Abstract
Endoscopic sinus surgery is an upcoming branch in rhinological practice but with some major risks since it has to play around the skull base area. Lateral lamella of cribriform plate is the thinnest area of the skull base. Thus this study is undertaken to evaluate the height of lateral lamella of cribriform plate and the depth of olfactory fossae by the help of computed tomographic images. Computed tomographic study of 50 patients was done in Advanced Imaging and Diagnostic center, Kathmandu Medical College. Coronal sections at the centre of infra-orbital foramina were taken as reference slide. The height of cribriform plate point was subtracted from the height of medial ethmoidal roof point to measure the length of lateral lamella of cribriform plates on both sides. The median height of LLCP in 100 slides was 2.8 mm. LLCP height was 0 to 3.9 mm in 86 slides, 4 to 7 mm in 12 slides and greater than 7mm in 2 slides. The LLCP length was greater in right side in 28 (56%) patients and was greater in left side in 19 (38%) patients. It was equal in both sides in only three patients (6%). As regards the length of LLCP; 0 to 3.9 mm length was most common. The olfactory fossa depth was more in the right side compared to the left side. Thus, right side is more vulnerable to injury during surgery. Thus adequate caution has to be exercised by the rhinological surgeon during endoscopic sinus surgery.
Highlights
Endoscopic sinus surgery is an upcoming branch in rhinological practice but with some major risks since it has to play around the skull base area
Analyzing the difference between the sides lamella of cribriform plate (LLCP) height was higher in the right side in 28 patients (56%) and LLCP height was greater in left side in 19 patients (38%)
Coronal plane is the best for evaluating ethmoid roof anatomy.4It is well established that the area at risk is not in the highest point of ethmoid sinus formed by fovea ethmoidalis but in the lateral lamella of cribriform plate in the region of ethmoid sulcus
Summary
Endoscopic sinus surgery is an upcoming branch in rhinological practice but with some major risks since it has to play around the skull base area. Lateral lamella of cribriform plate is the thinnest area of the skull base. This study is undertaken to evaluate the height of lateral lamella of cribriform plate and the depth of olfactory fossae by the help of computed tomographic images. Lateral lamella of cribriform plate (LLCP) lies medial to fovea ethmoidalis, which forms the roof of the ethmoidal labyrinth - the orbital plate of the frontal bone. It separates the ethmoidal air cells from olfactory fossa. The depth of olfactory fossa is determined by the height of the lateral lamella of the cribriform plate. In 1962, Keros defined three heights and classified the depth of olfactory fossa in Keros type I (0 to 3 mm), type II (4 to 7 mm), type III (8 to 16 mm).[1]
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