Evaluation of the Radiological Anatomy of the Temporal Bone Air Spaces and Morphometric Analysis in Turkish Healthy Adults / Evaluación de la Anatomía Radiológica de los Espacios Aéreos del Hueso Temporal y Análisis Morfométrico en Adultos Turcos Sanos

SUMMARY: The temporal bone is a complicate structure which located on the lateral skull. The objective of the present study was to determine the temporal bone air spaces' morphometry, morphology, and pneumatization in Turkish healthy adult people. This retrospective observational study was carried out from 82 subjects (47 males, 35 females) aged 18-69 years. The external auditory canal and related structures' diameters and the volume of these areas were evaluated. The means and standard deviations of the Meatus acusticus externus length (MAEL), meatus acusticus externus pars cartilaginea length (MAEcL), meatus acusticus externus pars ossea length (MAEoL), meatus acusticus externus pars cartilaginea surface (MAEcS), meatus acusticus externus pars ossea surface (MAEoS), meatus acusticus externus volume (MAEV), meatus acusticus externus pars cartilaginea volume (MAEcV), meatus acusticus externus pars ossea volume (MAEoV), processus mastoideus air cells volume (PMACV), cavum tympani volume (CTV), and temporale pneumatic spaces volume (OTPSV) were found as 23.21±3.70 mm, 12.69±3.72 mm, 7.80±3.70 mm, 669.89±107.7 mm2, 267.50±30.51 mm2, 743.50±119.6 mm3, 971.97±156.69 mm3, 419.51±48.67 mm3, 5915.93±650.34 mm3, 673.48±91.93 mm3, 7813.34±717.49 mm3 have found in 82 subjects, respectively. In this paper, the morphometric and volume properties of the temporal bone cavities measurements were significantly higher in males than females. These results may both provide reference values of Turkish healthy population, and lead to decrease potential surgical complications about temporal and mastoid regions.

El hueso temporal es una compleja estructura ubicada en el parte lateral del cráneo. El objetivo del presente estudio fue determinar la morfometría, morfología y neumatización de los espacios aéreos del hueso temporal en individuos adultos turcos sanos. Este estudio observacional retrospectivo que se llevó a cabo en 82 sujetos (47 hombres, 35 mujeres) de entre 18 y 69 años. Se evaluaron los diámetros del meato acústico externo y las estructuras relacionadas y el volumen de estas áreas. Las medias y las desviaciones estándar de la longitud del meato acústico externo (MAEL), la longitud de la parte cartilaginosa del meato acústico externo (MAEcL), la longitud de la parte ósea del meato acústico externo (MAEoL), la superficie de la parte cartilaginosa del meato acústico externo (MAEcS), la superficie de la parte ósea del meato acústico externo (MAEoS), volumen del meato acústico externo (MAEV), volumen de la parte cartilaginosa del meato acústico externo (MAEcV), volumen de la parte ósea del meato acústico externo (MAEoV), volumen de las células aéreas del proceso mastoideo (PMACV), volumen del cavum tympani (CTV) y el volumen de los espacios neumáticos temporales (OTPSV) se encontró como 23,21 ± 3,70 mm, 12,69 ± 3,72 mm, 7,80 ± 3,70 mm, 669,89 ± 107,7 mm2, 267,50 ± 30,51 mm2, 743,50 ± 119,6 mm3, 971,97 ± 156,69 mm3, 419,5. 1±48,67 mm3, 5915,93 ± 650,34 mm3, 673,48 ± 91,93 mm3, 7813,34 ± 717,49 mm3, respectivamente. En este artículo, las propiedades morfométricas y de volumen de las mediciones de las cavidades del hueso temporal fueron significativamente mayores en hombres que en mujeres. Estos resultados pueden proporcionar valores de referencia de la población sana turca y conducir a una disminución de las posibles complicaciones quirúrgicas en las regiones temporal y mastoidea.

A Systematic Literature Study of the Sinus Septi Nasi, Crista Galli and Other Minor Pneumatizations / Estudio Bibliográfico Sistemático del Seno Septi Nasi, Crista Galli y Otras Neumatizaciones Menores

SUMMARY: Variations in the paranasal sinuses and pneumatizations originating from these structures are clinically important for surgical procedures to be performed in the nose and nasal cavity regions. No systematic review examining the sinus septi nasi, crista galli and other minor pneumatizations was found in the literature review. This study aimed to review the papers in the literature including the sinus septi nasi, crista galli and other minor pneumatizations and standardize the mean incidence, distribution by sex, age and origin of these structures. Furthermore, it was aimed to examine the height, length, and width values of sinus septi nasi and crista galli pneumatizations, determine the measurement intervals and measurement values, and standardize them. The studies involving these pneumatizations were reviewed from various databases. After being evaluated according to the inclusion and exclusion criteria, 35 articles between the years 1991-2021 were reviewed. Based on the data obtained from these articles, we examined the incidence of sinus septi nasi, crista galli, and other minor pneumatizations. Middle nasal turbinate pneumatization had the highest incidence among all these pneumatizations. Uncinate process pneumatization had the lowest incidence. Considering the distribution by sex, no difference was found. Upon examining the age range, there were people aged between 1-95 years, and the mean age range was 33.05-41.48. The length, width and height values of crista galli and sinus septi nasi could not be standardized due to the insufficient number of studies and variable data in the literature. We believe that our study will contribute to similar future studies in larger populations with the clinical procedures to be performed in and around the nasal cavity.

Las variaciones en los senos paranasales y las neumatizaciones que se originan en estas estructuras son clínicamente importantes para los procedimientos quirúrgicos que se realizan en las regiones de la nariz y la cavidad nasal. En la revisión de la literatura no se encontró ninguna revisión sistemática que examinara el seno septi nasi, la crista galli y otras neumatizaciones menores. Este estudio tuvo como objetivo revisar los trabajos en la literatura que incluyen el seno septi nasi, la crista galli y otras neumatizaciones menores y estandarizar la incidencia media, la distribución por sexo, edad y origen de estas estructuras. Además, tuvo como objetivo examinar los valores de altura, longitud y ancho de las neumatizaciones del seno septi nasi y crista galli, determinar los intervalos de medición y los valores de medición, y estandarizarlos. Los estudios relacionados con estas neumatizaciones se revisaron a partir de varias bases de datos. Luego de ser evaluados según los criterios de inclusión y exclusión, se revisaron 35 artículos entre los años 1991-2021. Sobre la base de los datos obtenidos de estos artículos, examinamos la incidencia de septi nasi nasi, crista galli y otras neumatizaciones menores. La neumatización de la concha nasal media tuvo la mayor incidencia entre todas estas neumatizaciones. La neumatización del proceso uncinado tuvo la menor incidencia. Considerando la distribución por sexo, no se encontró diferencia. Al examinar el rango de edad, había personas con edades entre 1 y 95 años, y el rango de edad promedio fue de 33,05 a 41,48. Los valores de longitud, ancho y altura de crista galli y seno septi nasi no pudieron estandarizarse debido a la cantidad insuficiente de estudios y datos variables en la literatura. Creemos que nuestro estudio contribuirá a futuras investigaciones similares en poblaciones más grandes con los procedimientos clínicos que se realizarán en y alrededor de la cavidad nasal.

Morphometric Analysis of the Sella Turcica and Sphenoid Sinus: A Retrospective Cross-Sectional Study / Análisis Morfométrico de la Silla Turca y Seno Esfenoidal: Un Estudio Transversal Retrospectivo

SUMMARY: This study evaluated the effects of ethnicity, sex, and age on the linear dimensions of the sella turcica (ST) and the pneumatization patterns of the sphenoid sinus (SS). In this cross-sectional retrospective study, we examined digitally standardized computed tomography scans of 100 Jordanians. These study participants comprised 50 men and 50 women, and their age ranged from 23 years to 77 years. We assessed linear ST dimensions and SS pneumatization patterns and correlated this data to age and sex. Furthermore, we compared the data with different ethnic groups from previous studies. The mean (standard deviation [SD]) length, diameter, width, and depth of the ST were 9.98 (1.89) mm, 12.45 (2) mm, 11.96 (1.76) mm, and 8.38 (1.63) mm, respectively. The mean (SD) interclinoid diameter was 8.84 (2.03) mm. These measurements were not significantly correlated with sex or age. With regards to pneumatization patterns of the sphenoid sinus, the conchal type was observed in 2 % of the study participants. Presellar involvement was observed in 30 % of the patients. The sellar and postsellar type was observed in 66 % and 2 % of patients, respectively. In our study, ST measurements did not differ significantly between the sexes. Pneumatization patterns of the SS differed from the patterns reported for other races. The findings of this study could assist neurosurgeons, orthodontists, and forensic medical investigators in diagnosing and planning treatment for pituitary gland pathologies.

Este estudio evaluó los efectos de la etnia, el sexo y la edad sobre las dimensiones lineales de la silla turca y los patrones de neumatización del seno esfenoidal (SE). En este estudio retrospectivo transversal, examinamos tomografías computarizadas estandarizadas digitalmente de 100 jordanos. Los participantes del estudio comprendían 50 hombres y 50 mujeres entre los 23 y los 77 años de edad. Evaluamos las dimensiones lineales del SE y los patrones de neumatización del SE y correlacionamos estos datos con la edad y el sexo. Además, comparamos los datos con diferentes grupos étnicos de estudios previos. La media (desviación estándar) de la longitud, el diámetro, el ancho y la profundidad del SE fueron 9,98 (1,89) mm, 12,45 (2) mm, 11,96 (1,76) mm y 8,38 (1,63) mm, respectivamente. El diámetro interclinoideo medio era de 8,84 (2,03) mm. Estas medidas no se correlacionaron significativamente con el sexo o la edad. Con respecto a los patrones de neumatización del seno esfenoidal, el tipo conchal se observó en el 2 % de los participantes del estudio. Se observó afectación preselar en el 30 % de los pacientes. El tipo selar y postsillar se observó en el 66 % y el 2 % de los pacientes, respectivamente. En nuestro estudio, las medidas del SE no difirieron significativamente entre los sexos. Los patrones de neumatización de la silla turca diferían de los patrones informados para otras razas. Los hallazgos de este estudio podrían ayudar a los neurocirujanos, ortodoncistas e investigadores médicos forenses en el diagnóstico y el tratamiento de las patologías de la hipófisis.

Anatomical relationship of pterygoid process pneumatization and vidian canal / Relação anatômica da pneumatização do processo pterigoide e o canal vidiano

Abstract Introduction The 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. Objectives The 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. Methods Head 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. Results 46 (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. Conclusion Pneumatization of the pterygoid process indicates either type 2 or type 3 vidian canal configuration.

Resumo Introdução O canal vidiano atua como ponto de referência para a identificação da artéria carótida petrosa, especialmente durante abordagens endoscópicas endonasais extensas em cirurgias de base do crânio. Este estudo foi projetado com o objetivo de localizar o canal vidiano e entender a relação da pneumatização do processo pterigoide sobre o tipo de canal. Objetivos Descrever a relação anatômica da pneumatização do processo pterigoide com os tipos de canal vidiano. Foram avaliados o comprimento do canal vidiano, a relação com a placa medial do processo pterigoide e com a porção petrosa da artéria carótida interna. Método Foram estudadas tomografias computadorizadas de 52 indivíduos submetidos a tomografia computadorizada de cabeça por suspeita de doença em seio paranasal. Foram observados o grau de pneumatização do seio esfenoidal, a pneumatização do processo pterigoide e os tipos de canal vidiano (Tipos 1, 2 e 3). Observou-se o comprimento do canal vidiano, a distância do plano da placa pterigoide medial e a relação do canal vidiano com a junção da porção petrosa e gasseriana (ascendente) da artéria carótida interna. Resultados Eram do tipo selar 46 (92%) seios esfenoidais. Dos 104 lados estudados, 57 eram do processo pterigoide pneumatizado e 47 não eram pneumatizados. Em 49 lados (47,1%), o canal vidiano estava no mesmo plano que o da placa pterigoide medial na seção coronal. O canal vidiano em protusão parcial no seio esfenoidal (tipo 2) foi o tipo mais comum (50,9%), encontrado nos lados direito e esquerdo. Houve uma associação estatisticamente significante entre a pneumatização do processo pterigoide e a ocorrência da configuração do canal vidiano tipo 2 e tipo 3. O comprimento médio do canal vidiano foi de 16,16 ± 1,8 mm. Em 96 lados, a extremidade anterior do canal vidiano era inferolateral à porção petrosa da artéria carótida interna no plano coronal. Conclusão A pneumatização do processo pterigoide indica a configuração do canal vidiano tipo 2 ou tipo 3.

Neumatización detenida del seno esfenoidal: una condición benigna que simula lesiones patológicas / Arrested pneumatization of the sphenoid sinus: a benign condition that simulates pathological lesions

Resumen La neumatización detenida de los senos paranasales es una condición benigna poco conocida, que consiste en una variación de la neumatización normal, permaneciendo médula ósea grasa dentro de la cavidad, siendo más frecuente en el seno esfenoidal. Es generalmente asintomática y su diagnóstico suele ser incidental en el contexto de la realización de imágenes por otras causas, existiendo criterios imagenológicos definidos para esta condición. Su manejo es expectante y es esencial su distinción de otros diagnósticos diferenciales, con objeto de evitar procedimientos y tratamientos invasivos que solo aporten morbilidad. Presentamos dos casos de pacientes, de 15 y 16 años que, en estudio imagenológico por otra causa, se observan lesiones esfenoidales heterogéneas con focos de baja señal sugerentes de calcificaciones, con características compatibles con neumatización detenida del seno esfenoidal.

Abstract Arrested pneumatization of the paranasal sinuses is an under-recognized benign condition, which consists of a variation of the normal pneumatization, with fatty bone marrow remaining within the cavity, more frequent in the sphenoid sinus. It is generally asymptomatic, and its diagnosis is usually incidental in the context of imaging for other causes, with defined imaging criteria for this condition. Its management is expectant and its distinction from other differential diagnoses is essential, in order to avoid invasive procedures and treatments that only contribute morbidity. We present two cases of 15- and 16-year-old patients who, on imaging for another reason, show heterogeneous sphenoid lesions with low-signal foci suggestive of calcifications, with characteristics compatible with arrested pneumatization of the sphenoid sinus.

Gender Distribution and Clinical Significance of Pneumatization in Sphenoid Sinus

Introduction: Pneumatization of the sphenoid sinus is highlyvariable and it depends on the position of the sinus in relationto the sella turcica. The pattern of pneumatization of sphenoidsinus significantly affects safe access to the sella. Pneumatizedsphenoid sinus may distort the anatomical configuration so ifunaware, accidental injury can occur during invasive surgicaltechnique.Material and methods: This cross sectional observationalwas conducted by Postgraduate Department of Anatomyin collaboration with Department of Radiodiagnosis andImaging, Government Medical College, Srinagar. Thisstudy was done on CT scan of 200 cases (120 males and 80females). Since the aim of our study was to evaluate normalvariation in pneumatization of sphenoid sinus, cases foundto harbor pathology or disease enough to distort the regionalanatomy were excluded from the study. Extent of sphenoidpneumatization in relation to pituitary fossa was studied insagittal plane and categorized as sellar, presellar and conchal.Results were categorized for males and females separately.RESULTS: In our study of 200 cases, sellar type of sphenoidsinus pneumatization was majority accounting 180 (90%)while 18 (9%) were presellar and 2 (1%) were of chonchaltype. Both cases of chonchal type were males.Conclusion: The study was performed to demonstratesurgically dangerous variations of sphenoid sinuspneumatization for the safe removal of the intrasphenoid andpituitary lesions, with the goal of preventing complicationsand achieving the best possible results.

Measurements Of Maxillary Sinus In Correlation To Age And Gender By Computed Tomography

Introduction: The sinonasal region is often imaged because of infectious and allergic diseases of the nasal cavityand paranasal sinuses. Improved knowledge of normal pneumatization and development of paranasal sinusesis important to allow sinus diseases to be evaluated and an adequate treatment to be proposed.Materials and methods: 100 patients (72 males and 28 females) undergoing coronal and axial sections of computedtomography scan of maxillary sinus of head and neck aged between 1year to 90 years at the Radiology Department,Vydehi Institute of Medical Science & Research Centre Bangalore for reasons other than due to craniofacialabnormalities or sinus problem were taken for the study. Volume and dimensions of the maxillary sinuses withits anatomical variations were obtained. Mean, SD, significant difference between age & gender was calculated.Results: Maxillary sinuses in Males on both sides have higher values in mean height, depth and volume thanfemales except right side width which was lesser in value than females. All the mean parameters were more onleft sinus both in male and females, except mean height of right sinus in males, on side comparison all the meanparameters were more on right side in females. There is a significant difference in mean height of right and leftmaxillary sinus in between male and female. There is a significant difference on right and left side widthbetween male and female in the age group 51-60 yrs and 61-70 yrs. The maximum age growth in males was during11-20 yrs and 41-50 yrs in height, width and volume, in 21-30 yrs and 31-40 yrs in depth, later dimensions weredecreasing in growth by 61-70 yrs in height and 81-90 yrs both in depth, width and volume. In females maximumgrowth was in 21-30 yrs and 51-70 yrs for height, depth, volume, 11-20 yrs and 51-60 yrs for width dimensions, laterdecreases by 61-70 yrs onwards in height, width and 11-20 yrs in depth and volume.Conclusion: These results will be helpful in understanding normal and pathological conditions of the maxillarysinuses and useful in clinical planning of medical or surgical interventions of the maxillary sinuses

The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans / Avaliação anatômica do canal vidiano e estruturas adjacentes por tomografia computadorizada para a neurectomia do vidiano

Abstract Introduction: The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. Objective: The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning. Methods: This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625 mm of 250 adults. Results: The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p < 0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p < 0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p < 0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05 ± 7.71°. Conclusions: Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.

Resumo Introdução: O tipo de abordagem endoscópica para a neurectomia do vidiano pode ser definido pela avaliação do canal do vidiano e das estruturas adjacentes aos seios esfenoidais. Objetivo: Investigar as variações e a morfometria do canal vidiano com enfoque nas suas correlações funcionais, pois são parâmetros anatômicos cruciais para o planejamento pré-operatório. Método: Esse estudo foi realizado utilizando-se imagens de tomografia computadorizada multidetectores dos seios paranasais com espessura de corte de 0,625 mm obtidas de 250 indivíduos adultos. Resultados: A distribuição das 500 variantes do canal vidiano foi categorizada da seguinte forma: Tipo 1, dentro do corpo ósseo esfenoidal (55,6%); Tipo 2, protrusão parcial no interior do seio esfenoidal (34,8%); Tipo 3, no interior do seio esfenoidal (9,6%). A pneumatização do processo pterigoide foi observada principalmente no canal vidiano Tipo 2 (72,4%) e Tipo 3 (95,8%) (p < 0,001). As distâncias médias do canal vidiano até o forame redondo e o canal palatovaginal foram maiores no canal vidiano do Tipo 2 e 3, com a pneumatização do processo pterigoide (p < 0,001). A presença do septo intraesfenoidal entre o canal vidiano e a crista vomeriana e a extensão lateral, que termina na proeminência da carótida, foi muito maior no canal vidiano Tipo 3 do que nos outros tipos (p < 0,001). A angulação média entre a cauda da concha média e a margem lateral da abertura anterior do canal vidiano foi de 33,05° ± 7,71°. Conclusões: A análise radiológica pré-operatória do canal do vidiano e das estruturas circunjacentes permitem ao cirurgião escolher uma abordagem endoscópica apropriada e prever resultados pós-operatórios.

The Differences in Paranasal Sinus Pneumatization after Adolescence in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The embryological development of paranasal sinuses has been revealed by previous articles although few studies have reported on the differences of paranasal sinus pneumatization according to age after adolescence. We evaluated changes in paranasal sinus pneumatization in the ages ranging from 10s to over 60s. SUBJECTS AND METHOD: A retrospective review was carried out for patients who underwent osteomeatal unit three-dimensional computed tomography from January 2008 to March 2017. Two hundred and forty patients were selected and matched for age, sex, and existence of sinusitis. The biggest cross-sectional area (CSA) of each sinus was selected from each patient, which was then corrected to the size of the face. CSA and corrected CSA (cCSA) values were used together for analysis. RESULTS: CSAs of frontal, maxillary, sphenoid sinuses gradually increased in the ages ranging in the 30s, and then significantly decreased from those in the 40s onwards. In particular, these tendencies were statistically significant in all types of sinuses between the 30s and 40s, (p0.05). CSAs in patients with chronic sinusitis were not different from those in patients without chronic sinusitis in every sinus and all age groups (p>0.05). CONCLUSION: This study shows that older people have smaller sinuses, and sex difference and existence of sinusitis have no effect on the pneumatization of the sinuses.

An in vitro Experiment on Relationship Between Pulsatile Tinnitus and Temporal Bone Pneumatization Grade / 医用生物力学

Objective To study the relationship between pulsatile tinnitus and temporal bone pneumatization grade. Methods Through the in vitro experiment, the generation and transmission pathways of the venous sound were simulated. The sound signals at the position of eardrum were recorded and analyzed. Results In case of cortical plate dehiscence, the high pressure and pulse-synchronous venous sounds were received at eardrum. The highest sound pressure occurred in the normal pneumatization case. In case of cortical plate intactness, the non-pulsatile venous sounds with pressure close to the background control sound were received at eardrum. Temporal bone air cells (TBAC) with different pneumatization grades would transmit venous sound in different frequency ranges. Conclusions Normal pneumatization TBAC exhibited the highest amplification on venous sound, while hypopneumatization TBAC exhibited the lowest amplification on venous sound. The pneumatization grade of TBAC is neither the sufficient nor essential condition of pathogenic venous sound, while the cortical plate dehiscence is the sufficient or necessary condition of pathogenic venous sound.

Relation between Nasal Septal Deviation and Pneumatization of Mastoid Air Cells – A Computerised Tomographic Study

Introduction: The environment of middle ear cavity gets regulated mostly by pneumatized mastoid air cell system (MACS). Many theories exist that details the process of pneumatization of this MACS. The nasal septal deviation (NSD) has been shown to be instrumental in influencing pneumatization of paranasal sinuses to varied degrees. The effect of NSD on the pneumatization of MACS remains questionable due to limited literature available. And so this study was done to find the relation between the side of NSD and extent of Pneumatization of MACS on that side by computerized tomographs of Paranasal sinus region. Subjects and Methods: 120 CT images of paranasal region from archives of radiology department were studied for NSD. The NSD was classified according to the nasal septal angle. The extent of pneumatization of mastoid region was studied and classified. The relation between severe NSD and extent of mastoid pneumatization was noted. Results: NSD was found to be right sided in 90% cases studied and 20, 45, 55 were seen belonging to group I, II and III NSD respectively. The mean NSA was found to be 13.5o. Mastoid region was observed to be hypo pneumatized in the side of NSD in 42 cases of group III NSD. Conclusion: The findings of the study puts forth the need for assessment of NSD and planning possible correction of NSD prior to middle ear and mastoid surgeries for successful results.

Impact of Anterior Clinoid Process Pneumatization on Adjacent Anatomical Structures

The Anterior clinoid process is closely related to many important anatomical structures including vessels, nerves, and paranasal sinuses. In the majority of cases, this process is osseous, but its pneumatization has been recorded as an anatomic variant. Coronal CT scans of the head region that were done for thirty-seven patients at Tanta University hospitals were collected to be used in teaching radiological anatomy for medical students. During their routine investigation, a case of a female aged 21 years showed bilateral pneumatization of the anterior clinoid processes associated with some variants of the adjacent anatomical structures. These findings were discussed on anatomical basis with referral to their possible clinical implications. If a surgical removal of the anterior clinoid process is recommended, a comprehensive knowledge of its anatomy, pneumatization, and associated regional anatomic variants is crucial for neurosurgeons to avoid risky complications.

Obstructive Sleep Apnea and aberrant pneumatization of skull bones / Apnea obstructiva del sueño y neumatizaciòn aberrante de huesos del cráneo

ABSTRACT Objective: We aimed to assess the association between obstructive sleep apnea (OSA) and aberrant pneumatization of skull bones in Amerindians living in rural Ecuador. Methods: A random sample of community-dwelling individuals aged ≥60 years enrolled in the Atahualpa Project, were invited to undergo a single diagnostic night polysomnography (PSG) at the sleep unit of the Atahualpa Project Community Center. Exams were performed with an Embletta® X100™ Comprehensive Portable PSG System. A board-certified sleep neurologist carried out analyses of sleep efficiency, architecture, arousal indexes, apnea/hypopnea index, oxygen saturation, heart rate and motor activity. CT readings were focused on the presence and distribution of pneumatization of intracranial bones, as assessed by CT with bone window settings. Results: Thirty-eight participants were included. Mean age was 74.5 ± 6.8 years and 25 (66%) were women. The apnea/hypopnea index ranged from 0.2 to 56 (mean 15.7 ± 14.6) episodes per hour. Fifteen persons (39%) had ≥10 episodes per hour and were considered to have OSA. Abnormal pneumatization of skull bones was noticed in six persons, included five out of 15 (33%) with OSA and one out of 23 (4%) without (p=0.027). Air was found in the temporal squamas in five (bilateral in four), the occipital bones in one, and in both the temporal squamas and the occipital bones in the remaining person. Conclusion: This study shows a significant association between OSA and aberrant pneumatization of skull bones. These findings are of potential clinical relevance, since these individuals could be at increased risk of painless fractures from minor trauma or may be prone to develop spontaneous cerebrospinal fluid leaks.

RESUMEN Objetivo: Determinar la asociación entre apnea obstructiva de sueño y neumatización aberrante de huesos del cráneo en una población de Amerindios. Métodos: Una muestra aleatoria de adultos de 60 años o más enrolada en el Proyecto Atahualpa, fue invitada a realizarse una polisomnografía diagnóstica (una noche) en la Unidad de Sueño del Centro de Apoyo Comunitario del Proyecto Atahualpa. Los exámenes fueron realizados con una máquina portátil Embletta® X100™. Un neurólogo certificado en sueño realizó la lectura de todos los exámenes, con atención a eficiencia y arquitectura del sueño, índices de despertar, índice apnea-hipopnea, saturación de oxígeno, frecuencia cardiaca y actividad motora. La lecturas tomográficas se enfocaron en la presencia y distribución de neumatización aberrante de huesos del cráneo, valoradas con ventana ósea. Resultados: Se incluyeron 38 pacientes (edad media 74.5 ± 6.8 años, 66% mujeres). El índice apnea-hipopnea fluctuó entre 0.2 a 56 (promedio: 15.7 ± 14.6) episodios por hora. Quince participantes (39%) tuvieron ≥10 episodios por hora y fueron diagnosticados con apnea de sueño. Seis personas tuvieron neumatización aberrante de huesos craneales, incluyendo 5 de 15 (33%) con apnea de sueño y uno de 23 (4%) sin apnea de sueño (p=0.027). El aire se localizó en las escamas temporales en 5 casos, en los huesos occipitales en uno y en ambas localizaciones en la persona restante. Conclusión: Existe una asociación entre apnea de sueño y neumatización aberrante de huesos del cráneo. Estos hallazgos tienen relevancia clínica ya que estos individuos pueden tener riesgo aumentado de fracturas de cráneo luego de traumas menores o de desarrollar fístulas espontáneas de líquido cefalorraquídeo.

Pneumatization of crista galli in pre-adult and adult stages / Neumatización de la crista galli en etapas pre adultas y adultas

The sinonasal region in humans is one of the regions that commonly shows anatomical variations. These variations can be easily diagnosed by paranasal CT evaluation. One of these variations is Crista galli pneumatization. In recent years, there have been opinions supporting the hypothesis that pneumatization originates from the frontal sinus. In this study, we planned to evaluate whether the presence of Crista galli pneumatization varied in pre-adult and adult periods. In this retrospectively designed study, 218 coronal paranasal CT images collected between 2012 and 2013 were evaluated. Patients were divided into two groups according to age under or over 18 years. In the group under the age of 18 (97 cases), pneumatization was detected in 2.1 % of samples, while in the group over the age of 18 (121 cases), crista galli pneumatization was observed in 15.7 % of samples. According to these results, crista galli pneumatization was found to increase in adulthood. Considering that the frontal sinus is in a rudimentary state at birth, it is radiographically detected first at 6 years of age, and reaches its main size in puberty, this increase in pneumatization runs parallel to the development of the frontal sinus. Consequently, this supports the opinion that crista galli pneumatization originates from the frontal sinus.

La región nasosinusal en los seres humanos con frecuencia muestran variaciones anatómicas. Estas variaciones se pueden diagnosticar fácilmente mediante la evaluación por tomografía computadorizada (TC) de los senos paranasales. Una de estas variaciones es la neumatización de la Crista galli. En los últimos años, se ha apoyado la hipótesis de que ésta neumatización se origina en el seno frontal. En este estudio fue evaluada la presencia de neumatización de la Crista galli y su posible variación en los períodos pre-adultos y adultos. Se realizó un estudio retrospectivo donde se evaluaron 218 imágenes de TC coronal de senos paranasales, recogidas entre 2012 y 2013. Los pacientes fueron divididos en dos grupos según la edad, menores o mayores de 18 años. En el grupo de menores de 18 años (97 casos), se detectó neumatización en el 2,1 % de las muestras, mientras que en el grupo de mayores de 18 (121 casos), se observó neumatización de la Crista galli en el 15,7 % de las muestras. De acuerdo con estos resultados, la neumatización de la Crista galli aumenta en la edad adulta. Teniendo en cuenta que el seno frontal se encuentra en un estado rudimentario en el nacimiento, se detecta radiográficamente a los 6 años de edad alcanzando su tamaño principal en la pubertad; este aumento de la neumatización es paralelo al desarrollo del seno frontal. En consecuencia, esto apoya la opinión de que la neumatización de la Crista galli se origina en el seno frontal.

The Correlation of Normal Adult Mastoid Pneumatization Volume and the History of Otitis Media in Childhood / 听力学及言语疾病杂志

Objective To explore the volume size of mastoid pneumatization in normal adults and the relation‐ship with a history of recurrent otitis media in childhood .Methods A total of in 40 adults (80 ears) ,based on with or without otitis media in childhood ,were divided into the study group (n= 20) and the control group (n=20) . The volume sizes of mastoid pneumatization were measured by temporal bone CT scanning of three-dimensional re‐construction ,and the relationship with the history of childhood ear infections was studied .Results The average vol‐ume of pneumatization in all 80 temporal bones was 10 .4 ± 1 .8 ml .The average volume of pneumatization in sub‐jects without otitis media history (48 ears) and subjects with a history of otitis media (32 ears) were 9 .7 ± 2 .2 ml and 6 .3 ± 1 .7 ml ,respectively .The difference was statistically significant (P0 .05) .Conclusion The volumes of mastoid pneumatization in normal ears have a wide range .The subjects with a history of recurrent otitis media in childhood may be the cause of the volume decrease of mastoid pneumatization in adulthood .

Anatomic Variation of Sphenoid Sinus in Mysore Based Population: CT Scan Study.

Introduction: Sphenoid sinus is the most inaccessible paranasal sinus, enclosed within the sphenoid bone and intimately related to numerous vital neural and vascular structures.The internal structure of the sphenoidal sinus varies greatly in different skulls and on opposite sides of the same skull, and the great differences observed may be responsible for the total lack of any previous attempt to determine the arrangement and significance of the ridges and septa which are frequently found therein. Objective : To study the sphenoid air sinus anatomy in detail in relation to its Morphology and Pneumatization. Material and Methods: 80 macerated skulls (Males=48, Females=32) of age group 40-60 yrs are cleaned and subjected to 3D axial multislider CT scan. Axial and coronal images of slice thickness of 4mm were obtained. sphenoid sinus symmetry and pneumatisation was observed and classified. To obtain proper evaluation of the neighboring structures and their relation to the sphenoid sinus, 2-mm contiguous slice thickness will be used from anterior to posterior sphenoid sinus. Results: The present study showed symmetry in 56 skulls( 70%) , asymmetry in 18 skulls(22.5%) and presence of transverse septa in 6 skulls (7.5%). The sellar type of pneumatisation in 68 skulls (85%), presellar type in 8(10%) and post sellar type in 4 skulls (5%). Conclusion: This study will prove invaluable in the trans-sphenoidal approach to the pituitary as this technique needs thorough understanding of the pituitary fossa and surrounding structures.

Arrested pneumatization of the sphenoid sinus mimicking intraosseous lesions of the skull base

Arrested pneumatization of the sphenoid sinus is a developmental variant that is not always well recognized and is often confused with other pathologies associated with the skull base. This report describes the case of a patient referred for cone-beam computed tomography (CBCT) imaging for dental implant therapy. CBCT demonstrated a well-defined incidental lesion in the left sphenoid sinus with soft tissue-like density and sclerotic borders with internal curvilinear opacifications. The differential diagnoses included intraosseous lipoma, arrested pneumatization of the sphenoid sinus, chondrosarcoma, chondroid chordoma, and ossifying fibroma. The radiographic diagnosis of arrested pneumatization was based on the location of the lesion, its well-defined nature, the presence of internal opacifications, and lack of expansion. Gray-scale CBCT imaging of the area demonstrated values similar to fatty tissue. This case highlighted the fact that benign developmental variants associated with the skull base share similar radiographic features with more serious pathological entities.

Anatomic variations of sphenoid sinus pneumatization in a sample of Turkish population: MRI study / Variaciones anatómicas de la neumatización del seno esfenoidal en una muestra de población turca: estudio por resonancia magnética

There are a number of variations regarding morphometric anatomy and degree of pneumatization of the sphenoid sinus. In our study, we planned to examine and show the differences of pneumatization of the sphenoid sinus particularly to guide the neurosurgeon during transsphenoidal surgery. Sagittal T1-weighed spin-echo Magnetic Resonance Images (MRIs) of 616 adult individuals (406 women and 210 men) were analyzed, retrospectively. According to the collected data from our study, the most common type of the sphenoid sinus was the sellar type (83%; n=511) for the whole study group. Of the 616 individuals 16.6% (n=102) had presellar type and 0.5% (n=3) had conchal type of sphenoid sinus. Preoperative detailed detection of the anatomical characteristics of sphenoid sinus is essential. A thorough information obtained from studies of the regional anatomy and awareness of its variability can provide a safe and accurate transsphenoidal and extended endoscopic skull base approaches.

Existen variaciones respecto a la anatomía morfométrica y el grado de neumatización del seno esfenoidal. En nuestro estudio, se examinaron las diferencias de neumatización del seno esfenoidal, especialmente para guiar al neurocirujano durante la cirugía transesfenoidal. Fueron analizadas las imágenes sagitales T1-spin de resonancia magnética (RM) de 616 individuos adultos (406 mujeres y 210 hombres). De acuerdo con los datos obtenidos a partir de nuestro estudio, el tipo más común de seno esfenoidal fue el de silla turca (83%, n=511) para todo el grupo de estudio, 16,6% (n=102) corresponden al tipo presellar y 0,5% (n=3) al tipo conchal. Una detección preoperatoria detallada de las características anatómicas del seno esfenoidal es esencial. Información exhaustiva obtenida de los estudios de la anatomía y el conocimiento de su variabilidad regional puede proporcionar un abordaje endoscópico transesfenoidal extenso, seguro y preciso, de la base de cráneo.

Morphologic Analysis of Crista Galli Using Computed Tomography

OBJECTIVE: We often observe the variation of Crista galli (CG) which lies in the midline above the cribriform plate on computed tomography (CT) scans. We investigated the variations in CG and the factors which affect its pneumatization. MATERIALS AND METHODS: We analyzed the CT images of 818 chronic rhinosinusitis patients between July 2003 and July 2011. We investigated height, position relative to the cribriform plate, degree of pneumatization, and cell origin for the pneumatization in CG. We analyzed the relationship between several factors (age, sex, and position of CG) and pneumatization of CG. RESULTS: The average height of CG was 17.98 mm. In 13.9% of subjects, the base of CG did not extend below the level of the cribriform plate. In 84.2%, CG extended less than 50% of its height below the cribriform plate. In 1.8%, CG extended more than 50% of its height below the cribriform plate. Pneumatization of CG was found in 12.2%. Except one, every pneumatization was connected with the frontal sinus. The rate of pneumatization was significantly different depending on age. CONCLUSION: Our study demonstrated that CG showed various morphology and pneumatizaiton. The pneumatization of CG was mainly originated from frontal sinus and related to aging.

Epitympanic Development and Mastoid Pneumatization in Chronic Otitis Media with and without Cholesteatoma

BACKGROUND AND OBJECTIVES: Chronic otitis media (COM) is strongly related to the degree of aeration of the middle ear and mastoid. The developmental pattern of these air cell systems can affect those of COM, especially cholesteatoma, or vice versa. We investigated several anatomical indexes representing the middle ear and mastoid air cell system to research their relationship with different types of COM. SUBJECTS AND METHODS: Temporal bone computed tomography were performed on 51 patients with cholesteatoma, 50 with COM, and 50 normal subjects. Height of epitympanum, degree of mastoid pneumatization and anterior epitympanic space (AES) development were measured. AES development was classified into three categories: undeveloped, single cell and multiple cells. Anatomical index measurements were compared according to the types of COM. RESULTS: The mean height of epitympanum was 5.12mm in cholesteatoma, 6.04 mm in COM, and 7.40 mm in normal group (p<0.05). The degree of pneumatization was 20.9%, 17.2%, and 42.2% respectively. AES was undeveloped in 65%, single cell in 33%, and multiple cells in only 2% of cholesteatoma patients. In COM and normal groups, the proportions of AES were 60%, 30%, 10% and 7%, 48%, 45% respectively (p<0.05). Comparing between attic and pars tensa types of cholesteatoma, all indexes failed to show any difference. However, there was a significant difference in height of epitympanum between affected ear (5.12 mm) and contralateral ear (5.62 mm) in cholesteatoma group. CONCLUSIONS: In patients with COM, the degree of development of epitympanum and AES are significantly lower than control group. We believe epitympanic underdevelopment may be related to the pathogenesis of COM, especially with cholesteatoma.