Correlation of frontal sinus recess anatomy with ethnicity, gender, and pathology.

PURPOSE: Research on frontal sinus cells has been conflicting regarding relationship between frontal sinus cells and frontal sinus disease. There are no published studies regarding gender differences in frontal sinus disease. No comparisons between African Americans and Caucasians and frontal sinus disease have been published. This study attempts to define the above relationships as well as the relationship between number and types of cells and disease. METHODS: A retrospective chart review was performed on sinus CT scans done from 2003 to 2011 at an academic medical center. Exclusion criteria included previous frontal sinus surgery, sinus malignancy, obvious trauma, congenital anomalies, and poor quality of scan. Number and type of frontal cells were recorded for 602 scans. Statistical analysis performed demographic comparisons and compared number and types of cells to evidence of disease. RESULTS: Males were more likely than females to have frontal sinus disease. Patients with Type 3 and Type 4 cells were more likely to have disease. No significant ethnic related differences in disease were found using a multivariate logistic regression model. Total number of cells did not significantly affect likelihood of disease. CONCLUSIONS: This is one of the largest collections of data on frontal sinus cells as predictors of frontal sinus disease. These results suggest that gender and certain types of cells affect likelihood of disease. This study is the first to demonstrate a lack of difference in disease in African Americans and Caucasians. These results are significant regarding gender, race, number and type of cells as predictors of disease.

Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities.

OBJECTIVE: To evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities. STUDY DESIGN: Retrospective administrative database analysis. SETTING: US-based outpatient settings. METHODS: All patients from the MarketScan Medicaid database with endoscopic sinus surgery from 2009 to 2013 were stratified by ethnicity, age (5-year increments, as per US Census), and sex. Crude rates of endoscopic sinus surgery per age group and sex were compiled for all patients and each ethnic group (African American, Caucasian, Hispanics, and others). Age and sex standardization was done with the MarketScan Medicaid overall population as standard. The coefficient of variation, extremal ratio, and chi-square statistics were calculated to determine variation across ethnicities. RESULTS: Overall sinus surgery rates per 1000 people in the Medicaid population ranged from 0.36 to 0.40 from 2009 to 2013 (African Americans: 0.24-0.26; Hispanics: 0.21-0.37; Caucasians: 0.47-0.56; rate of surgery statistically lower for African American vs Hispanics for 4 of 5 years). The coefficient of variation and extremal ratio ranged from 29.3% to 45.6% and 1.98 to 2.6, respectively. Differences among groups were significant for all years (P < .0001). Comparison of sex-adjusted ratios by age group demonstrated greater rates of surgery in the Caucasian group versus other groups for all age categories. CONCLUSION: The Medicaid database was selected for this analysis to eliminate payer and wealth as potential confounders in access to health care. Despite this approach, significant differences in surgery rates among ethnic groups were observed. Further research is critical to understand those differences and provide actionable and effective recommendations for change.

Multiplanar computed tomographic analysis of the frontal recess region in Chinese subjects without frontal sinus disease symptoms.

The purposes of this study were to determine the prevalence of frontal-ethmoidal cells and to evaluate variation in the superior attachment of the uncinate process in Chinese subjects. 202 normal Chinese subjects (404 sides) underwent spiral computed tomography and multiplanar reconstruction images were evaluated. Agger nasi cells showed a prevalence of 94.1%. Of all the frontal cells identified in 159 sides (39.6%) of frontal recesses, the prevalence of type I, type II and type III cells was 24.4, 7.0 and 8.2%, respectively. Suprabullar, frontal bullar and interfrontal septal cells were identified in 148 sides (36.6%), 36 sides (9.0%) and 25 subjects (12.4%), respectively. 244 uncinate processes (60.4%) had 1 superior attachment and the remainder (39.6%) had 2 superior attachments. The prevalence of terminal recesses was 89.1%. Our results characterized normal frontal recess pneumatization patterns in Chinese subjects. That, together with variation in the superior attachment of the uncinate process, emphasized the role of agger nasi cells and the uncinate process in endoscopic frontal sinus surgery.

Ethnic variation in sinonasal anatomy on CT-scanning.

Computed tomography (CT) scanning of the paranasal sinuses provides valuable information in assessing extent of disease and fine detailed anatomy prior to endoscopic sinus surgery. Awareness of the different anatomic variants of the bony sinonasal anatomy will help the rhinologic surgeon's orientation during the procedure. We conducted a study to look at the incidence of the anatomic variation within the lateral wall of the nose and sinuses and to determine if there is any ethnic difference in these variants between a cohort of 100 Caucasian patients undergoing endoscopic sinus surgery in London and 100 Chinese patients treated in Hong Kong. We compared the two groups with chi-square test and the significant areas are those with p value of less than 0.05. The results show a higher incidence of pneumatisation of the middle turbinate (concha bullosa) and paradoxical bending of the middle turbinate in the Caucasian population. The infraorbital and suprabullar cell development was greater in the Caucasian population though the incidence of sphenoethmoidal cells was much greater in the Chinese population. When asymmetry of the anterior ethmoidal roof was considered, the left was consistently the highest in both groups, though there was no difference in the depth of the cribiform niche between right and left or between Caucasian and Chinese. The incidence of bent uncinate process and of complete absence of a sinus was higher in the Chinese population. There was no difference in the presence of pneumatisation of the agger nasi, of the uncinate process, or of the anterior clinoid process. There was no difference in the presence of septation adjoining the carotid in the lateral wall of sphenoid or in the exposure of the optic nerve within sphenoid or posterior ethmoid sinuses. Although there is no evidence that variants of the sinonasal anatomy seen on CT Scan have a causative effect in the disease process; a knowledge of their presence is paramount in minimising the potential for surgical complications.

Mucosal antral cysts in a Chinese population.

Although mucosal antral cysts (MACs) are a frequent finding in surveys of panoramic radiographs in several western populations, its prevalence has not been reported in an oriental population. The panoramic radiographs of two sets of 1000 consecutive patients attending the University of Hong Kong Dental School in 1981 and 1990 were reviewed. The mean prevalence of MACs was 5.2% and they were twice as frequent in males. There was no significant difference in either the prevalence or the mean area of the MACs in patients with periapical bone loss and/or complaining of pain and swelling arising from dental disease in the adjacent maxillary alveolus when compared with those without. It is concluded that the prevalence and presentation of MACs in this oriental population is broadly consistent with that reported in western populations.