Yüksek Rezolüsyonlu BT ile Erişkin Yaş Grubunda Ünsinat Proçes Anatomik Varyasyonlarının ve Maksiller Sinüs Hastalıkları ile İlişkisinin Değerlendirilmesi

Year 2018, Volume: 5 Issue: 3, 4 - 10, 04.12.2018

Emrah Doğan

Abstract

Ünsinat proçes (UP) osteomeatal kompleksin ve
nazal lateral duvarın ana parçalarından biridir ve UP varyasyonları inflamatuar
paranazal sinüs hastalıklarına zemin hazırlamaktadır. En yaygın UP
varyasyonları laterale ve mediale deviasyon, büllöz varyasyon ve çatı
varyasyonlarıdır. Bu çalışmanın amacı, Paranazal BT çekimi gerçekleştirilen
hastalarda UP varyasyonlarını ve diğer popülasyondan farklarını tanımlamak ve
maksiller sinüs hastalıkları ile ilişkisini bildirmektir. Çalışma Ocak
2018-Mart 2018 tarihleri arasında çekilen 176 adet paranazal sinüs BT üzerinden
gerçekleştirilen retrospektif bir çalışmadır. Tip I, II, III, IV olmak üzere
çatı insersiyonları, maksiller sinüzit (MS) ve maksiller sinüs hipoplazisi (MH)
ile ilişkileri, tokmak ve çengel UP varyasyonları bilateral olarak kemik ve
yumuşak doku pencerelerinde değerlendirdi. Çatı varyasyonları: Sağ %67.05 Tip
II, %18.2 Tip III, %13.6 ile Tip I, %1.15 Tip IV; Sol %71 Tip II, %15.9 Tip
III, %12.5 Tip I, %0,6 Tip IV Deviasyon anomalileri: Sağda %86.9 nötr, %7.4
medialize, %5.7 lateralize; Solda %92 nötr, %5.9 medialize, %2.1 lateralize.
Büllöz varyant: %7.7 MS-deviasyon, MH- deviasyon ilişkileri p< 0.05 çengel
ve tokmak UP, çift orta konka: %0.6. Çatı varyasyonları bölgesel olarak
belirgin farklılıklar göstermektedir. Araştırmanın yapıldığı popülasyonda Tip
II varyant çoğunluktaydı. Deviasyon anomalileri literatürle benzer orandaydı.
Büllöz varyant Türkiye’de yapılan araştırmalar ile benzer olarak diğer ülkelere
göre daha yüksek orandaydı. MS ve MH ile deviasyon anomalileri arasında ilişki
mevcuttu. Çatı varyasyonları ile MS ve MH ilişkisi izlenmedi.

Keywords

Anatomik Varyasyonlar, Maksiller, Paranazal Sinüs BT, Ünsinat Proçes

Evaluation of Uncinate Process’ Anatomical Variations in Adult Age Group with High Resolution CT and Their Relationship with Maxillary Sinus Pathologies

Abstract

Uncinate process (UP)
is one of the key parts of the osteomeatal complex and the nasal lateral wall.
UP variations can lead to inflammatory paranasal sinus diseases. The most
common UP variations are lateral and medial deviations, bullous variation, and
superior tip insertions. The purpose of this study is to describe the different
variations of UP in patients undergoing CT scan and to report their association
with maxillary sinus diseases. We conducted a retrospective study of 176 paranasal
sinus CT performed between January 2018 and March 2018. Root insertions such as
Type I, II, III and IV; bilateral hammer and hook UP variations were evaluated
in bone and soft tissue windows and correlated to maxillary sinusitis (MS) as
well as maxillary sinus hypoplasia (MH). Roof Variations: in the right side
67.05% were Type II, 18.2% Type III, 13.6% Type I and 1.15% Type IV; in the
left side 71% were Type II, 15.9 Type III, 12.5% Type I and 0.6% Type IV.
Deviation Anomalies; in the right side 86.9% were neutral, 7.4% medialized and
5.7% lateralized; in the left side 92% were neutral, 5.9% medialized and 2.1% lateralized.
Bullous variation were found in 7.7% of the patients. Hook and hammer UP,
double middle concha were found in 0.6% of the patients. Roof variations showed
significant regional differences. In our study, Type II variation was dominant.
Rates of UP deviation anomalies were similar to the literature. Bullous variant
had higher rates than observed in other countries and similar to researches
done in Turkey. A significant correlation (p <0.05) were found between MS
and UP deviations’ type as well as between MH and UP deviations’ type.
Relationship between roof variations and MS, MH as well as UP deviations were
not found.

Keywords

Anatomical Variations, Maxillary, Paranasal Sinus CT, Uncinate Process

References

• 1. Orhan I, Soylu E, Altın G, Yılmaz F, Calım OF, Ormeci T. Analysis of anatomic variations of paranasal sinus by computed tomography. Abant Med J. 2014;(3)2:145-9.
• 2. Kennedy DW, Zenreich SJ, Rosenbaum AE, Johns ME. Functional endoscopic sinus surgery. Theory and diagnostic evaluation. Arch Otolaryngol. 1985;111:576-82.
• 3. Stammberger H. Endoscopic endonasal surgery-concepts in the treatment of recurring rhinosinusitis-I: Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg. 1986;94:143-7.
• 4. Bolger WE. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinüs surgery. Laryngoscope. 1991;101:56-64.
• 5. Mafee MF. Endoscopic Sinus Surgery: Role of the Radiologist. Am J Neuroradiol. 1991;12:855-60.
• 6. Zinreich SJ, Albayram S, Benson M, et al. The Ostiomeatal Complex And Functional Endoscopic Surgery. In: Som Pm, Curtin Hd, Editors. Head And Neck Imaging. 4th Ed. St. Louis: Mosby. 2003;149-174.
• 7. Earwaker J. Anatomic variants in sinonasal CT. Radio Graphics. 1993;13:381-415.
• 8. Adeel M, Rajput MS, Akhter S, Ikram M, Arain A, Khattak YJ. Anatomical variations of nose and para-nasal sinuses; CT scan review. J Pak Med Assoc. 2013:63(3);317-9.
• 9. Riello APDFL, Boasquevisque EM. Anatomical variants of the ostiomeatal complex: tomographic findings in 200 patients. Radiol Bras. 2008;41;149-54.
• 10. Stammberger H, Koop W, Dekornfeld TJ. Special endoscopic anatomy. In: Stammberger H, Hawke M, editors. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Philadelphia, PA: BC Decker. 1991; pp:61-90.
• 11. Landsberg R, Friedman M. A computer-assisted anatomical study of the nasofrontal region. Laryngoscope. 2001;111:2125-30.
• 12. Turgut S, Ercan I, Sayin I, Basak M. The relationship between frontal sinusitis and localization of the frontal sinus outflow tract: A computer assisted anatomical and clinical study. Arch Otolaryngol Head Neck Surg. 2005;131:518-22.
• 13. Stammberger HR, Bolger WE. Paranasal sinuses: anatomic terminology and nomenclature. The Anatomic Terminology Group. Ann Otol Rhinol Laryngol Suppl. 1995;167:7-16.
• 14. Arun G, Sanu PM, Mohan M, Khizer Hussain MA, Aparna ST. Anatomical variations in superior attachment of uncinate process and localization of frontal sinus outflow tract. Int J Otorhinolaryngol Head Neck Surg. 2017;3(2):176-9.
• 15. Krzeski A, Tomaszewska E, Jakubczyk I, Galewicz-Zielinska A. Anatomic variations of the lateral nasal wall in the computed tomography scans of patients with chronic rhinosinusitis. Am J Rhinol. 2001;15(6):371-5.
• 16. Min Y, Koh T, Rhee C, Han M. Clinical implications of the uncinate process in paranasal sinusitis: radiological evaluation. Am J Rhinol. 1995;9(3):131-5.
• 17. Tuli IP, Sengupta S, Munjal S, Kesari SP, and Chakraborty S. Anatomical Variations of Uncinate Process Observed in Chronic Sinusitis. Indian J Otolaryngol Head Neck Surg. 2013;65(2):157-61.
• 18. Demir K. Nazal Polipozis Tanılı Hastalarda Endonazal Anatomik Varyasyonların Görülme Sıklığının Tespiti Ve Toplum ile Karşılaştırılması. Uzmanlık tezi. İstanbul Eğitim ve Araştırma Hastanesi K.B.B. Kliniği. 2006.
• 19. Stammberger H. Wolf G. Headaches and Sinus Disease: The Endoscopic Approach. Ann Otol Rhinol Laryngol Suppi. 1988;97:323-4.
• 20. Akan H. Baş Boyun Radyolojisi. Ankara, MN Medikal & Nobel Tıp Kitabevi. 2008; p:179-89.
• 21. Mısırlıoglu M, Nalçacı R, Adısen MZ, Yardimci S. The evaluation of paranasal sinuses and anatomical variations with dental volumetric tomography. AÜ Diş Hek Fak Derg. 2011;38(3):143-52.
• 22. Wanamaker HH. Role of Haller’s cell in headache and sinus disease: a case report. Otolaryngol Head Neck Surg. 1996;114(2):324-7.
• 23. Aiyer RG, Pandya VK, Soni GB, Dhameja PJ, Gupta R, Patel M. Etiopathogenesis of rhinosinusitis in relation to ethmoid anatomy. Clin Rhinol Int J. 2010;3(1):17-21.
• 24. Asruddin, Yadav RK, Singh J. Low dose CT in chronic sinusitis. Indian J Otolaryngol Head Neck Surg. 1999;52(1):17-22.
• 25. Cagıcı CA, Yilmaz M, Erkan AN, Yilmazer C, Ozluoglu L. Concurrence of paranasal sinus mucosal thickening and Anatomic Variation. Turk Arch Otolaryngol. 2006;44(4):211-7.
• 26. Keast A, Sofie Y, Dawes P, Lyons B. Anatomical variations of the paranasal sinuses in Polynesian and New Zealand European; Computerized tomography scans. Otolaryngology. 2008;139: 216.
• 27. Zinreich SJ. Functional anatomy and computed tomography imaging of the paranasal sinuses. Am J Med Sci. 1998;316: 2-12.
• 28. Branstetter BF, Weissman JL. Role of MR and CT in the paranasal sinuses. Otolaryngol Clin North Am. 2005;38:1279-99.
• 29. Dogru H, DonerbF, Uygur K, et al. Pneumatized inferior turbinate. Am J Otolaryngol. 1999;20:139-41.
• 30. Tessema B, Brown SM. Nasal cavity anatomy, physiology, and anomalies on CT scan. 2011. (Internet) (Updated 2018 Jun 25; cited 2018 Aug 2).
• 31. Isobe M, Murakami G, Kataura A. Variations of the uncinate process of the lateral nasal wall with clinical implications. Clin Anat. 1998;11(5):295-303.
• 32. Bolger W, Woodruff W, Morehead J, et al. Maxillary sinus hypoplasia: classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg. 1990;103:759-65.
• 33. Stammberger H. Endoscopic sinus surgery-concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique. Otolaryngol Head Neck Surg. 1986;94:147-56.
• 34. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101:56-64.
• 35. Meyers RM, Valvassori G. Interpretation of anatomic variations of computer tomography scans of the sinuses: a surgeon’s perspective. Laryngoscope. 1998;108:422-5.
• 36. Wang RG, Jiang SC, Gu R: The cartilaginous nasal capsule and embryonic development of human paranasal sinuses. J Otolaryngol. 1994;23:239-43.
• 37. Gungor G, Okur N, Okur E. Uncinate Process Variations and Their Relationship with Ostiomeatal Complex: A Pictorial Essay of Multidedector Computed Tomography (MDCT) Findings. Pol J Radiol. 2016;81:173-180.
• 38. Tan HM, Chong VFH: CT of the paranasal sinuses: normal anatomy, variants and pathology. CME Radiol. 2001;2:120-5.