Sinus Pneumatization Research Articles

Evaluation of Significant Radiographic Findings and Their Impact on the Oral Health-Related Quality of Life of Patients with Complete Dentures.

The aim of this study was to assess the frequency and location of positive radiographic findings in edentulous patients and to evaluate the oral health-related quality of life (OHRQoL) and complacency of patients with positive radiologic findings. A total of 1,349 asymptomatic edentulous patients were retrospectively evaluated using a digital panoramic system for the presence of retained root fragments, impacted teeth, foreign bodies, radiolucencies, radiopacities, mental foramen at or near the alveolar crest, and maxillary sinus pneumatization. The patients with positive findings were called for a follow-up to take a new panoramic radiograph. The functional status and symptoms of participants were measured with the Oral Health Impact Profile (OHIP-14). At least one or more of the radiographic findings were observed in 35.21% of the evaluated radiographs. The most frequent finding was sinus pneumatization (20.9%). The mean total OHIP score was 9.74 ± 8.34. There was no statistically significant difference observed for gender, age, education levels, marital status, or having surgical interventions for total OHIP-14 scores (P > .05). The results of this study suggest that routine radiographic examination of edentulous patients may not be crucial before rehabilitation, and using a total percentage of positive radiographic findings may result in the exaggeration of the disease risk in edentulous patients.

Assessment of variations in sphenoid sinus pneumatization in Indian population: A multidetector computed tomography study.

Background and Purpose:The purpose of our study was to assess the prevalence of variations in the extent of sphenoid pneumatization in the Indian population and compare with existing literature.Materials and Methods:This retrospective study included 500 patients who underwent CT of the paranasal sinuses. The multiplanar reformations of paranasal sinus were assessed for the type of pneumatization of the sphenoid sinus and type of clival, lateral recess, lesser wing, and anterior recess extensions.Results:The conchal, presellar, incomplete sellar, and complete sellar types comprised 0%, 1.2%, 22.2%, and 76.6% of patients. The extensions of pneumatization subtypes in the study population were clival in 76.6% subjects; lateral recess, lesser wing, and anterior recess in 59.7%, 20.4%, and 20.4% of sinuses, respectively. The pure forms were seen in 25.4% and combined forms in 61% of sinuses. The presellar type (1.2%) was less common and sellar type (98.8%) being common in our population compared to the Caucasian and East Asian population. The sphenoid sinuses were extensively pneumatized in our population compared to the Chinese and Caucasian population, the prevalence being 76.6%, 68%, and 44.5% for clival; 59.7%, 46%, and 28.3% for lateral recess; 20.4%, 32%, and 12% for lesser wing extension, respectively. The pure forms were relatively less common and combined forms being more common compared to the Chinese and Caucasian population in our study.Conclusion:The extent of pneumatization of the sphenoid sinus has clinical and surgical implications in sellar and central skull base lesions, and variability in different populations confirms that ethnicity influences the differences in prevalence.

Carotid canal and optic canal at sphenoid sinus.

In the present study, we investigated the relationship between sphenoid sinus, carotid canal, and optic canal on paranasal sinus computed tomography (PNSCT). This study was performed retrospectively. PNSCT images of 300 adult subjects (159 male, 141 female). Sphenoid sinus (pneumatisation, dominancy, septation, inter-sinus septa deviation), anterior clinoid process pneumatisation, Onodi cell, carotid and optic canals (width, dehiscence, classification) were measured. In males, type 3 pneumatised sphenoid sinus (in both sides) and in females type 2 pneumatised sphenoid sinus (right side) and type 3 pneumatised sphenoid sinus (left side) were detected more. Anterior clinoid pneumatisation was present 47.2% in males and 39.7% in females. In male group, more septation (i.e. 22.6%, ≥ 3 septa) in sphenoid sinus were detected. Onodi cell was present 26.6 and 19.1% in males and females, respectively. Carotid canal protrudation to the sphenoid sinus wall was present 23.9-32.1% in males and 35.5-36.2% in females. Dehiscence in carotid canal was detected more in females (34%) compared to males (22%). Optic canal protrudation was 33.3 and 30.5% in males and females. Type 4 optic canal was detected more in both gender. Optic canal dehiscence was detected 11.3 and 9.9% in males and females. Carotid and optic canal diameters were higher in males. In pneumatised sphenoid sinuses and in females, type 3 carotid canal (Protrudation to SS wall) (bilaterally) and type 1 optic canal type (No indentation) (ipsilateral side) were detected more. In elderly patients, carotid and optic canal width increased. When carotid canal protrudation was detected, there was no indentation in optic canals In pneumatised SS, carotid canal protrudation was observed with a greater risk in surgery. However, type 1 (non indentation) optic canal was present in highly pneumatised SS with lower risk for the surgery. In women, the risk of carotid canal protruding (about 1/3) is greater than that of males, and carotid canal dehiscence rates are also higher in females. Therefore, physicians should be very careful during the preparatory stages of the sphenoid sinus surgery. Otherwise, it may not be possible to prevent lethal carotid artery bleeds.

Neurovascular Surgical Keys Related to Sphenoid Window: Radiologic Study of Egyptian's Sphenoid

The anatomic variations of the sphenoid sinus and its relation to the surrounding neurovascular structures are a subject of interest. The purpose of this study was to radiologically assess the frequency of protrusion/dehiscence of key neurovascular landmarks surrounding the Egyptians' sphenoid. This is a cross-sectional descriptive study of sinonasal computed tomography of the sphenoid sinus in 500 adult Egyptians, conducted at Mansoura University Hospitals; Egypt, over a period of 1 year. Two archives were used for collecting the data; the hard archive and the electronic archive. Variables of interest included the extent of sphenoid sinus pneumatization; intersphenoid septation pattern; protrusion/dehiscence of the internal carotid artery, optic nerve, maxillary nerve, and vidian nerve; and detection of the Onodi cell. Population of this study included 265 women and 235 men. Their ages ranged from 18-68 years. The bilateral sellar-type pneumatization was shown as the most common pneumatization type (96.8%). Pneumatizations of the pterygoid process, anterior clinoid process, and greater wing of the sphenoid were identified in 9.3%, 8.9%, and 31.8% consequently. A single intersphenoid septum was detected in 85.2%, whereas multiple intersphenoid septums were noted in 11.6%. Protrusion of the internal carotid artery, optic nerve, vidian nerve, and maxillary nerve was recorded in 8.5%, 9.1%, 6.6%, and 3.4% consequently, while dehiscence was reported in 7.2%, 15%, 11.9%, and 4.2% consequently as well. Onodi cell was recognized in 18%. This radiologic study highlights significant variations of surgically important anatomic structures related to the sphenoid sinus in Egyptians.

Arrested pneumatization of the sphenoid sinus mimicking skull base tumours: MRI prevalence in children with haematologic diseases

ABSTRACTObjective: Arrested pneumatization of the sphenoid sinus is a developmental anatomic variation but may be confused with serious diseases of the skull base. The purpose of this study was to investigate the prevalence of arrested pneumatization of the sphenoid sinus in paediatric patients with haemotologic diseases like sickle cell anaemia, thalassemia and leukemia.Materials and Methods: One hundred and eight paediatric patients (43 girls, 65 boys; age range: 4–18 years; median age: 13 years) with haemotologic diseases who underwent at least one magnetic resonance imaging of the head and neck between 2010 and 2017 in a single institution were included. Magnetic resonance imaging studies were retrospectively reviewed. Well-defined and fat-containing non-expansile lesions located at the sphenoid sinus region were diagnosed as arrested pneumatization of the sphenoid sinus. Medical diagnoses, lesion sizes, age and sex of the patients were recorded.Results: Five (4.6%) of 108 patients demonstrated arrested pneumatization of the sphenoid sinus (3 girls, 2 boys; age range: 9–18 years; median age: 14 years). One (1.2%) of 83 patients with acute leukemia, 2 (15%) of 13 patients with sickle cell anaemia and 2 of 12 (17%) patients with thalassemia demonstrated arrested pneumatization of the sphenoid sinus. No statistical correlation was found between arrested pneumatization of the sphenoid sinus and possible risk factors like patient age and sex.Conclusions: Patients with haemoglobinopathies like sickle cell anaemia and thalassemia involving red-blood-cells had higher prevalence of arrested pneumatization of the sphenoid sinus than patients with leukemia which involves the white-blood-cells. This supported the suggestion that regional blood-flow disorders induce arrested pneumatization of the sphenoid sinus. Correct diagnosis prevents invasive procedures like biopsy and surgery.

External endoscopic multiportal frontal sinus obliteration for laterally pneumatized frontal sinus: a feasibility study

IntroductionOsteoplastic flap procedure is a standard method used for frontal sinus obliteration. Endoscopic external frontal sinus obliteration is a minimally invasive new technique confined to small-sized and medium-sized pneumatized frontal sinuses.ObjectiveThe aim of this study was assess the feasibility and surgical application of this technique for far-lateral pneumatized frontal sinuses.Materials and methodsTen sides of adult dry skull were assessed for frontal sinus pneumatization and supraorbital cells by computerized tomography. Three sides were selected with frontal sinus pneumatization extending beyond midorbital line. Feasibility of obliteration of frontal sinus was tested. Endoscopic external multiportal frontal sinus approach was done using angled endoscopy and standard instrumentation. Classic frontal sinus trephine port was performed initially to safely locate the frontal sinus. In-situ nondisplaced superiorly based miniosteoplastic flap reaching to midorbital plane was performed providing another port. Additional lateral trephine port beyond midorbital plane was performed. Angled endoscopy and standard instrumentation were used reciprocally through different ports to reach different areas of frontal sinus. Outcome parameters were ability to reach corners of frontal sinus, remove sinus septae and nasofrontal duct, and maintain integrity of anterior wall of frontal sinus. Surgical application was done in two cases of frontal sinus mucocele and meningoencephalocele.ResultsIn three laterally pneumatized frontal sinuses of dry skulls, corners, septae, and nasofrontal ducts could be handled using external multiportal endoscopic approach without disruption of anterior frontal wall. Three ports allowed two-hand surgical technique. Surgical application in two cases with follow-up over 6 months revealed no significant complication. Subcutaneous collection developed in one case after 2 weeks and resolved with medical treatment.ConclusionExternal endoscopic multiportal obliteration is feasible for frontal sinuses with lateral pneumatization beyond midorbital line. This technique is minimally invasive with less morbidity. Long-term follow-up in a larger series is needed.

Simultaneous implant placement with sinus augmentation using a modified lateral approach in the pneumatized posterior maxilla: A Case Report

In the posterior maxillary area, due to resorption of the ridge after extraction and pneumatization of the maxillary sinus, the height of the alveolar ridge may not be sufficient for placement of implants. To solve this problem, sinus augmentation using both crestal and lateral approaches have been widely used. Jung et al. (2010) introduced the modified lateral approach technique, which is a simplified technique that combines the advantages of crestal and lateral approaches. The purpose of this case report is to report two cases in the posterior maxilla in which simultaneous implant placement with maxillary sinus augmentation has been performed using the modified lateral approach technique. In two female patients, 67 and 74 years old, respectively, simultaneous implant placement was performed using the modified lateral approach technique on the left maxillary second premolar and the first molar. In both patients, the residual bone height on the distal side of the maxillary second premolar was measured to be approximately 5 mm, and the residual bone height of the first molar was measured to be 2-3 mm. After flap elevation, osteotomy of the lateral window was performed in the form of a mesiodistally extended slot above the sinus floor and the Schneiderian membrane was elevated. Sequenced drilling was performed while protecting the membrane with a periosteal elevator. Bone graft and implant placement was performed after preparation of the implant site. Sufficient primary stability was achieved for each implant and sinus membrane was not perforated. After four and five months respectively, implant second surgery was performed. Clinically, the implants were observed to be stable. Implants and surrounding peri-implant mucosa were well maintained after prosthodontic treatment. In conclusion, the modified lateral approach could be a predictable and efficient technique for implant placement in the atrophied posterior maxilla.

Facial sinus endoscopic evaluation, radiologic assessment, and classification.

To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classification. Facial sinus was studied by endoscopy and high-resolution computed tomography (HRCT) scan in 39 temporal bones that underwent exclusive transcanal endoscopic approach. A radiomorphologic classification based on the relationship between the facial sinus and the mastoid portion of the facial nerve is created as follows. In type A facial sinus, the pneumatization of the facial sinus did not extend medially or posteriorly to the mastoid portion of the facial nerve. In type B facial sinus, the pneumatization extended posteriorly to the mastoid portion of the facial nerve. In type C facial sinus, the pneumatization extended posteriorly and medially to the mastoid portion of the facial nerve. In all the specimens that underwent HRCT (n = 31), facial sinus could be identified, and its depth classified, in relation to the facial nerve. In this group, 58% type A, 29% type B, and 13% type C facial sinuses were identified. In all the specimens (n = 39), the facial sinus could be assessed by means of an exclusive endoscopic transcanal approach, and anatomical variants of the chordiculus, previously known as chordal ridge, could be described: ridge (39%), bridge (18%), incomplete (15%), and absent (28%). Endoscopic exploration of the retrotympanum guarantees a very good exposure of the facial sinus, allowing detailed anatomic descriptions of its conformation and relationships with other structures. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery. Angled endoscopes (e.g. 45 °, 70 °) can guarantee a better view of the facial sinus. NA. Laryngoscope, 128:2397-2402, 2018.

Imaging and anatomical features of ethmomaxillary sinus and its differentiation from surrounding air cells.

The aim of this study was to investigate the imaging anatomical characteristics and clinical significance of the ethmomaxillary sinus (EMS). The study included a total of 280 ENT Outpatient Department patients with nasal symptoms whose paranasal sinus CT scans were analyzed from January 2012 to December 2016. The anatomical imaging characteristics of EMS were observed. EMS was observed in 23 of 280 patients, with an incidence of 8.2%. Bilateral EMS appearance in 17 cases (73.9%) was significantly higher than that of unilateral EMS in 6 cases (26.1%) (P < 0.01). EMS occurs when there are anterior or anterior-inferior cells of the posterior ethmoidal sinus (PEs) extending toward the maxillary sinus (MS) and entering the MS through the maxillary hiatus rather than spreading from outside of the MS. EMS is surrounded by five walls, and the main position of EMS was invariably located in the posterior-superior corner of the MS and draining to the superior nasal meatus (SNM). EMS must be differentiated from SNM, sphenoid sinus, and retromaxillary pneumatization of PEs, because they may appear between the MS and the orbital floor. EMS was not a rare variation that should be careful identification during endoscopic sinus surgery. Accurately confirming EMS is the key to completely opening and removing lesions in the MS and EMS.

Maxillary sinus floor pneumatization and alveolar ridge resorption after tooth loss: a cross-sectional study.

This is a cross-sectional study that aimed to estimate maxillary sinus floor (MSF) pneumatization in single missing tooth of posterior maxilla, by using cone-beam computed tomography (CBCT). CBCT images were analyzed bilaterally and divided into 2 groups: edentulous site (EdS) - edentulous single region of upper second premolar, first or second molars; Tooth site (TS) - contralateral region homologous to the EdS region, with tooth present. Variables evaluated were: sinus height (SH), estimated sinus pneumatization (eSP: ∆ EdS - TS), healed ridge height (HR) and presence of localized sinus pneumatization (LSP) in molars teeth at TS. HR were categorized according to therapeutic option for posterior maxilla. 183 CBCT scans were included and it was observed that EdS presented a higher SH than the TS (p < 0.001) showing an eSP of 0.9 ± 2.93 mm. First molars presented the highest SH for both sides, although significant differences were detected when compared to second molars. First molars were mostly affected by LSP at TS (36 out of 43). Individuals with LSP at TS presented lower HR than the ones without LSP (p < 0.05). 54% of the cases presenting LSP obtained HR < 5 mm, which indicates sinus lift surgery. The present study showed that tooth loss in posterior maxilla favors sinus pneumatization and the identification of LSP at molar roots seems to indicate a greater necessity for sinus lift surgeries.

Experience of treating patients with lateral sphenoid sinus recess CSF leak

The study purpose was to analyze our own experience in treating patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess and, based on the obtained results, develop an algorithm for the treatment of this pathology. We retrospectively reviewed a series of 89 patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess who were treated at the Burdenko Neurosurgical Institute in the period between 2001 and 2017. The demographic characteristics of patients, clinical data, and aspects of surgical treatment were analyzed. Treatment outcomes were assessed based on analysis of recurrences and postoperative complications. The obtained data were compared to the literature data. In the series of 89 patients with CSF leak and meningoencephalocele in the lateral sphenoid sinus recess, the mean age was 49 years. Surgery through the transsphenoid approach was performed in 89 (74%) patients. There were 25 (28%) recurrences in this group. Nine (7%) patients underwent repair of a complex skull base defect using the transethmoidal approach; there were 3 (33%) recurrences. The transpterygoid approach was used in 22 (17%) patients; there were 3 (14%) recurrences in this group. Endoscopic endonasal repair is an effective technique for treating complex skull base defects in the lateral sphenoid sinus recess. The choice of an approach to the defect depends on the degree of pneumatization of the sphenoid sinus, surgeon's experience, and availability of the necessary equipment and tools. The endoscopic transpterygoid approach is advisable to use in cases of excessive pneumatisation of the sinus with developed lateral processes and recurrent nasal CSF leak. This enables visualization of the defect edges in this hard-to-reach area and adequate repair.

Management of maxillary posterior inadequate ridge height for prosthetic rehabilitation

The rehabilitation of patients affected by posterior maxillary atrophy by the aid of implant-supported fixed prosthesis presents a challenge in many cases. The available residual alveolar ridge is insufficient for the placement of dental implants because of alveolar bone resorption, pneumatization of the maxillary sinus, or their combination. Maxillary sinus floor augmentation is the treatment of choice in such cases. Sinus lift procedure can be carried with or without simultaneous implant placement. Recently, various newer techniques have been introduced for sinus floor elevation such as antral membrane balloon elevation, water lift technique, and piezosurgery. Furthermore, short implants and zygomatic implants can also be done in severe posterior atrophied maxilla.

Dental status, salivary flow, and sociodemographic aspects in Sheehan Syndrome patients.

BackgroundSheehan’s syndrome (SS) is one of the leading causes of hypopituitarism in developing countries. It occurs after postpartum necrosis of the pituitary gland, and it is considered a significant public health problem. This paper, apparently unpublished, aimed to perform an analysis on oral aspects in patients with SS.Material and MethodsA cross-sectional study was performed with 23 women diagnosed with SS at the Division of Endocrinology and Diabetes (Walter Cantídio University Hospital, Fortaleza, Brazil).ResultsData on sociodemographic, dental and salivary flow aspects were collected through a clinical approach and a panoramic radiograph request. The mean age was 64 ± 11.5 years old, with the sample consisting mainly of married women (56.5%), socioeconomic class C2 or D / E (78.2%) and years of education up to 8 years (69.5%). The presence of horizontal bone loss (p<0.001) and bilateral pneumatization of the maxillary sinus (p=0.015) were significant data. The mean number of absent teeth considering all subjects was 23.17±9.7, being statistically significant (p<0.001). In relation to age, the mean number of missing teeth was higher in individuals over 65 years old (p=0.048). Reduced salivary flow was observed in 78.3% of the patients. In a bivariate analysis, considering the outcome variables “missing teeth” and “reduced salivary flow”, it was observed that economic class (p< 0.001), family income (0.037) and maxillary sinus pneumatization (0.032) were statistically significant.ConclusionsIn brief, patients with SS showed severe teeth loss, reduced salivary flow, and low educational status. This study addressed important aspects regarding oral findings in SS and highlighted the importance of researches in oral medicine. Key words:Sheehan’s Syndrome, hypopituitarism, tooth loss, salivary flow.

The relationship between the roots and furcation of the maxillary first molar to the maxillary sinus: A cone-beam computed tomography study

Introduction: Pneumatization of maxillary sinus leads to posterior root displacement into the sinus cavity associated with potential complications following extraction of these teeth, or planning an implant in case of missing ones. Thus the relation of the maxillary sinus to the maxillary posterior teeth is of utmost importance. Hence the study was taken up to evaluate the relation of maxillary first molar to the maxillary sinus. Objectives: Assessing the relationships between the roots and furcation of the maxillary first molar to the floor of the maxillary sinus. Materials and Methods: A retrospective study where 50 CBCT scans of maxillary first molars of 36 patients were taken and the vertical relationship of the roots and furcation with the floor of the sinus were analyzed and classified. Results: Totally 14 (28%) mesio buccal roots, 8 (16%) disto buccal roots and 5 (10%) palatal roots were in Class 3, which is perforating into the sinus and total of 18 scans had furcations whose distance from the sinus floor was less than 5mm with Mean ± SD as 3.64 ± 1.14 and rest had more than 5mm with Mean ± SD as 6.19 ± 2.63 Conclusion: Our study concluded that though most roots were not in touch with the maxillary sinus, a notable amount were either in touch or penetrating into it. Thus any pathology assessment or treatment plan in the first molar region must be dealt with proper three dimensional images to understand the approximation of the sinus and plan out procedure best suited for the patient.

Sphenoid Sinus Pneumatization, Septation, and the Internal Carotid Artery: A Computed Tomography Study.

Background:The air spaces of the nasal cavity and the sphenoid sinus (SS) constitute a convenient corridor to access lesions of the skull base using the endoscopic endonasal transsphenoidal approach (EETA). Safe EETA depends on the SS and skull base anatomy of the patient. Individual variations exist in the degree and pattern of SS pneumatization. This study aims to examine the variations in SS pneumatization, the inter-sphenoid septum (ISS), and their relationship with the internal carotid artery (ICA) among adult Nigerians.Materials and Methods:We reviewed computerized tomography (CT) images of 320 adult patients that had imaging for various indications. This excluded those with traumatic, inflammatory, or neoplastic process that may alter anatomical landmarks. The images were evaluated for the types of SS pneumatization, number and insertion of ISS, and the protrusion of ICA into the sinus cavity.Results:Prevalence of SS pneumatization types: 1.9% conchal, 1.2% presellar, 56.6% sellar, and 40.2% postsellar. The lateral extension of SS occurred into the pterygoid in 138 patients (45.1%), greater wing 112 (35%), lesser wing 37 (11.6%), the full lateral type was seen in 97 (30.3%) patients. One ISS occurred in 150 (46.9%) patients, 162 (50.6%) had multiple, and 8 (2.5%) had none. ISS insertion into ICA bony covering occurred in 101 (31.6%) patients, whereas protrusion of ICA into SS cavity occurred in 110 (34.4%) patients.Conclusion:Variations of the SS, ISS, and ICA anatomy are present among native Africans. Detailed imaging evaluation of each patient is considered for EETA is mandatory.

Maxillary sinus augmentation.

The placement of endosseous implants in posterior edentulous maxilla is normally a challenging task in implant dentistry due to maxillary sinus pneumatization. Various sinus augmentation techniques have been used with impressive success rates aimed at developing these sites for implant placement. Knowledge of anatomy of maxillary sinus guides us not only in proper preoperative treatment planning but also helps us to avoid the possible complications that may arise during sinus augmentation procedure. This topic attracts a rising number of publications with most of them reporting results that suggest, the patients with atrophic maxillae requiring implant treatment can benefit considerably from the use of sinus augmentation. This article explains the basic techniques, namely, direct and indirect techniques used for maxillary sinus elevation and augmentation.

Volumetric assessment of sphenoid sinuses through segmentation on CT scan.

Computed tomography represents the gold standard for the assessment of morphological characteristics of sphenoid sinuses, whose anatomy has acquired a novel interest because of the recent introduction of transsphenoidal surgery and robot-assisted procedures. One of the most relevant parameters for planning surgical intervention is the volume of sphenoid sinuses, and with time few population studies have been published. However, at present, no data are available concerning the relation between volume and anatomical variants of sphenoid sinuses. We retrospectively evaluated head CT-scans of 100 patients (age range 25-99years; mean age males 45.0; mean age females 50.5years) to calculate the volume of sphenoid sinuses through automatic segmentation. Possible statistically significant differences according to sex and variants of pneumatization, and type of sinus were assessed, respectively, through Student's t test and one-way ANOVA test (p < 0.05). Average volume of sphenoid sinuses in males was 10.005 ± 5.101cm3, in females 7.920 ± 3.176cm3. Differences according to sex were statistically significant (p < 0.05). Patients with pneumatization of pterygoid processes, dorsum sellae and anterior clinoid processes had a significantly higher volume than unaffected subjects. Moreover, differences of volume according to the type of sphenoid sinus were statistically significant (p < 0.05). Results show that volume of sphenoid sinuses strongly depend upon the type of sinus and possible pneumatization variants. Moreover, the important of ethnic variability is confirmed.

An observational study of the optimal placement of a cerebral oximeter probe to avoid the frontal sinus in children.

The frontal sinus is an airspace behind the brow ridge in the skull and can affect the accuracy of the regional cerebral oxygen saturation measurements. We evaluated the optimal location for placement of a cerebral oximeter probe while avoiding the frontal sinus in pediatric patients. This retrospective observational study included 203 pediatric patients aged 3-17years who had undergone brain computed tomography from November 2010 to December 2015. The patients were divided into five subgroups based on their age. The frontal sinus height was measured from the superior orbital rim. Pneumatization of the frontal sinus was not visible in 78% (3-5years) and 22% (6-8years) of the patients. The mean (SD) of the frontal sinus height was 5.9 (3.4), 9.5 (4.1), 14.0 (6.2) 18.6 (8.4), and 21.1 (7.9)mm in the 3-5, 6-8, 9-11, 12-14, and 15-17year age-groups, respectively. Age was positively correlated with the frontal sinus height (r = 0.61, P < 0.001, 95% confidence interval [CI] 0.513-0.688). A frontal sinus height shorter than 1, 2, and 3cm were seen in 10 of 11 (91%), 69 of 74 (94%), and 108 of 118 (90%) patients aged 3-5, 6-10, and 11-17 years, respectively. When oximeter probes are applied in pediatric patients, placement based on age can help avoid the frontal sinus.

Evaluation of Single Tooth Loss to Maxillary Sinus and Surrounding Bone Anatomy With Cone-Beam Computed Tomography: A Multicenter Study.

Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images. The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated. The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other. The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9.3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

Computer-assisted anatomical evaluation of the nasal sinuses in 2-3 years old children

Objective:To analyze the anatomical and developmental characteristics of nasal sinuses in 2-3 years old children.Method:Coronal CT scans of 62 cases (2-3 years old children) were studied with the imaging station. The gasification conditions of the sinuses were identified and measured.Result:The mean of the transverse and vertical diameters for the left side of the maxillary sinuse was (17.51±2.92)mm and (16.63±3.46)mm. Those for the right side were (17.28±2.51)mm and (17.24±3.72)mm. The mean for the left side of the anterior ethmoid sinus were (5.06±1.18)mm and (13.61±2.49)mm. Those for its right side were (5.00±1.45)mm and (13.64±2.30)mm. The mean for the left side of the posterior ethmoid sinus were (7.94±1.72)mm and (12.80±1.78)mm. Those for the right side were (7.88±1.85)mm and (12.64±.96)mm.96.77%(120 sides) of the sphenoid sinuses were developed. The mean for the left side of the sphenoid sinus were (7.38±3.11)mm and (8.67±3.14)mm. Those for the right side were (7.48±2.70)mm and (8.63±2.42)mm. 30.65% (38 sides) of the frontal sinuses were developed.Conclusion:The all nasal sinuses in 2-3 years old children have been already developed. The pneumatization of the frontal sinus was defined in some babies. It can help radiologist make correct diagnosis of paranasal sinuses in children.