Location Of Ostium Research Articles

Evaluation of the relationship between the presence of an accessory maxillary ostium and the presence and types of nasal septum deviation: A computed tomography study.

The maxillary accessory ostium (AMO) has been associated with chronic rhinosinusitis and nasal septal deviation (NSD), but AMO may also be present in healthy individuals. AMO's purpose, origin, and effects are uncertain. This study aimed to investigate the types and frequency of AMO and NSD, as well as their relationship. In our retrospective, single-center study, paranasal sinus tomographs performed in our clinic between 2022 and 2023 were scanned, and 200 patients who met the inclusion criteria were evaluated in terms of AMO direction (right/left), accessory ostium location (superior/middle/inferior 1/3), presence of NSD, and deviation type according to the Mladina index. 60.5% of the patients were female and 39.5% were male. AMO distribution was similar between the groups (p>0.05). There was no significant correlation between the presence and localization of AMO and the presence of NSD (p>0.05). NSD was detected in 93 patients (89.4%) with AMO and 78 patients (81.3%) without AMO (p=0.16). The distribution of NSD presence and types was similar in right or left localization, AMO (+) and AMO (-) patients (p>0.05). The evidence that AMOs cause chronic sinusitis and FESS failure is insufficient and cannot explain the presence of AMOs in healthy individuals or children. There are very few studies in the literature examining the NSD-AMO relationship. In our study, high rates of NSD and AMO were found in individuals without paranasal disease, but no statistically significant relationship was found between the presence, location, and type of NSD and AMO. Early-onset, long-term prospective studies on the relationship between NSD and AMO may help to explain the etiopathogenesis of paranasal diseases that reduce quality of life.

Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review.

Biological sex is increasingly recognized as a critical variable in health care. The authors reviewed the current literature regarding sex-based differences in rhinology to summarize the data and identify critical knowledge gaps. A scoping review was conducted. Publications reporting sex-based differences in anatomy, physiology, and pathology focusing on disease prevalence, disease burden, and outcomes in rhinology were identified. Seventy-five relevant manuscripts were identified. While paranasal sinuses are of similar size at birth, they become larger in males leading to differences in ostium location. Females outperform males in olfactory identification but only in the 18- to 50-year age group. Estrogen and progesterone administration can impact muscarinic and α1 -adrenergic nasal mucosa receptor density. Chronic rhinosinusitis (CRS) and CRS without nasal polyps are more prevalent in females while CRS with nasal polyps is more prevalent in males. CRS symptom burden is higher in females before and after endoscopic sinus surgery; however, no difference in endoscopic sinus surgery utilization was found based on sex. Allergic rhinitis is more common in males before puberty and in females after puberty. Epistaxis is more prevalent in males and postmenopausal females compared with premenopausal females, perhaps from differences in sex-hormonal and hypertension status. In nasopharyngeal carcinoma, the incidence of sinus abnormalities was higher in males than females. Although many sex-based differences exist in rhinology, further research is necessary to offer evidence-based treatment guidelines. Gonadal hormones should be studied as a therapeutic in rhinologic pathology as baseline physiologic differences exist such as those found in nasal mucosa receptor density.

A thorough cadaveric investigation of coronary ostia and its relationship with sinotubular junction

Coronary arteries take origin from the sinus of Valsalva present at the aortic root bounded by a circumferential ridge called sinotubular junction (STJ). Developmentally, the location and morphology of these ostia may vary, and can cause variations in origin of coronary arteries and further complications in any interventional cardiac procedure. This has made it necessary to find the variation in number and location of ostia, their size, shape and relation with surrounding structures. The present study included 40 formalin-fixed cadaveric hearts. The average diameter of the right coronary ostium (RCO) was 3.1 mm and the left coronary ostium (LCO) was 4.2 mm. With regard to the shape of the ostium, the RCO was described as circular in 92.5% (37/40), horizontally elliptical in 7.5% (3/40) of cases. The LCO was circular in 90% (36/40), horizontally elliptical in 5% (2/40) of cases. The RCO was located below STJ in 65% cases (26/40), at STJ in 22.5% (9/40) and above STJ in 22.5% (9/40) cases. LCO were below STJ in 50% (20/40), at STJ in 27.5% (11/40) and above STJ in 22.5% (9/40) cases. Multiple ostia in single aortic sinus were recorded in 24.4 % of cases. The study of the location, shape and morphometry of coronary ostia is essential for any cardiac interventional procedures done for diagnostic and therapeutic evaluation

Anatomic characterization of the location of the esophageal ostium relative to the rima glottidis on CT in adult Labrador Retrievers.

To characterize the anatomic location of the esophageal ostium relative to the rima glottidis in adult Labrador Retrievers with the use of CT. 98 CT scans of 75 adult Labrador Retrievers. A search of the medical records database identified records of Labrador Retrievers that underwent CT of the head and neck between January 1, 2015, and December 31, 2018. Evaluators, blinded to each other's results, reviewed CT images and measured esophageal area at the level of the rima glottidis. For each dog, the left esophageal percentage (LEP) was calculated as the esophageal area left of the rima glottidis midline divided by the overall esophageal area at that level. Variables (age, sex, patient position, intubation status, and maxillary support during CT) were evaluated for association with LEP. The CT images of dogs that had multiple scans were assessed for within-patient variance. Mean LEP was 56.2 ± 18.1% for all dogs. Only right lateral recumbency was significantly associated with LEP, with a lower LEP for dogs positioned in right lateral recumbency (42.4 ± 12.7%), compared with left lateral (63.0 ± 7.4%) or sternal (57.3 ± 18.8%) recumbency. No association was detected between LEP and other variables assessed. Eleven dogs had multiple CT scans; within-patient variance for LEP was ± 26.6%. Results indicated that, although most dogs had an LEP > 50%, the esophageal ostium was fairly centrally located in most dogs and may be more mobile than previously thought. Additional research is warranted to assess this mobility and whether the esophageal ostium location, relative to the larynx, affects the incidence of aspiration pneumonia in dogs undergoing surgical treatment for geriatric-onset laryngeal paralysis and polyneuropathy.

Flow Dynamics in Anomalous Aortic Origin of a Coronary Artery in Children: Importance of the Intramural Segment

This study aims to assess the differences in pressure, fractional flow reserve (FFR) and coronary flow (with increasing pressure) of the proximal coronary artery in patients with anomalous aortic origin of a coronary artery with a confirmed ischemic event, without ischemic events, and before and after unroofing surgery, and compare to a patient with normal coronary arteries. Patient-specific flow models were 3D printed for 3 subjects with anomalous right coronary arteries with intramural course, 2 of them had documented ischemia, and compared with a patient with normal coronaries. The models were placed in the aortic position of a pulse duplicator and precise measurements to quantify FFR and coronary flow rate were performed from the aortic to the mediastinal segment of the anomalous right coronary artery. In an ischemic model, a gradual FFR drop (emulating that of pressure) was shown from the ostium location (∼1.0) to the distal intramural course (0.48). In nonischemic and normal patient models, FFR for all locations did not drop below 0.9. In a second ischemic model prior to repair, a drop to 0.44 was encountered at the intramural and mediastinal intersection, improving to 0.86 postrepair. There is a difference in instantaneous coronary flow rate with increasing aortic pressure in the ischemic models (slope 0.2846), compared to the postrepair and normal models (slope >0.53). These observations on patient models support a biomechanical basis for ischemia and potentially sudden cardiac death in aortic origin of a coronary artery, with a drop in pressure and FFR in the intramural segment, and a decrease in coronary flow rate with increasing aortic pressure, with both improving after corrective surgery.

Three-dimensional printing for assessment of paravalvular leak in transcatheter aortic valve implantation

BackgroundThree-dimensional (3D) models have the unique ability to replicate individualized cardiac anatomy and may therefore provide clinical benefit. Transcatheter aortic valve implantation (TAVI) currently relies on preoperative imaging for accurate valve sizing, type of valve used, and avoidance of complications. Three-dimensional (3D) modelling may provide benefit for optimal preoperative TAVI planning. The goal of this study is to assess the utility of 3D modelling in the prediction of paravalvular leak (PVL) post TAVI.MethodsRetrospective analysis of five patients who underwent TAVI at our center. Pre-operative cardiac gated CT images were utilized to create a 3D printed model with true size aortic root dimensions, including the coronary artery ostium location and left ventricular outflow tract. Deployment of the corresponding model and size TAVI valve into the created 3D model at a similar depth of implantation via fluoroscopy was performed for each patient. Degree of PVL was assessed using a closed system with water infusion under pressure over a duration of 5 s. Correlation was made between the volume obtained in the closed loop model during the pressurized period and the degree of PVL reported on the patients post TAVI placement on transthoracic echocardiogram.ResultsOne female, and four males (age in years ranged from 68 to 87) underwent successful TAVI (0% 30-day mortality). PVL on post procedure TTE ranged from none to trivial. Successful deployment of TAVI valves inside the 3D model occurred in all cases. The average volume of water collected on three trials over 5 s ranged between 19.1–24.1 ml A multivariate linear regression showed significant association between the degree of PVL reported on post-operative transthoracic echocardiogram and the amount of volume detected in the 3D model (difference: -3.9657, 95% CI: (− 4.6761,-3.2554), p < 0.001).ConclusionsOur experiments show that replicated 3D models have potential clinical utilization in predicting PVL in the TAVI population. Future research into the role of 3D modelling in the field of TAVI should continue to be explored.

Ostium Characteristics and Its Relevance in Successful Outcome Following Endoscopic Dacryocystorhinostomy.

Study aims to assess the postoperative ostium shrinkage pattern and also attempted to evaluate various ostium parameters and their impact on surgical outcome by using DOS scoring system. Prospective study comprising 44 patients of NLD obstruction with 52 procedures performed during October 2016 to November 2018. Various dimensions of bony neo-ostium were recorded intraoperatively and during 1st, 3rd and 6th month follow up. Degree of ostium shrinkage and its correlation with anatomical and functional success was studied. DCR ostium (DOS) scoring system, comprised of ten various ostium parameters, was used to evaluate postoperative ostium. Intraoperative mean ostium height and width were 13.67 ± 2.76mm and 7.0 ± 1.94mm and surface area was 98.33 ± 38.46 mm2. Maximum ostium shrinkage (by 66.93%) occurred at 1month and after which, average size of ostium was quite stable with little change. The anatomical and functional success rate was 94.23% and failure rate was 5.77%. DOS score was "excellent" in 40(75.92%), "good" in 9(17.31%) and "poor" in 3(5.77%) cases. Meticulous evaluation at regular intervals is important for surgeon to understand the characters of ostium during healing and also helps in early detection of pathologies and may facilitate early corrective intervention. We believe that DOS system provides an effective protocol to standardize the ostium evaluation. The ostium parameters with favourable surgical outcome are ostium location anterior to axilla of MT, circular/ oval shape with shallow base, size > 8 × 5mm, clearly visualized and dynamic ICO, absence of ostium cicatrization, granulomas, synechiae and other pathologies.

The Location and Diameter of the Primary Maxillary Sinus Ostium in Malaysians: A Cone-Beam Computerized Tomography Study

Rhinosinusitis is one of widely spread diseases in the region and the role of the anatomical variations in its pathogenesis remains unresolved. A retrospective study using CBCT scan was employed to locate and measure the diameter of 320 primary maxillary ostium (PMO) (n = 160 subjects) among the Malay and Chinese populations (Mongoloid race) in Malaysia. Image analysis was performed using the i-CAT Vision Software, employing the multiplanar reconstruction window in which axial, coronal and sagittal planes were visualized in 0.3 mm intervals. The mean diameter of the PMO was significantly larger in the Chinese than the Malay. Females had larger size than the male and bilateral asymmetry was noticed, where the right side PMO was larger than the left side (p &lt; 0.05). In addition, PMO opened more in the posterior third position of the hiatus semilunaris (61.9%) than anterior and middle third. The PMO showed a statistically significant posteriorly placed position in the Chinese than the Malays and this was more evident in the right side PMO (p &lt; 0.01). In conclusion, the PMO commonly opens in the posterior third of the hiatus semilunaris and its diameter is significantly greater in the Chinese female with evidence of bilateral asymmetry. Awareness the anatomical variation of the Ostium diameter and location among the Malay and Chinese populations potentially has important clinical effects during surgical procedures.

Unicuspid Aortic Valve with Bilateral Superior Vena Cavae, Abnormal Coronary Anatomy, and Right Ventricular Clot: A Rare Case Report

A teenager presented with congestive heart failure due to severe aortic stenosis. She had also developed ventricular clots due to ventricular dysfunction, therefore, was taken up for emergency aortic valve replacement. To our surprise, she had bilateral superior vena cava, which has not been reported with unicuspid aortic valve and ventricular clots, to the best of our knowledge. She also had an abnormal location of coronary ostia making them susceptible to injury during routine aortotomy, but it was picked up during transesophageal echocardiography and a careful aortic incision was planned. This report emphasizes the importance of careful aortotomy in congenital aortic pathologies, where coronary ostia may be located in abnormal positions. The role of transesophageal echocardiography is paramount in this situation to find the location of coronary ostia before incising the aorta.

Morphological and Clinical Significance of Thebesian Valve Guarding Ostium of Coronary Sinus

Abstract Background The advent of novel therapeutic techniques require cannulation of coronary sinus. The Thebesian valve guarding the ostium of coronary sinus can pose practical difficulties during such procedures. Aim With this background we undertook a detailed study of the morphological features of Thebesian valve, so that we can substantially evaluate the clinicoanatomical importance of it. Materials and Methods Fifty human dissected cadaveric heart specimens were selected from the department of anatomy, SDM College of Medical Sciences and Hospital, Dharwad. The location of ostium of coronary sinus and the occurrence of the Thebesian valve and its shape, composition, and extent of occlusion of the ostium were carefully observed and noted. Results Our observations revealed that 90% of specimens had the Thebesian valve guarding the opening of coronary sinus. It was semilunar in shape in 74% of specimens. The valve was membranous in composition in 46% of specimens. Among these, in 26% of specimens the valve almost covered more than 50% of the ostium of coronary sinus indicating moderate to severe occlusion.

Prevalence and spectrum of coronary artery anomalies in 8021 patients: A single center study in South India

ObjectiveTo identify the prevalence of coronary artery anomalies (CAAs) and their subtypes based on Angelini et al. classification in symptomatic yet stable population of South India using 64- slice dual source multi detector CT coronary angiography (MDCT-CA). MethodsWe retrospectively reviewed reports of 8021 symptomatic patients predominantly South Indians who were referred for CT coronary angiography (CT-CA) to our tertiary cardiac care center in Hyderabad, India from January 2011 to March 2017. ResultsWe identified a total of 838 coronary artery anomalies in 812 patients with a prevalence of 10.09%. 96.9% of patients were older than 30 years of age with a M:F ratio of 1.39:1. Coronary artery disease (CAD) was seen in 61.5% of these patients. Among these anomalies, myocardial bridging (MB) was the most common anomaly followed by anomalous location of coronary ostium at improper sinus (ACOIS). ConclusionThere is no significant difference in prevalence of CAAs (including and excluding MB) in Indian and World population. CAAs were more common in males than females and most of these patients remain asymptomatic during first three decades of their life. Myocardial bridging is the most common anomaly detected by MDCT-CA followed by ACOIS. Right coronary artery (RCA) arising from left coronary sinus (LCS) is the most commonly encountered ACOIS.

The prevalence of coronary artery anomalies in adults: Studied with computed tomography coronary angiography

Background/Aim. Coronary artery anomalies are an uncommon but important cause of chest pain, and in some cases of hemodynamically significant abnormalities, sudden cardiac death. The aim of the research was to establish the prevalence of the coronary arteries anomalies in our population. Methods. The study group included 1,562 patients (810 men, 752 women, average age 64.3 ? 12.0 years; range 32?80 years) who were scheduled for 64-slice computed tomography (MSCT), which enables detailed visualization of coronary arteries and heart anatomy. All examinations were made due to suspicion (atypical chest pain, angina equivalent symptoms or multiple risk factors for cardiovascular disease) or assumption of progression of coronary artery disease. Results. From January 2010 till December 2014 a total number of 1,562 patients were sent for evaluation of coronary arteries. The coronary anomalies were found in 45 (2.88%) patients. The most frequent coronary anomaly seen in our population group was absence of left main trunk with the separate origin of the left anterior descending artery (LAD) and left circumflex artery (LCx) originating from a left coronary sinus (LCS). This was found in 12 patients (an incidence of 0.77% or 26.7% of all coronary anomalies). Anomalous location of coronary ostium outside normal aortic sinuses in our study was present as right coronary artery (RCA) that arises from left anterior sinus in 5 (0.32%) patients and left coronary artery from non-coronary sinus in two (0.13%) patients. Conclusion. Knowledge of anomalies of the coronary arteries and their recognition on the multislice computed tomography is of great importance for the further planning of a possible therapeutic treatment. Coronary anomalies that are considered insignificant will require no further therapeutic treatment. But the detection of malignant coronary anomalies will certainly save many lives.

Efficacy of biolimus A9-eluting stent for treatment of right coronary ostial lesion with intravascular ultrasound guidance: a multi-center registry.

The aim of this study was to assess the efficacy of a biolimus A9-eluting stent in patients with a right coronary artery (RCA) ostial lesion. Ostial lesions of the RCA have been a limitation of percutaneous coronary intervention even in the drug-eluting stent (DES) era. However, clinical outcomes after the deployment of a second generation DES to an RCA ostial lesion with intravascular ultrasound (IVUS) guidance have not been fully elucidated. From September 2011 to March 2013, 74 patients were enrolled in 17 centers from Japan. RCA ostial lesion was defined as de novo significant stenotic lesion located within 15mm from ostium. IVUS was used for all cases to confirm the location of ostium and evaluate stent coverage of ostium. Patients with hemodialysis were excluded. The primary endpoint is a major adverse cardiac event (MACE) at 1year. Forty two percent of patients had multi-vessel disease. Angiographically severe calcification was observed in 26% of the lesions. The mean stent diameter was 3.3±0.3mm (3.5mm, 72%, 3.0mm, 25%, and 2.75 and 2.5mm, 3%), stent length was 17.5±5.8mm, and dilatation pressure of stenting was 15.6±4.1atm. RCA ostium was covered by stent in all lesions in IVUS findings. Post dilatation was performed for 64% of lesions (balloon size 3.7±0.6mm). MACE rate at 1year was 5.4% (target lesion revascularization 5.4%, myocardial infarction 1.2%, and no cardiac death). The biolimus A9-eluting stent for RCA ostial lesions with IVUS guidance showed favorable results at 1-year follow-up.

Variations in the Number of Pulmonary Veins Draining into Left Atrium and its Clinical Significance

Background : Pulmonary veins, normally two on each side bring oxygenated blood from lungs to left atrium. During early embryonic life, absorption of pulmonary venous network by the left primitive atrial chamber results in opening of four pulmonary veins which drain independently into its chamber. The extent of absorption and hence, the number of pulmonary veins which open into left atrium may vary. Objective : The study was done to observe the variation in the number of pulmonary veins opening in the left atrium. Materials and method : The present study was done on 30 formalin fixed hearts of unknown age and sex which were obtained from the department of anatomy, Government medical college, Chandigarh. These hearts were observed for the variations in pulmonary ostia on right and left sides and were compared on both sides and also with the earlier data. Results : In 8 (26.67%) out of these 30 hearts, variations were observed in the number of pulmonary veins and ostia either on one side or on both sides of the left atrium. 22 hearts (73.33%) out of 30 hearts had normal pulmonary veins which opened into left atrium via two separate pulmonary ostia, on either side. Conclusion : Knowledge of number of pulmonary veins and their ostia locations is important to ensure that all ostia are ablated, as ectopic foci may go untreated in variant veins.

Variations in the Number of Pulmonary Veins Draining into Left Atrium and its Clinical Significance

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Pulmonary veins, normally two on each side bring oxygenated blood from lungs to left atrium. During early embryonic life, absorption of pulmonary venous network by the left primitive atrial chamber results in opening of four pulmonary veins which drain independently into its chamber. The extent of absorption and hence, the number of pulmonary veins which open into left atrium may vary.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective&lt;/strong&gt;: The study was done to observe the variation in the number of pulmonary veins opening in the left atrium.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and method&lt;/strong&gt;: The present study was done on 30 formalin fixed hearts of unknown age and sex which were obtained from the department of anatomy, Government medical college, Chandigarh. These hearts were observed for the variations in pulmonary ostia on right and left sides and were compared on both sides and also with the earlier data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: In 8 (26.67%) out of these 30 hearts, variations were observed in the number of pulmonary veins and ostia either on one side or on both sides of the left atrium. 22 hearts (73.33%) out of 30 hearts had normal pulmonary veins which opened into left atrium via two separate pulmonary ostia, on either side.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Knowledge of number of pulmonary veins and their ostia locations is important to ensure that all ostia are ablated, as ectopic foci may go untreated in variant veins.&lt;/p&gt;

Preoperative 3D and 4D-CT imaging using 640-Multislice CT (640-MSCT) in diagnosis of female urethral diverticulum

ObjectiveTo determine the sensitivity and specificity of 640-Multislice CT (640-MSCT) in diagnosing the female UD.Materials and methodsWe investigated 16 patients with symptomatic UDs preoperatively in our hospital from August 2010 to March 2016. The patients’ average age was 38.8 years. All patients were performed 640-MSCT of pelvis; then, 3D and 4D images were reconstructed preoperatively.ResultsIn 3D and 4D-CT images, out of 16 patients, thirteen patients had one ostium, two had 2 ostia and one had 3 ostia. Out of those thirteen patients, eight patients’ ostia were located at 5 o’clock and five patients’ at 7 o’clock. Patients with 2 ostia location were at 5 and 6 o’clock and 5 and 7 o’clock, respectively. Patients with 3 ostia location were at 5, 6 and 7 o’clock. The mean distance from the bladder neck to the ostia was 22.5 mm. The shape of UD was out-pouching in 11 patients (68.8%), U-shaped in four patients (25.0%) and circumferential in 1 patient (6.2%). The CT findings were confirmed by surgical findings.Conclusions640-MSCT is a useful tool in identifying UD’s shape and ostium (including number, location) before operation. Preoperative 640-MSCT should be an adaptable modality for clinically suspected UD patients.Advances in knowledgeSeveral imaging methods have been used to diagnose female UD. 640-MSCT may be more suitable to diagnose it for its higher sensitivity and specificity in diagnosis of female UD, especially in identifying UD’s shape and number and location of ostium.

Dacryocystorhinostomy ostium: parameters to evaluate and DCR ostium scoring.

AimThis study aims to provide a systematic protocol for the evaluation of a dacryocystorhinostomy (DCR) ostium and to propose a scoring system to standardize the assessment.MethodsRetrospective evaluation of 125 consecutive lacrimal ostia post-DCR was performed. Medical records were screened, and photographs and videos were assessed to note the details of various ostial parameters. The major time points in evaluation were 4 weeks, 6 weeks, 3 months, and 6 months post-DCR. The ostia were defined and parameters like shape, size, location, and evolution of ostium were noted. Evaluation parameters were defined for internal common opening (ICO), ostium stents, and ostium granulomas. Ostium cicatrix and synechiae were graded based on their significance. Surgical success rates were computed and ostium characteristics in failed cases were studied.ResultsA total of 125 ostia were evaluated on the aforementioned ostium parameters. Because five ostia showed a complete cicatricial closure with no recognizable features, the remaining 120 ostia were studied. The ostium location was anterior to the axilla of middle turbinate in 85.8% (103/120) of the cases. Moreover, 76.6% (92/120) of the ostia were circular to oval in shape, with a shallow base. The ostium size was >8×5 mm in 78.3% (94/120) of the cases. The ICO was found to be located in the central or paracentral basal area in 75.8% (91/120). The anatomical and functional success rates achieved were 96% and 93.6%, respectively. All the five cases with anatomical failures showed a complete cicatrization and the ICO movements were poor in all the three cases of functional failure.ConclusionThe article attempts to standardize the postoperative evaluation of a DCR ostium and provides a systematic protocol and scoring system for possible use by surgeons and researchers alike.

The relationship of the natural sphenoid ostium to the skull base.

Various intranasal landmarks have been described to aid in the localization of the natural sphenoid sinus ostium. The objectives of this study are to identify the ostium location relative to the skull base and assess the relationships between the location of the ostium and sphenoid disease or pneumatization pattern. Descriptive study. Consecutive Xoran Mini-CAT (Ann Arbor, MI) scans of patients with no history of sinus surgery (n = 202) were evaluated. The natural sphenoid ostium was identified in axial, coronal, and sagittal planes. Distances from the planum to the ostium and from the planum to the sinus floor were calculated. Lund-Mackay score and pneumatization pattern were recorded for each sphenoid sinus. The mean distance from planum to ostium was 11.2 ± 2.6 mm (range 4.4-19.2). On average, this encompassed 45.5% ± 10% of the total sphenoid height. ANOVA with posthoc Tukey analysis revealed that the ostium was closer to the planum in sinuses with sellar (P = 0.05) or presellar (P = 0.02) pneumatization, compared to those with postsellar pneumatization. There was no significant relationship between the ostium location and degree of sinus disease. There was a significant difference in the pneumatization pattern between males and females (P = .04). More males had postsellar pneumatization than expected, and more females had sellar pneumatization than expected. The natural ostium of the sphenoid sinus is located at approximately the midpoint of the sphenoid face. Nevertheless, significant variability can be observed based on the pneumatization pattern. Surgeons should recognize that the ostium may be closer to the skull base when the sinus is less pneumatized.

Prevalence of Congenital Coronary Artery Anomalies of Korean Men Detected by Coronary Computed Tomography

Background and ObjectivesIt has been demonstrated that the anomalous origin of coronary arteries (AOCA) are generally asymptomatic and rare diseases. However, some cases can cause severe life threatening events. To detect these anomalies, coronary angiographies and autopsies were used to detect coronary artery anomalies, but these procedures have limitations because of their invasiveness. The new device, Multidetector Computed Tomography (MDCT), now replaces the method of choice for detecting coronary anomalies. The prevalence of these anomalies in Korea has not been studied yet. This present analysis attempted to determine the prevalence of AOCA in Korean men by MDCT.Subjects and Methods1582 Korean male police officers underwent coronary MDCT for their health screening voluntarily. After reconstruction of CT images, we could confirm coronary artery anomalies.ResultsThe prevalence of AOCA in Korean men was 1.14% (18 out of 1582 cases). The most common abnormality (11 cases, 0.70%) was the origin of the coronary artery. Anomalies of the coronary artery end point were observed in 5 cases (0.32%). The anomalous location of coronary ostium on the aortic root was observed in 1 case (0.06%). An anomalous collateral vessel was observed in 1 case (0.06%).ConclusionThe prevalence of coronary artery anomalies in Korean men was 1.14%. Coronary CT is a safe and noninvasive modality for detecting coronary anomalies.

The aerodynamics of the sinonasal interface: the nose takes wing—a paradigm shift for our time

Ventilation of and gas exchange between the nose and the paranasal sinuses are believed to occur by convection and diffusion based on experiments that neglect the effects of physiological respiration and aerodynamic forces at the sinonasal interface (SNI). Based on these experiments, the exchange of gas is presumed to be slow, and principally dependent on gas concentration and diameter, number, and location of ostia. In 12 healthy adult volunteers, real-time sinus nitric oxide measurements were obtained with catheters placed through natural ostia during respiratory maneuvers. The nose is a masterful collection of aerodynamic foils and channels designed to accomplish powered sinonasal gas exchange and ventilation within a few seconds during each inspiration. The new perspective on the functional anatomy of the SNI demands a paradigm shift that is followed by physiological, medical, and surgical implications and a radical change in our perception and understanding.