The incidence of pneumatised inferior turbinate and relation to close anatomic structures.

BACKGROUND: Pneumatisation of the inferior turbinate (PIT) is a rare abnormality of the paranasal sinus. It is very difficult to differentiate from the hypertrophia of the inferior turbinate clinically. Thus, it is important to be considered, especially in cases with no response to medical treatments. We aimed to investigate the presence and the frequency of PIT by computed tomography (CT). MATERIALS AND METHODS: A total of 2905 cases (1381 female, 1524 male) with an age range between 16 and 84 were included. RESULTS: The pneumatisation of the inferior turbinate was observed in 1.72% of the cases with a percentage of 1.88% in women and 1.57% in men. In PIT (+) cases the bilaterality was found in 54% of them. According to the subtypes, 70% was lamellar, 28% was bullous and 2% was extensive. No statistically significant difference was found for age distribution. The most commonly associated variations were the pneumatisation of the middle and upper turbinate and the septal deviation. CONCLUSIONS: The pneumatisation of the inferior turbinate is a rare variation with a similar frequency among men and women. It is diagnosed by CT and when symptomatic, the optimal treatment is surgery.

MRI-based detailed evaluation of the anatomy of the human coccyx among Turkish adults.

AIM: The human coccyx varies considerably in shape and size. The objective of this study was to investigate the morphology and morphometry of the coccyx on pelvic magnetic resonance imaging in asymptomatic individuals among Turkish adults. MATERIALS AND METHODS: This study was conducted retrospectively on the pelvic magnetic resonance images of 456 adult patients without a history of trauma in the coccyx region. The coccygeal vertebrae count, number of bone segments, and intercoccygeal and sacrococcygeal joint fusions were determined from the sagittal plane images. In addition, the length and angles (the sacrococcygeal angle, intercoccygeal joint angle, and sacrococcygeal joint angle) were measured. STATISTICAL ANALYSIS USED: Data were analyzed using the T-test or Mann-Whitney U-test, the ANOVA, or Kruskal-Wallis tests, and the chi-square test was used for the categorical variables. RESULTS: The coccyx is formed by four, five, or three vertebrae in a decreasing ratio. The coccyx is composed of one to five bone segments; one bone segment was found in 2.8% of the cases. Intercoccygeal joint fusions been observed predominantly in the last intercoccygeal joint, with or without sacrococcygeal joint fusion. The coccyx was found to be longer in adult males than in adult females. The sacrococcygeal angle might be anteverted or retroverted. CONCLUSION: The findings are contrary to the conventional knowledge in that the vertebrae shaping the coccyx were completely fused and consisting of a single bone in very few cases. Better understanding of the anatomical variation of the coccyx may be useful for clinicians evaluating patients presenting with conditions in the coccygeal region.

Central region morphometry in a child brain; age and gender differences.

BACKGROUND: Data on central region morphometry of a child brain is important not only in terms of providing us with information about central region anatomy of the brain but also in terms of the help of this information for the plans to be applied in neurosurgery. OBJECTIVE: In the present study, central region morphometry of a child brain in mid-sagittal MR images was analyzed in age and gender groups. MATERIALS AND METHODS: Different points determined previously, commissura posterior0 (PC) and the distances between cerebral cortex point (VCS) vertical to commissura anterior- commissura posterior line, sulcus centralis (CS), sulcus marginalis (MS), and the angle (α) between CS-PC-MS were determined and measured together with difference of gender in three different age groups (aged 6-9, 10-13, and 14-17). RESULTS: Central region measures of the brains of boys aged 6-17 are higher than girls except for MS-PC distance. While VCS-PC, CS-PC, and MS-PC measures display a significant difference in the girls aged 14-17 when compared to the other age groups of 6-9 and 10-13 (P < 0.05), angle α is not significantly different in age and gender groups (P > 0.05). However, while VCS-PC, CS-PC and MS-PC distances show a significant increase in girls beginning from the age of 14, this increase is limited in boys. CONCLUSION: Morphometric differences observed in different age groups in boys and girls shall contribute our evaluation of the alterations in brain development in both of genders and shall be useful in preparation of surgical operation plans to be applied to the central region.

Fenestration of the vertebral artery: case presentation.

Fenestrations of vertebral arteries are considered to be rare abnormalities observed in angiographic and autopsy studies. They result from vascular abnormalities that occur during the embryological development of vertebral artery. Fenestrations of the vertebral artery are vascular structures having 2 different lumens and endothelium layers, sharing either the same or separate adventitia layers. As a result of the carotid Doppler ultrasonography performed on a 65-year-old woman applying to the Neurology Clinic of Cumhuriyet University Faculty of Medicine, Research and Practice Hospital with the complaints of vertigo and numbness in the head, a plaque leading to 60% stenosis in the right internal carotid artery, close to the place of initiation was seen. The patient, whose vertebral artery lumen structures and calibrations have found to be normal in the Doppler ultrasonography of vertebral artery, was scheduled for double-sided selective carotid and vertebral artery angiography. With the performed digital subtraction angiography imaging method, an atheroma plaque, extending to internal carotid artery proximal starting from sinus caroticus through the right internal carotid artery and leading to 50% stenosis, having the appearance of an ulcer, was observed. In the vertebral artery angiography of the case, while the right vertebral artery was found to be normal, fenestration in the upper cervical segment was observed in the left vertebral artery. This situation has been presented in this paper with radiological and embryological evaluation.

Inferior vena cava hypoplasia with right hepatic vein and accessory inferior hepatic vein shunt.

Inferior vena cava (IVC) hypoplasia is a rare condition. Venous blood flow is usually provided through collaterals in the azygos or hemiazygos venous systems. However, portosystemic shunts with intrahepatic venous collateral are extremely rare. The case is presented here of a large shunt between the right hepatic vein, accessory inferior hepatic vein, and inferior vena cava in a 37-year-old female patient with IVC hypoplasia.

Radiological evaluation of the styloid process length in the normal population.

BACKGROUND: The aim of this study was to evaluate the styloid process (SP) length in the normal population using multidetector computed tomography (MDCT). MATERIALS AND METHODS: In this study, 160 patients who underwent paranasal MDCT between January 2012 and December 2012 were retrospectively evaluated. The patients were divided into groups according to their age and gender: Group 1 age 31-40 years old, 111 subjects; Group 2 age 41-50 years old, 49 subjects; Group A 98 males; Group B 62 females. The mean SP length was calculated from the mean of 2 measurements. SPs were assessed for their average lengths in different gender and age groups. Student's t-test was used for the comparison of the mean SP lengths between the groups. Differences were considered to be statistically significant at p<0.05. RESULTS: The mean SP length on both sides varied from 18 to 51 mm (28.4±5.5) in all the patients. The mean SP length was 27.2±5.2 mm in females and 29.2±5.6 mm in males. There was a statistically significant difference between the mean SP lengths in terms of gender (p<0.028). The mean SP length was 28.5±5.7 mm in Group 1 and 28.2±5.1 mm in Group 2. There was no statistically significant difference between the mean SP lengths in terms of age (p>0.718). CONCLUSIONS: In conclusion, there is still no consensus on the normal values of SP length. Normal values should be determined according to the geographical regions and ethnic groups for the diagnosis of Eagle's syndrome.

Evaluation of the length and angulation of the styloid process in the patient with pre-diagnosis of Eagle syndrome.

Clinical symptoms caused by the elongated styloid process (SP) or calcified stylohyoid ligament were first described by W. Eagle and they are now known as Eagle syndrome (ES). Normal length of SP was stated by Eagle as 2.5 cm. The objective of this study was to determine and discuss the length of SP and medial angulation degree with computed tomography (CT), which is an affective modality in the identification of ES, and a comparison with related studies. Three-dimensional (3D) images obtained from the axial CT scans of 22 cases (11 males and 11 females) aged between 24 and 80 years, who referred to Cumhuriyet University Hospital, Department of Radiology for multi slice CT with the pre-diagnosis of ES, were used. Lengths of the SP and medial angulations were measured on the obtained images. Inter- and intra-group comparisons were carried out using Wilcoxan and Mann-Whitney U tests. The mean length of the SP was found as 4.1 ± 1.1 cm. When inter- and intra-group lengths of the right and left SP were compared, the difference was not significant (p 〉 0.05). The mean medial angulation of the SP was found as 67.5 ± 5.1°. There was a significant difference found between the right side medial angulation and left side medial angulation in all persons (p 〈 0.05). Lengths of the right and left SP of the patients with pre-diagnosis of ES were close to each other. However, the right-side angulation was observed to be smaller than the left medial angulation in all the patients. Similarly, right side medial angulation of the females was smaller than the left side medial angulation, but this difference was absent in the males. Eagle syndrome should be kept in mind in patients with a sore throat radiating to the ears with swallowing and an observed non-compliance between the complaints such as feeling a foreign body in the throat and facial pain, and physical examination of those who do not have a response to long-term medical therapy should be performed.