Frontal Sinus Aplasia Research Articles

Hidden unilateral aplasia of the frontal sinus: a radioanatomic study.

Hidden unilateral frontal sinus aplasia is the absence of 1 frontal sinus with increased pneumatization of contralateral sinus toward the aplastic side. It may give the false impression of the presence of 2 separate frontal sinuses, creating potential for complications during the surgery. The aim of this study was to evaluate the prevalence and morphology of this anatomical variation using multiplanar reconstruction of computed tomography (CT) results. A total of 305 CT examinations were analyzed. Hidden unilateral frontal sinus aplasia was defined as lack of pneumatization of 1 frontal sinus beyond the level of the orbital roof, with increased pneumatization of the contralateral sinus, extending to the sagittal plane, crossing the lamina papyracea on the side of the aplastic sinus. Eleven patients (3.6%) with hidden unilateral frontal sinus aplasia were identified, 5 on the left and 6 on the right side, in 5 female and 6 male patients. Twenty-four (7.8%) patients with "regular" frontal sinus aplasia (without hyperplastic contralateral frontal sinus) were found, 4 with bilateral aplasia and 20 with unilateral aplasia. Hidden unilateral aplasia of the frontal sinus is a relatively uncommon anatomical variation. Its presence should be considered during routine preoperative CT evaluation because it poses the risk of intraoperative complications.

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.Analysis of the presence of respiratory disease in bone material is particularly difficult, but the use of modern methods: X-rays, CT scans and endoscopy significantly extends the capability to unravel the underlying causes of bygone diseases.

Combined Aplasia of Sphenoid, Frontal, and Maxillary Sinuses With Hypoplasia of The Ethmoid Sinus

Dear Editor, Paranasal sinuses are prone to a great diversity of anomalies. Aplasia of the frontal sinus is a relatively common phenomenon and may be accompanied with hypoplasia of the maxillary sinus, but combined aplasia or underdevelopment of the paranasal sinuses is unusual (1, 2).These developmental pathologies may be misdiagnosed as sinusitis or neoplasm (2). Computerized Tomography (CT) is an excellent imaging technique that is used to map sinus anatomy (3). Here, we present a 23-years old male patient who has combined aplasia of sphenoid, frontal, and maxillary sinuses accompanied by ethnocide sinus hypoplasia, which is the second reported case to our knowledge. Twenty three years old male patient presented with complaints of headache and nasal obstruction to the Otorhinolaryngology outpatient clinic. Axial and Coronal CT scans (5mm slice thickness) delineated lack of pneumatization in the frontal, sphenoid and maxillary sinuses and minimal pneumatization in the ethmoid cells eg. Total aplasia of the frontal, sphenoid and maxillary sinuses and hypoplasia of the ethmoid sinuses. (Figure 1) No other craniofacial anomaly was observed. He had no previous history of facial trauma, irradiation or systemic diseases affecting the skeletal system such as Paget’s disease, osteopetrosis, or fibrous dysplasia. No other abnormality was found on clinical and laboratory examinations, including cystic fibrosis. The paranasal sinuses begin their development as an evagination of the mucosa from the nasal cavities during the third and fourth fetal months. They undergo major expansion after birth, along with the development of the facial cranium and teeth (1) The underdevelopment or aplasia of the paranasal sinuses is a rare phenomenon that refers mainly to the frontal (12%) and secondarily to the maxillary sinuses (5% and 6%). Agenesis of the sphenoid sinuses is extremely rare (4). The agenesis of the paranasal sinuses occurs more frequently in syndromes of craniosynostosis, osteodysplasia (Melnick-Needles), as well as in cases of Down’s syndrome (hypoplasia of the frontal sinus) (3). Developmental anomalies of paranasal sinuses in cystic fibrosis patients is significantly high compared to normal population (3). The developmental pathologic abnormalities may be misdiagnosed as sinusitis or neoplasm (4). The maxillary sinus is the first of the paranasal sinuses to develop in the human fetus and is present at birth. Development of the maxillary sinus may become arrested in children with recurrent chronic rhino sinusitis (4). For many authors there is a connection between reduced nasal ventilation and abnormal maxillary growth, but Diner et al observed normal development of maxillary sinus in 11 patients with unilateral choanal atresia. Chronic obstruction due to narrow infundibular passage and absence of natural osmium leads to thick effusion in hypo plastic sinuses (2, 4)Maxillary sinus hypoplasia may be misdiagnosed as chronic sinusitis. The sphenoid sinus develops embryo logically from the skull base. By the age of 12, the sphenoid pneumatization reaches its final form to a size equivalent to that of an adult. Sphenoid sinuses vary in size and shape. The average measurements of the sphenoid sinus are as follows: vertical height, 2 cm; transverse breadth, 1.8 cm; and anterosuperior depth, 2.1 cm. Hypoplasia of the sphenoid sinuses is shown frequently in patients with cystic fibrosis. However, agenesis of the sphenoid sinus is highly uncommon (4). Based on their anatomical studies, Wertheim and Grunwald reported in the early 1900s that agenesis of the sphenoid sinuses can indeed occur in 1–1.5% of cases. The diagnosis of sphenoid sinus hypoplasia is potentially important in patients in whom trans-spheroidal hypophysectomy is contemplated. In conclusion this patient seems to be the second case to have combined aplasias of the sphenoid, frontal, and maxillary sinuses with hypo plastic ethmoid cells without any systemic or skeletal disease. This extremely rare anomaly should also be kept in mind to prevent complications during endoscopic sinus surgery. Figure 1 Paranasal Sinus CT, Coronal Section, Indicating Aplasia of the Maxillary Sinus and Minimal Pneumatization in the Ethmoid Cells.

Bilateral aplasia of paranasal sinuses

Paranasal sinus anatomical anomalies with unknown etiology are common. Maxillary and/or frontal sinus aplasia or hypoplasia are more common than the other types. Although there are some reports about paranasal sinus anomalies in the literature, there is no case similar to ours, with total paranasal sinus aplasia. Here, we present a unique case of total paranasal sinus aplasia with a symptom of fullness on the face.

Combined sphenoid and frontal sinus aplasia accompanied by bilateral maxillary sinus hypoplasia in a child with sinusitis

Objective: The effectiveness of adenoidectomy in the management of pediatric sinusitis is still a controversial issue. The size of the adenoid and associated diseases are the factors for consideration. The adenoid has been studied and is proved to be a probable source of infection for the paranasal sinus. The purpose of this study is to evaluate the efficacy of adenoidectomy in reducing the frequency of sinusitis in children. Methods: A prospective study was done in pediatric patients with rhinosinusitis admitted for adenoidectomy from January 2000 to January 2002. Pre-operative frequency of rhinosinusitis, underlying diseases and the diseases caused by the adenoid were recorded. The adenoid size was evaluated by lateral skull X-ray. The patients were followed after surgery and frequency of rhinosinusitis and associated diseases were compared with the pre-operative period. Results: There were 37 patients with mean age of 6±2.8 years. Mean duration for pre-operative review was 436.7 days and mean duration for post-operative follow up was 450.2 days. Almost all (92%) of the patients had obstructive sleep disorder and 88.2% had adenoid–nasopharyngeal ratio >0.7. There was a statistically significant reduction of episodes per year of rhinosinusitis and obstructive sleep disorder after surgery (P-value < 0.001 and 0.008, respectively). Conclusion: Adenoidectomy was proved to be effective in the management of pediatric rhinosinusitis in this series. Adenoidectomy should be most beneficial as a surgical option before endoscopic sinus surgery (ESS), especially in younger children with obstructive symptoms.

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.

Combined Aplasia of Sphenoid, Frontal, and Maxillary Sinuses Accompanied by Ethmoid Sinus Hypoplasia

To report the case of a woman who had combined aplasia of sphenoid, frontal, and maxillary sinuses accompanied by ethmoid sinus hypoplasia. A 47-year-old woman presented with complaints of headache, nasal obstruction, and postnasal drainage. She had no previous history of either facial trauma or systemic diseases affecting the skeletal system. She had a history of functional endoscopic sinus surgery twice in an other institution. However, the surgeries did not significantly alter her symptoms. Coronal and axial computed tomographic scans of the nose and the paranasal sinuses showed poorly developed frontal, sphenoid sinuses, ethmoid cells, and very severe and profound hypoplasia (aplasia) of bilateral maxillary sinuses. To our knowledge, this patient seems to be the first case having combined aplasias of the sphenoid, frontal, and maxillary sinuses with hypoplastic ethmoid cells without any systemic or skeletal disease.

Combined sphenoid and frontal sinus aplasia accompanied by bilateral maxillary sinus hypoplasia in a child with sinusitis

Abstract Paranasal sinus agenesis is unusual clinical condition. The frontal sinus agenesis is more frequently seen, whereas agenesis of sphenoid sinus is extremely rare. Agenesis of both frontal and sphenoid sinus is very unique. This case presents a 13-year-old child with combined sphenoid and frontal sinus agenesis accompanied by bilateral maxillary sinus hypoplasia with scoliosis and coccyx abnormality.

THE PREVALENCE OF FRONTAL SINUS APLASIA IN MASHHAD, NORTHEAST OF IRAN

Introduction: There are various reports of the prevalence of frontal sinus aplasia in different geographical areas and ethnic origins. The size and shape of frontal sinus is different among various populations. This study used CT scan images to investigate the frequency of absence of frontal sinuses in adults of northeastern Iran. Materials and Methods: The present study was performed retrospectively on the axial and coronal CT scans of the paranasal sinuses from a series of 588 patients who had referred to CT scan ward of Mashhad Imam Reza hospital without any other sinus pathology. Results: The mean age of patients was 44.39± 19.44 years. Unilateral and bilateral aplasia of frontal sinuses was seen in 36 and 51 patients, respectively. The dominant sinus was in the left side in 68.24% of cases. Conclusion: The lower incidence of frontal sinus aplasia in this particular ethnic and geographical area relative to other populations emphasizes the effect of environmental and genetic factors on the development of frontal sinuses.

Combined sphenoid and frontal sinus aplasia accompanied by bilateral maxillary and ethmoid sinus hypoplasia

We describe CT scans of a case with bilateral aplasia of frontal and sphenoid sinuses with symmetrical hypoplasia of the ethmoid cellules and maxillary sinuses. This case appears to be first in the English-language literature with these combined findings.

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.

RADIOGRAPHICALLY VISUALIZED SKELETAL CHANGES ASSOCIATED WITH MUCOPOLYSACCHARIDOSIS VI IN CATS

The radiographic skeletal form and structure of all cats with mucopolysaccharidosis VI is described. Common manifestations included epiphyseal dysplasia, generalized osteoporosis, abnormal nasal turbinate development, his subluxation, impaired development of skeletal growth, pectus excavatum, hyoid hypoplasia, aplasia, hypoplasia and fragmentation or abnormal ossification of the dens, and aplasia or hypoplasia of frontal and sphenoid sinuses. The skeletal measurements of two affected cats were compared with those of normal, sex‐matched littermates, and the measurements of two affected female cats were compared with those of a normal male littermate.

Woake's syndrome. A case report in a teenager

Woake's syndrome was described for the first time in the European literature in 1885 and features necrotic ethmoiditis, nose broadening due to polyps in early childhood, frontal sinus aplasia, bronchiectasis and production of highly viscous mucus (dyscrinia). A case is reported and the literature is reviewed.

Woakes' syndrome: The problems of infantile nasal polyps

Usually, nasal polyposis in early childhood (children aged less than 5 years) is caused by cystic fibrosis or Kartagener's syndrome. In later age groups, recurrent sinus infections, allergy and ASA disease (asthma, aspirin intolerance and nasal polyps) have to be taken into consideration. Four cases of early childhood polyposis are reported which fit into none of these etiological groups. This newly defined Woakes' syndrome comprises recurrent nasal polyposis with broadening of the nose, frontal sinus aplasia, bronchiectasis, and dyscrinia (production of highly viscous mucus). The disease seems to be hereditary. The possible origins of the disease are discussed.