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1.
Nat Immunol ; 23(4): 581-593, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35347285

RESUMO

Meningeal lymphatics near the cribriform plate undergo lymphangiogenesis during neuroinflammation to drain excess fluid. Here, we hypothesized that lymphangiogenic vessels may acquire an altered phenotype to regulate immunity. Using single-cell RNA sequencing of meningeal lymphatics near the cribriform plate from healthy and experimental autoimmune encephalomyelitis in the C57BL/6 model, we report that neuroinflammation induces the upregulation of genes involved in antigen presentation such as major histocompatibility complex class II, adhesion molecules including vascular cell adhesion protein 1 and immunoregulatory molecules such as programmed cell death 1 ligand 1, where many of these changes are mediated by interferon-γ. The inflamed lymphatics retain CD11c+ cells and CD4 T cells where they capture and present antigen, creating an immunoregulatory niche that represents an underappreciated interface in the regulation of neuroinflammation. We also found discontinuity of the arachnoid membrane near the cribriform plate, which provides unrestricted access to the cerebrospinal fluid. These findings highlight a previously unknown function of local meningeal lymphatics in regulating immunity that has only previously been characterized in draining lymph nodes.


Assuntos
Osso Etmoide , Vasos Linfáticos , Animais , Osso Etmoide/fisiologia , Linfangiogênese/fisiologia , Sistema Linfático
2.
J Clin Neurosci ; 98: 207-212, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35189546

RESUMO

OBJECTIVES: This study investigated the visualization of the anterior ethmoidal artery (AEA) as notch, canal and sulcus, its relationship between supraorbital ethmoid cells (SOECs) and the Keros classification of the olfactory fossa on paranasal sinus computerized tomography (PNSCT). METHODS: In this retrospective study, the paranasal sinus computerized tomography (PNsCT) images of 204 patients (103 males and 101 females) were analyzed. AEA canal, notch and sulcus, SOECs, the distance between AEA notch and ethmoid roof, AEA canal angle and Keros classification of the olfactory fossa were evaluated. RESULTS: AEA notch in all patients and AEA canal (37.6 to 45.6%) and AEA sulcus (53.5 to 61.2%) were visualized. In the AEC canal and sulcus visualized patients, the Keros classification revealed higher. AEA notch and ethmoid roof distance increased in patients with higher Keros types. The presence of SOECs was significantly higher in males (41.7%) than females (19.8%) on the left side. There was a positive correlation between SOEC presence and Keros classification. In patients with SOEC, bilateral AEA canal and sulcus visualized more; and bilateral AEA notch and ethmoid roof distance increased. On the right side, the AEA canal angle of the males was significantly higher than that of the females. In patients with SOEC, the left AEA canal angle also increased. CONCLUSION: When detected SOECs and higher Keros types, the AEA was detected away from the skull base, AEA notch-ethmoid roof distance increased; and the AEA canal angle increased. To avoid intracranial penetrations, PNSCT should be evaluated carefully during the preoperative period.


Assuntos
Seio Etmoidal , Seio Frontal , Osso Etmoide/diagnóstico por imagem , Seio Etmoidal/irrigação sanguínea , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Feminino , Humanos , Masculino , Artéria Oftálmica , Estudos Retrospectivos
3.
Tomography ; 8(1): 316-328, 2022 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-35202191

RESUMO

(1) Background: For good surgical performance, sound knowledge of anatomy is required. Although the ethmoid air cells and sphenoid sinuses are subject to a high degree of variation, their possible extensions above the nasal fossa at the posterior end of the cribriform plate of the ethmoid bone (CPEB) were seemingly overlooked. (2) Methods: We retrospectively studied 162 case files from 55 male and 107 female cases, with ages varying from 42 to 80, which were scanned using Cone Beam Computed Tomography. (3) Results: In 56.17% of cases, an unpneumatized CPEB (type I) was found. Nasal roof recesses of ethmoidal origin (type II) were found at the posterior end of the CPEB in 20.37% of cases. Different types of sphenoidal pneumatizations of the posterior end of the CPEB (type III) were found in 22.83% of the cases. Onodi cells projected nasal roof recesses (type IV) in only 10 cases. In all types, nasal roof recesses were found either above the CPEB or within/underneath it. Moreover, such nasal roof recesses were found to be either unilateral, extended contralaterally, or bilateral. (4) Conclusions: As such recesses of the posterior CPEB, previously overlooked, belong to the posterior rhinobase, they should be carefully documented preoperatively to avoid unwanted surgical damage to the olfactory bulb or CSF fistula.


Assuntos
Osso Etmoide , Seio Esfenoidal , Tomografia Computadorizada de Feixe Cônico , Osso Etmoide/anatomia & histologia , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/cirurgia , Feminino , Humanos , Masculino , Cavidade Nasal/diagnóstico por imagem , Estudos Retrospectivos
4.
Folia Morphol (Warsz) ; 81(1): 175-182, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33511625

RESUMO

BACKGROUND: The objective of this study is to investigate the position and frequency of dehiscences in the medial orbital wall and to reveal that dehiscences and orbital adipose tissue hernias are distinct entities. MATERIALS AND METHODS: Two hundred-thirty medial orbital walls of 115 patients with a preliminary diagnosis of headache and sinusitis but without active ethmoidal sinusitis were examined by computer tomography in the axial plane. Two separate radiologists assessed continuity of the medial orbital wall and orbital fat tissue herniation in ethmoid cells. The medial orbital wall was divided into four quadrants and the dehiscence distribution was evaluated. RESULTS: Bone defects were detected in 71 (30.9%) patients in 230 orbital medial wall reviews of 115 patients (59 males, 56 females). Eight (3.5%) of these cases (4 male, 4 female) had herniation of the orbital adipose tissue into the ethmoid sinus. Of the 108 dehiscences, 47 were localised in the posterior upper quadrant. A statistically significant difference was found in the dehiscence distribution according to the quadrants. No significant relationship was found among age, gender, side of dehiscence and frequency of dehiscence. CONCLUSIONS: Dehiscences in the posterior upper quadrant are more common in the medial orbital wall. Although bone dehiscences in the medial orbital wall and the herniation of the orbital fat tissue are two different entities, they are used interchangeably in most of the literature and in radiological reporting.


Assuntos
Osso Etmoide , Órbita , Seio Etmoidal , Feminino , Humanos , Masculino , Órbita/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Eur Ann Otorhinolaryngol Head Neck Dis ; 139(1): 33-37, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33931331

RESUMO

The concept of ethmoidal sinuses composed of ethmoidal air cells does not appear to fit with the embryological origin of the ethmoid. Post-natal formation of the paranasal sinuses, as visualized by MRI, appears to be fundamentally different from the embryological development of the ethmoid sinus. These two organs also appear to have very distinct functions: paranasal sinuses play a role in respiration and sanitization of the respiratory tract, while the ethmoid sinus plays a role in olfaction. However, human acquisition of bipedalism resulted in ethmoidal compartmentalization into olfactory clefts lined by olfactory mucosa and the ethmoidal labyrinth formed by a meshwork of ethmoturbinals that have lost their olfactory mucosa. Ethmoturbinals are septa that increase the surface area of olfactory mucosa in mammalian olfactory chambers. Embryological development of the human ethmoid sinus can be seen as the result of curved stacking of ethmoturbinal septa forming passages. Surgically, these passages can be accessed via the middle, superior and supreme meati. An ethmoidectomy technique following the ethmoturbinal passages can therefore be described. This structure of the ethmoidal labyrinth is both useful and necessary for the teaching of ethmoidal surgery.


Assuntos
Seio Etmoidal , Seios Paranasais , Animais , Osso Etmoide/cirurgia , Seio Etmoidal/cirurgia , Humanos , Olfato
6.
Ann Plast Surg ; 88(4): 410-414, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34393196

RESUMO

PURPOSE: The aim of this study was to present a case series emphasizing low medial maxillary (pyriform) buttress displacement in naso-orbito-ethmoid (NOE) fractures as an operative indication, in the absence of the typical NOE surgical indications (medial canthus displacement, midface bony comminution, nasal bone collapse, and orbital indications), to prevent nasal airway obstruction. METHODS: Five cases of minor NOE fractures are reviewed, where only the low medial maxillary buttress was displaced. The typical surgical indications for NOE repair were absent. RESULTS: In each case, the pyriform buttress was medially and posteriorly displaced, creating nasal airway obstruction in each patient. The medial canthal tendons were all nondisplaced, there was no diplopia, and the other 2 cardinal buttresses (infraorbital rim and nasofrontal junction) were minimally displaced or greensticked. In the acute setting, patients were treated with open reduction and internal fixation. With delayed presentation, septorhinoplasty or osteotomy and fixation were used. Among the patients who had adequate follow-up, nasal airway obstruction was resolved. CONCLUSIONS: This series suggests that, in NOE fractures with isolated displacement at the medial maxillary buttress, nasal airway obstruction should be considered an operative indication (independent of the classical indications) in order to prevent or resolve nasal airway obstruction.


Assuntos
Traumatismos Faciais , Obstrução Nasal , Fraturas Orbitárias , Fraturas Cranianas , Osso Etmoide/cirurgia , Humanos , Osso Nasal/cirurgia , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Fraturas Orbitárias/complicações , Fraturas Orbitárias/cirurgia , Fraturas Cranianas/complicações , Fraturas Cranianas/cirurgia
7.
Anat Rec (Hoboken) ; 305(3): 643-667, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34117725

RESUMO

In a species of baleen whale, we identify olfactory epithelium that suggests a functional sense of smell and document the ontogeny of the surrounding olfactory anatomy. Whales must surface to breathe, thereby providing an opportunity to detect airborne odorants. Although many toothed whales (odontocetes) lack olfactory anatomy, baleen whales (mysticetes) have retained theirs. Here, we investigate fetal and postnatal specimens of bowhead whales (Balaena mysticetus). Computed tomography (CT) reveals the presence of nasal passages and nasal chambers with simple ethmoturbinates through ontogeny. Additionally, we describe the dorsal nasal meatuses and olfactory bulb chambers. The cribriform plate has foramina that communicate with the nasal chambers. We show this anatomy within the context of the whole prenatal and postnatal skull. We document the tunnel for the ethmoidal nerve (ethmoid foramen) and the rostrolateral recess of the nasal chamber, which appears postnatally. Bilateral symmetry was apparent in the postnatal nasal chambers. No such symmetry was found prenatally, possibly due to tissue deformation. No nasal air sacs were found in fetal development. Olfactory epithelium, identified histologically, covers at least part of the ethmoturbinates. We identify olfactory epithelium using six explicit criteria of mammalian olfactory epithelium. Immunohistochemistry revealed the presence of olfactory marker protein (OMP), which is only found in mature olfactory sensory neurons. Although it seems that these neurons are scarce in bowhead whales compared to typical terrestrial mammals, our results suggest that bowhead whales have a functional sense of smell, which they may use to find prey.


Assuntos
Baleia Franca , Animais , Osso Etmoide , Cavidade Nasal/diagnóstico por imagem , Mucosa Olfatória , Crânio
8.
J Craniofac Surg ; 33(1): e2-e4, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34267126

RESUMO

ABSTRACT: Position of anterior ethmoidal artery and height of lateral lamella of cribriform plate (LLCP) represent critical variants in endoscopy.In 200 maxillofacial computed tomography scans of patients the position of anterior ethmoidal foramen (AEF) in relation to ethmoid roof was recorded. The height of LLCP was measured and classified according to Keros classification.Differences in AEF position and distribution of Keros types, and LLCP height according to sex were assessed through chi-square test (P < 0.05) and 1-way analysis of covariance (ANCOVA) test, respectively (P < 0.05). Differences in LLCP height according to different AEF position were assessed through Mann-Whitney test (P < 0.05).No differences were observed in prevalence of AEF exposure according to sex (P > 0.05); LLCP height was higher in males than in females, with a higher frequency of Keros type 3 (P < 0.05). Moreover, subjects with AEF exposure had a significantly higher LLCP height (P < 0.01).Results highlighted innovative data useful for improving the knowledge of these sensitive variants.


Assuntos
Osso Etmoide , Seios Paranasais , Endoscopia , Osso Etmoide/diagnóstico por imagem , Seio Etmoidal , Feminino , Humanos , Masculino , Tomografia Computadorizada por Raios X
9.
Vestn Otorinolaringol ; 86(5): 119-123, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34783485

RESUMO

The article provides an overview of foreign and domestic studies on the anatomy of the medial wall of the orbit. Possible structural variants of the osseus structures of the medial wall and their applied clinical significance are indicated, including those having individual occurrence: additional lacrimal bone, morphological features of the structure of the fossa of the lacrimal sac, location, shape and size of the cells of the ethmoid bone, Onody cells, Haller infraorbital cell, the relative position of the anterior and posterior ethmoid foramina, the presence of additional ethmoid foramina, dysgenesis of the lacrimal bone and the orbital plate of the ethmoid bone. The anatomical prerequisites for the occurrence of intraoperative complications with surgical access to the medial wall of the orbit are described.


Assuntos
Ducto Nasolacrimal , Órbita , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/cirurgia , Humanos , Complicações Intraoperatórias , Órbita/diagnóstico por imagem
10.
Laryngorhinootologie ; 100(11): 931-934, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34715716
11.
Rom J Morphol Embryol ; 62(1): 227-231, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34609425

RESUMO

The osseous nasal septum (NS) consists of the perpendicular plate of the ethmoid bone (PPE) and the vomer bone. Few studies evaluated the possibilities of septal pneumatization of the PPE, or adjacent to it. We aimed to observe the anatomical possibilities of NS pneumatizations. A retrospective lot of cone-beam computed tomography (CBCT) files was used. One hundred seventy-one CBCT files from 51 males and 120 females were documented. There were found 46 files that were null for septal pneumatization. The other cases (73.1%) had different septal pneumatizations extended from neighboring air spaces. Pneumatized crista galli (CG) exclusively extended from a frontal sinus was found in 7.01% of cases. The frontal sinuses had minor extensions anterior to the PPE in 7.6% of cases. Unique or double pneumatizations of the sphenoidal rostrum extending within the posterior part of the PPE were detected in 71.34% of cases. In six cases were found ethmoidal pneumatizations of the PPE, either from an anterior ethmoid cell, or from a posterior one, or from a pneumatized CG. In this last case was found a sinus septi nasi of 25.37 mm sagittal size. The supra-septal recesses of the ethmoid air cells were roofing the respective nasal fossa. As all the morphological possibilities of NS pneumatization involve the upper part of the PPE, they should be adequately discriminated anatomically, as well as when the NS and the cribriform plate of the ethmoid bone are approached surgically.


Assuntos
Seio Frontal , Septo Nasal , Osso Etmoide , Feminino , Humanos , Masculino , Cavidade Nasal , Septo Nasal/diagnóstico por imagem , Estudos Retrospectivos
13.
Artigo em Inglês | MEDLINE | ID: mdl-34535221

RESUMO

BACKGROUND: Functional endoscopic sinus surgery might lead to dangerous complications. Studying and analysing preoperative CT scans provides surgeons with a precise knowledge of their patient's anatomy, thus reducing the risk of potential complications. Checklists highlighting key anatomical areas have been published and proven useful. However, none of these are widely accepted or systematically used in daily practice. OBJECTIVE: In this paper, the rhinology group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS) aim to create and validate a new checklist designed to be fast and user friendly for daily practice. METHODS: Two CT sinonasal scans were selected as test cases. Forty otolaryngologists were selected from five tertiary referral hospitals. It was a cross-sectional study; each participant was their own control. All participants completed a questionnaire after the analysis of both CT scans to prevent learning bias. The evaluation included ten items critical in endoscopic sinus surgery according to previous publications. RESULTS: There were 80 evaluations. There was a significant increase in the number of correctly identified critical structures with the use of the checklist (p=.009). There was a statistically significant difference in low- experience evaluators, while it was not statistically significant for experienced surgeons. The most unanswered structures were suprabullar recess, dangerous v2 nerve, anterior ethmoid artery, dangerous vidian nerve and Onodi cell. The most wrongly identified structures were Keros type, septal deviation and cribiform middle turbinate. CONCLUSION: The YO-IFOS radiological checklist has proven a useful tool for correctly studying sinonasal anatomical variations. There is a clear learning component in the use of the checklist although it does not in any way exempt specialists from thorough study of sinonasal anatomy. Given the risk-benefit ratio, we strongly suggest the routine use of the checklist to systematically assess CT-scans prior to endoscopic sinonasal surgery.


Assuntos
Lista de Checagem , Endoscopia , Estudos Transversais , Osso Etmoide , Humanos , Conchas Nasais
14.
Clin Anat ; 34(8): 1186-1195, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34370888

RESUMO

A precise nomenclature and terminology is the foundation of communication in Anatomy and related biomedical sciences. The olfactory bulbs and nerves lie above and below the cribriform plate (CP), respectively. Hence, many anatomical landmarks in this region have names adopting the term "olfactory" as qualifiers. Ambiguous use of these "olfactory" terms exists, with some potential repercussions on patient treatments. We performed a publication database analysis to determine the frequency of misuse of names for seven anatomical "olfactory" spaces close to the CP and nasal cavity. We searched PubMed® publications having the keyword "olfactory" in their title or abstract, plus one of seven other keywords: "groove", "fossa", "recess", "cleft", "vestibule", "sulcus", and "cistern". We reviewed all abstracts for accuracy of these terms relative to accepted norms or customary definitions. By February 2020, we found all these keywords in 1255 articles. For the terms olfactory "groove" and "fossa", the number of relevant articles (and percentage of those inaccurately using these terms) were 374 (1.1%), and 49 (8.2%), respectively. All 52 abstracts containing "olfactory" and "vestibule" were irrelevant, relating to the "nasal vestibule" and olfactory function, instead of "olfactory vestibule". Overall, terms used to describe "olfactory" spaces near the CP are seldom ambiguous or inaccurate, but the terms olfactory "groove" and "fossa" are occasionally misused, We propose several new "olfactory" terms for inclusion in the Terminologia Anatomica, and stress the need for uniform nomenclature leading to greater consistency and accuracy in clinical use of anatomical terms containing the word "olfactory" as a descriptor.


Assuntos
Osso Etmoide/anatomia & histologia , Cavidade Nasal/anatomia & histologia , Terminologia como Assunto , Osso Etmoide/diagnóstico por imagem , Humanos , Cavidade Nasal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
Surg Radiol Anat ; 43(12): 1989-1998, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34245351

RESUMO

PURPOSE: This study aimed to examine the morphometry of the crista galli (CG) on paranasal sinus computed tomography (PNCT) images to develop a new approach of morphological classification with objective radiological criteria and to investigate the relationship of morphometric and morphological characteristics with gender. METHODS: The height, width, and length of the CG were measured on the PNCT images of 533 subjects (266 males, 267 females). Based on the dimensions and the presence of the cavitary component of the CG, the CG was classified into three morphological types. The success of CG dimensions and new morphological classification of CG in the determination of gender was evaluated with ROC and Paired Logistic Regression analyses. RESULTS: The morphometric cutoff values of the height, width, and length of the CG for the estimation of gender were determined as 15.15, 3.45, and 13.25 mm, respectively. CG length (accuracy 83.7%) showed more successful classification rate on gender determination as compared to height (accuracy: 81.4%), and width (accuracy 81.2%) of the CG. The presence of ossified type CG accurately identified the male sex at a rate of 88.7%, and teardrop type CG determined female sex at a rate of 82.9%. Tubular type CG identified male sex correctly at the rate of 65.8%. CONCLUSION: The height, length, and width measurements of CG on PNCT images and the new morphological types recommended in this study can be used in the determination of gender with high accuracy rates.


Assuntos
Osso Etmoide , Seios Paranasais , Feminino , Cabeça , Humanos , Masculino , Tomografia Computadorizada por Raios X
16.
J Craniofac Surg ; 32(8): 2888-2891, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34231515

RESUMO

ABSTRACT: Pneumatization variants of the temporal bone have a crucial importance in several surgical interventions. However, very few data are known about possible correlation with other pneumatization variants.Pneumatization of glenoid fossa, petrous apex, and infralabyrinthine portion of temporal bone was assessed in 200 computed tomography scans, equally divided between males and females (18-92 years). Pneumatization variants of the ethmoid (concha bullosa, agger nasi, pneumatized crista galli) and the sphenoid sinuses (pneumatized pterygoid processes, anterior clinoid processes, dorsum sellae, volume) were recorded as well.Differences in prevalence of each pneumatization type according to sex and side, among different portions of the temporal bone, and between temporal bone and the pneumatized variants of the ethmoid bone and sphenoid sinuses, were assessed through chi-square test (P < 0.05). Differences in sphenoid volume among different pneumatization degrees of the temporal bone were assessed through 1-way analysis of covariance test (P < 0.05).Pneumatization of the petrous apex and the infralabyrinthine portion was significantly more frequent in males than in females, whereas pneumatization of the glenoid fossa was more often observed on the right side (P < 0.05). Variants of the temporal bone are all related one with each other in males, whereas in females only the relationship between pneumatized petrous apex and infralabyrinthine portion was found. Moreover, in females the pneumatized petrous apex was related with pneumatized anterior clinoid process, and the pneumatized infralabyrinthine portion was related with the sphenoid sinus volume.Results may be useful for predicting these important variants in planning surgical interventions of the cranial base.


Assuntos
Osso Etmoide , Osso Esfenoide , Feminino , Humanos , Masculino , Osso Petroso/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem
17.
Artigo em Chinês | MEDLINE | ID: mdl-34304506

RESUMO

Objective:To investigate the role of the supraorbital ethmoidal cell(SOEC) in identifying the frontal sinus ostium(FO) and the anterior ethmoidal artery(AEA) in endoscopic sinus surgery, and to evaluate the clinical significance of a proposed endoscopic classification of AEA. Methods:The clinical data of 116 patients with chronic rhinosinusitis were collected. Thirty-six patients(47 sides) with SOEC and DraftⅡA frontal sinusotomy were included. The radiological-anatomical relationship between SOECs and FO, AEAs were recorded. Endoscopic classification of AEA was proposed according to the relationship between the AEA and the ethmoidal roof(EF): type 1, the AEA prominence did not extend beyond the lateral one-third of the EF; type 2, that exceed the lateral one-third but not beyond two-thirds of the EF; type 3, that exceed the lateral two-thirds of the EF. Results:The incidence of SOECs was 26.1%(47/180) of the DraftⅡA operating sides. On computed tomography images, seven sides of FO were occupied by supra agger frontal cells or supra bulla frontal cells; the other 40 sides(85.1%) were immediately anterior to the SOECs. The AEAs were 100% located near the posterior margins of SOECs with 6(12.8%) running under the EF and 41(87.2%) low-lying distant from the EF. Under endoscopy, the identification rate of SOECs was 89.4%(42/47), and five(10.6%) SOECs were not confirmed due to edematous mucosa, bleeding, and other reasons. The identification rate of the AEA was 76.6%(36/47), of which type 1, type 2 and type 3 accounted for 41.7%(15/36), 38.9%(14/36) and 19.4%(7/36) respectively. After removing the frontoethmoidal cells, all the FO were located anteriorly or anteromedially to the SOECs. All the identified AEAs were located in the posterior boundary of the SOEC openings at the level of the anterior ethmoidal foramen. Conclusion:The SOEC is a reliable landmark for locating the FO and the AEA in endoscopic sinus surgery. The new endoscopic classification of AEA helps the surgeon dissect the frontoethmoidal region precisely.


Assuntos
Seio Etmoidal , Seio Frontal , Artérias , Endoscopia , Osso Etmoide , Seio Etmoidal/cirurgia , Humanos
18.
Artigo em Inglês | MEDLINE | ID: mdl-34294224

RESUMO

BACKGROUND: The frontal sinus drainage pathway is formed by either the ethmoid infundibulum or the middle meatus, which depends on the superior insertion of the uncinate process. According to Landsberg & Friedman the are 6 types of superior uncinate process insertion. The aim of this study is to find an association between the uncinate process insertion type and the development of frontal sinus mucoceles. METHODS: Fifty sinus CT scans were analysed. Exclusion criteria were previous nasal surgeries, malignancy, polyposis and an insufficient image quality. Superior insertions of the uncinate process were analysed according to the Landsberg & Friedman classification. The results were tabulated and analysed using SPSS 25.0. RESULTS: The analysis revealed type 1 insertion in 6% of the CT scans, type 2 in 32%, type 3 in 26%, type 4 in 0%, type 5 in 28% and type 6 in 8%. Despite 44% of the CT scans with frontal sinus mucocele showing a type 2 insertion of the uncinate process, both the Chi-Square test and the Cramer's V test showed no statistical significance (p>.05). Logistic regression also showed that uncinate process insertion type does not influence the likelihood of development of frontal sinuses mucoceles. CONCLUSIONS: The insertion of the uncinate process does not influence the development of frontal sinus mucoceles.


Assuntos
Seio Frontal , Mucocele , Doenças dos Seios Paranasais , Osso Etmoide , Seio Etmoidal , Seio Frontal/diagnóstico por imagem , Humanos , Mucocele/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem
19.
Am J Rhinol Allergy ; 35(6): 871-878, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34039073

RESUMO

BACKGROUND: Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS. OBJECTIVE: To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation.Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). RESULTS: The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP. CONCLUSIONS: According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.


Assuntos
Osso Etmoide , Seio Frontal , Endoscopia , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/cirurgia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Humanos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia
20.
Plast Reconstr Surg ; 147(5): 777e-786e, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33835093

RESUMO

BACKGROUND: Naso-orbitoethmoid fractures associated with ipsilateral zygomaticomaxillary complex fractures are more challenging injuries than zygomaticomaxillary complex fractures alone. However, there is a paucity of information on this complex fracture pattern in the pediatric population. This study investigated the cause, treatment, and outcomes of combined zygomaticomaxillary complex and naso-orbitoethmoid fractures versus isolated zygomaticomaxillary complex fractures in pediatric patients. METHODS: This was a 25-year retrospective cohort study of pediatric patients who presented to a single institution with zygomaticomaxillary complex fractures. Baseline patient demographics and clinical information, and concomitant injuries, treatment/operative management, and postoperative complications/deformities were recorded and compared between patients with combined zygomaticomaxillary complex and naso-orbitoethmoid fractures and patients with isolated zygomaticomaxillary complex fractures. RESULTS: Forty-nine patients were identified to have had zygomaticomaxillary complex fractures in the authors' 25-year study period, of whom 46 had adequate clinical documentation and follow-up. Seventeen patients had combined zygomaticomaxillary complex-naso-orbitoethmoid fractures, of whom six had panfacial fractures. Both patient groups (zygomaticomaxillary complex only and combined zygomaticomaxillary complex-naso-orbitoethmoid fractures) were similar in terms of demographics. However, a significantly greater proportion of combined fracture patients experienced postoperative complications compared to isolated zygomaticomaxillary complex fracture patients, even after excluding those with panfacial fractures (87.5 percent versus 35.3 percent; p < 0.001). Enophthalmos (37.5 percent) and midface growth restriction (37.5 percent) were the two most common complications/deformities in all combined fracture patients. CONCLUSIONS: High-impact trauma can lead to zygomaticomaxillary complex fractures with associated naso-orbitoethmoid fractures in children. This injury pattern was found to cause significantly greater postoperative morbidity than isolated zygomaticomaxillary complex fractures alone. Thus, pediatric patients presenting with this complex facial fracture pattern should be closely monitored. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Osso Etmoide/lesões , Fraturas Múltiplas/etiologia , Fraturas Múltiplas/cirurgia , Fraturas Maxilares/etiologia , Fraturas Maxilares/cirurgia , Osso Nasal/lesões , Fraturas Orbitárias/etiologia , Fraturas Orbitárias/cirurgia , Fraturas Cranianas/etiologia , Fraturas Cranianas/cirurgia , Fraturas Zigomáticas/etiologia , Fraturas Zigomáticas/cirurgia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Fraturas Maxilares/complicações , Fraturas Orbitárias/complicações , Estudos Retrospectivos , Fraturas Cranianas/complicações , Resultado do Tratamento , Fraturas Zigomáticas/complicações
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