Endoscopically managed giant frontoethmoidal osteoma with orbital extension.

A patient in his 20s presented with a change in the appearance of his left eye with evidence of relative afferent pupillary defect. Imaging revealed a giant frontoethmoidal osteoma, a benign sinonasal tumour, invading three-quarters of the orbit. Multidisciplinary discussion involving opthalmology, maxillofacial surgery, neurosurgery and otolaryngology resulted in the decision to attempt entirely endoscopic excision of this lesion, which was performed with successful outcomes. This case demonstrates how a sinonasal osteoma should be considered in the differential diagnosis for a patient presenting with proptosis or other eye signs suggestive of compression of the orbital compartment. This case report and literature review highlights the possibility of managing giant sinonasal osteomas with orbital extension through a completely endoscopic approach.

Surgical management of naso-orbito-ethmoidal fractures: a systematic review.

OBJECTIVE: Naso-orbito-ethmoidal fractures (NOE) fractures are uncommon but critical injuries. This review aims to investigate the patient factors, procedural factors, and postoperative outcomes associated with the surgical management of NOE fractures. STUDY DESIGN: PubMed and Scopus databases were systematically searched between 1993 and 2023 using the search strategy "(naso-orbito-ethmoidal OR nasoethmoid OR nasoorbitoethmoidal) AND fracture." Articles reporting clinical studies investigating the surgical management of NOE fractures were included. Articles that were duplicates, non-English, or non-full text; reported an unclear age range; reported insufficient data; and/or reported on a sample size less than 10 were excluded. Data on patient factors, procedural factors, and postoperative outcomes were extracted. RESULTS: Of the 412 articles identified, 6 eligible articles (retrospective case series) representing 95 adult cases and 84 pediatric cases were included. The mean ages were 29.0 and 10.2 years, respectively. Most cases were male (65.3%; 73.9%). Motor vehicle accidents were the most common mechanism of injury (79.2% and 50.0%, respectively). Coronal incision was the most common approach. Epiphora (n = 33) and scar problems (n = 21) were the most common complications in adult and pediatric cases, respectively. CONCLUSIONS: Further robust longitudinal studies with a clear description of fracture classification and surgical timing would be helpful. Gaps in knowledge include concomitant injuries, digitally-assisted applications, and risk factors for adverse outcomes.

Cribriform plate dehiscence with encephalomeningocele revealed by recurrent meningitis: A case report.

INTRODUCTION: Meningitis is a potentially life threatening illness. It requires prompt diagnosis and treatment. Recurrent meningitis needs detailed investigations to identify the underlying cause. OBSERVATION: We report a case of recurrent pneumococcal meningitis in a 9-year-old boy with an underlying congenital skull base abnormality. Brain computed tomography (CT) scan showed no obvious skull base defects. A magnetic resonance imaging (MRI) of the brain revealed a dehiscence of the cribriform plate with encephalomeningocele. The patient underwent an endoscopic repair of the bony defect and had not developed any new infections ever since. CONCLUSION: This case highlights the need to investigate recurrent bacterial meningitis with CT scan and MRI of the brain and skull base. Repair of these congenital skull base defects are mandatory to prevent the recurrence of meningitis.

Photon Counting Computed Tomography for Accurate Cribriform Plate (Lamina Cribrosa) Imaging in Adult Patients.

Detailed visualization of the cribriform plate is challenging due to its intricate structure. This study investigates how computed tomography (CT) with a novel photon counting (PC) detector enhance cribriform plate visualization compared to traditionally used energy-integrated detectors in patients. A total of 40 patients were included in a retrospective analysis, with half of them undergoing PC CT (Naeotom Alpha Siemens Healthineers, Forchheim, Germany) and the other half undergoing CT scans using an energy-integrated detector (Somatom Sensation 64, Siemens, Forchheim, Germany) in which the cribriform plate was visualized with a temporal bone protocol. Both groups of scans were evaluated for signal-to-noise ratio, radiation dose, the imaging quality of the whole scan overall, and, separately, the cribriform plate and the clarity of volume rendering reconstructions. Two independent observers conducted a qualitative analysis using a Likert scale. The results consistently demonstrated excellent imaging of the cribriform plate with the PC CT scanner, surpassing traditional technology. The visualization provided by PC CT allowed for precise anatomical assessment of the cribriform plate on multiplanar reconstructions and volume rendering imaging with reduced radiation dose (by approximately 50% per slice) and higher signal-to-noise ratio (by approximately 75%). In conclusion, photon-counting technology provides the possibility of better imaging of the cribriform plate in adult patients. This enhanced imaging could be utilized in skull base-associated pathologies, such as cerebrospinal fluid leaks, to visualize them more reliably for precise treatment.

Are the Ethmoidal Foramina Through the Frontal Bone, Ethmoid Bone, or Frontoethmoidal Suture?

INTRODUCTION: To investigate the locations of the anterior, middle, and posterior ethmoidal foramina and their relationships to the frontoethmoidal suture. METHODS: One hundred twenty sides from sixty adult human skulls were used. Specimens with significant damage to the medial orbit wall were excluded. The number of ethmoidal foramina (anterior, middle, and posterior) on the medial orbital wall and the relationship of each foramen to the frontoethmoidal suture were recorded and classified as follows: Type I: superior to the frontoethmoidal suture; Type II: on the frontoethmoidal suture; Type III: inferior to the frontoethmoidal suture. RESULTS: Of the ninety-four sides, fourteen (14.9%) had one foramen, sixty-two (66.0%) had two , and eighteen (19.1%) had three. In total, 192 ethmoidal foramina were observed. Among the fourteen sides with one foramen, eight foramina were anterior and six were posterior. Among the 192 ethmoidal foramina, 162 were eligible for fur ther classification (74 anterior, 14 middle, and 74 posterior). Types I, II, and III ethmoidal foramina were found in 38.3% (62/162), 61.7% (100/162), and 0% (0/162), respectively. CONCLUSIONS: Our current study found a higher incidence of type I than previously reported. It is important to be aware of the significant incidence of foramen variations when the medial orbit wall is manipulated during surgery. Unless caution is observed, an inadvertent surgical injury can occur and lead to life-threatening complications. Therefore, a good understanding of orbital anatomy and its potential variations is critical for improving patient out comes.

Naso-Orbital-Ethmoid Fracture Repair Techniques: A Systematic Review.

PURPOSE: Naso-orbital-ethmoid (NOE) complex fractures present a challenge to repair. The classification system used to categorize the fracture type was established in 1991 based off the medial canthal tendon attachment. The primary objective was to systematically review the literature outlining repair techniques for NOE fracture after the adoption of the Markowitz classification system. METHODS: A systematic search was performed in PubMed, Embase, and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on operative techniques used to repair NOE fractures in adult patients after 1991. Two investigators independently reviewed all articles and extracted data. Level of evidence was assessed by Oxford Center for Evidence-based Medicine guidelines. RESULTS: This review identified 16 articles that met inclusion/exclusion criteria representing 517 patients. One article outlined a closed reduction technique with transnasal wiring. The remaining articles discussed open approaches with various exposure techniques, most common being the coronal incision. Miniplates and screws were most often implemented for rigid fixation as well as transnasal wiring to repair disrupted medial canthal tendon and canthal bearing bone in Type 2 and 3 NOE fractures. Ten of the studies included in this review had a level of evidence of 4. CONCLUSIONS: NOE fractures present a complex fracture pattern and challenge to repair. New exposure techniques and multidisciplinary approaches have been described. However, fixation techniques have remained relatively consistent through the years. Surgeon preference and comfort with performing the specific techniques leads to the best patient outcomes. With the low level of evidence referenced, more robust research is needed to evaluate these techniques.

Surgical Treatment of Complex Craniofacial Fractures.

OBJECTIVE: Severe craniofacial fractures may present different needs in treating intracranial lesions over facial injuries. This paper examines the results of our strategy, consisting of a single-stage combined neurosurgical-maxillofacial treatment. METHODS: A retrospective review was conducted of 33 consecutive patients with complex fractures of the anterior cranial fossa and facial skeleton, who required elective surgery for craniofacial reconstruction. Patients who required emergency surgery for intracranial clots or penetrating wounds were excluded. In all cases, all or almost all the anterior skull-base was injured with compound fractures of the frontal sinus, the orbital roofs, the lamina cribrosa, and the planum sphenoidale. In all cases, the prioritization of treatment was carefully discussed, and surgical timing and strategy were agreed. RESULTS: There was 1 dead. Olfactory injuries were always found intraoperatively. There were no mucoceles, CSF-leak recurrences, cranial infections, or neurologic worsening. The functional and neurologic results were highly satisfactory. CONCLUSIONS: The one-stage surgical treatment of complex craniofacial fractures has numerous advantages, including the possibility of reducing facial fractures without the risk of CSF leaks. It also eliminates the need for repeated procedures in fragile patients, and the need to dismantle the facial reconstruction if the skull base repair is performed later. The main issue is the surgical timing, considering that the maxillofacial surgeon usually favors early facial repair, whereas the neurosurgeon generally prefers delayed manipulation of the contused frontal lobes. A timeframe of 10-14 days after trauma may be a good compromise for safe procedures with excellent neurologic and functional outcomes.

Crista Galli Morphometry and Morphology: An Anatomical, Radiological, and Machine Learning Application Study / Crista Galli Morfometría y Morfología: Un Estudio de Aplicación Anatómica, Radiológica y de Aprendizaje Automático

SUMMARY: The study purposed to examine the morphometry and morphology of crista galli in cone beam computed tomography (CBCT) and apply a new analysis, supervised Machine Learning techniques to find the answers to research questions "Can sex be determined with crista galli morphometric measurements?" or "How effective are the crista galli morphometric measurements in determining sex?". Crista galli dimensions including anteroposterior, superoinferior, and laterolateral were measured and carried out on 200 healthy adult subjects (98 females; 102 males) aged between 18-79 years. Also, crista galli was classified with two methods called morphological types and Keros classification. In this study, the Chi-square test, Student's t-test, and Oneway ANOVA were performed. Additionally, Machine Learning techniques were applied. The means of the CGH, CGW, and CGL were found as 14.96 mm; 3.96 mm, and 12.76 mm in males, respectively. The same values were as 13.54 mm; 3.51 mm and 11.59±1.61 mm in females, respectively. The CG morphometric measurements of males were higher than those of females. There was a significant difference between sexes in terms of morphological classification type. Also, when the sex assignment of JRip was analyzed, out of 102 male instances 62 of them were correctly predicted, and for 98 female instances, 70 of them were correctly predicted according to their CG measurements. The JRip found the following classification rule for the given dataset: "if CGH<=14.4 then sex is female, otherwise sex is male". The accuracy of this rule is not high, but it gives an idea about the relationship between CG measurements and sex. Although the issue that CG morphometric measurements can be used in sex determination is still controversial, it was concluded in the analysis that CG morphometric measurements can be used in sex determination. Also, Machine Learning Techniques give an idea about the relationship between CG measurements and sex.

En el estudio se propuso examinar la morfometría y la morfología de la crista galli del hueso etmoides usando tomografía computarizada de haz cónico (CBCT) y aplicar un nuevo análisis, técnicas de aprendizaje automático supervisado para encontrar las respuestas a las preguntas de investigación "¿Se puede determinar el sexo con mediciones morfométricas de la crista galli?" o "¿Qué tan efectivas son las medidas morfométricas de la crista galli para determinar el sexo?". Las dimensiones de la crista galli, incluidas los diámetros anteroposterior, superoinferior y laterolateral, se midieron y realizaron en 200 sujetos adultos sanos (98 mujeres; 102 hombres) con edades comprendidas entre los 18 y los 79 años. La crista galli se clasificó con dos métodos llamados tipos morfológicos y clasificación de Keros. En este estudio, se realizaron la prueba de Chicuadrado, la prueba t de Student y ANOVA de una vía. Adicionalmente, se aplicaron técnicas de Machine Learning. Las medias de CGH, CGW y CGL se encontraron en 14,96 mm; 3,96 mm y 12,76 mm en hombres, respectivamente. Los mismos valores fueron 13,54 mm; 3,51 mm y 11,59 ± 1,61 mm en mujeres, respectivamente. Las medidas morfométricas del CG de los hombress fueron más altas que las de las mujeres. Hubo una diferencia significativa entre sexos en cuanto al tipo de clasificación morfológica. Además, cuando se analizó la asignación de sexo de JRip, de 102 instancias masculinas, 62 de ellas se predijeron correctamente, y de 98 instancias femeninas, 70 de ellas se predijeron correctamente de acuerdo con las mediciones de CG. El JRip encontró la siguiente regla de clasificación para el conjunto de datos dado: "si CGH<=14.4, por tanto el sexo es femenino, de lo contrario, el sexo es masculino". La precisión de esta regla no es alta, pero da una idea de la relación entre las medidas del CG y el sexo. Aunque la pregunta si las medidas morfométricas CG se pueden usar en la determinación del sexo sigue aún siendo controvertida. Se concluyó en el análisis que las medidas morfométricas CG se pueden usar en la determinación del sexo. Además, las técnicas de aprendizaje automático dan una idea de la relación entre las medidas de CG y el sexo.

Évaluation tomodensitométrique des variations anatomiques du toit de l'os ethmoïde chez l'adulte noir / Computed tomography evaluation of anatomical variations of the ethmoid bone roof in black adults

Etudier à la tomodensitométrie, les variations anatomiques du toit de l'os ethmoïde en déterminant la prévalence des variantes à haut risque. Matériels et méthodes: Etude transversale, avec une collecte rétrospective, descriptive et analytique menée sur une période de 06 mois dans deux services de radiologie et imagerie médicale à Lomé. Elle portait sur des examens de tomodensitométrie normaux des sinus de l'adulte. Résultats: L'âge moyen était de 50,69 ± 16,18 ans. La profondeur moyenne de la fosse olfactive dans le sexe masculin était de 4,03± 1,40 mm contre 4,45±1,59 mm dans le sexe féminin (p=0,0136). Le type III de Keros a été retrouvé dans 11 cas (3,5%). L'asymétrie de la profondeur de la fosse olfactive a été observée chez 107 (69%) patients. L'angle de Gera mesurait en moyenne 58,5±14,6 degrés et 60 (19,4%) toits de l'ethmoïde étaient classés dans le type III. On notait une asymétrie de l'angle de Gera chez 102 (65,8%) patients. La longueur moyenne de la lamelle latérale de la lame criblée était de 5,34 ± 1,4 mm. La longueur moyenne de la fovéa ethmoïdale chez les hommes était de 10 ± 2,5 mm contre 9,3 ± 2,2 chez les femmes (p=0,0078). Il existait une corrélation linéaire positive entre la profondeur de la fosse olfactive et l'angle de Gera (r=0,498; p=0,002). Conclusion: La fréquence élevée de l'asymétrie du toit ethmoïdal suggère que ces variations soient précisées par les radiologues dans les compte-rendu des examens de tomodensitométrie des sinus pour bilan préopératoire

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.

Ethmoidal osteoma in children: Literature review and presentation of a case report / Osteoma etmoidal en niños: revisión de la literatura y presentación de un caso

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Adult Nasoethmoidal Encephalocele Corrected by Supraorbitary Approach: Case Report and Literature Review

Encephalocele is a protrusion of the central nervous system elements through a defect in the dura mater and in the cranium. The prevalence of encephalocele ranges from 0.08 to 0.5 per 1,000 births. The posterior encephaloceles are more common in North America and Europe, while frontal defect is frequently found in Asia. The present paper describes a 26-year-old male patient presenting with cerebrospinal fluid leak and meningitis symptoms. He was diagnosed with congenital nasoethmoidal encephalocele and treated surgically using a supraorbital approach without complications.

Treatment of naso-orbito-etmoidal Type III fracture in adolescents: case report / Tratamiento de la fractura naso-orbito-etmoidal Tipo III en adolescentes: relato de un caso

The naso-orbito-ethmoidal region is composed of delicate bones and when fractured may result in significant aesthetic-functional impairment. Diagnosis through clinical and imaging findings is extremely important for surgical planning. This study aims to report a case of type III fracture of the naso-orbito-ethmoidal region. Patient D.R.S., female, 13 years old, attended the emergency department of Hospital dos Fornecedores de Cana de Piracicaba (HFCP) - SP with complaint of pain in the fronto-nasal region and respiratory distress after trauma in face of baseball bat. Physical examination showed edema and short blunt injury in the region of the nasal dorsum and frontal region, bilateral periorbital hematoma, hyposphagma in right eye and traumatic telecanthus. When analyzing the computed tomography, it was observed fracture of the nasal bones, also affecting the medial wall of the orbit. The procedure was osteosynthesis of the fractures and reconstruction of the nasal dorsum. The fracture traces were exposed from coronal access, reduction of fractures and use of calvarial bone graft for nasal dorsum reconstruction. The fracture and the graft were fixed with plates of 1,6mm. Postoperative computed tomography analysis showed good graft positioning, but there was still a slight sinking of the left lateral wall of the nose. In a second moment another surgical intervention was done to reduce this wall and an internal containment device was installed. Currently the patient is in a state of observation and a follow-up period of 665 days. In cases of complex nasoorbito-ethmoidal fractures early diagnosis and treatment is essential to minimize sequelae and provide a better aesthetic and functional result.

La región etmoidal nasoorbital está compuesta de huesos delicados y, cuando se fractura, puede provocar una lesión estética-funcional significativa. El diagnóstico mediante hallazgos clínicos y de imagen es de suma importancia para la planificación quirúrgica. El paciente D.R.S., mujer, 13 años, leucoderma, asistió al servicio de emergencia del Hospital de Proveedores de Caña de Azúcar de Piracicaba quejándose de dolor en la región frontal-nasal y dificultad para respirar después de un traumatismo en la cara con un palo. El examen físico reveló edema y lesión contundente en el dorso nasal y la región frontal, hematoma periorbitario bilateral, hiposfagma del ojo derecho y telecanto traumático. Al analizar la tomografía computarizada se observó fractura de los huesosnasales en libro abierto, afectando también la pared medial de la órbita. El enfoque aplicado fue la osteosíntesis de fracturas y la reconstrucción del dorso nasal. Los rastros de fractura se expusieron del abordaje coronal, se redujeron las fracturas y se usaron injertos de casquete para reconstruir el dorso nasal. La fractura y el injerto se fijaron con placas de sistema de 1,6 mm y se realizó la cantopexia de los ligamentos cantales mediales. Se requirió cirugía reparadora secundaria para la corrección de la pared lateral de la nariz, que persistió en el postoperatorio. Actualmente el paciente se encuentra en un estado de conservación y período de seguimiento de 665 días. En casos de fracturas nasoorbitales-etmoidales complejas, el diagnóstico y el tratamiento tempranos son esenciales para minimizar las secuelas y proporcionar un mejor resultado estético y funcional.

Analysis of the anatomic variations of the ethmoid roof among Saudipopulation: A radiological study

The olfactory fossa (OF) is a depression in the anterior cranial cavity whose floor is formed by the cribriform plate of ethmoid, bounded laterally by the lateral lamella of cribriform plate and medially by crista galli. Keros categorized the olfactory fossa depth into 3 types. For a successful endoscopic sinus surgery, the surgeons should pay attention to the details when dealing with the complex anatomy of the paranasal sinuses (PNS) and skull base. The aim of this study was to describe the distribution of Keros classification of the height of ethmoid roof among Saudi population by using multidetector computed tomography (MDCT). This was a retrospective study conducted on 511 patients (360 males and 151 female) referred for MDCT assessment of PNS over a two-year period. The mean age of our patients was 34.47± 10.69 years, aged between 18 and 79 years. Patients with nasal trauma, surgeries or any pathological diseases affecting the ethmoid roof were excluded from the study. Keros type II was the commonest presentation observed in 53.2% of cases, followed by type I in 12.5%, then type III in 11.7% of cases. Out of the 511 patients analyzed, 115 (22.5%) cas-es had asymmetry (different types of OF) on both sides. Conclusion: The majority of studied Saudi adult population showed Keros type II (53.3%), followed by type I (12.5%). Keros type III was seen in 11.7% among the studied population

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Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches / Análise tomográfica das variações da lâmina papirácea e da morfologia orbital em abordagens cirúrgicas endoscópicas

Abstract Introduction: Radiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit. Objective: The goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry. Methods: This retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations. Results: Lamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14 mm, 147.88º and 9.6 mm, 152.72º, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3 mm, 7.2 cm2, 6.89 cm2, 4.51 cm2 and 12.46 cm2 respectively. The orbital height and width were measured as 35.9 mm and 39.2 mm respectively. The mean orbital cavity depth was 46.3 mm from optic foramen to the orbital entrance and the orbital volume was 19.29 cm3. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types. Conclusion: Precise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.

Resumo Introdução: A avaliação radiológica é mandatória para avaliar o tipo de abordagem endoscópica no tratamento cirúrgico de doença nasossinusal e na reconstrução de fraturas antes de quaisquer modalidades de tratamento relacionadas à parede medial orbital. Objetivo: O objetivo foi proporcionar uma melhor compreensão das variações da lâmina papirácea e a relação com a morfometria orbital. Método: Este estudo retrospectivo foi realizado por meio de tomografia computadorizada de 200 órbitas, e os resultados foram comparados em relação à idade, sexo, lateralidade e variações da lâmina pairácea. Resultados: As variações da lâmina papirácea foram categorizadas como tipo A, 80,5% (161/200); tipo B, 16% (32/200); tipo C, 3,5% (7/200). Para a parede medial, as medidas das alturas anteriores e posteriores da lâmina papirácea e ângulos foram de 17,14 mm, 147,88º e 9,6 mm, 152,72º, respectivamente. Além disso, as medidas do seu comprimento da, da área média do assoalho orbital, e da parede medial, lâmina papyracea e entrada orbital foram: 33,3 mm, 7,2 cm2, 6,89 cm2, 4,51 cm2 e 12,46 cm2, respectivamente. As medidas da altura e da largura orbitais foram 35,9 mm e 39,2 mm, respectivamente. A profundidade média da cavidade orbital foi de 46,3 mm, do forame óptico até a entrada orbital, e o volume orbital foi de 19,29 cm3. Analisamos as medidas morfométricas com tendência a aumentar com o envelhecimento e nos indivíduos do sexo masculino, e a relação das mesmas com os tipos de lâmina. Conclusões: O conhecimento preciso da anatomia da lâmina papirácea por meio de tomografia computadorizada é essencial para uma cirurgia mais segura e eficaz, além de permitir pré-moldar as dimensões do implante. Assim, as complicações pós-operatórias podem ser minimizadas, obtendo-se melhores resultados.

Crisis epiléptica por neumoencéfalo como primera manifestación de un osteoma etmoido-frontal / Epileptic crisis by pneumoencephalon as the first manifestation of an ethmoid-frontal osteoma

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Dehiscencia de la lámina papirácea del etmoides / Dehiscence of the lamina papyracea of the ethmoid bone

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The incidence of sinus crista galli in children and adults: a computerized tomography study / La incidencia del sinus crista galli en niños y adultos: un estudio de tomografía computarizada

The pneumatization area in the crista galli region of the ethmoid bone can be called Sinus Crista Galli (SCG). The authors would like to recommend the terminology as sinus crista galli for pneumatized crista galli. Our aims in this study are to determine SCG on three dimensional Computerized Tomography (CT) images, to investigate its frequency, dimension and to emphasize their clinical significance in children and adults. A total of 360 adult images (160 female, 200 male) and 68(43 female, 25 male) pediatric images were examined. The presence SCG was recorded with axial and coronal paranasal sinus CT images. The height, width, anterposterior diameter of the sinus was measured. All the data we obtained from this study were analyzed using the SPSS 18.0 program. Descriptive statistics are shown as mean ± Sdt. Sinus crista galli was found in 17 examined images of the 360 (4.72 %) in adult group. Chronic pansinusitis was detected in 7 of 17 cases. Frontal sinusitis findings were detected in 7 cases. Sinusitis was not observed in 3 cases. The incidence of SCG was found in 4 pediatric images out of 68 (5.88 %). In 1 out of 4 cases, infection was detected in SCG. We did not observe SCG in the pediatric group with 0-7 years of age. Sinus crista galli was found at low rates in adult and pediatric age group. However; relationship was found between these variation and chronic rhinosinusitis. Additionally, detection of SCG in paranasal sinus CT can be provided better results and reduce complications in anterior cranial fossa surgery.

El área de neumatización en la crista galli del etmoides se puede denominar sinus crista galli (SCG). Los autores recomiendan incluir en la terminología anatómica el término sinus crista galli para la crista galli neumatizada. Los objetivos del estudio fueron determinar la SCG en imágenes tridimensionales de tomografía computarizada (TC), investigar su frecuencia, dimensión y enfatizar su importancia clínica en niños y adultos. Se examinaron un total de 360 imágenes de adultos (160 mujeres, 200 hombres) y 68 (43 mujeres, 25 hombres) en imágenes pediátricas. La presencia de SCG se registró con imágenes de tomografía axial y axial del seno paranasal. Se midió la altura, anchura y diámetro anteroposterior del seno del proceso crista galli. Todos los datos obtenidos se analizaron mediante el programa SPSS 18.0. Las estadísticas descriptivas se muestran como media ± DS. El seno crista galli se encontró en 17/360 (4,72 %) de las imágenes examinadas en el grupo de adultos. Se detectó pansinusitis crónica en 7 de 17 casos. Se detectaron hallazgos de sinusitis frontal en 7 casos. Sinusitis no se observó en 3 casos. La incidencia de SCG se encontró en 4 imágenes pediátricas de 68 (5,88 %). En 1 de cada 4 casos, se detectó infección en SCG. No observamos SCG en el grupo pediátrico con 0-7 años de edad. El seno crista galli se encontró en bajas tasas en adultos y en niños. Sin embargo, se encontró relación entre estas variaciones y la rinosinusitis crónica. Además, la detección de SCG en la tomografía computarizada del seno paranasal puede proporcionar mejores resultados y reducir las complicaciones en la cirugía de la fosa craneal anterior.

Origen intraorbitario de las arterias etmoidales: estudio anatómico / Intraorbital origin of the ethmoidal arteries: anatomical study

RESUMEN Introducción: Ramas de la arteria oftálmica contribuyen a la irrigación de diversos territorios de la fosa nasal y de los senos paranasales. Objetivo: El objetivo de nuestro estudio es describir las arterias etmoidales desde su origen intraorbitario, y su relación con las estructuras musculares y nerviosas. Material y Método: Se realizó un estudio anatómico endoscópico en 20 fosas nasales y órbitas de diez cadáveres. Resultados: La disección del plano muscular permitió definir dos espacios de entrada a la órbita. Un primer espacio entre el músculo recto inferior y músculo recto medial (área 1) y otro entre el músculo recto medial y músculo oblicuo superior (área 2). En el área 1, la arteria oftálmica discurrió superior al nervio óptico en el 90%. La arteria etmoidal anterior se observó en todos los casos inferior al músculo oblicuo superior. En el área 2, la arteria etmoidal posterior, se localizó en todos los casos superior al músculo oblicuo superior. No se identificó la arteria etmoidal media en ningún caso. El origen de la arteria supraorbitaria se identificó entre las dos arterias etmoidales. Conclusión: La comprensión anatómica del origen intraorbitario de la arteria oftálmica permite el abordaje de determinada patología intraorbitaria compleja a través de la pared medial de la órbita.

ABSTRACT Introduction: Branches of the ophthalmic artery contribute to the irrigation of various territories of the nasal cavity and paranasal sinuses. Aim: The aim of our study is to describe the intraorbital course of the ethmoidal arteries and their relationship with the muscular and nervous structures. Material and method: We performed twenty nasal cavities and orbital dissections in ten adults cadaveric heads. Results: The dissection of the muscular orbital wall allowed defining two surgical orbital corridors, between the inferior rectus and the medial rectus muscles (area 1) and between the medial rectus and the superior oblique muscles (area 2). In area 1, the ophthalmic artery crosses over the optic nerve in 90% of the cases. The anterior ethmoidal artery was observed inferior to the superior oblique muscle. In area 2, the posterior ethmoidal artery was located superior to the superior oblique muscle in all cavities. No middle ethmoidal artery was identified. The origin of the supraorbital artery was found between the two ethmoidal arteries. Conclusions: The anatomical understanding of the intraorbital origin of the arteries of the ophthalmic artery allows perform two surgical approaches through the media orbital wall.

Nervus terminalis and nerves to the vomeronasal organ: a study using human fetal specimens / 대한해부학회지

The human nervus terminalis (terminal nerve) and the nerves to the vomeronasal organ (VNON) are both associated with the olfactory nerves and are of major interest to embryologists. However, there is still limited knowledge on their topographical anatomy in the nasal septum and on the number and distribution of ganglion cells along and near the cribriform plate of the ethmoid bone. We observed serial or semiserial sections of 30 fetuses at 7–18 weeks (crown rump length [CRL], 25–160 mm). Calretinin and S100 protein staining demonstrated not only the terminal nerve along the anterior edge of the perpendicular lamina of the ethmoid, but also the VNON along the posterior edge of the lamina. The terminal nerve was composed of 1–2 nerve bundles that passed through the anterior end of the cribriform plate, whereas the VNON consisted of 2–3 bundles behind the olfactory nerves. The terminal nerve ran along and crossed the posterior side of the nasal branch of the anterior ethmoidal nerve. Multiple clusters of small ganglion cells were found on the lateral surfaces of the ethmoid's crista galli, which are likely the origin of both the terminal nerve and VNON. The ganglions along the crista galli were ball-like and 15–20 µm in diameter and, ranged from 40–153 in unilateral number according to our counting at 21-µm-interval except for one specimen (480 neurons; CRL, 137 mm). An effect of nerve degeneration with increasing age seemed to be masked by a remarkable individual difference.