Sinus Agenesis Research Articles

The prevalence of frontal sinus agenesis (aplasia) among Kurdish populations of Erbil city.

Background and objective: The frontal bone contains a pair of air-filled hollow cavities called frontal sinuses, the size, shape and anatomic measurements and dimensions of the frontal sinuses are determined by the degree of its pneumatization. Any disturbance to the sinus during its early development stages could results whether in hypoplasia (underdevelopment) or aplasia (total lack) of the sinus either unilaterally or bilaterally. This study aims to investigate the prevalence of aplasia of the frontal sinus among Kurdish populations of Erbil city, in addition to assessment of the type of aplasia and gender impact on the condition if there is any. Methods: This retrospective/radiological study was conducted on randomly selected PA (Caldwell view or occipito-frontal) plain radiographic images of 512 Kurdish individuals of mixed genders, ages ranging between 18 to 64 years and images were taken from the periods between April 2020 to May 2022. Results: Careful examination of 512 assessed PA radiographs (with patient’s ages ranging between 18 to 65 years) showed agenesis of the frontal sinus in 26 cases (5.16 %), 17 females and 9 male cases), the type and location of the agenesis varied greatly as it was bilateral agenesis type only in 7 cases, and unilateral in remaining 19 cases, among the unilateral sinus agenesis cases 2 were observed to be agenesis of the left and 17 of the right frontal sinuses respectively. Keywords: Prevalence, Frontal bone, Frontal sinus, Aplasia, Kurdish peoples, Anatomical variations

Computed Tomography Based Evaluation of the Anterior Group of the Paranasal Sinuses

Objective: The study aims to ascertain the prevalence of paranasal sinus variations among healthy adults in the Turkish population, as well as to analyze the symmetry of these variations. Methods: The CTIs of 200 adult patients who did not have any trauma, carcinoma, tumor, surgery, or a condition that could affect the paranasal anatomy, such as chronic rhinosinusitis, were included. The prevalences of the Agger nasi cell (ANC), supraorbital ethmoid cell (SOEC), Haller's cell (HC), middle turbinate pneumatization, and frontal sinus (FS) agenesis variations in the adult Turkish population were revealed. Results: Bilateral SOECs were found 38.5% of 200 patients, and at least 53% of patients had SOECs on one side. In 21.5% of instances, LCs were observed on both sides; in 35% of instances, they were observed on at least one side. ANCs were observed bilaterally in 68.5% of the total, the rate of patients with ANC on at least one side was 84.5%. The rate of bilaterality of the Haller cell (HC) was 24%, it was observed at least one side in 43% of the cases. Bilateral concha bullosa (CB) were observed in 19% while CB variation on at least one side was 42%. Bilateral absence of the FS was found to be 8.5%, and unilateral absence was 2.5%. Conclusion: The most common paranasal sinus variation was ANC, while the least was FS agenesis. Bilateral inheritance was found to be most prevalent in SOEC. The findings of our study hold significance for interventional procedures involving the paranasal region.

Étude anatomique scanographique du sinus frontal des patients transgenres en vue d’une chirurgie de frontoorbitoplastie de féminisation

Little is known about the anatomical elements that allow safe and predictable performance of fronto orbital surgery for facial feminization. The primary objective of this study was to analyze the characteristics (dimensions, pneumatization rate, and anterior wall thickness) of the frontal sinus in MtF transgender patients. The secondary objective was to establish reproducible criteria for CT measurements that could guide preoperative planning of frontal impaction in feminization frontoplasty (FF). Fifty preoperative facial mass scans of FF surgery patients were included. The mean age of the operated patients was 34 years. The F line represented the ideal forehead tilt in the absence of a frontal hump. The height, width, depth, and thickness of the anterior sinus wall were 26.6mm (±5.7), 49.5mm (±11.3), 10.9mm (±3.3), and 3mm (±0.7), respectively. The mean sinus width to skull width ratio was 0.73 (±0.12). Six percent of patients had bilateral frontal sinus agenesis. An osteotomy of the anterior wall of the frontal sinus was performed in the 64% of patients with frontal sinus projection anterior to the F-line. The emergence of the supraorbital nerves from the frontal bone was through a bony notch in 73.8% of cases. Knowledge of the anatomy of the frontal sinus and preoperative study of the scans of the facial mass is essential for planning the FF. These characteristics guide the surgical technique of bone remodeling as well as the procedure for releasing the supraorbital nerves.

Orthodontic Treatment Does Not Affect Frontal Sinus Development in Female Adults: A Clinical Study.

Frontal sinus growth is gradual and lasts until post-puberty. However, the influence of biomechanical stimuli, such as orthodontic treatment, on frontal sinus development after the growth period has ended remains unclear. This study was designed to elucidate the impact of orthodontic treatment on the frontal sinus morphology of adult females. Sixty women were included and divided into three groups, based on the Frankfort mandibular plane angle. All participants underwent computed tomography and lateral cephalometry before and after treatment. Although two participants exhibited frontal sinus agenesis, most exhibited a bilaterally symmetric frontal sinus without fusion. The frontal sinus width and height were almost similar, irrespective of the vertical skeletal pattern, where the frontal sinus depth was significantly larger in the average mandibular plane angle group than in the low- and high-angle groups. Furthermore, the sinus volume in the low-angle group was likely smaller than that in the average and high-angle groups. On comparing pre-treatment and post-treatment measurements, minimal or no changes to the frontal sinus dimension were detected after treatment. In conclusion, orthodontic treatment did not affect frontal sinus development after the end of growth.

Aneurysmal dilatation of vein of galen associated with thalamic arteriovenous malformation and straight sinus agenesis

Straight sinus agenesis is a rare congenital anatomical variation that is usually accompanied by persistent falcine sinus. Concomitance of straight sinus agenesis and absence of falcine sinus are associated with thalamic arteriovenous malformation by the disturbance of the venous flow. In this report, a very rare case of aneurysmal dilatation of the vein of Galen associated with thalamic arteriovenous malformation and straight sinus agenesis is presented.

Pneumatization Patterns of the Sphenoid Sinus in Adult Nigerians and Their Clinical Implications.

The variant pneumatization patterns of the sphenoid sinus have significant surgical implications due to their associated inconsistent neurovascular relations. This study aimed at evaluating the pneumatization patterns of the sphenoid sinus in adult Nigerians. This was a retrospective study conducted at the Radiology Department of a Tertiary Hospital in Nigeria after obtaining institutional ethical approval. Brain Computed Tomography images of 336 patients (137 females, 199 males) aged ≥20 years were studied for the variant pneumatization patterns of the sphenoid sinus. Statistical Package for Social Sciences version 23 was used for data analysis. Chi-square test was used to assess for the association of the variants with gender and side. Pvalue was considered significant at <0.05. The predominant pneumatization pattern in relation to the seller turcica was the sellar type (181;53.9%) followed by the presellar type (65;19.3%), post-sellar (62;18.5%), and lastly the conchal type (28;8.3%). The most prevalent clival recess was the subdorsal type (25;7.4%) followed by the dorsal (18;5.4%), combined (7;2.1%), and lastly occipital (3;0.9%). The frequency of pneumatized anterior clinoid process, greater wing of sphenoid and pterygoid process was 76;22.6%, 60;17.9% and 141;42% respectively and these showed significant side difference (P=0.001 each). None of the pneumatization patterns showed a significant gender difference. Sphenoid sinus agenesis was not observed. The pneumatization patterns in our study varied from the findings in previous Nigerian studies and other populations. There is therefore the need for preoperative evaluation before endoscopic transsphenoidal surgical procedures.

Frequency of the frontal sinus aplasia among Saudi Arabian population. A single-center retrospective case review.

ABSTRACTObjectives:To assess the frequency of frontal sinus aplasia using computed tomography (CT) of the paranasal sinus among Saudi Arabian population.Methods:A retrospective case review of medical records from January 2019 to December 2019 in the Otorhinolaryngology Department, King Abdulaziz University, Riyadh, Saudi Arabia.Results:A total of 449 cases were reviewed. The incidence of bilateral frontal sinus aplasia was 3.3%. The incidence of right sinus agenesis was 5.12% and left was 1.33%. The mean age of reviewed patients was 39.15 years.Conclusion:The frequency of frontal sinus aplasia is low; however, this must be considered before surgical operations related to the sinuses.

Synostosis of the lambdoid suture: a spectrum.

Lambdoid synostosis (LS) is a rare condition, which is either isolated; associated with sagittal synostosis, the "Mercedes-Benz" syndrome (MBS); or with synostosis of the coronal sutures (oxycephalic form). In addition, LS is part of the phenotype of a growing number of genetic diseases. The nosology, pathophysiology, and management are controversial. We decided to review our experience with LS. We reviewed retrospectively pediatric cases of LS proved on CT-scanner, isolated or associated with other conditions, followed in our craniofacial center during the last 15 years, regarding clinical presentation, anatomical lesions, syndromic associations, surgical management, and outcome. We reviewed 48 cases: 6 isolated LS, 22 MBS, and 20 oxycephalic. A syndromic context was present in 72% (up to 80% of oxycephalic cases), and faciostenosis was present in 23%, mostly oxycephalic cases (40%). Transverse sinus agenesis was found in 61% of documented patients. A total of 31% of children had a dystocic birth, up to 45% of MBS. Decompressive craniectomy or cranioplasty was needed in a majority of patients, often young infants, while posterior fossa decompression was mostly performed in older children. LS is rarely isolated and non syndromic; most cases are found in a wide spectrum of diseases, and LS is often associated with sagittal or coronal synostosis. Genetic evaluation is mandatory for LS; conversely, geneticists may require neurosurgical advice for LS in an increasing number of very rare diseases. The surgical management of LS should be tailored according to clinical presentation, age, and syndromic context.

The Significance of Magnetic Resonance Imaging and Computed Tomography Findings in Sphenoid Sinus Agenesis

Agenesis of the sphenoid sinuses is a very rarely encountered anatomic variation. Findings on magnetic resonance imaging can mislead the radiologist and clinician. Therefore, the gold standard for diagnosis is computed tomography (CT) of the paranasal sinuses. We present the case of a 28-year-old man who was admitted to our hospital with a 3-month history of headache. CT of the paranasal sinuses revealed isolated bilateral sphenoid sinus agenesis.

Association between frontal sinus development and persistent metopic suture

Frontal sinuses are 2 irregular cavities, placed between 2 lamina of frontal bone. Expansion continues during childhood and reaches full size after puberty. Persistent metopic suture is one of the factors that are related to abnormal frontal sinus development. In this study, we want to discuss about the coexistence of persistent metopic suture and abnormal frontal sinus development using radiological techniques. In this retrospectively planned study, images of 631 patients were examined, 217 (34.4%) of them were men and 414 (65.6%) of them were women. Brain computed tomography and magnetic resonance images were retrieved from the electronic archive for analysis. In this study, frontal sinus development is categorised as right side atrophy, left side atrophy, bilateral atrophy and bilaterally developed sinuses. The presence of metopic suture was accepted as persistent metopic suture. Frontal sinus atrophy was found in 22.7% and persistent metopic sutures were found in 9.7% of overall. In this study, no significant results were detected that were relatedto the frontal sinus agenesis or dismorphism associated with persistent metopicsuture. We conclude that, although publications propounding metopism thatleads to abnormal frontal sinus development are present in the literature, noreasonable explanation has been mentioned in these articles; and we believe thatthese findings are all incidental.

Torcular Herophili classification and evaluation of dural venous sinus variations using digital subtraction angiography and magnetic resonance venographies

The configurations of cerebral veins and dural venous sinuses differ not only between individuals, but also between the two brain hemispheres of an individual, making the anatomical classification of the cerebral veins difficult. We evaluated the superior dural venous sinuses and classified their types and variations using magnetic resonance venography (MRV) and digital substraction angiography (DSA). A total of 394 patients were studied retrospectively. Superior dural venous sinuses were evaluated and the confluence of the sinuses was classified on 2-dimensional time-of-flight MRV, contrast-enhanced 3-dimensional spoiled gradient recalled echo magnetic resonance imaging, and/or cerebral DSA. Confluens sinuum was divided into three types: true confluence, partial confluence, and non-confluence. Of the three types, partial confluence (type II) was most frequently seen. Co-dominance of the transverse sinuses was most frequently observed. An occipital sinus was observed in 15 % of the patients. There were statistically significant differences between the left transverse sinus agenesis and the presence of the occipital sinus (p < 0.001), between the co-presence of the partial confluence type torcular and the occipital sinus (p = 0.040), and between the co-presence of the fenestrated straight sinus and the occipital sinus (p = 0.010). Although anatomical variations of dural venous sinuses are seen frequently, classification of venous sinuses helps surgeons in preoperative evaluation and management, and prevention of possible complications. In this study, we think that a comprehensive evaluation and classification of dural venous sinuses is a significant contribution to the literature.

Frontal Sinus Agenesis Using Computed Tomography

In adults, paranasal sinus agenesis is an uncommon anomaly that appears mainly in the frontal sinus. The aim of this study was to investigate the prevalence of agenesis of the frontal sinus using computed tomography in a population of Iranian individuals. Computed tomographic scans in the axial and coronal planes of the frontal sinus of 565 patients were examined for evidence of the absence of the frontal sinus. A bilateral agenesis of the frontal sinus was seen in 8.32% of cases, and unilateral absence of the frontal sinus was observed in 5.66%. The information provided in the current study is useful for some craniofacial surgeries and improves the anthropometric knowledge of humanity. There are limited studies on agenesis of the frontal sinus in the literature, but comparing our findings with the available data, there were differences regarding the incidence of this condition. This may be related to geographic and racial features. More studies on other population are required.

Persistent falcine sinus and unilateral renal agenesis in a girl with Sotos syndrome

Sotos syndrome is an overgrowth syndrome characterized by distinctive facial features, developmental delay, and macrocephaly. Here, we present a 10-year-old girl with prenatal and postnatal overgrowth, prominent forehead, pointed chin, and advanced bone age. She also has a persistent falcine sinus in the posterior falx cerebri, patent ductus arteriosus, unilateral renal agenesis, and scoliosis. A pituitary macroadenoma was also found with external compression of the inferior aspect of the optic chiasm. We identified a de novo missense mutation of the NSD1 (nuclear receptor-binding SET domain protein 1) gene in this patient. Computational three-dimensional structural analysis revealed that the NSD1 mutation induced major alterations.

Aplasia and Agenesis of the Frontal Sinus in Turkish Individuals: A Retrospective Study Using Dental Volumetric Tomography

Agenesis of the paranasal sinuses is an uncommon clinical condition that appears mainly in the frontal (12%) and maxillary (5-6%) sinuses; in some populations, it appears at a higher proportion. This study investigated the prevalence of agenesis of the frontal sinuses using dental volumetric tomography (DVT) in Turkish individuals. The frontal sinuses of 410 patients were examined by DVT scans in the coronal planes for evidence of the absence of the frontal sinuses. A bilateral and unilateral absence of the frontal sinuses was seen in 0.73% and 1.22% of cases, respectively. In one case, both agenesis and aplasia of the frontal sinus was seen (0.24%). The low percentage of frontal sinus agenesis must be considered during pre-surgical planning related to the sinuses. DVT may be used as a diagnostic tool for the examination of frontal sinus aplasia.

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

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

A retrospective analysis of sphenoid sinus hypoplasia and agenesis using dental volumetric computed tomography in turkish individuals

In adults, sphenoid sinus agenesis is an extremely rare anomaly. The objective of this study was to investigate the prevalence of sphenoid sinus hypoplasia and agenesis using dental volumetric computed tomography (DVCT) in a population of Turkish individuals. DVCT scans in the axial, coronal and sagittal planes of the sphenoid sinus of 384 patients were examined for evidence of sphenoid sinus agenesis and hypoplasia. In the DVCT scans, bilateral agenesis of sphenoid sinus was not seen. Unilateral agenesis of sphenoid sinus was seen in 0.26% of the sample, and sphenoid sinus hypoplasia was seen in 0.52%. Unilateral hypoplasia of the sphenoid sinus was observed in 0.26% of the sample, and bilateral hypoplasia of sphenoid sinus was observed in 0.26%. In this study, we found a low frequency of sphenoid sinus agenesis. Compared with sphenoid sinus agenesis, the frequency of sphenoid sinus hypoplasia was higher. DVCT may be used as a diagnostic tool to investigate the paranasal sinus.

Agenesis of sphenoid sinus: three cases

Paranasal sinus agenesis is an unusual clinical condition. The frontal sinus agenesis is more frequently seen, whereas agenesis of the sphenoid sinus is extremely rare. This report presents three new cases of sphenoid sinus agenesis. The absence of the sphenoid sinus was demonstrated by computed tomography (CT) in all cases.

Agenesis of sphenoid sinuses

A 22-year-old female patient presented to our hospital complaining of a headache. Evaluation with magnetic resonance imaging (MRI) demonstrated the absence of sphenoid sinus. Agenesis of sphenoid sinus is a rare entity; it usually occurs with syndromes. A case of sphenoid sinus agenesis without any anomaly or syndrome is reported.

Quiz case

With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the preoperative work-up. To be in the known anatomical variants with some accompanying pathologies, directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. A review of 512 (1024 sides) paranasal sinus tomographic scans was carried out to expose remarkable anatomic variations of this region. We used only coronal sections, but for some cases to clear exact diagnosis, additional axial CT scan, magnetic resonance imaging (MRI) and nasal endoscopy were also performed. In this pictorial essay, rates of remarkable anatomic variations in paranasal region were displayed. The images of some interesting cases were illustrated, such as the Onodi cell in which isolated mucocele caused loss of visual acuity, agger nasi cell, Haller's cell, uncinate bulla, giant superior concha bullosa, inferior concha bullosa, bilateral carotid artery protrusion into sphenoid sinus, maxillary sinus agenesis, bilateral secondary middle turbinate (SMT) and sphenomaxillary plate. The clinical importance of all these variations were discussed under the light of the literature. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in the preoperative evaluation.

Unifocal Langerhans’ Cell Histiocytosis and Frontal Sinus Agenesis: Report of a Rare Case

Unifocal Langerhans' cell histiocytosis of the frontal bone is rare. We report a most unusual case of Langerhans' cell histiocytosis of the frontal bone in a patient who had been affected by frontal sinus agenesis. We believe this is the first reported case of its kind. We also review previously reported cases of solitary eosinophilic granuloma of the frontal bone and we discuss its clinical, radiologic, and histopathologic features.