Paranasal Sinus Computed Tomography Research Articles

Comparison of Anthropometric and Cephalometric Measurements Obtained by Stereophotogrammetry and 3D Computed Tomography of the Nose Before Septorhinoplasty.

Computed tomography (CT) is normally used in evaluation of patients with esthetic and functional nasal deformities. Stereophotogrammetry (SPG) is a measurement device that is an alternative to CT and does not harm human health. In this single-center retrospective study, we aimed to evaluate measurements obtained with CT and SPG. The measurements of 18 patients who applied to our clinic between January 2022 and August 2022 and planned for septorhinoplasty were performed on both 3D images obtained with paranasal sinus CT and SPG device (SLR type Vectra H1 system). Measurements included that dorsocolumellar length, columella-filtral length, nasal tip projection ratio (dorsocolumellar length/columella-filtral length), columella-labial angle, nasofrontal angle, tip deviation direction, tip deviation angle, tip deviation distance and dorsal nasal hump. Most of patients were male (61.1%). Mean age was 24.5 years. Only columella-labial angle measurements showed a low level of significant difference (p<0.05). However, there was no significance difference in other measurements (p>0.05). A significant strong correlation was observed between all Vectra and CT measurements (p=0.000). SPG device can be applied quickly in polyclinic without giving radiation to patient. Measurements can be taken automatically using a software. Its use in postoperative period does not carry any risk. Disadvantage of SPG is lack of information about internal nasal passage. However, there is a strong correlation between measurements obtained from both measurement devices. Therefore, SPG can be considered as an alternative to CT imaging in operation planning. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effects of Nasal Septal Deviation on Anterior Skull Base Parameters

Abstract Introduction Functional endoscopic sinus surgery and endoscopic skull base surgery are frequently performed surgeries today. Nasal septal deviation is a common finding and can affect the surgical area. Therefore, it is important to examine the effect of this deviation on other anatomical structures. Objectıve The aim of the present study was to determine whether there is a relationship between the degree of nasal septal deviation and anterior skull base structures using computed tomography (CT). Methods A total of 312 patients (aged 18 to 65 years old) whose paranasal sinus CT images were available were included in the study. Measurements were obtained on images retrieved from Picture Archiving and Communication System (PACS) and Horos image archive systems in the bone window in the coronal and axial plane. Results The mean age of 312 patients was 33.00 years old (standard deviation [SD] 11.22 years). The presence of septal deviation was not associated with changes in olfactory fossa (OF) depths, Keros degrees, and the angle between the lateral lamella and the cribriform lamella. However, OF depths and Keros degrees on the deviated side of the septum were found to change at a significant level (p &lt; 0.05). No significant association was observed between the degree of septal deviation and cribriform lamella-lateral lamella angle. Conclusion The study showed significantly increased OF depth and Keros degree on the deviated side of the nasal septum. Performing CT scans before endoscopic sinus surgery and endoscopic skull base surgery is important to increase the chances of a successful surgical outcome and to reduce complications.

Is there a relationship between sphenoid sinus pneumatization and carotid canal–intersinus septa connection?

Objectives We investigated the relationship between sphenoid sinus (SS) pneumatization types, carotid canal types and carotid canal–intersinus septa connection. Methods The paranasal sinus computed tomography (PNSCT) images of 274 patients (141 males and 133 females) were evaluated retrospectively. SS pneumatization, SS intersinus septation, SS intersinus septa deviation, carotid canal classification, carotid canal dehiscence, carotid canal–intersinus septa connection and presence of Onodi cells were evaluated. Results In presellar and sellar SS, type 1 carotid canal was detected. However, type 3 carotid canal was detected more in postsellar SS. On the left side, in 26.4% of the postsellar SS, carotid canal dehiscence was detected. On the right side, carotid canal-intersinus septa connection was detected in 55.8% of the postsellar SS and 35.1% of the sellar SS. On the left side, it was detected 58.3% of the postsellar SS and 30.9% of the sellar SS. In postsellar type SS pneumatized cases, right caroid canal-intersinus septa connection increased by 5.4 fold and left carotid canal-intersinus septa connection increased by 7.3 fold compared to presellar type SS pneumatization. In 2≥ intersinus septa group, left carotid canal-intersinus septa connection increased 5.0 fold compared to ‘no septa’ group. Conclusion In this study, we evaluated SS pneumatization types and their relation with carotid canal types and carotid canal-intersinus septa connections. Type 3 carotid canal (protrudation to SS wall) was detected more in postsellar SS. In these cases, surgeons should be very careful during surgery to avoid damage to the internal carotid artery (ICA).

Pneumatization of the sphenoid sinus is the major factor determining the variations of adjacent vital structures

BackgroundSphenoid sinus (SS) is an important landmark for endoscopic sinus surgery (ESC) and endoscopic skull base surgery. This study examines the relation of the extent of pneumatization of the sphenoid sinus with adjacent vital structures such as the internal carotid artery, optic canal, and Vidian nerve by using paranasal sinus computed tomography (PNSCT).MethodsThe study was designed retrospectively. PNSCT images in axial, coronal, and sagittal planes on both sides (right, R; left, L) were examined for sphenoid sinus, Vidian canal (VC), optic canal (OC), and carotid canal (CC) bilaterally.ResultsThe carotid canal did not show identification on the SS wall in females compared to males bilaterally (right, p= 0.002 and left, p= 0.002). The mean age was significantly higher in patients with a presellar type of sphenoid sinus (p=0.003). The mean age was significantly lower on the right side with a VC completely within the sphenoid sinus (p=0.005). The mean age of patients with an optic canal protrudation to the SS wall was significantly higher than patients with an optic canal indentation to the SS wall (p= 0.007). On the left side, cases with an optic canal protruding to the SS wall were older than cases with an optic canal indentation to the SS wall (p= 0.008). SS variations on the sagittal plane were significantly correlated with RVC, RCC, LVC, and LCC variations. Also, SS variations on the coronal plane were significantly related to types of LVC and RVC.ConclusionsPneumatization of SS significantly affects the development of surrounding vital structures, especially with increasing age.

Imaging anatomy of the vidian canal and its clinical significance.

Vidian neurectomy (VN) is an effective surgical treatment for severe allergic rhinitis (AR). However, little research has been conducted on the imaging anatomy of the vidian canal (VC). This study aimed to analyze the computed tomography (CT) imaging of the VC and its surrounding structures and investigate the morphometric characteristics and clinical significance of VN. We analyzed 118 paranasal sinus CT scans (55 male and 63 female patients), with axial, coronal, and sagittal slices being used in the study. Among the 118 patients in this study, the average length of the VC in male and female patients was 14.00±3.35 and 12.51±3.42 mm, respectively; the transverse diameter of the posterior segment of the VC in females was larger than that in males; and the length of the VC and the distance between VC and foramen rotundum (FR) in males were longer than those in females. The angle between the VC and the sagittal plane and the angle between the sphenopalatine foramen (SPF) and the VC in females were larger than those in males, and the distance between the attachment to the end of the middle turbinate (MT) and the VC was greater. Type 2 VC occupied a dominant position. The VC was mostly at the same line as the medial wall of the maxillary sinus (MS) and was located on the medial side of the medial pterygoid plate (MPTG). The highest point of the VC was mostly superior to that of the palatovaginal canal (PVC). Most of the VC was inferior to the internal carotid artery (ICA), and no cases were observed in which the VC was above the ICA. Some of the measurements of the VC and its surrounding structures were correlated. The position and morphometric information of the VC could be reflected in a CT scan, which may contribute to the evaluation of VN preoperatively and postoperatively.

Maxillary sinus volume and adenoid tissue size in children: computed tomographic evaluation

Abstract OBJECTIVES. Adenoid hypertrophy is related to obstructive sleep apnea syndrome (OSAS). In this study, we investigated the relationship between adenoid tissue size and maxillary sinus volumes by examining the paranasal sinus computed tomography (PNSCT) images. MATERIAL AND METHODS. PNSCT images of 41 children were included in this study. According to the adenoid/nasopharynx (A/NP) ratio, two groups were identified. Group 1 (n=19, 9 males and 10 females): A/NP≤0.50 and Group 2 (n=22, 16 males and 6 females): A/NP&gt;0.50. The following measurements were performed: adenoid width, NP width, A/NP ratio, air column, soft palate, maxillary sinus volume and mucosal thickening. RESULTS. Adenoid width of group 2 (16.11±2.26 mm) was higher than that of group 1 (10.97±2.26 mm). In group 2, with an A/NP ratio of 0.61±0.07, the air column value (6.30±2.27 mm) was lower than that of group 1 with an A/NP ratio of 0.40±0.07 (air column value: 10.06±3.78 mm). NP width, soft palate and maxillary sinus volumes were not different between groups 1 and 2. As the adenoid width increased, the A/NP ratio increased, and the air column decreased. CONCLUSION. The increase of the A/NP ratio was related to the decreased air column. In older children, air column and bilateral maxillary sinus volumes increased. In males, the adenoid width value was larger than that in females. There was no significant relationship between A/NP ratio and maxillary sinus volume or NP width values. However, higher A/NP ratio values were related to lower air column measurements.

Comparison of Low-Dose Non-contrast CT in Detecting Anatomical and Surgically Important Variants of Paranasal Sinuses to Standard Dose Non-contrast CT: Experience from a Tertiary Care Hospitalin Sub-Himalayan Region of Northern India.

Computed tomography (CT) is the gold standard for diagnosing sinusitis and anatomical variations and a guide for paranasal sinus (PNS) surgeries. High doses of radiation lead to increased risk of head and neck malignancies, radiation-induced cataracts, hypothyroidism, and hyperthyroidism. The purpose of this study was to assess the effectiveness of low-dose CT as compared to standard-dose CT in the identification of anatomical variants of paranasal sinus and rhinosinusitis. This was a prospective cross-sectional study consisting of 72 patients who were divided equally into cases (underwent low-dose CT for PNS) and controls (underwent CT for PNS using standard dose protocols). Prevalence of anatomical variants and sinusitis were compared. Image quality was assessed using volume CT dose index (CTDIvol), dose length product (DLP), scan length, and noise. Subjective assessment was done by two radiologists, and scores were given. The comparison and analysis of the quantitative and qualitative variables were done. Anatomical variants were comparable among cases and controls, with post-sellar sphenoid being most common and paradoxical middle turbinate being least common surgically important variant. The difference in meanSD of CTDIvol (mGy), DLP (mGy-cm), effective dose (mSv), globe, and air noise between low and standard doses was statistically significant. A moderate agreement (with kappa 0.50) in cases and substantial agreement (with kappa 0.69) in controls was observed between both observers. Low-dose CT PNS and standard-dose CT PNS are comparable in delineating the paranasal sinus anatomy, with a 3.53× reduction of effective radiation dose to patients.

Evaluation of the Image Quality of Ultra-Low-Dose Paranasal Sinus Computed Tomography Scans

Objective: We aimed to investigate the image quality of paranasal sinus computed tomography (CT) scans obtained with the “Advanced intelligent Clear-IQ Engine” (AICE) software and ultra-low dose parameters in patients with prediagnosed rhinitis, sinusitis or nasal septum deviation. Methods: The first 50 patients (31 men and 19 women, aged 18-70 years) who agreed to participate in our prospectively planned study were included in the study. Imaging of the patients was performed with a 160-slice multidetector CT device Canon Aquilion Prime SP (Canon Medical Systems, Otawara, Japan). Tube voltage of 80 kV and tube current of 40 mA were chosen. The effective radiation dose (ED) was calculated based on the “dose-length product” (DLP) information of each patient. Evaluation of images was made on reformat images made with “AiCE Bone” filter in the axial and coronal planes. All images were double-blindly evaluated by 2 radiologists out of 5 points (5 = very good; 1 = not diagnostic). The visibility of 17 bilateral important anatomical landmarks examined on paranasal sinus CT was scored (0 = not visible; 2 = completely visible). In the evaluation of images, the agreement between radiologists was evaluated with Kappa statistics. Results: The median ED value of the CT protocol was 0.015±0.001 mSv [range 0.012-0.017 mSv]. The overall image quality of the images in our study was interpreted as 4 (good) or 3 (moderate) for all patients. Inter-research agreement was 92%. Most of the anatomical landmarks evaluated were completely visible. Six (bilateral of three) anatomical landmarks could be partially visible in some patients. Conclusion: Combining the ultra-low dose CT protocol and the AiCE reconstruction algorithm makes it possible to achieve very low ED values ​​in paranasal sinus CT scans and still obtain sufficient image quality in indications such as septum deviation and sinusitis.

Anatomical Variation of Olfactory Fossa on Computed Tomography of Paranasal Sinuses

Objective: To determine the frequency of anatomical variation of olfactory fossa among the adult Pakistani population by Keros classification on computed tomography (CT) of paranasal sinuses.&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital, Rawalpindi Pakistan, from May 2019 to Mar 2020.&#x0D; Methodology: A total of 65 patients of either gender were included. Patients with previous trauma or surgery of the skull base or paranasal sinuses, malignant diseases of the sinuses and congenital anomalies were excluded. All the included patients in the study underwent CT paranasal sinuses. Measurements of the olfactory fossae followed by grouping as per Kero’s classification were done, and CT findings were recorded.&#x0D; Results: The patients included in the study ranged from 18 to 65 years, with a mean age of 33.09±10.86 years and 72.3% of patients 18 to 40 years of age. Of 65 patients, 36(55.4%) were males, and 29(44.6%) were females. The mean CT depth of the olfactory fossa was 6.34 ±4.03mm. Type-I olfactory fossa by Keros classification was found in 17(26.2%), Type-II in 35(53.8%) and Type-III in 13(20%) of patients.&#x0D; Conclusion: This study concluded that Keros Type-II is the most common anatomical variation of olfactory fossa among the adult Pakistani population on CT of paranasal sinuses with an intermsediate risk of intracranial complications during endoscopic sinus surgery involving this region.

Relationship Between Nasal Septal Deviation Angles and Turbinates: A Computed Tomography Study.

Background This study aimed to evaluate inferior turbinate hypertrophy caused by nasal septum deviation, nasal septal deviation (SD) angles, and age differences with the help of paranasal computed tomography (CT) and to investigate the relationship between these parameters. Methodology The paranasal sinus CT images of 100 patients (50 males and 50 females) were retrieved from the hospital's picture archiving and communication system. In this retrospective study, patients were examined in two groups. There were 50 patients aged >35 years in group 1 and 50 patients aged <35 years in group 2. The SD side was determined using a coronal image and was mentioned as the ipsilateral side. The contralateral side of the SD side was mentioned as the contralateral side. Additionally, the SD curve angle (SDCA), superior SD angle (SSDA), and diameters and mucosal thicknesses of the inferior turbinates were measured. Concomitant ipsilateral sinusitis and ipsilateral concha bullosa (in the middle concha) were also noted as present or absent. Results In our study, the SDCA values of the ≥35-year age group were significantly higher than those of the <35-year age group (p < 0.05). Furthermore, the SSDA values of the ≥35-year age group were significantly lower than those ofthe <35-year age group (p < 0.05). In each of the age groups, ipsilateral inferior turbinate mucosal thickness and ipsilateral inferior turbinate diameter values were significantly higher than those of the contralateral sides (p < 0.05). Ipsilateral concha bullosa was present in 30.0% of the <35-year age group and 18.0% of the ≥35-year age group.Ipsilateral sinusitis was present in 34.0% of the <35-year age group and 52.0% of the ≥35-year age group. Conclusions SD and inferior turbinate hypertrophies should be evaluated together and measured with paranasal CT to provide more efficient nasal aeration. Studies with larger patient series are needed to elucidate the etiology.

Maxillary sinus volume and mucosal thickening according to the septal deviation angle and age of the children.

We examined the relationship between nasal septal deviation (SD) angle and maxillary sinus volumes by examining the paranasal sinus computed tomography (PNSCT) images in children. In this retrospective study, PNSCT images of 106 children with one-sided nasal SD were included. According to the SD angle, two groups were identified: Group 1 (n = 54): SD angle ≤ 11°, Group 2 (n = 52): SD angle > 11°. There were 23 children between 9 and 14 years and 83 children between 15 and 17 years. Maxillary sinus volume and mucosal thickening were evaluated. In 15- to 17-year age group, maxillary sinus volumes of males were higher than females bilaterally. For each of the males and females, ipsilateral maxillary sinus volume was significantly lower than the contralateral side in all children and in 15- to 17-year age group. In each of the SD angle values (≤11 or >11) separately, ipsilateral maxillary sinus volume was lower; and in the SD angle > 11° group, maxillary sinus mucosal thickening values were higher than those of the contralateral side. In young children in 9- to 14-year age group, bilateral maxillary sinus volumes decreased, in this group maxillary sinus volume was not affected according to the SD. However, in 15- to 17-year age groups, maxillary sinus volume was lower on the ipsilateral SD side; and ipsilateral and contralateral maxillary sinus volumes of the males were significantly higher than those in the females. SD should be treated at an appropriate time to prevent SD-related maxillary sinus volume shrinkage and rhinosinusitis.

Supraorbital ethmoid cells (SOECs), anterior ethmoid artery notch and ethmoid roof relation in PNSCT

ObjectivesWe investigated supraorbital ethmoid cell (SOEC) presence and types in paranasal sinus computed tomography (PNSCT). MethodsThe PNSCT images of 188 adult patients (93 males and 95 females) were evaluated as SOEC group (n = 87 sides), and non-SOEC group (n = 289 sides, control). In both groups, anterior ethmoid artery (AEA) notch-ethmoid roof distance and presence of AEA canal were evaluated. In the SOEC group, SOEC types (type 1 to 3) and SOEC angle are also examined. ResultsSOEC was detected in 87 sides (23.13 %). SOEC type 2 was the most detected type (71.3 %). AEA notch-ethmoid roof distance of the SOEC group was significantly higher than those in the non-SOEC group. AEA notch-ethmoid roof distance of the SOEC Type 3 group was significantly higher than SOEC Type 2 group. AEA notch-ethmoid roof distance was 3.74 ± 1.81 mm in the SOEC group and 0.68 ± 1.16 mm in the non-SOEC group. When SOEC types were considered, this distance was 5.29 ± 2.66 mm in type 3, 3.35 ± 1.35 mm in type 2 and 3.48 ± 0.92 mm in type 1. In higher SOEC types, SOEC angle; and AEA notch-ethmoid roof distance increased. ConclusionIn more pneumatized SOEC presence, SOEC angle increase, and AEA notch-ethmoid roof distance increases, AEA runs inferiorly in the ethmoid cells and freely below the skull base; and is more susceptible to injury. The surgeons should be more careful not to damage AEA in the FESS when detecting well-pneumatized SOECs (SOEC Type 3).

Radiological Evaluation of Uncinate Process Variations using Multidetector Computed Tomography

Introduction: Functional endoscopic sinus surgery has emerged as a superior technique in sinus surgery with a lower incidence of associated complications as compared to traditional surgeries; however, it still carries risks of possible complications, some of which could be attributable to the variations that exist in the nose and paranasal sinus anatomy. Variations in the uncinate process, one of the important structural landmarks in functional endoscopic sinus surgery can have implications during sinus surgery. Therefore, identifying the variations in the uncinate process becomes a very important consideration. The objective of this study was to identify the variations of the uncinate process on Multidetector Computed Tomography of paranasal sinuses&#x0D; Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Birat Medical College and Teaching from December 2021 to June 2022 after obtaining ethical clearance from IRC. A total of 240 participants referred to the Department of Radiodiagnosis for CT of paranasal sinuses were included in the study.&#x0D; Results: The most frequent superior attachment of uncinate was found to be Type I and the least common was Type IV. The least frequent variation was UP pneumatisation. Most of the cases showed typical angulation followed by medial orientation and lateral orientation.&#x0D; Conclusion: Variations in the uncinate process exist and Multidetector CT is a commendable tool for identifying these variations.

The Role of Serum Galactomannan Assay as a Potential Surrogate Biomarker for Fungal Microinvasion in Allergic Fungal Rhinosinusitis.

We conducted this study to determine if serum galactomannan (GM) can be used as a marker to implicate the invasiveness of allergic fungal rhinosinusitis (AFRS), and correlate this value with the aggressiveness of disease documented via computed tomography (CT). All paranasal CT scans done for AFRS patients prospectively over a five-year period (2015-2019) were included. An indigenous 20-point score was used to document the extent of bone erosion seen on CT, wherein a higher score meant a greater extent of bone erosion. It was then correlated with serum GM scores. The median CT scores of galactomannan-positive (GM+) patients were compared with the median CT scores of galactomannan-negative (GM-) patients 3 using Mann-Whitney U test. The patients were divided into five groups based on the extent of disease-No bone erosion, erosion of only sinus wall/orbit, 3 erosion of orbit and skull base, erosion of only skull base and lateral extension of disease into infratemporal fossa (ITF). Subgroup analysis was conducted over mean GM values in these groups using ANOVA test. p-value < 0.05 was considered significant. Statistical analysis was performed using SPSS version 25.0. A total of 92 patients were included (56 males, 36 females). No statistically significant difference was found (p-value = 0.42) between the CT scores of galactomannan-positive (GM+) group and galactomannan-negative (GM-) group. The mean GM scores amongst the five sub-groups did not show a statistically significant difference. Serum galactomannan values correlate poorly with aggressiveness of disease quantified on non-contrast CT of paranasal sinuses.

Anatomical variations of frontal sinus pneumatization: A computed tomography-based study

Background: The pneumatization of the frontal sinus is variable between individuals, including monozygotic twins. The volumetric anatomic variants of the frontal sinus are classified into aplasia, hypoplasia, medium-sized, and hyperplasia. We aimed to study the frontal sinus morphology in Omani patients using computed tomography (CT) evaluations. Methods: Retrospectively, 1220 paranasal sinus CT scans from 610 patients investigated at Sultan Qaboos University Hospital, Oman, from January 2019 to December 2020 were reviewed. The frontal sinus morphology was classified according to the classification proposed by Guerram et al. The Chi-square test was used to determine the influence of sex. Results: With regard to the unilateral occurrence, the most prevalent frontal sinus category observed was medium-sized (13.3%), followed by hyperplasia (7.9%), hypoplasia (5.4%), and aplasia (2%) categories. Similarly, in bilateral occurrence, the most common frontal sinus category observed was medium-sized (53%), followed by hyperplasia (13.1%), hypoplasia (3.4%) and aplasia (2%) categories. Right and left frontal sinus aplasia were observed in 2.1% and 1.8% of cases, respectively. In terms of sex influence, the left unilateral (p&lt;0.01) and the bilateral hypoplasia (p&lt;0.05) were significantly higher in females. On the other hand, the left unilateral (p&lt;0.01) and the bilateral hyperplasia (p&lt;0.05) were higher in males. Conclusions: The baseline data of frontal sinus category frequencies reported in the present study is helpful in the diagnostic evaluation of sinusitis in the clinical setting. The preoperative recognition of frontal sinus types, particularly frontal sinus aplasia in multiplanar CT scans, is crucial to avoid unexpected complications while performing endoscopic sinus surgery.

Otologist's Perspective of Recurrent Meningitis

Objectives: Congenital cerebrospinal fluid (CSF) leaks of the ear can be a potential cause of recurrent meningitis. Diagnosing the otogenic cause can be a challenge due to the spectrum of presentations. We aim at studying the various modes of presentation, radiology, and intraoperative findings of such CSF leaks. Methodology: This was a retrospective study of six patients of recurrent meningitis. Detailed history and clinical signs were noted. Audiometry was done. Computed tomography (CT) scan of the paranasal sinus and high-resolution CT of the temporal bone were done. CT cisternography was done for confirmation. Magnetic resonance brain was done in the immediate postmeningitic phase when CT cisternography is contraindicated. All the cases were explored surgically to identify and repair the site of the leak. Results: One had unilateral deafness and five had bilateral deafness. Two had incomplete partition (IP)-I deformity and four had IP-II. Surgical exploration revealed the leak site as only oval window in three patients and both round and oval windows in two. Conclusion: Otorhinology consultation is a must for all cases of recurrent meningitis. It is important to pick up subtle clinical signs for diagnosis. Multiple leak sites should be anticipated in such cases intra-operatively.

Development of the sphenoid sinus from newborn to age 18: A computed tomography imaging analysis

The sphenoid sinus (SS) is an important anatomical formation in terms of its location and relationship with important neurovascular structures. It is essential to evaluate the pneumatization and dimensions of the SS with Computed Tomography (CT) in the preoperative period of transsphenoidal interventions to be performed on tumors located in this region. The aim of this study was to evaluate the correlation of the volume and dimensions of the SS measured with CT with age in the period from birth to 18 years of age. In this retrospective study, a total of 360 brain, paranasal sinus, temporal bone and maxillofacial CT scans of individuals from birth to 18 years of age were evaluated. The cohort was divided into 18 groups with 20 (10 female, 10 male) patients in each age group. The height, width, length and volume values of the SS were measured on CT and their correlations with age and the differences between genders were evaluated statistically. It has been determined that the increases in the size and volume of the SS accelerate especially between 1 and 2 years of age and begins to reach adult dimensions after 12 years of age. Height and length of the sphenoid sinus showed a high correlation coefficient (r=0.717 and r=0.731 respectively) with age, while its width and volume showed a moderate correlation coefficient (r=0.662 and 0.543 respectively). There was no statistically significant difference between the genders in terms of SS height, width, length and volume. SS dimensions and volume showed a logaritmic growth pattern from birth to 18 years. The results of this study may help to better understand the normal development of SS in children and may serve as a reference for more comprehensive CT studies. In addition, it can help surgeons to evaluate the developmental characteristics of SS in surgical interventions for SS in children.

Nasal steroid use and osteitis development in chronic rhinosinusitis with nasal polyps

ObjectivesOsteitis and tissue remodeling are inflammatory processes associated with the severity of chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal steroids are the mainly recommended therapeutics in the treatment of the disease, and besides their beneficial effects, they may worsen osteitis via osteopenia. This study aimed to search for the coalescence of osteitis in CRSwNP and nasal steroid use (NSU).MethodsA cross-sectional study was designed. Patients who underwent paranasal sinus computed tomography (PNSCT) imaging were queried, and the sino‐nasal outcome test-22 (SNOT-22) was completed. Regular NSU was defined as a continued treatment for 2 months in the last 6 months. The cumulative period of NSU during the last 6 months was determined and classified as no use or, for 1 to 3 months, or more than 3 months. Lund-MacKay scores (LMS) and Global Osteitis Scores (GOS) were calculated for 10 sinuses via PNSCT.ResultsSixty-two patients were included in the study. The mean GOS score was 5.7 ± 1.7 points higher in patients with regular NSU (p = 0.002, 95% CI: 9.2–2.2, t-test). LMS and SNOT-22 scores also were significantly higher for patients with regular NSU (p = 0.036 and < 0.001 consecutively). The mean GOS score showed a significant increase according to the cumulative period of NSU (p < 0.001, one-way ANOVA test). Similarly, LMS and SNOT-22 scores were also significantly associated with the duration of total NSU. GOS score showed a significant positive high correlation with LMS and SNOT-22 scores (p < 0.001, r = 0.608 and r = 0.753 consecutively).ConclusionsThis association found between the severity of GOS and NSU is probably due to the severity of the disease. However, it may question the value of the NSU effect in the development of osteitis. The presence of NSU should be investigated in future histopathological studies.Level of evidenceIV

Evaluation of Cribriform Plate Dimensions and Middle Turbinate Length in Patients With Vomeral Agenesis: A Computed Tomography Study.

The cribriform plate and attachment area of the middle turbinate are anatomical structures that may potentially be injured during septoplasty and/or endoscopic sinus surgery. The purpose of this study is to compare the cribriform plate and middle turbinate length dimensions between patients with vomer agenesis (VA) and the control group using paranasal sinus computed tomography (CT). Paranasal sinus CTs performed in our hospital between January 2011 and January 2021 were evaluated and patients with VA were identified. A control group was created from patients who underwent paranasal sinus CT for various reasons during the same date interval. The cribriform plate and middle turbinate lengths were statistically compared between the groups. A total of 10,095 paranasal sinus CTs were evaluated and 54 patients with VA were identified. Seven patients with VA were excluded from the study because their measurements could not be made accurately. Forty-seven VA patients were included in the study group, while 94 patients were included in the control group. There was no statistical difference in cribriform plate dimensions (medial ethmoid roof plate height, cribriform plate height, cribriform plate lateral lamella height and width) between the groups (for all dimensions P >0.05). The middle turbinate length was significantly higher in the VA group (for right and left P =0.020 and 0.011, respectively). These findings theoretically suggest that the risk of cribriform plate injury during septoplasty and/or endoscopic sinus surgery is similar in patients with or without VA.

Curved Planar Reformation: A Useful Method for Screening Dental Pathologies in Chronic Rhinosinusitis via Paranasal Sinus Computed Tomography.

(1) Background: Curved planar reformation (CPR) is a multiplanar reformatting technique of computed tomography (CT) commonly used during dental cone-beam CT (CBCT) to generate panorex-like images for dental evaluation. Here, we evaluated the utility of an additional CPR sequence in detecting dental pathologies in patients with chronic rhinosinusitis (CRS). (2) Methods: CRS patients who underwent paranasal sinus CT were enrolled retrospectively. The CT images featured three orthogonal sequences and a reconstructed CPR sequence. Additional dental CBCT was performed in patients with pathologies with a strongly suspected odontogenic origin. Dental pathologies detected by CT, CPR, and CBCT were analyzed. (3) Results: A total of 82 CRS patients (37 females and 45 males; mean age 47.3 ± 13.7 years) were included, of whom 23 underwent dental CBCT. In total, 1058 maxillary teeth were evaluated. Compared with paranasal sinus CT, CPR identified greater frequencies of dental pathologies, particularly caries (p < 0.001), periapical lesions (p < 0.001), and fistulae (p = 0.014). CBCT identified greater frequencies of periodontal dental pathologies (p = 0.046) and premolar caries (p = 0.002) compared with CPR. CBCT and CPR detected molar dental pathologies at similar frequencies. (4) Conclusions: CPR could increase the diagnostic rate of odontogenic pathologies compared with standard CT orthogonal views, especially when the sinusitis is caused by caries, periapical lesions, or fistulae. The addition of a CPR sequence allows for simple screening of dental pathologies in CRS patients without a need for additional radiation.