Application of Sphenoid Sinus Morphological Characteristics in Sex Estimation Based on Magnetic Resonance Imaging Images / Aplicación de las Características Morfológicas del Seno Esfenoidal en la Estimación del Sexo Basada en Imágenes de Resonancia Magnética

SUMMARY: Sex determination of unknown persons plays an important role in forensic science. As most bones used for sex determination are recovered in incomplete state, it is often necessary to use bones that are recovered intact e.g., the sphenoid sinus. This study aimed to evaluate the diagnostic value of sphenoid sinuses dimensions for sex determination using Magnetic Resonance Imaging (MRI) images in Chinese adults. MRI images of 79 sphenoid sinuses (from 44 men and 35 women) were retrospectively selected. The height, anterior-posterior diameter, area, and perimeter were measured in the midsagittal view of the sphenoid sinuses. All data were subjected to descriptive and discriminative functional analysis with unpaired t-test and canonical discriminant. Comparison between male and female groups showed significant statistical differences regarding the height, anterior-posterior diameter, area, and perimeter of sphenoid sinuses. The predictive accuracy rate of the sphenoid sinus to identify sex was 63.6 % in males and 62.9 % in females with an overall accuracy of 63.3 %. This study proposed the importance of sexual dimorphism of sphenoid sinus dimensions, especially if other methods are not available. It suggested using MRI in forensics science thus obviating the complete dependence on the usage of conventional computed tomography (CT) and facilitating the study of forensic anatomy at the level of soft tissue.

La determinación del sexo de personas desconocidas juega un papel importante en la ciencia forense. Como la mayoría de los huesos utilizados para la determinación del sexo se recuperan en un estado incompleto, a menudo es necesario utilizar huesos recuperados intactos, por ejemplo, el seno esfenoidal. Este estudio tuvo como objetivo evaluar el valor diagnóstico de las dimensiones de los senos esfenoidales para la determinación del sexo utilizando imágenes de resonancia magnética en individuos adultos chinos. Se seleccionaron retrospectivamente imágenes de resonancia magnética de 79 senos esfenoidales (de 44 hombres y 35 mujeres). La altura, el diámetro anteroposterior, el área y el perímetro de los senos esfenoidales, se midieron en vista mediana sagital. Todos los datos se sometieron a análisis funcional descriptivo y discriminativo con prueba t no pareada y discriminante canónico. La comparación entre los grupos de hombres y mujeres mostró diferencias estadísticas significativas en cuanto a la altura, el diámetro anteroposterior, el área y el perímetro de los senos esfenoidales. La tasa de precisión predictiva del seno esfenoidal para identificar el sexo fue del 63,6 % en hombres y del 62,9 % en mujeres, con una precisión general del 63,3 %. Este estudio propuso la importancia del dimorfismo sexual de las dimensiones del seno esfenoidal, especialmente si no se dispone de otros métodos. Se sugiere utilizar la resonancia magnética en la ciencia forense, obviando así la dependencia total del uso de la tomografía computarizada convencional y facilitando con esto el estudio de la anatomía forense a nivel de los tejidos blandos.

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.

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.

Nasosinusal Endoscopic Anatomy and Physiology

The present article focuses on the analysis of the nasal cavity's anatomy succinctly and descriptively. This essay was carried out through a bibliographic review, directed to the detailed anatomy of the nasal cavity, and the structures that form its sinuses. We have identified the need formore studies directed to the related anatomical area so that the improved knowledge of this region ensures a nasoendoscopic treatment with better effectiveness and no complications.

Sinus computed tomography findings in patients with COVID-19 / Achados de imagem em tomografias computadorizadas de seios paranasais em pacientes com COVID-19

ABSTRACT Objective: To analyze computed tomography scans of paranasal sinuses of a series of patients with coronavirus disease 2019, and correlate the findings with the disease. Methods: Computed tomography scans of 95 adult patients who underwent a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were analyzed. Clinical data were obtained from patients' records and telephone calls. Paranasal sinus opacification was graded and compared according to severe acute respiratory syndrome coronavirus 2 positivity. Results: Of the patients 28 (29.5%) tested positive for severe acute respiratory syndrome coronavirus 2 (median age 52 [range 26-95] years) and 67 were negative (median age 50 [range 18-95] years). Mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses. Minimal or mild mucosal thickening (score 1)and normally aerated sinuses (score 0) corresponded to 71.4% and 21.3% of all paranasal sinuses, respectively. The mean score of each paranasal sinus among severe acute respiratory syndrome coronavirus 2 positive and negative patients was 0.85±0.27 and 0.87±0.38, respectively (p=0.74). Median paranasal sinus opacification score among severe acute respiratory syndrome coronavirus 2 positive patients was 9 (interquartile range 8-10) compared to 9 (interquartile range 5-10) in negative patients (p=0.89). There was no difference in mean score adjusted for age and sex. Nasal congestion was more frequent in severe acute respiratory syndrome coronavirus 2 positive than negative patients (p=0.05). Conclusion: Severe acute respiratory syndrome coronavirus 2 infection was associated with patient recall of nasal congestion, but showed no correlation with opacification of paranasal sinuses.

RESUMO Objetivo: Analisar imagens de tomografia computadorizada de seios paranasais de pacientes com a doença por coronavírus 2019, e correlacionar os achados com a doença. Métodos: Foram analisadas imagens de tomografia computadorizada de 95 pacientes submetidos a teste de reação em cadeia da polimerase para coronavírus 2 da síndrome respiratória aguda grave. Os dados clínicos foram obtidos por meio dos prontuários dos pacientes e de ligações telefônicas. A opacificação dos seios paranasais foi graduada e comparada entre pacientes positivos e negativos para coronavírus 2 da síndrome respiratória aguda grave. Resultados: Vinte e oito (29,5%) dos pacientes tiveram resultado positivo para coronavírus 2 da síndrome respiratória aguda grave (idade mediana de 52 [26-95] anos) e 67, resultado negativo (idade mediana de 50 [18-95] anos). O espessamento mucoso estava presente em 97,4% dos seios maxilares, 80% das células etmoidais anteriores, 75,3% das células etmoidais posteriores, 74,7% dos seios frontais e em 66,3% dos seios esfenoidais. Mínimo ou discreto espessamento mucoso (pontuação 1) e seios com aeração normal (pontuação 0) corresponderam a 71,4% e 21,3% de todos os seios paranasais, respectivamente. A nota média de cada seio paranasal entre pacientes positivos e negativos para coronavírus 2 da síndrome respiratória aguda grave foi de 0,85±0,27 e 0,87±0,38, respectivamente (p=0,74). A nota mediana de opacificação dos seios paranasais entre pacientes positivos para coronavírus 2 da síndrome respiratória aguda grave foi de 9 (intervalo interquartil de 8 a 10), comparada a 9 (intervalo interquartil de 5 a 10) em pacientes negativos (p=0,89). Não houve diferença na nota média ajustada para idade e sexo. A congestão nasal foi mais frequente em pacientes positivos para coronavírus 2 da síndrome respiratória aguda grave que naqueles com resultados negativos (p=0,05). Conclusão: A infecção pelo coronavírus 2 da síndrome respiratória aguda grave apresentou associação com congestão nasal, mas não mostrou correlação com espessamento mucoso dos seios paranasais.

Study of the pterygoid canal (vidian canal) through images of cone beam computer tomography / Estudo do canal Pterigóideo (canal Vidiano) por meio de imagens de tomografia computadorizada de feixe cônico

Objective: The aim of this study was to evaluate the pterygoid canal (PC) by Cone Beam Computed Tomography (CBCT), establishing its configuration and proximity with anatomical structures. Material and Methods: We evaluated 398 CBCT exams, all from a public University radiology clinic archive. Four parameters were evaluated: single or double PC, distance between PC and the inferior part of the sphenoid sinus (SS), ratio of PC and SS and the distance between the PC and the foramen rotundum. Results: It was observed that most of the PC of the sample presented simple morphology, the most frequent type of relationship between the PC and the SS on both sides was the close contact with the wall. Among the cases that there were some distances between the PC and the inferior wall of the SS, the mean of this distance did not exceed 3.20 mm, being the left side (3.03 mm) slightly closer than the right (3.20 mm). Finally, the distances between the PC and the corresponding Foramen Rotundum are presented with mean values of 5.87 mm for the right side and 6.31 mm for the left side. Conclusion: CBCT examination is of paramount importance for PC identification; once in the studied sample, the mean values found evidence the close relation between the PC and the SS (AU)

Objetivo: O objetivo deste estudo foi avaliar o CP pela TCFC, estabelecendo sua configuração e proximidade com estruturas anatômicas. Material e Métodos: Foram avaliados 398 exames de TCFC, todos de um arquivo público da clínica de radiologia da Universidade. Foram avaliados quatro parâmetros: CP único ou duplo, distância entre PC e parte inferior do seio esfenoidal (SS), razão entre PC e SS e a distância entre o PC e o forame redondo. Resultados: Observou-se que a maioria dos CP da amostra apresentava morfologia simples, o tipo de relação mais frequente entre o CP e o SS de ambos os lados foi o contato próximo com a parede. Entre os casos em que houve algumas distâncias entre o CP e a parede inferior da ES, a média dessa distância não excedeu 3,20 mm, sendo o lado esquerdo (3,03 mm) um pouco mais próximo do que o direito (3,20 mm). Finalmente, as distâncias entre o PC e o forame redondo correspondente são apresentadas com valores médios de 5,87 mm para o lado direito e 6,31 mm para o lado esquerdo. Conclusão: O exame TCFC é de suma importância para a identificação do CP; uma vez na amostra estudada, os valores médios encontrados evidenciam a estreita relação entre o CP e o SS. (AU)

Adenoma hipofisario ectópico del seno esfenoidal persistente tras cirugía manejado con tratamiento conservador / Ectopic pituitary adenoma in the sphenoid sinus persistent after surgery managed with conservative treatment

Los adenomas hipofisarios ectópicos (EPA) constituyen un reto diagnóstico, dada su escasa prevalencia y variada presentación en la que puede incluirse un síndrome de hipersecreción de hormonas hipofisarias. La clínica suele ser larvada e inespecífica, no presentan ninguna característica radiológica diferencial y el diagnóstico habitualmente es anatomopatológico. Sin embargo, a pesar de ser tumores benignos, pueden presentar un comportamiento agresivo, con invasión ósea y difícil resección completa, por lo que un diagnóstico de sospecha precoz podría resultar en un tratamiento más eficaz y con un menor número de complicaciones. Presentamos el caso de una paciente con un adenoma hipofisario ectópico silente en el seno esfenoidal con inmunohistoquímica positiva para Hormona de crecimiento (GH) y prolactina que presentaba restos tumorales tras la intervención quirúrgica y ha sido manejada con tratamiento médico conservado, con buenos resultados.

Ectopic pituitary adenomas constitute a diagnostic challenge, given their low prevalence and varied presentation in which a pituitary hormone hypersecretion syndrome may be included. Clinical symptoms are usually latent and nonspecific, they have no differential radiological characteristics and the diagnosis is usually anatomopathological. However, despite being benign tumors, they can exhibit aggressive behavior, with bone invasion and difficult complete resection, so a diagnosis of early suspicion could result in more effective treatment and fewer complications. We present the case of a patient with a silent ectopic pituitary adenoma in the sphenoid sinus with positive immunohistochemistry for Growth Hormone (GH) and prolactin who had tumor remnants after surgery and was managed with conservative medical treatment, with good results.

Blindness from fungal rhinosinusitis of the paranasal sinuses: A case report

@#Objective: To present a unique case of blindness resulting from fungal rhinosinusitis involving multiple sinuses mimicking a malignant process in a pregnant patient. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Result: A 36-year-old pregnant woman developed unilateral blindness during her 20th week of gestation with a history of binocular diplopia, unilateral nasal obstruction and anosmia for 13 months during the pre-pregnancy period. Sphenoid sinus malignancy was suspected on imaging. The planned biopsy was intraoperatively shifted to endoscopic sinus surgery when clay-like materials were seen involving the left maxillary sinus and bilateral sphenoid and ethmoid sinuses. Histopathologic examination confirmed fungal growth. Postoperatively, nasal symptoms resolved but blindness of the left eye and blurring of vision of the right eye persisted. Conclusion: Fungal rhinosinusitis rarely occurs in multiple sinuses and is commonly misdiagnosed. It can afflict pregnant patients and mimic a malignant process. A high index of suspicion early on, especially in the presence of nasal congestion and diplopia may prevent potentially irreversible complications.

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.

Neumatización gigante del seno esfenoidal: Reporte de cuatro casos y revisión de la literatura / Giant pneumatization of sphenoid sinus: Report of four cases and review of literature

El hueso esfenoidal ocupa la mayor parte de la zona anterior de la fosa craneal media, está compuesto por un cuerpo, dos pares de alas (mayores y menores) las que se proyectan lateralmente desde el cuerpo, y dos procesos pterigoideos proyectados inferior y lateralmente de las coanas. Este hueso representa el límite entre la fosa craneal anterior y media. Usualmente, el seno esfenoidal se encuentra ubicado en su cuerpo, el cual presenta una gran variación en su neumatización, variando desde ausente hasta extenso. Puede extenderse a distintas partes del hueso esfenoidal e inclusive a estructuras óseas cercanas. Su localización profunda hace difícil el diagnóstico mediante radiografías, especialmente cuando se utilizan técnicas convencionales. Se presentan cuatro casos de neumatización gigante del seno esfenoidal observados como hallazgo imagenológico. (AU)

Sphenoid bone occupies most of the anterior part of the middle part of the skull base, it is compound by a body, two pair of wings (greater and lesser) which are laterally projected from the body and two pterygoid process projected inferiorly and laterally from choana. This bone represents the limit between the anterior and middle cranial fossa. Usually, the sphenoid sinus is located in the sphenoid body, and has a large variation in its pneumatization, ranging from absent to extensive. It is able to extent to different parts of the sphenoid bone or even to surrounding ones. The deep location makes difficult the radiographic diagnosis, especially when conventional radiographic techniques are used. Four cases of a giant pneumatization of the sphenoid sinus are presented observed as a radiological finding. (AU)

The determination of sphenoid sinus dimensions in Turkish healthy adult subjects: an MRI study / Determinación de las dimensiones del seno esfenoidal en sujetos adultos sanos turcos: un estudio de resonancia magnética

SUMMARY: The aim of this study was to identify sphenoid sinus dimensions; and distance between columella nasal and sphenoid sinus; and columella nasal and hypophysis in healthy adult subjects using magnetic resonance imaging (MRI) and to evaluate differences between genders and age groups. The MRI results of 300 healthy subjects (192 females; 108 males) aged 18-68 years were studied. The midsagittal and axial images were used for shape of the sphenoid sinus, and the distance measurements of its related adjacent structures on MRI. The mean values of the distance between columella nasal; and columella nasal and hypophysis; and sinus sphenoidalis width were 65.73±5.22 mm, 87.05±4.79 mm and 37.67±8.40 mm in females respectively, whereas the same values were 71.79±5.06 mm, 94.52±6.07 mm and 41.95±9.32 mm in males, respectively. The means of all measurements were lower in healthy female subjects than in healthy males.Additionally, the classification of sphenoid sinus types were determined to be postsellar type (131), sellar type (46), presellar type (14) and conchal type (1) in females, respectively. The same measurement were determined as postsellar type (82), sellar type (23) and presellar type (3) in males, respectively. Differences between sexes and age related changes were observed in the variations of the size, location and shape of sphenoid sinus were observed The observations presented in this report have defined anatomic parameters that need to be taken into consideration for reference data to determine gender discrepancies, age related changes and helpful for radiologists and clinicians to plan safe surgical approach and avoid surgical risks.

RESUMEN: El objetivo de este estudio fue identificar las dimensiones del seno esfenoidal y la distancia entre la columela nasal y el seno esfenoidal y, la glándula nasal y la hipófisis en sujetos adultos sanos con imágenes de resonancia magnética (RM), para evaluar las diferencias entre los sexos y los grupos de edad. Se estudiaron los resultados de RM de 300 sujetos sanos (192 mujeres, 108 hombres) de 18 a 68 años. Se usaron imágenes sagitales y axiales para la forma del seno esfenoidal y las mediciones de distancia de sus estructuras adyacentes relacionadas en la RM. Los valores medios de la distancia entre columela nasal; y columela nasal e hipófisis; y la anchura del seno esfenoidal fue de 65,73 ± 5,22 mm, 87,05 ± 4,79 mm y 37,67 ± 8,40 mm en mujeres, respectivamente, mientras que los mismos valores fueron de 71,79 ± 5,06 mm, 94, 52 ± 6,07 mm y 41,95 ± 9,32 mm en varones, respectivamente. Las medias de todas las mediciones fueron menores en mujeres sanas que en hombres sanos. Adicionalmente, se determinó que la clasificación del seno esfenoidal era de tipo postsellar (131), tipo selar (46), tipo presellar (14) y tipo conchal (1), en las mujeres, respectivamente. Las mismas medidas se determinaron como tipo postsellar (82), tipo sellar (23) y tipo presellar (3) en varones, respectivamente. Se observaron diferencias entre sexos y los cambios relacionados con la edad en las variaciones de tamaño, ubicación y forma del seno esfenoidal. Las observaciones presentadas en este informe establecen parámetros anatómicos que se deben considerar como referencia para determinar las diferencias de sexo, y edad. La información de estas diferencias será útil para los radiólogos y los médicos en la planificación de un abordaje quirúrgico seguro y para evitar riesgos quirúrgicos.

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.

A Case of Septal Abscess and Sphenoid Sinusitis after Dental Implant / 대한이비인후과학회지

A nasal septal abscess results from the collection of purulent fluid between the cartilage of bony septum and overlying mucoperichondrium or mucoperiosteum. Unless early diagnosis and surgical treatment are performed, serious complications such as cavernous sinus thrombophlebitis, sepsis, and saddle nose may occur. We report a case of septal abscess and sphenoid sinusitis that occurred after dental implant. A 74-year-old female with diabetes and liver cirrhosis was referred to the hospital for management of rapidly aggravated perinasal pain, nasal obstruction, and headache. The patient had undergone dental implant in the right upper incisor area 6 days ago. A CT revealed septal abscess and bilateral sphenoid sinusitis. The patient was operated upon to drain septal abscess, and both sphenoid sinuses were opened widely.

Two Cases of Bilateral Paranasal Sinus Fungus Balls with Sphenoid Sinus Involvement / 대한이비인후과학회지

A fungus ball is the most common manifestation of fungal sinusitis. Bilateral involvement of fungus balls is rare, and bilateral sphenoid involvement is even more uncommon. The authors report two cases of bilateral fungus balls with sphenoid sinus involvement successfully treated with endoscopic sinus surgery. Both patients complained of nonspecific headache; diagnoses were made with CT and histopathological examinations, and surgical removal was achieved via transostial approach. Bilateral fungus balls involving the sphenoid sinus are rare but do occur; their removal is possible through endoscopic sinus surgery with a high cure rate. We thus recommend using CT scanning to identify typical findings of a sphenoid fungus ball even in bilateral paranasal sinusitis and perform aggressive surgical treatment.

Evaluation of Sodium and Chloride Biochemical Tests in Drowning Autopsy Cases / 대한법의학회지

There are several diagnostic findings required for confirming a postmortem diagnosis of drowning. However, postmortem diagnosis of drowning remains challenging for forensic pathologists. In previous reports, several biochemical tests using various body fluids have been studied for their potential use in the postmortem diagnosis of drowning. In this study, the concentration of sodium and chloride was tested in various postmortem body fluids (vitreous humor, sphenoid sinus fluid, pleural fluid, cerebrospinal fluid, etc.) and their results were interpreted for their potential use in postmortem diagnosis of drowning. We examined 67 autopsy cases (freshwater drowning, 12 cases; seawater drowning, 16 cases; control group, 39 cases). The sodium and chloride concentration in the vitreous humor, sphenoid sinus fluid, and pleural fluid significantly correlated with each other. Furthermore, the concentrations of sodium, chloride, and the sum of the concentrations of the two in the various postmortem body fluids were significantly different in the three groups, when compared with each other (generally the concentration being the highest in the seawater drowning group, followed by the control group and the freshwater drowning group). Biochemical tests using various postmortem body fluids may serve as useful indicators for the postmortem diagnosis of drowning and for the differential diagnosis between freshwater and seawater drowning.

Epidural Abscess Caused by Eikenella corrodens in a Previously Healthy Child

Eikenella corrodens rarely causes invasive head and neck infections in immunocompetent children. We report a case of epidural abscess caused by E. corrodens in a previously healthy 13-year-old boy who presented with fever, headache, and vomiting. On physical examination upon admission, there was no neck stiffness, but discharge from the right ear was observed. Brain magnetic resonance imaging (MRI) revealed approximately 4.5-cm-sized epidural empyema on the right temporal lobe as well as bilateral ethmoid and sphenoid sinusitis, right mastoiditis, and right otitis media. During treatment with vancomycin and cefotaxime, purulent ear discharge aggravated, and on follow-up brain MRI, the empyema size increased to 5.6×3.4 cm with interval development of an abscess at the right sphenoid sinus. Burr hole trephination was performed, and foul-smelling pus was aspirated from the epidural abscess near the right temporal lobe. Pus culture yielded E. corrodens. Endoscopic sphenoidotomy was also performed with massive pus drainage, and the same organism was grown. The patient was treated with intravenous cefotaxime for 3 weeks and recovered well with no other complications. Therefore, E. corrodens can cause serious complications in children with untreated sinusitis.

Referencias anatómicas óseas en tomografía computada para el abordaje transesfenoidal a la base de cráneo / Anatomical bone landmarks in computed tomography for the transsphenoidal approach to the skull base

Objetivo: Aportar valores teóricos promedio de referencias anatómicas en tomografía computada con el fin de optimizar los abordajes transesfenoidales a la base de cráneo. Materiales y Métodos: Se desarrolló un diseño descriptivo, prospectivo, transversal y observacional de cien estudios de tomografía computada de macizo facial y base de cráneo. Mediante planillas de registro diseñadas ad Hoc, se confeccionó la base de datos considerando: sexo, edad, línea media, posición del rostrum esfenoidal y de la silla turca, posición de los ostium esfenoidales, presencia de las paredes óseas del seno esfenoidal, distancia entre las arterias carótidas internas y los nervios ópticos, neumatización de los recesos óptico-carotídeos, neumatización del seno esfenoidal, dimensiones del seno esfenoidal, número de tabiques intra-seno esfenoidal y su sitio de inserción posterior. Resultados: El rostrum esfenoidal es el mejor reparo de línea media para los abordajes transesfenoidales a la región selar. Los tabiques internos no deben considerarse como reparos de línea media seguros. Los ostium esfenoidales se localizan laterales a la línea media y conforman un sitio seguro para iniciar la apertura de la pared anterior del seno esfenoidal. Las paredes óseas laterales del seno esfenoidal no siempre están presentes a nivel de las prominencias carotídeas y ópticas. El canal de trabajo para abordar la silla turca está determinado por la distancia entre ambas arterias carótidas internas, siendo en promedio de 11,24 mm. Conclusión: La tomografía computada permite obtener un conocimiento de la anatomía del seno esfenoidal preciso para la planificación de un abordaje transesfenoidal a la silla turca o extendida a la base de cráneo.

Objective: To provide average theoretical values for anatomic references in computed tomography (CT) images and, thereby, improve the transsphenoidal approach to the skull base. Methods and Materials: A descriptive, prospective, cross-sectional, observational study was conducted of 100 CT evaluations of facial bones and the skull base. A database was created using ad hoc registration forms, entering data on patient gender and age, midline, position of the sphenoid rostrum, position of the sella, position of the sphenoid ostium, presence of the bony walls of the sphenoid sinus relative to the carotid and optic prominences, distance from the internal carotid arteries, distance between the optic nerves, pneumatization of the optic-carotid recesses, pneumatization of the sphenoid sinus, dimensions of the sphenoid sinus, and the number and posterior insertion sites of sphenoid septa. Results: The sphenoid rostrum was found to be the best midline reference for transsphenoidal approaches to the sellar region. Internal septa should not be considered safe midline references. The sphenoid ostium are located laterally to the midline, and are a safe site at which to initiate the opening of the anterior wall of the sphenoid sinus in the mid-caudal direction. The lateral bony walls of the sphenoid sinus are not always present at the carotid and optic prominence levels. The working channel to approach the sella is determined by the distance between the internal carotid arteries, the average distance being 11.24 mm. Conclusions: Computed tomography reveals the anatomy of the sphenoid sinus and sellar region and, thus, facilitates the trans-sphenoidal approach to the skull base.

The septation of the sphenoidal air sinus: a cadaveric study / Septación del seno esfenoidal: investigación cadavérica

The purpose of this study was to investigate the sphenoidal sinus septation in a select South African population, and document the relation of the number and location of the septa to the structures intimately related to the sinus. The intersinus and intrasinus septa of the sinus, the number and attachments of the septa were recorded from forty five cadaveric head specimens. The sphenoidal sinus intersinus septa were recorded as follows: Type 0 (absent septum) in 7.5 %, Type 1 (single septum) in 65 % and Type 2 (double septa) in 22.5 % of cases. The incidence of intersinus septa deviating to the left was prevalent; hence, the right sphenoidal sinus was dominant. The occurrence of intrasinus septa was observed in 93.3 % of cases, with a higher prevalence in males. The intrasinus septa formed cave like chambers on the sinus walls in 65.6 % cases. Incidences of the intersinus septa attaching to sella turcica (ST) (46.25 %) were prevalent compared to cases where they attached to the internal carotid artery (ICA) (6.25 %), maxillary (MN) (1.25 %) and vidian (VN) (1.25 %) nerves. However, the intrasinus septa attached more to the ICA (52.63 %) compared to their attachment to the other neurovascular structures (ST - 26.32 %; MN - 5.36 % and VN - 2.63 %). Surgeons need to be aware of the complex anatomical variations of the sphenoidal sinus septation when performing endoscopic endonasal transsphenoidal surgeries.

El propósito de este estudio fue investigar la septación del seno esfenoidal en una población sudafricana y documentar la relación del número y la ubicación de los septos en relación a las estructuras íntimamente relacionadas con el seno. Los septos interseno e intraseno del seno, el número y las uniones de los septos se registraron a partir de cuarenta y cinco cadáveres. El septo interseno del seno esfenoidal se registró de la siguiente manera: Tipo 0 (tabique/septo ausente) en el 7,5 %, Tipo 1 (tabique/septo único) en el 65 % y Tipo 2 (tabiques/septos dobles) en el 22,5 % de los casos. La incidencia de septos intersenos desviados hacia la izquierda fue prevalente. Por lo tanto, el seno esfenoidal derecho fue dominante. La ocurrencia de septo intraseno se observó en el 93,3 % de los casos, con una mayor prevalencia en varones. Los septos intrasenos formaron cámaras, como cuevas, en las paredes del seno en un 65,6 % de los casos. La incidencia de septos intersenos que se adhieren a la silla turca (ST) (46,25 %) fueron prevalentes en comparación con los casos en que se unieron a la arteria carótida interna (ACI) (6,25 %), al nervio maxilar (NM) (1,25 %) y nervio vidiano (NV) (1.25%). Sin embargo, los septos intersenos se adhirieron más a la ACI (52,63 %) en comparación con su unión a otras estructuras neurovasculares (ST - 26,32 %; NM -5,36 % y NV - 2,63 %). Los cirujanos deben ser conscientes de las complejas variaciones anatómicas de la tabicación del seno esfenoidal cuando se realizan cirugías transesfenoideas endonasales endoscópicas.

Pneumatization of the Frontal and Sphenoid Sinus in Korean Adults: A Study of Using Computed Tomography Scans / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For safe sinus surgery, it is essential to understand the anatomical structure and developmental state of the paranasal sinuses. Structural abnormalies such as aplastic and marked hypoplastic sinuses may not be amenable to sinus surgery or balloon sinuplasty. The purpose of this study is to evaluate the degree of pneumatization of the frontal and sphenoid sinuses in Korean adults. SUBJECTS AND METHOD: This retrospective study utilized CT images of 1190 sides from 595 Korean adults. The frontal sinus was classified into normal, hypoplasia, aplasia and unilateral hidden aplasia. The sphenoid sinus was evaluated the incidence regarding the aplasia and unilateral hidden hypoplasia. RESULTS: Bilateral frontal sinus hypoplasia was observed in 8.5% of women and 4.2% of men (p 0.05). Bilateral frontal sinus aplasia was observed in 7.1% of women and 2.9% of men (p 0.05). Unilateral hidden frontal sinus aplasia was observed in 1.7% of women and 1.5% of men (p>0.05). There was no bilateral sphenoid sinus aplasia and only one woman had unilateral sphenoid sinus aplasia. Unilateral hidden sphenoid sinus hypoplasia was observed in 1.4% of women and 2.9% of men (p>0.05). CONCLUSION: Bilateral frontal sinus hypoplasia and aplasia are more common in women than in men. Although the incidences of unilateral hidden frontal sinus aplasia and hidden sphenoid sinus hypoplasia are low, sinus surgeons should carefully review CT for sinus surgery or balloon sinuplasty.

Traumatic cerebrospinal fluid leakage following septorhinoplasty

Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.