Pneumatization Of Sphenoid Sinus Research Articles

Anatomical Variations of Sphenoid Sinus in South Indian Population: All That You Need for Trans-Sphenoidal Pituitary Surgery.

Pituitary adenomas are one among the most common neurosurgical tumors with an incidence of 10-25% among intracranial neoplasms (Ezzat et al., Cancer 101:613-619, 2004). Surgical management for the same has been practiced since long, and has evolved from trans cranial approach to endoscopic trans sphenoidal method (Hammer and Radberg, Acta Radiol 56:401-422, 1961). Preoperative radiological analysis with CT &MRI is inevitable in planning endonasal trans-sphenoid surgery to avoid complications because of the high variability concerned with sphenoid anatomy. The present study intends to analyze the incidence of various anatomical variations of sphenoid sinus in a cohort of south Indian population as detected by CT& MRI and assess its impact on surgical approach. Retrospective analysis of CT&MRI images of patients who underwent Endonasal Trans-sphenoidal resection of pituitary tumors at JSS Hospital Mysuru from a period of 2009 to 2020 is done. Anatomical variations of sphenoid sinus esp. degree of pneumatization, sellar configuration, septation pattern, inter carotid distance were evaluated. Results were significant and in concordance with other similar studies. Most frequently encountered pnuematization was sellar type and least was conchal type Sphenoid sinus pneumatization is directly linked to safe access to sella. Presence of septae within sinus need to be identified preoperatively to avoid damage and confusion intraoperatively. A meticulous preoperative analysis of sphenoid sinus anatomy will help surgeon in smooth conduct of a complication free surgery.

NEUROIMAGING DATA OF THE STUDY OF THE CHIASMAL-SELLAR REGION STRUCTURES

NEUROIMAGING DATA OF THE STUDY OF THE CHIASMAL-SELLAR REGION STRUCTURES

Normal Variations in Sphenoid and Their Significance Regarding Endoscopic Sinus Surgeries: Multislice Computed Tomographic Study

Background:Sphenoid sinus (SS) is one of the most variables of all sinuses and its relation to vital vascular and nervous elements as optic nerve (ON), cavernous sinus, pituitary gland, and internal carotid arteries. This makes its transsphenoidal approach a challenge for functional endoscopic sinus surgeries (FESS). We aimed to delineate SS radiologically using multislice computed tomography (MSCT), to show normal variations in pneumatization pattern, septation, intercarotid distance, bony covering of carotid artery and ON, to provide successful and safe FESS -transsphenoidal surgeries and to decrease morbidity and mortality during its surgeries. Methods and materials: A prospective observational study on 210 patients from May 2017 to July 2019 was conducted and included all cases requiring MCTS, with free sphenoid sinus. We excluded patients who have pathology in SS, or previous SS surgery. Results: Onodi cells presented in 67 of cases case (31.9%) from whom 30 cases (14.3%) were bilateral, and 143 cases were absent (68.1%). Pneumatization of SS, sellar (adult) type is the most common type of pneumatization that presented in 160 cases (76.2%), presellar (juvenile) type in 48 cases (22.9%), then conchal (fetal) type only in 2 cases (0.95%). The relation between pneumatization of anterior clinoid process (ACP) and dehiscence of ON showed that among 168 cases who had absent ACP pneumatization, 159 of them showed no ON dehiscence (94.6%). Pneumatization of greater wing of sphenoid was in 28 cases (41.8%). Type I ON presented in 321 cases (76.4%), type II was in 54 (12.8%), type III was in 21 (5%), and type IV was in 24 cases (5.7%). Inter sphenoid septum was found in 119 cases (56.7%), multiple septa were found in 87 (41.4%), and no septum in 4 cases (1.9%). Dehiscence in carotid artery occurred in 17% of cases. Conclusion: We concluded SS variations, septation pattern, type of pneumatization, and onodi cells. All that will help preoperative regarding transsphenoidal surgeries, as that decrease morbidity and mortality by avoiding injury of important structures.

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).

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)

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.

Objective and subjective assessment of astructured approach to computed tomography scans of the paranasal sinuses

HintergrundDie Voraussetzung zur Vermeidung potenziell schwerwiegender Komplikationen in der Nasennebenhöhlenchirurgie ist eine fundierte Kenntnis der individuellen Anatomie. Für die Nasennebenhöhlen stellt die Computertomographie (CT) die Bildgebung der Wahl dar, um die individuelle Anatomie und das Ausmaß der Erkrankung präoperativ darzustellen.Ziel der ArbeitDas Ziel der vorliegenden Arbeit ist die Bewertung des Nutzens einer CT-Checkliste zur Identifikation wichtiger anatomischer Normvarianten in der CT der Nasennebenhöhlen.Material und MethodenJung- und Altassistent*innen der HNO-Klinik wurden gebeten, CTs der Nasennebenhöhlen vor und nach der Einführung der CLOSE-Kriterien auf anatomische Normvarianten zu untersuchen. Der Prozentsatz der korrekt identifizierten Normvarianten wurde berechnet. Zusätzlich wurde der subjektive Nutzen anhand eines Fragebogens beurteilt.ErgebnisseSechs Jung- und 6 Altassistent*innen wurden in die Studie eingeschlossen. Die Rate der korrekt identifizierten Normvarianten verbesserte sich nach der Einführung der CLOSE-Kriterien signifikant von 23,1 auf 50,9 % bzw. von 24 auf 39,8 %. Die subjektive Beurteilung der CLOSE-Checkliste war sehr positiv.SchlussfolgerungEin strukturiertes Vorgehen zur Analyse von CTs der Nasennebenhöhlen kann die Identifikation kritischer anatomischer Strukturen verbessern und wird von Weiterbildungsassistenten als sehr hilfreich bewertet.

A Computed Tomography Study of the Prechiasmatic Sulcus Anatomy in Children

To investigate the characteristics of the prechiasmatic sulcus in children aged between 1-20 years. Patient files of 200 children admitted to the university hospital on 2019 were analyzed, retrospectively. The computed tomography images of patients were used to obtain anatomical knowledge containing prechiasmatic sulcus types and dimensions. The measurements related to the sulcal length (6.94 ± 1.25 mm) and sulcal angle (31.01 ± 18.13°) showed that the sulcal length did not alter in children between 1 and 20 years, whereas the sulcal angle did not vary from infancy to prepubescent period, but it was decreasing in postpubescent period. In 29 patients, the sulcal length was observed to divide into 2 parts with an evident angle. The interoptic distance and planum length were found as follows: 14.70 ± 2.85 mm and 14.84 ± 4.12 mm, respectively. The order of PS types was observed as type 4 (26.5%, 53 cases) > type 2 (26%, 52 cases) > type 1 (24%, 48 cases) > type 3 (23.5%, 47 cases). The sulcal length did not vary in children, whereas the sulcal angle decreased with an irregular pattern. The sulcal angle decreased after prepubescent period, possibly due to the sphenoid sinus pneumatization and spheno-occipital synchondrosis. The sulcal length angle mostly in infants and young children may cause surgical orientation difficult during the resection of tumors using transcranial approaches.

Fetal Anatomy of the Optic Strut and Prechiasmatic Sulcus with a Clinical Perspective

The main objective of the study was to show the morphologic features of optic strut (OS) and prechiasmatic sulcus (PS) in the fetal skull base with a surgical anatomical perspective. Twenty-three fetal cadavers (9 female, 14 male) with an average age of 21.70 ± 3.12 (range: 16-28) weeks of gestation in the inventory of the Anatomy Department were included in the study. Measurements were made with a digital image analysis software and goniometer. The sulcal length, interoptic distance, planum length, and sulcal angle were detected as follows: 3.91 ± 0.74 mm, 6.88 ± 1.04 mm, 6.55 ± 1.51 mm, and 24.52 ± 9.51°, respectively. Considering the location of the posteromedial margin of OS according to PS, OS was identified as the sulcal in 56.5% (13 cases), postsulcal in 30.4% (7 cases), and asymmetric in 13% (3 cases). According to the sulcal length and angle, PS was identified as type 1 in 26.1% (6cases), type 2 in 21.7% (5 cases), type 3 in 30.4% (7cases), and type 4 in 21.7% (5 cases). Our findings suggest that the sulcal length and angle reach adult size in utero. Taking into account the fetal and the gathered adult measurements, the high percentage of steep angle compared to flat angle show that after birth, PS become more flat, probably depending on the variations of the sphenoid sinus pneumatization. Thus, more studies conducted on the alterations in PS and OS types relative to the pneumatization are needed in terms of patient positioning, selection of appropriate surgical approach, and intraoperative decision-making.

Assessment of sphenoid sinus types in patients with cleft lip and palate on cone-beam CT.

The aim of this study is to examine the sphenoid sinus morphology and variations in patients with cleft lip and palate (CLP) on cone-beam computed tomography (CBCT) images, and to compare them with healthy controls. CBCT images of 54 patients (28 males and 26 females,) with CLP and 54 age- and gender-matched healthy individuals (28 males and 26 females) were retrospectively evaluated. Sphenoid sinus main types (conchal, presellar, sellar, postsellar), sellar subtypes, clival and lateral extensions, and sinus septation were analyzed in CLP and control groups. The data were statistically analyzed using Chi-square test to compare the groups. A statistically significant difference was found between CLP and control groups for sphenoid sinus main types (p < 0.05). Presellar type was more commonly observed in CLP group (18.5%), while the postsellar (31.5%) and clival (17.7%) types were more frequent in control group. There was a significant difference between the groups among different sellar sinus subtypes (p < 0.05). A significant difference was detected between the groups for clival extensions of sphenoid sinus (p < 0.05), but no difference was found for the lateral extensions (p > 0.05). No significant difference was determined between groups for sphenoid sinus septation (p > 0.05). Significant differences were found between the CLP and control groups in terms of sphenoid sinus main types, sellar subtypes and the clival extensions. Knowledge of sphenoid sinus pneumatization in patients with CLP is important for preventing complications during transsphenoidal surgery.

Vidian canal and sphenoid sinus: an MDCT and cadaveric study of useful landmarks in skull base surgery.

To present the anatomical variations of vidian canal (VC) and sphenoid sinus (SS), relative to other anatomical landmarks of skull base area, which may be helpful for safer surgical approach to this area. MDCT scans (128-row MDCT system) of 90 patients (mean age 62years) and six cadaveric heads were studied, and the following parameters were evaluated: mean length and types of VC, distance between VC and foramen rotundum (FR) and optic canal (OC), position of the VC regarding the lateral pterygoid plate (MPTG) and petrous ICA, pneumatization of SS, position of intrasinus septum regarding ICA and OC, bone dehiscence and protrusion of ICA and OC into SS. Six cadaveric heads underwent MDCT and endoscopic dissection, and the type and length of VC were evaluated. The statistical significance was assessed using Chi-square (χ2) test. Significance level was set at p < 0.05. A statistical analysis was performed between the measurements at both sides, as well as between measurements in MDCT and dissection of the six cadaveric heads. Statistically significant difference was found between right and left sides in the horizontal and vertical distances between FR and VC, as well as between VC and OC. Also, there was a statistically positive correlation between type II of VC and lateral pneumatization on the right side. There was not statistically significant difference concerning VC type and length between MDCT and dissection measurements. Surgeons addressing skull base surgery must be familiar with the anatomical and positional variations of VC and SS in the preoperative CT images so as to avoid serious complications during surgery.

Cone Beam Computed Tomography Analysis of Sphenoid Sinus Pneumatization and Relationship with Neurovascular Structures.

The sphenoid sinus is considered as the most variable pneumatized structure of the skull. The aim of the present study was to determine the prevalence of the Onodi cell as well as to evaluate the relationship between the sphenoid sinus type of pneumatization and the presence of surrounding neurovascular protrusion using cone beam computed tomography (CBCT). The CBCT images of 500 patients/996 sides [203 males (40.6%) and 297 females (59.4%)] were analyzed in this study. The type of sphenoid sinus pneumatization, prevalence of internal carotid artery (ICA) and optic nerve (ON) protrusion and dehiscence, and also the frequency of Onodi cell were assessed. The percentages of the conchal, presellar, sellar, postsellar (a), and postsellar (b) types of pneumatization were 1%, 11.5%, 35.5%, 38.9%, and 13.1%, respectively. The more the sphenoid sinuses pneumatized, the greater the frequency of ON and ICA protrusion and dehiscence of their wall to the sinus. The prevalence of Onodi cell was 38.8%. A significant correlation was found between ON dehiscence and the presence of Onodi cells. The present study demonstrated a significant relationship between the sinus type and frequency of neurovascular protrusions. Therefore, the sphenoid sinus extent of pneumatization might be useful in predicting the risk of iatrogenic damage to the surrounding structures.

Relation between optic and carotid canals with sphenoid sinus in patients with communicant hydrocephalus: a computed tomography evaluation study.

There are neuro-ophthalmologic findings in patients with communicant hydrocephalus (CH). To investigate the relationships of the optic canal and carotid canal classifications at sphenoid sinus and anterior clinoid process (ACP) pneumatization in patients with CH. In this multicentric retrospective cross-sectional study, the cranial computed tomography (CT) images of 38 patients with CH (20 men, 18 women) and 40 controls (25 men, 15 women) were included. Optic and carotid canal classification at sphenoid sinus, ACP pneumatization, and sphenoid sinus septation were evaluated. In the CH group, type 3 optic canal was detected in 21.1% of the patients and type 4 optic canal was detected in 2.6% of the patients on the left side which was significantly different from the control group (P<0.05). In the CH group, type 3 carotid canal was detected in 21.1% of the patients (left) and 18.4% of the patients (right). ACP pneumatization was present in 13.2% of the patients in the CH group bilaterally. There were positive correlations between optic canal classifications and ACP pneumatization (P<0.05). There were also positive correlations between the right and left carotid canal classifications and ACP pneumatization (P<0.05). To avoid complications, CT should be evaluated carefully in patients with CH before surgical interventions in sphenoid sinuses and surgeons should work carefully in the sphenoid sinus or adjacent structures. The protrusion possibility of the optic canal or carotid canal to the sphenoid sinus may be higher in pneumatized ACP patients.

Effect of Sphenoid Sinus Pneumatization on the Surgical Windows for Extended Endoscopic Endonasal Transsphenoidal Surgery

Little is known on the impact of the pattern and extent of pneumatization of the sphenoid sinus (SS) on the dimensions of the surgical windows used in extended endoscopic endonasal transsphenoidal approaches. We therefore investigated whether the distances between the 2 optic canals and between the paired paraclival carotid arteries are influenced by the pattern and extent of pneumatization of the SS. One hundred high-resolution computed tomography scans from 47 adult female and 53 adult male patients were analyzed. The pattern of SS pneumatization was classified into conchal, presellar, and sellar types. Sellar-type sinuses were then classified according to a newer detailed classification system. Maximal anteroposterior (AP), transverse (TR), and craniocaudal diameters of the SS, interoptic distance at the limbus sphenoidale (IODL) and at the entrance of the optic canal (IODE) and the intercarotid distance between the paraclival carotids (ICD) were measured. A 2-tailed Mann-Whitney Utest and Pearson correlation coefficient (R) were used for statistical analysis. A P value <0.05 was considered statistically significant. Positive correlation was found between IODL and both AP and TR diameters of the SS; between IODE and both AP and TR diameters of the SS; and between ICD and all diameters of the SS. The highest correlation for each of the IODL, IODE, and ICD was noted with the TR diameter of the SS. During the development of the SS, pneumatization progress likely exerts quantitative and direction-specific forces, which gradually increase the interoptic and intercarotid distances.

The impact of sphenoid sinus pneumatization type on the protrusion and dehiscence of the adjacent neurovascular structures: A prospective MDCT imaging study

Sphenoid sinus (SS) pneumatization is greatly variable. Precise determination of the pattern of SS pneumatization and its relationship to the vital neurovascular structures will provide a more comprehensive understanding of the regional SS anatomy to avoid the risk of potentially serious neural and vascular injury. We aimed to study the relationships among SS pneumatization type, extent of pneumatization, and protrusion/dehiscence of adjacent neurovascular structures using the multi-detector computed tomography. One hundred seventy healthy patients were prospectively examined by multi-detector computed tomography of the head. The type of pneumatization of the SS was determined. The protrusion/dehiscence of the internal carotid artery, optic nerve, vidian nerve, and maxillary nerve into the SS cavity was evaluated. The relationships between the SS pneumatization type and the extent of protrusion/dehiscence of the examined variables were statistically analyzed. We had 70 patients with no protrusion/dehiscence, 37 patients with unilateral protrusion/dehiscence, and 63 patients with bilateral protrusion/dehiscence. The presellar type was dominant (61.4%) in the group with no protrusion/dehiscence, the sellar type was dominant (56.8%) in the group with unilateral protrusion/dehiscence, and the postsellar type was dominant (55.6%) in the group with bilateral protrusion/dehiscence. The protrusion rates of the internal carotid artery, optic nerve, vidian nerve, and maxillary nerve in the postsellar type were 50.6%, 52.3%, 56.9%, and 54.1%, respectively (p< 0.001). The prevalence of protrusion/dehiscence of the neurovascular structures is significantly related to the type of SS and increases as the degree of SS pneumatization increases.

Evaluation of sphenoid sinus variations by using cone beam computed tomography in patients with cleft lip/palate.

The purpose of this study is to evaluate the sphenoid sinus variations in patients with cleft lip/palate. Sixty three (63) patient's cone beam computed tomography (CBCT) images, taken from the head and neck region, were evaluated. Images were divided into two groups; [Group 1; patients with cleft lip/palate (CLP Group) (n = 23) Group 2; patients without cleft lip/palate (control group) (n = 40)]. The main pneumatization types (conchal, sellar, and presellar) of sphenoid sinuses were assessed on sagittal sections of the CBCT images. The sphenoid body, lateral and lesserwing types were evaluated on coronal sections and anterior type pneumatization was evaluated on axial sections. The mean age ranged from 12 to 26 (16.57 ± 4.46) in Group 1 and 12 to 25 (16.58 ± 3.71) in Group 2. In both groups, the male and female distribution was found similar (P = 0.342). The sellar type was the most common pneumatization type of sphenoid sinus both for the Group 1 (91.3%) and Group 2 (80%). Any statistically significant difference was not found between the two groups in terms of the incidence of pneumatization types. Combined type pneumatization was detected in 65.6% of the Control group and 76.2% of the CLP group. In this study, the prevalence of sphenoid sinus pneumatization types in CLP patients was compared with the normal population. Any significant difference was not determined in the two groups.