Development Of Paranasal Sinuses Research Articles

Atmospheric pressure as a force that fills developing bones with marrow and air

Many theories try to explain the existence and function of paranasal sinuses. This paper is an attempt to correlate process of paranasal sinus development in human with bone pneumatization processes in animals. It is here proposed that this mechanism starts in utero and continues after birth. During endochondral development, a solid hyaline cartilage model transforms into long bones. Central chondrocytes hypertrophy and their lacunae become confluent. Dissolving of the cartilage intercellular matrix forms a primitive marrow cavity. It is soon invaded by the periostal bud. Once circulation is established in the developing bone, the dissolved hyaline matrix can be slowly washed away from the bone cavity. Circulation in the bone cavity can develop slight subatmospheric pressures, similar to negative interstitial pressures in subcutaneous tissues. The amniotic fluid conducts atmospheric pressure to the fetal body. The pressure is trying to fill enlarging bone cavities through the existing vascular openings, or to create new openings. Bone walls of developing paranasal bones are to weak to resist the pressure gradient on their walls. New openings form on the weakest spots allowing airway mucosa to form initial paranasal sinuses. The enlarging cavities of long bones that are remote from the body surface and airway also develop a slightly subatmospheric pressure that fills them with cellular elements. These elements enter bone through the feeding vessels and form bone marrow. During after birth skeletal growth, bone remodeling shapes paranasal sinuses in a process of slow evolution that do not require measurable pressure gradients. When two sinuses come in vicinity, their growth rate declines, since the remaining thin and fragile bone lamella between them does not retract anymore.

Paranasal sinus development: a radiographic study.

To demonstrate the development of the paranasal sinuses in a pediatric population by computed tomography scans. Radiology records at a tertiary care institution were reviewed for the computed tomography scans of the face, orbit, or paranasal sinuses in patients aged 0 to 12 years. Computed tomography scans were reviewed by a head and neck radiologist and otolaryngologist for the development of the frontal, maxillary, ethmoid, and sphenoid sinuses. The size of the pneumatized paranasal sinuses was measured in two planes and graded on a scale of 0 to 3. Ossification of the maxillary crest and vomer, obliteration of the foramen cecum, and development of agger nasi cells, Haller cells, and the superior turbinate were studied. Patients with syndromes, nasal stenosis, choanal atresia, or cystic fibrosis were excluded from the study. In all, 91 computed tomography scans in 66 patients were studied. Serial development could be followed in 16 patients who underwent repeat scans. Patients were divided into six age cohorts based on their age at the time of the scan: 0 to 3 months (10%), 3 to 12 months (13%), 1 to 3 years (13%), 3 to 5 years (20%), 5 to 8 years (29%), and 8 to 12 years (16%). Ethmoid sinuses were the first to fully develop, followed sequentially by maxillary, sphenoid, and frontal sinuses. Each sinus has a rapid rate of development during specified age cohorts. The results will aid the physician when correlating the clinical and radiographic findings of pediatric patients aged 0 to 12 years who are being evaluated for sinus disease and potential surgical intervention.

Nasal nitric oxide.

Nasal nitric oxide.

CT characterization of developmental variations of the paranasal sinuses in cystic fibrosis.

To describe variations of paranasal sinus development in patients with cystic fibrosis (CF) and in non-CF patients examined for inflammatory sinonasal disease. We focused on anatomic variants that predispose to orbital and cerebral penetration during functional endoscopic sinus surgery (FESS), e.g. hypoplasia of the maxillary sinus and low ethmoid roof. One hundred and sixteen CF patients (3-54 years, median 18) and 136 control patients (7-51 years, median 31) were examined with coronal CT of the paranasal sinuses. CF patients were grouped according to number of confirmed mutations: CF-2 (n=70), CF-1 (n=32), CF-0 (n=14). CT images were evaluated with respect to paranasal sinus development, pneumatization variants and bony variants. Frontal sinus aplasia and maxillary, ethmoid, and sphenoid sinus hypoplasia were markedly more frequent in CF-2 than in control patients. No CF-2 patient had pneumatization variants such as Haller cells or concha bullosa. Low ethmoid roof was seen in 30% of CF-2 children, but in no control children. CF-1 and CF-0 groups had prevalences of aplasia and hypoplasia intermediate to that of CF-2 and control patients. Genetically verified CF patients had less developed sinuses, lacked pneumatization variants, and more often had anatomic variants that predispose to complications during FESS. Normally developed sinuses and pneumatization variants in some genetically unverified CF patients (CF-1, CF-0) suggest that these patients may be erroneously diagnosed.

CT characterization of developmental variations of the paranasal sinuses in cystic fibrosis

To describe variations of paranasal sinus development in patients with cystic fibrosis (CF) and in non-CF patients examined for inflammatory sinonasal disease. We focused on anatomic variants that predispose to orbital and cerebral penetration during functional endoscopic sinus surgery (FESS), e.g. hypoplasia of the maxillary sinus and low ethmoid roof. One hundred and sixteen CF patients (3-54 years, median 18) and 136 control patients (7-51 years, median 31) were examined with coronal CT of the paranasal sinuses. CF patients were grouped according to number of confirmed mutations: CF-2 (n=70), CF-1 (n=32), CF-0 (n=14). CT images were evaluated with respect to paranasal sinus development, pneumatization variants and bony variants. Frontal sinus aplasia and maxillary, ethmoid, and sphenoid sinus hypoplasia were markedly more frequent in CF-2 than in control patients. No CF-2 patient had pneumatization variants such as Haller cells or concha bullosa. Low ethmoid roof was seen in 30% of CF-2 children, but in no control children. CF-1 and CF-0 groups had prevalences of aplasia and hypoplasia intermediate to that of CF-2 and control patients. Genetically verified CF patients had less developed sinuses, lacked pneumatization variants, and more often had anatomic variants that predispose to complications during FESS. Normally developed sinuses and pneumatization variants in some genetically unverified CF patients (CF-1, CF-0) suggest that these patients may be erroneously diagnosed.

Quantitative impact of pediatric sinus surgery on facial growth.

To quantitatively evaluate the long-term impact of sinus surgery on paranasal sinus development in the pediatric patient. Longitudinal review of eight pediatric patients treated with unilateral sinus surgery for periorbital or orbital cellulitis with an average follow-up of 6.9 years. Control subjects consisted of two groups, 9 normal adult patients with no computed tomographic evidence of sinusitis and 10 adult patients with scans consistent with sinusitis and a history of sinus-related symptoms extending to childhood. Application of computed tomography (CT) volumetrics, a technique allowing for precise calculation of volumes using thinly cut CT images, to the study and control groups. Paired Student t test analyses of side-to-side volume comparisons in the normal patients, patients with sinusitis, and patients who had surgery revealed no statistically significant differences. Comparisons between the orbital volumes of patients who did and did not have surgery revealed a statistically significant increase in orbital volume in patients who had surgery. Only minimal changes in facial volume measurements have been found, confirming clinical impressions that sinus surgery in children is safe and without significant cosmetic sequelae.

Paranasal sinus development and choanal atresia.

Although the determinates of paranasal sinus development and sinusitis are not well defined, a candidate factor is blockage of the choana. Maxillary sinuses ipsilateral to unilateral choanal atresia are comparatively small and have more evidence of sinusitis than do the contralateral sinuses. Retrospective. Children's hospitals. Sixteen nonsyndomic children with isolated unilateral congenital choanal atresia. Determination of maxillary sinus volumes and mucoperiosteal thickening on preoperative computed tomograms. Maxillary sinuses ipsilateral to unilateral choanal atresia have slightly larger volumes than, and mucoperiosteal thickening that is similar to, the contralateral sinuses. These data suggest that maxillary sinus development and sinusitis are independent of posterior nasal ventilation and drainage.

Morphogenic mechanisms in the development of ethmoidal sinuses.

The current teaching in regard to the development of paranasal sinuses is that they are evaginations of the nasal cavity; this seems to totally ignore earlier observations. Serial coronal sections of the heads of 23 human fetuses from 18-mm CR length to 282-mm CR length were stained by various methods and studied. The ethmoidal sinuses develop by the formation of 'turbinal cushions' at the 33-mm CR stage. By the 45-mm CR stage, the cushions have grown toward each other and made contact. The epithelium covering the cushions also proliferates to fill up the enclosed space, and it proliferates dorsoventrally as well. The cushions fuse at the 50-mm CR stage. The fusion part of the process should be described as a 'constriction' of the nasal cavity. Next, the epithelium disintegrates and results in the formation of the sinus. This part of the process only can be described as an 'evagination' of the nasal cavity. As the advancing epithelium of the sinus encounters cartilage, it causes disintegration of the developing nasal cartilage. This area of disintegration appears as a spot stained pink with H & E, black with mucicarmine, and yellow with van Gieson's stains, respectively. These spots are seen between the 89-mm and the 225-mm CR stages (both inclusive). Two mechanisms operate in the development of ethmoidal sinuses: constriction of the nasal cavity by a pair of turbinal cushions, and evagination from the nasal cavity by proliferation and subsequent disintegration of the nasal epithelium.

Paranasal sinuses in pediatric patients by MRI: normal development and preliminary findings in disease

A two-part study using medium field strength magnetic resonance imaging (MRI) was designed to describe the normal paranasal sinus development and to provide preliminary criteria for clinical sinus disease. In part I of the study the paranasal sinuses were retrospectively evaluated in 80 infants and children aged 0–17 years undergoing brain MRI for indications both unrelated and related to sinus disease. We developed MRI criteria for independent grading of paranasal sinus development and ‘anatomical’ sinus disease, i.e., disease as seen by the radiologist. We quantified the variability in extent of sinus pneumatization (a measure of sinus development) in infants and young children. Part II of the study was a double-blind prospective study in 21 patients to correlate ‘anatomical’ disease with ‘clinical’ sinus disease. In this limited preliminary study, clinical sinus disease was only seen in the patients with moderate or severe anatomical disease (sensitivity 100%; specificity 100%).

Pediatric Maxillofacial Trauma: Age-Related Variations in Injury

Seventy-two children were treated for maxillofacial injuries by the otolaryngology service between January 1984 and June 1988. Patients were divided into three age groups on the basis of the development of paranasal sinuses and dentition. Differences in fracture characteristics, associated injuries, and treatment modalities were correlated to the maturational changes in the pediatric facial skeleton. The fracture site tended to shift from the upper to the lower aspect of the face with increasing age of the patient. Associated injuries were frequent, especially cranial injuries, and temporal bone fractures were notably more common in the youngest age group. Conservative treatment was found to be successful, particularly in the youngest age group, because of the unique remodeling potential of the pediatric facial skeleton.

Development of paranasal and mastoid sinuses: a computed tomographic pilot study.

Paranasal sinus and mastoid disease in children is an important potential source of intracranial sepsis. Cranial computed tomographic (CT) scans are a primary imaging modality for assessment of the paranasal sinuses and mastoids. Radiographic assessment of paranasal sinus development has largely been confined to plain radiographs and polytomographic examination. We report a pilot, quantitative analysis of 30 CT scans obtained from patients without known ear, nose, or throat disease, and aged from 3 weeks to 13.8 years. Ethmoid, sphenoid, and mastoid sinus development was assessed by a "pneumatization index" (PI) derived from each CT scan. At all ages, the rank order of sinus development was ethmoid greater than mastoid greater than sphenoid. Individual developmental rates showed considerable variation. In the newborn, mastoid and sphenoid sinus development was minimal, whereas ethmoid sinuses showed substantial aeration. The data suggest that, for children older than 5 years of age, an ethmoid sinus PI less than or equal to 0.714 is highly suspicious of paranasal sinus disease.

Extreme development of the paranasal sinuses. Report of a case.

Extreme development of the paranasal sinuses. Report of a case.