Sinus Pneumatization Research Articles

Comparative evaluation of effect of three different crown to implant ratio on marginal bone loss: A systematic review

Partial rehabilitation in the posterior edentulous region remains a challenge due to the anatomical condition present in the area. Excessive pneumatization of the maxillary sinus and accentuated bone crest resorption following teeth extraction cause bone atrophy and may lead to impossibility of inserting standard implants. Constant efforts are aiming at the reduction of the invasiveness of implant surgery. This has led to increase the use of implants with shorter length in the posterior maxilla and mandible region which reduces the need for additional surgical procedure causing less morbidity of the site and faster healing of the region. Does crown to implant ratio has an effect on the marginal bone loss (MBL) around implants in the posterior maxillary and mandibular region? A systematic search was conducted on two databases for the studies published from January 1, 2006, to July 31, 2018. Cross-references were checked. Hand searching was done in the library. Studies were included if they were done among healthy, nonhospitalized individual, and compared for the crown-to-implant ratio and MBL. A total of 143 articles were found through search. Thirteen articles remained after removing duplicates, reading the full text and reviewing abstracts. Thirteen articles were included for the data extraction. Crown-to-implant ratio has no role in the crestal bone loss, but other factors need to be evaluated for its role along with crown-to-implant ratio that can cause the MBL.

Sinus Development and Pneumatization in a Primary Ciliary Dyskinesia Cohort

Sinus Development and Pneumatization in a Primary Ciliary Dyskinesia Cohort

Three-dimensional linear and volumetric assessment of the maxillary sinus following posterior teeth extraction with implications for dental implant: A split mouth cross-sectional cone-beam computed tomographic study

Purpose: Maxillary sinus pneumatization is usually noted after posterior teeth extraction. The pneumatization occurs at the expense of the alveolar bone and may compromise the residual ridge dimensions for further procedures. This article aimed to assess three dimensionally the linear and volumetric changes of the maxillary sinus following posterior teeth extraction using a split mouth study design.Materials and Methods: Fifty cone-beam computed tomography (CBCT) scans with unilateral missing molar(s) or premolar(s) were assessed. Linear craniocaudal measurement from the orbital floor to the maxillary alveolar ridge was noted, and the sinus volume was measured using 3Diagnosys software (v3.1, 3Diemme, Cantu, Italy) and compared between the test and control side. Statistical analysis was performed using a paired Student's t-test.Results: Linear dimensions of the maxillary sinus increased from 33.12 (±3.99) mm on the control side to 33.34 (±3.95) mm on the test side (P = 0.0005). An increase in the volume from 13.78 (±2.55) ml to 13.99 (±2.61) ml was observed in the control and test side, respectively (P = 0.0002).Conclusion: A significant increase in sinus dimension and volume is seen after posterior teeth extraction. This may hinder further implant-supported rehabilitative procedures in this region.

Endoscopic assisted supraorbital approach for management of extensive and/or complicated frontal sinus lesions

Background: Successful surgical management of frontal sinus disease remains a significant challenge for rhinologists. The purely endoscopic/endonasal approach has limitations, especially in patients with complex frontal sinus pneumatization patterns as well as alterations in anatomy. Supraorbital approach that provides improved access and visualization of these challenging anatomical regions might enhance the management of anterior skull base and extensive frontal sinus lesions.Aim: To evaluate the efficacy and safety of the supraorbital approach for management of extensive frontal sinus lesions.Patients and Methods: The study was conducted on 20 patients with extensive frontal sinus pathologies using the supraorbital approach via the eyebrow incision at Kasr Al-Ainy Hospital and Alexandria Main University Hospital in 4 years (from March 2015 till March 2019). The patients were followed-up for 24 months.Results: Supraorbital approach used alone or in multiportal combination with endoscopic sinus surgery to safely and effectively treat extensive frontal sinus lesions. The only complication that occurred was parasthesia in the forehead due to supraorbital nerve injury in one patient (5%) which is resolved within 6 months post-operatively. No late complications or evidence of recurrence of the disease were developed till the end of the follow-up period.Conclusion: The supraorbital approach is a safe, direct and minimally disruptive approach to the anterior skull base and frontal sinus lesions and should be considered as an alternative to more extensive craniofacial approaches for selected pathologies of the frontal sinus and the anterior skull base.

Surgical Anatomy of Variations in Sphenoid Sinus Pneumatisation using Computerized Tomograph

Background: The cavity of the sphenoid sinus is a natural surgical route for accessing the middle cranial fossa. The extent of pneumatisation of the sphenoid is key to the preoperative evaluation of transsphenoidal, surgical procedures. Aim: To determine the prevalence and variations in the extent of pneumatisation of the body of the sphenoid bone using computerised tomography (CT). Methodology: Head CT scans of 323 patients were studied at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, after ethical approval was granted. The CT scans were taken with a GE Bright Speed Multidetector Helical CT Scanner, and viewed with the Digital Imaging and Communication in Medicine (DICOM) viewer, powered by RadiAnt Version 4.2 software. Sphenoid sinus pneumatisation was defined by the anteroposterior extent of the sinus cavity of the sphenoid bone on sagittal images. The extent of pneumatisation was classified into four; conchal, presellar, sellar and postsellar, based on the position of the posterior wall of the cavity in relation to the anterior and posterior walls of the sellar turcica. Results: The predominant type of pneumatisation was the postsellar. The prevalence of the different types of pneumatisation were: postsellar, 50.2%, sellar, 32.0%, presellar, 14.7%, and conchal, 3.1%. There was no statistically significant relationship between pneumati- sation and sex (X2 = 0.585), or age (X2 = 0.076). Conclusion: With the prevalence of the different types of pneumatisation, a pre-operative CT assessment of the sphenoid sinus anatomy is essential, whenever the options for a transsphenoidal access to the sellar is being contemplated.

Radiologic analysis of correlations between sinonasal anatomical variations in patients with nasal septal deviation

Objective: This study aims to analyze the sinonasal anatomical variations accompanying the nasal septal deviation, the correlations between these variations, and their relationship with the septal deviation angle.Methods: In this retrospective study, preoperative paranasal computed tomography (CT) scans of 206 patients who underwent septoplasty between January 2015 and December 2019 were examined. In CT scans, different nasal septal deviation types, Keros classification, optic nerve type, ethmoid air cell variants, nasal concha variants, paranasal sinus pneumatization variants, and the correlation between accessory pneumatization variants and their relationship with the septal deviation angle were analyzed.Results: In patients with nasal septal deviation, supraorbital ethmoid cell, anterior clinoid process pneumatization and onodi cell were more frequent compared to the literature. Any significant correlation between the nasal septal deviation angle and the presence of sinonasal variants was not detected (p > 0.05). Correlations were significant between the presence of Frontal sinus hypoplasia and Haller cell (ϕ = -0.142, p = 0.042), Supraorbital Ethmoid cell (ϕ = -0.173, p = 0.013) and Paradoxal middle concha (ϕ = 0.152, p = 0.029).Conclusion: Careful examination of paranasal CTs before craniomaxillofacial surgeries is important to determine sinonasal anatomic variants, to determine the appropriate treatment plan and to prevent possible complications peroperatively.

Intercarotid artery distance in the pediatric population: Implications for endoscopic transsphenoidal approaches to the skull base

ObjectiveComprehensive quantitative evaluation of the intercarotid artery distance (ICD) in the pediatric population has not been sufficiently explored. This study aims to measure the minimal ICDs at multiple levels of the skull base to assess changes in the ICD during development. MethodsMeasurement of the ICDs between the paired paraclival, parasellar, and paraclinoid segments of the internal carotid artery (ICA) was performed on coronal MRI from 540 patients ranging from 0 to 17 years old (n = 30 for each age). Comparison of these indices in the very young (0–5 years, Group 1) and young (6–17 years, Group 2) patients, and assessment of the degree of sphenoid sinus pneumatization was employed. ResultsThe narrowest ICD was located at the paraclinoid ICAs in the vast majority of cases (89.44%). When comparing the ICDs in very young age patients with the ICDs of 17 years old subjects, a statistically significant difference was found at the paraclival (ages 0–5), parasellar (ages 0–2), and paraclinoid (ages 0–4) ICDs (p < 0.05). Comparison of the ICDs between the intergroups (Group 1 and 2) also demonstrated a statistically significant difference (p < 0.0001). Pneumatization of the sphenoid sinus was initially noted to start at 3 years of age, and there were no patients with a non-pneumatized sphenoid sinus identified after 7 years of age in our cohort. ConclusionMeasurement of ICDs at multiple levels provides a valuable reference for EEA procedures in the pediatric population. While the ICD may be largely stable in the pediatric population after 5 years of age, additional anatomic factors may restrict transsphenoidal access in very young patients (0–5 years).

Comparative analysis of dimensional alterations following extraction of maxillary molars using three-dimensional images' superimposition: a CBCT study.

The aims of this study were to (i) evaluate the bone alterations following maxillary molar extraction and (ii) identify the factors associated with bone alterations using a tomographic analysis. Cone Beam Computer Tomographies (CBCTs) of 17 subjects with 25 maxillary molars were analyzed, before and, in average, 12months following extraction. Fifty CBCTs were segmented as 3D models that were used as reference for analysis. Cross-sectional planes were established to measure the dimensional changes in the vertical, horizontal aspects, and the area of the alveolar bone. Associations between root divergence, initial bone location related to the maxillary sinus, and the thickness of buccal and palatal bone at baseline was assessed using mixed-effect models. Overall, the average reduction in vertical bone height was 35.23% (2.61 ± 1.76mm). The mean reduction of area of alveolar process and horizontal bone width were 18.89% (56.08 ± 44.23mm2) and 65.10% (8.33 ± 4.51mm), respectively. There was a marginal significant association between horizontal bone changes and the thickness of palatal bone (p = 0.05). The results of the present study indicated that following maxillary molar extraction, significant dimensional changes occur in both the vertical and horizontal directions. The vertical changes were mainly attributed to remodeling on the coronal aspect of the alveolar ridge and sinus pneumatization was rare.

Zygomatic Implants: A Review

Zygoma implants (or zygomatic implants) vary from traditional dental implants in that they attach in ratherthan maxilla (upper jaw) in the zygomatic bone (cheekbone). They can be used where the consistency orquantity of maxillary bone is insufficient for normal dental implant placement. Inadequate maxillary bonevolume can be due to bone resorption as well as maxillary sinus pneumatization or a mixture of both. Therequired bone height for typical implant placement in the upper jaw posterior area should be approximately10 mm to ensure appropriate implant survival. Where there is inadequate bone available, bone graftingprocedures and sinus raising procedures should be done to increase bone volume. Procedures for bonegrafting in the jaws have the downside of extended care, limiting denture wear, the morbidity of donorsurgical site &amp; graft rejection.

The evaluation of the effect of hypercalcemia in oral pathologies

ObjectiveHypercalcemia is determined as an increase in the serum calcium level (above 10.5 mg/dL or ionized calcium is above 1.5 mmol/L). It was aimed to evaluate the effect of the increased serum calcium levels in dental panoramic radiographs with oral pathologies. Materials & MethodsThe final sample number of the present study was determined as 143. 61 patients with hypercalcemic calcium levels were grouped in Hypercalcemia Group (HPEG) whereas 82 patients were grouped in Normal Group. (NG) Measurements were performed only on the panoramic radiographs. The evaluated parameters were cyst-tumor or granuloma existence, sinus pneumatization, stylohyoid ligament calcifications, lamina dura loss, bone loss existence, etc. Statistical tests were carried out at p < 0.05 significance level. ResultsThe cyst-tumor formation (p = 0.03) and stylohyoid ligament calcification (p = 0.009) and increased radiopacity (p = 0.03) were significantly more common in NG than the HPEG group. Alveolar bone loss (p = 0.001) and periodontal defects (p = 0.01) were significantly more common in HPEG than the NG group. There was no significant relationship between other examined parameters. (p > 0.05) ConclusionThe serum calcium level revealed statistically significant outcomes and a close relationship with the pathologies occurring in the alveolar bone in the oral and maxillofacial region. However, it is highly recommended to include more patients in the newly planned studies and another bone-related biomarker should be evaluated simultaneously.

Types of Sphenoid Sinus Pneumatization among Nepalese Population

Background: The sphenoid sinus is a very important route during the surgical procedure for the lesions inside and around the sella tercica. With the aim to evaluate the anatomical variations of these sphenoid sinuses in the Nepalese population, this study was performed.&#x0D; Methods and Materials: This is a Cross-Sectional analytical study with a non-probability consecutive sampling. Patients of all age groups and all gender who underwent a CT scan of head for any reason were collected, excluding the patients whose sella and / or sphenoid sinus was distorted or fractured for various reasons. A recon image of all the CT scans was made, then were classified base on the sphenoid sinus pneumatization and clival extension of the sphenoid sinus. This was done on the midsagittal image of the CT scan of the head in the bone window. Age was presented as mean and standard deviation (SD), and stratification in groups. Gender, types of sphenoid sinus pneumatization, and clival extension were presented in frequencies and percentages. An association of age and gender with sphenoid sinus pneumatization and clival extension were evaluated using Fischer’s Exact test in SPSS 20.&#x0D; Result: The total number of cases enrolled in the study was 58 with a mean age of 41.62 (SD 22.46) years. The most common type of sphenoid pneumatization was a complete sellar type (52%). Similarly, sub-dorsal clival extension (71%) was more common in this study sample followed by other types. There was a significant association of different age categories with the type of sphenoid pneumatization. The conchal type of the sphenoid pneumatization was exclusively seen only in children. Similarly, gender also showed statistically significant association with the sphenoid pneumatization, where males were associated with more complete type and females with more presellar and incomplete type.&#x0D; Conclusion: The prevalence of complete sellar pneumatization and sub-dorsal type of clival extension were the most common findings in the Nepalese population. Conchal type of sphenoid pneumatization is the predominant findings in childhood. More extensive sphenoid pneumatization and clival extension were the significant findings among the male population.

Effect of sphenoid sinus volume and pneumatization type on isolated chronic sphenoid sinusitis (fungi and polyps)

Effect of sphenoid sinus volume and pneumatization type on isolated chronic sphenoid sinusitis (fungi and polyps)

Impact of the ethmoid volume on endoscopic medial wall decompression outcomes in Graves’ orbitopathy

Background Endoscopic orbital decompression is a well-established technique for Graves orbitopathy treatment. Aims Measurement of the ethmoid volume and its correlation with proptosis reduction in patients undergoing endoscopic orbital decompression for Graves’ orbitopathy. Methods We retrospectively reviewed clinical charts of 209 patients (319 orbits) operated by a surgeon at our institution between 1998 and 2019. Results Average age was 46.9 years. About 83.3% of the patients were female, 54.6% were smokers, 93.8% were euthyroid at the time of decompression, 3.8% were hypothyroid and 2.4% were hyperthyroid. About 77.5% of the patients underwent bilateral surgery, the remainder and unilateral. Subsequent stages included strabismus surgery in 22.5% patients, Müllerectomy 37.8%, with or without canthoplasty (14.8 vs. 23%). Mean proptosis reduction was 4.61 mm. Mean ethmoid volume was 5.57 mm3. Ethmoid volume had a moderate positive correlation with proptosis reduction (r s = 0.49, p < .001). Further investigation, statistically significant moderate correlation was found only in the small (SE) and big (BE) ethmoid groups. Conclusion We advise evaluating ethmoid sinus pneumatization on computed tomography before decompression to estimate possible anatomical limitations. Additional wall decompression might be advocated in most severe cases.

Volumetric Investigation of Sphenoid Sinus in an Elderly Population.

The aims of this study were to determine the sphenoid sinus volume in an Austrian population, evaluate the relationship between volume and different types of pneumatization and investigate possible age-related sphenoid sinus volume degeneration in the elderly. A total of 50 human cadaver including 25 male and 25 female samples (=100 sphenoid sinuses, age range 65-100, mean age 84.52 ± 9.50) were selected to obtain volume and anatomical variants of pneumatization by using sphenoid sinus casts, made of quadrofunctional hydrophilic addition reaction silicone. The mean sphenoid sinus volume was 4.79 ± 2.39 cm. Males showed statistically significant larger sinus volumes than females (P = 0.048). The volume differed statistically significant for the different types of pneumatization (P < 0.001). The combined type of sphenoid sinus pneumatization presented the largest volume with 7.20 cm, followed by lateral, clival, sphenoid body, presellar, and conchal sinus type with 5.72, 5.63, 4.25, 2.08, and 0.5 cm, respectively. No significant correlation between age and sphenoid sinus volume was found (P = 0.707). This study highlights the close relationship between volume and morphology of sphenoid sinus and confirms ethnic variability. Moreover, our data shows no age-related volume degeneration.

A new classification proposal for sphenoid sinus pneumatization: a retrospective radio-anatomic study.

The sphenoid sinus variations are very diverse and the frequency of these sinus variations is high. During operations involving the sphenoid sinus, such as pituitary surgeries, the surgeon should have detailed information about these variations. The aim of this study is to reclassify the sphenoid sinus pneumatizations in detail and to evaluate the incidence of pneumatization types in a Turkish population according to this classification. New classification proposal was made. In accordance with the proposed new classification, sphenoid sinus pneumatizations were evaluated on CBCT images. When the posteroanterior pneumatization of 128 patients was evaluated; 2.3% conchal, 3.9% presellar, 35.9% sellar, and 57.8% postsellar pneumatization was detected. Of these cases, 28.9% had anterior pneumatization on the right and 23.4% on the left. When lateral direction pneumatizations were evaluated, lateral body type was found to be the most common on both right (44.1%) and left (42.5%) sides. In this study, sphenoid sinus pneumatizations were evaluated three-dimensionally with the help of CBCT, and a new classification suggestion was made to eliminate the classification confusion we encountered in our previous studies. Pneumatizations and variations can affect the field of operation and even change planning. It should be taken into account that the paranasal sinuses may have variations due to their surgical importance and their close association with many vital structures.

Anatomical relationship of pterygoid process pneumatization and vidian canal

IntroductionThe vidian canal acts as landmark for the identification of the petrous carotid artery, especially during extended endoscopic endonasal approaches in cranial base surgeries. In order to localize the canal and to understand the relationship of pneumatization of pterygoid process to the type of vidian canal, this study was designed. ObjectivesThe objective was to describe the anatomical relationship of pneumatization of the pterygoid process with types of vidian canal. The length of vidian canal, relationship to medial plate of pterygoid process and relationship to the petrous part of internal carotid artery were evaluated. MethodsHead computer tomography scans of 52 individuals for suspected paranasal pathology were studied. The degree of sphenoid sinus pneumatization, pterygoid process pneumatization and types of vidian canal (type 1, 2 and 3) were noted. The length of vidian canal, distance from the plane of medial pterygoid plate and relation of vidian canal to the junction of petrous and Gasserian (ascending) part of internal carotid artery was noted. Results46 (92%) sphenoid sinuses were of the sellar variety. Out of 104 sides that were studied, 57 sides demonstrated a pneumatised pterygoid process and 47 were not pneumatised. In 49 sides (47.1%) the vidian canal was on the same plane as that of the medial pterygoid plate in the coronal section. The vidian canal partially protruded into the sphenoid sinus (type 2) was the most common type (50.9%), found both on right and left sides. There is a statistically significant association between the pterygoid process pneumatization and occurrence of type 2 and type 3 vidian canal configuration. The average length of the vidian canal was 16.16 ± 1.8 mm. In 96 sides, the anterior end of vidian canal was inferolateral to petrous part of internal carotid artery in the coronal plane. ConclusionPneumatization of the pterygoid process indicates either type 2 or type 3 vidian canal configuration.

Sphenoid Sinus and Related Neurovascular Structures-Anatomical Relations and Variations on Radiology-A Retrospective Study.

The aim of this study was to evaluate sphenoid sinus pneumatisation and its anatomical relation with adjacent neurovascular structures in Indian population. We performed a retrospective cross-sectional study, in which the pattern of sphenoid sinus pneumatization was studied on high-resolution computed tomography scans (n = 400), and association of the optic nerve, vidian canal and foramen rotundum along with related morphometric measurements were studied. Out of 400 CT scans, 60.5% were males. Majority had sellar type of pneumatization (89.5%) and single intersinus septum (68%). The most common configuration of relation of optic nerve canal was DeLano type 2 (34.75%). Vidian canal (VC) and Foramen rotundum (FR) were found dehiscent in 40.5% and 6.38% respectively. Average distance of FR from midline on right and left side was 16.3 ± 2.19mm and 16.7 ± 2.23mm respectively. Average distance of VC from midline on right and left side was 12.4 ± 5.84mm and 12.4 ± 4.18mm respectively. Average right FR to VC distance was 4.17 ± 2.16mm and left FR to VC was 4.44 ± 2.20mm. Anatomical variations of the sphenoid sinus are well known. In the present study, we have tried to highlight the importance of knowledge of various anatomical variations in relations to sphenoid sinus as they are critical in planning of surgery. Pre-operative radiological study and correlation is inevitable to assess type and extent of sinus pneumatisation, bony dehiscence and septal terminations to avoid injury to vital structures.

Role of computed tomography in the assessment of anatomical variations of maxillary sinus

Background: Maxillary sinus shows normal anatomical variations and it is important to know about them. Evaluating maxillary sinus and identifying its variations on computed tomography not only detects the different variations but also helps in planning and guiding various sinus surgery and preventing possible complications.Purpose: Aim of this study was to detect anatomical variations of maxillary sinuses in patients using Multi-detector Computed Tomography.Materials and Methods: Paranasal sinuses of 56 patients who were subjected to Computerised Tomography of Paranasal Sinus with CT (Seimens 16 slice Somatomscope) machine were studied.Results: A total Para Nasal Sinuses of total 56 patients were studied. Out of which only 33 patients had maxillary sinus variations. Among accessory ostia of maxillary sinus was the commonest anatomical variation and was seen in 14(25%) of cases. Hyper pneumatization of maxillary sinus was detected in 12 cases (21.4%) and maxillary antral septa were found in 7 cases (12.5%).Conclusion: Accurately assess the maxillary sinus on Computed Tomography and to determine the various anatomical variations of the same so as to differentiate pathological lesions from an anatomical variation and avoiding unnecessary surgical explorations and complications.

Characterization and implications of the lingual process of the sphenoid bone: a cadaveric and radiographic study.

The surgical significance of the lingual process of the sphenoid bone (LPSB) has not been sufficiently addressed. The purpose of this study was to describe the anatomical details of the LPSB in relation to the quadrangular space. Moreover, the incidence of the LPSB and its correlation with the pneumatization of the sphenoid sinus and the development of the lateral recess of the sphenoid sinus (LRSS) were also evaluated. A dissection and exposure of the LPSB and the quadrangular space was performed on 10 cadaveric specimens (20 sides). The incidence, length, and height of the LPSB were also assessed on computed tomography (CT) images (60 patients, 120 sides). The association between the presence of the LPSB with the pneumatization type of the sphenoid sinus and the presence of a LRSS was evaluated. In a cadaveric model, the LPSB, in association with the petrolingual ligament extending from the LPSB to the petrous apex, was identified on 7 sides (35%). The LPSB was continuous with the mandibular strut. The overall incidence of a LPSB was 48.33% on CT images, and the average length and height of the LPSB was (mean ± standard deviation) 5.30 ± 1.44 mm and 6.51 ± 1.32 mm, respectively. A significant correlation was identified between presence of the LPSB with the pneumatization type of the sphenoid sinus (p = 0.004) but no correlation was identified with the presence of the LRSS (p = 0.071). The LPSB and the petrolingual ligament are useful landmarks for procedures in the quadrangular space and Meckel's cave. However, the LPSB is not consistently present.

Sinus Development and Pneumatization in a Primary Ciliary Dyskinesia Cohort.

BackgroundPrimary ciliary dyskinesia (PCD) is a genetically diverse disease which causes impaired mucociliary clearance, and results in pulmonary, otologic, and rhinologic disease in affected patients. Genetic mutations in multiple genes impair the ability of patients to clear mucous from the lungs, middle ear, and sinonasal cavity and lead to chronic pulmonary and sinonasal symptoms.MethodsWe identified 17 PCD patients who had available CT scans. Volumes for bilateral maxillary, sphenoid, and frontal sinuses were calculated. A control population of patients who had preoperative CT scans for endoscopic endonasal resection of skull base pathology without sinonasal cavity involvement was also identified.ResultsThe mean age of PCD was 33 and ranged from 13 to 54 years. Patients were age- and gender-matched to a control group that underwent resection of anterior skull-base tumors and had a mean age of 35 that ranged between 17–53 years old. The volumes for all thee sinus cavities were significantly smaller (p < 0.007) compared to the control population. The average Lund-Mackay score was 10.6 in the PCD cohort (range 6–16) in comparison to an average of 0.7 in the control cohort (range 0–2).ConclusionsOverall sinus volumes were smaller in patients with PCD compared to our control population. Future studies will be aimed at understanding defects in sinus development as a function of specific genetic mutations in PCD patients. Ultimately, a better understanding of the underlying pathophysiology of PCD will allow us to identify the optimal treatment practices for this unique patient group.