蝶窦、额窦相对较小,以上结构均对称分布。兔鼻腔、鼻窦在CT扫描下显示清晰。兔鼻腔、鼻窦的解剖与人类鼻腔、鼻窦解剖结构既有相似也有不同,其上颌窦解剖部位与人相似且窦腔较大便于操作,具有动物实验模型建立的可行性,适用于鼻窦炎动物模型建立,可应用于模拟人类鼻窦炎的研究。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

Heavy physical exercise decreases nitric oxide levels in the nasal airways in humans

A continuous production of nitric oxide (NO) takes place in human nasal airways. NO in the nasal airways is mainly derived from the paranasal sinuses. The factors that regulate NO synthesis in the upper airways are presently not known. We have investigated the effects of physical exercise on NO levels in the nasal airways. Nasal cavity NO levels were measured by chemiluminescence technique in five healthy non-smoking male subjects before, during and after 5 min of maximal exercise (245 W) on an ergometer cycle. In addition, in one subject NO levels were measured directly in the maxillary sinus during exercise. Nasal cavity NO levels were decreased by 47% after only 1 min of exercise compared with the control situation. A maximal 76% reduction was found at the end of the exercise period and thereafter NO levels slowly increased, reaching basal levels again in about 15–20 min. NO levels in the sinus decreased in a similar manner during exercise. The decrease in nasal cavity NO levels cannot be explained merely by dilution of nasal air due to changes in nasal cavity volume or increased ventilation. We conclude that the excretion of NO in the nasal airways is decreased acutely during heavy short term physical exercise.     

Effect of septal deviation on nasomaxillary shape: A geometric morphometric study

Nasal cavities in their primitive stage communicate with the oral cavity until the 8th week of intrauterine life where the posterior palate initiates its development. Hence, starting from the initial growth phases, a significant connection lays between the nasal structures and the maxillary bone and witnessing key functional roles, among which the respiration. Proper nasal breathing has been proven to be a crucial factor for the maturity of the craniofacial complex, and obstruction of the respiratory airway due to nasal septum deviation can generate clinically significant reduction of the nasal airflow. This situation will imply irreversible repercussions that hinders the harmonious development of the craniofacial complex. In order to understand such potential impacts of septal deviation, our first objective was to materialize the relation between septum deviation, and both nasal cavity and maxillary structures. For the second objective, we used Procrustes analysis to assess the shape variation of these two anatomical regions, the bivariate plots of Principal Components to evaluate their shape space, and a two-block Partial Least Square (PLS) to explore their covariation. We analysed, in this cross-sectional study, 62 posteroanterior cephalometric radiographs of adult subjects from both sexes (23 males, 39 females; mean age 25.3 years) collected from the database of the Department of Orthodontics at Lebanese University. Landmarks were plotted and variables were calculated and divided into nasal septum, nasal cavity and maxillary ones. The sample was further divided into two groups based on septal deviation severity (a septal deviation is considered minor if <6). The results suggested that nasal septum deviation was correlated to reduced nasal cavity area and a reduced maxillary area. Moreover, the comparison of the two groups concluded that the difference between all variables was statistically significant with higher scores in the minor septal deviation group. These findings were corroborated with the shape analysis where the mean centroid size of nasal cavity and that of the maxilla in the group of reduced septal deviation were significantly greater than those of the group with increased angle of deviation. Results of PLS analysis concluded to a strong covariation between nasal septum and nasomaxillary complex. These conclusions support the early septoplasty in growing patients as a solution to redirect the normal course of growth and re-establish a good function of the nasomaxillary complex.     

Classification of human maxillar sinuses according to their geometric features.

119 casts of maxillary sinuses have been taken out of 60 dry skulls. In these specimens, the volume V, the area of the basal (i.e. corresponding to the nasal cavity) surface S and the height h have been measured. The sinuses are subsequently arranged into 4 classes, according to their similarity to solids of revolution such as: semi-ellipsoid (class a: 15% of specimens); paraboloid (class b: 30%); hyperboloid (class c: 47%) and cone (class d: 8%). As criterion for this classification, the value of the coefficient K, equal to v/Sh has served. Beyond the eventual anatomical and anthropological interest of this classification, a clinical interest may exist in combination with Computed Tomography or eventually with Echography. The asymmetry that exists between maxillary sinuses (56% of our sample comprises pairs of sinuses arranged in different classes) suggests the eventual necessity of separate radiography of each individual sinus.     

Lipid peroxidation and antioxidant enzyme activities in experimental maxillary sinusitis

The aims of this study were to assess whether th e increased oxidative stress of acute maxillary sinusitis is reflected by tissue lipid peroxidation and whether the activities of selected antioxidant enzymes are altered during inflammation of the maxillary sinus mucosa. Unilateral rhinosinusitis was induced in 8 rabbits by instillation of 0.2 ml of a killed suspension of Staphylococcus aureus into the right maxillary sinus cavity; control instillation of saline solution into the left maxillary sinus cavity of the same rabbits was also performed. At 7 days post-treatment, mucosal samples were excised from the treated and control sinuses for measurements of superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and malondialdehyde (MDA). The SOD activity in mucosa of the inflammed sinuses was significantly higher than in control sinus mucosa; GPx activity was significantly lower in the inflammed sinuses than in the controls. No significant differences were found in CAT activities or MDA levels of the inflammed versus the control sinus mucosa. These findings demonstrate that experimental induction of acute maxillary sinusitis in rabbits does not increase lipid peroxidation as evidenced by MDA levels in the sinus mucosa, but does alter the activities of some antioxidant enzymes.     

Gas monitoring in human sinuses using tunable diode laser spectroscopy

We demonstrate a novel nonintrusive technique based on tunable diode laser absorption spectroscopy to investigate human sinuses in vivo. The technique relies on the fact that free gases have spectral imprints that are about 10.000 times sharper than spectral structures of the surrounding tissue. Two gases are detected; molecular oxygen at 760 nm and water vapor at 935 nm. Light is launched fiber optically into the tissue in close proximity to the particular maxillary sinus under study. When investigating the frontal sinuses, the fiber is positioned onto the caudal part of the frontal bone. Multiply scattered light in both cases is detected externally by a handheld probe. Molecular oxygen is detected in the maxillary sinuses on 11 volunteers, of which one had constantly recurring sinus problems. Significant oxygen absorption imprint differences can be observed between different volunteers and also left-right asymmetries. Water vapor can also be detected, and by normalizing the oxygen signal on the water vapor signal, the sinus oxygen concentration can be assessed. Gas exchange between the sinuses and the nasal cavity is also successfully demonstrated by flushing nitrogen through the nostril. Advantages over current ventilation assessment methods using ionizing radiation are pointed out.     

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.     

Effect of accessory ostia on maxillary sinus ventilation: A computational fluid dynamics (CFD) study

We evaluated, by CFD simulation, effects of accessory ostium (AO) on maxillary sinus ventilation. A three-dimensional nasal model was constructed from an adult CT scan with two left maxillary AOs (sinus I) and one right AO (sinus II), then compared to an identical control model with all AOs sealed (sinuses III and IV). Transient simulations of quiet inspiration and expiration at 15L/min, and nasal blow at 48L/min, were calculated for both models using low-Reynolds-number turbulent analysis. At low flows, ventilation rates in sinuses with AOs (I≈0.46L/min, II≈0.54L/min), were both more than a magnitude higher than sinuses without AOs (III≈0.019L/min, IV≈0.020L/min). Absence of AO almost completely prevented sinus ventilation. Increased ventilation of sinuses with AOs is complex. Under high flow conditions mimicking nose blowing, in sinuses II, III, and IV, the sinus flow rate increased. In contrast, the airflow direction through sinus I reversed between inspiration and expiration, while it remained almost constant throughout the respiration cycle in sinus II. CFD simulation demonstrated that AOs markedly increase maxillary sinus airflow rates and alter sinus air circulation patterns. Whether these airflow changes impact maxillary sinus physiology or pathophysiology is unknown.     

比格犬上颌窦的应用解剖

目的探讨比格犬上颌窦正常解剖,为与上颌窦有关的动物实验提供解剖学依据。方法收集16个比格犬上颌窦,利用锥形束投照计算机重组断层影像(CBCT)扫描,并完成局部解剖,详细观察上颌窦形态、位置、容积、自然窦口位置及与周围组织的毗邻关系。另购买2只健康成年比格犬,利用CBCT确定上颌窦窦底,经腭侧开窗,显露软组织,夹取该位点黏膜行组织学检查,光学显微镜下验证所夹取黏膜是否为上颌窦黏膜。结果比格犬上颌窦形状略似锥形,前部较窄,后部宽大,位于上颌第3前磨牙与第1磨牙之间的腭侧,四周均有骨壁包绕。于第4前磨牙远中牙尖腭侧,距腭中缝约17~18mm处可见上颌窦最低点。同一个体双侧对比,差异无统计学意义。结论比格犬双侧上颌窦无明显差异,有利于上颌窦相关研究进行随机分组;窦腔内无明显骨嵴或分隔,降低窦黏膜穿孔的危险;行上颌窦外提升时,结合CBCT于上颌窦最低点经腭侧骨板开窗是最佳的术式。     

Solitary fibrous tumor of nasal cavity in patient with long-standing history of cocaine inhalation

We report a solitary fibrous tumor in the nasal cavity of a 48-year-old woman who presented with a history of bilateral nasal obstruction and long-standing cocaine inhalation. Physical examination revealed a large mass involving the right nasal cavity and extending into the posterior aspect of the left nasal cavity. The computed tomography scan showed opacification of airways. During surgery, the mass was found to involve the entire nasal cavity, with extension to the right maxillary sinus, posterior nasal airways, and left nasal cavity. The mass was completely excised. Pathologic examination revealed a polypoid mass 3.7 x 3.0 x 1.2 cm. This tumor was composed of spindle cells that were cytologically bland in a background of ropey and nodular collagen, giving a "patternless" pattern. Immunohistochemically, the neoplastic cells stained for CD34 and vimentin but not for S100 protein, keratin, desmin, HMB-45, and c-Kit. This immunohistochemical pattern confirmed the diagnosis of solitary fibrous tumor. Although solitary fibrous tumors are usually found in the pleura, they can occur in various other locations, such as the orbit, nasal cavity, paranasal sinuses, mediastinum, breast, vagina, meninges, and soft tissues. This case is of interest because the tumor occurred in a patient with prolonged cocaine inhalation. Such an association has not been previously described. The exact causal relationship between cocaine inhalation and the tumor is not known.