Septoplasti ve Septorinoplasti Hastalarında Etmoid Çatı Derinliğinin ve Sinonazal Anatomik Varyasyonların Retrospektif Radyolojik Analizi

Yıl 2022, , 738 - 742, 30.09.2022

Mehmet Akif Alan , Muhammed Fazıl Aras

https://doi.org/10.16899/jcm.1127673

Öz

Giriş: Sinonazal semptomlardan şikayet eden hastalarda bilgisayarlı tomografi (BT), sinonazal anatomi ve osseokartilajinöz patolojilerin doğru bir şekilde değerlendirilmesini sağlar. Rutin olarak kabul edilen bir uygulama olmasa da septoplasti ve septorinoplasti planlanan hastaların preoperatif taramalarında BT sıklıkla kullanılmaktadır. Bu çalışmada kliniğimizde gerçekleştirilen septoplasti ve septorinoplasti ameliyatlarında preoperatif çekilen BT görüntülerde anatomik varyasyonlar ve etmoid lateral lamella yükseklikleri retrospektif analiz edilerek güncel literatür bilgileriyle tartışıldı.
Gereç ve Yöntem: Ocak 2014– Ağustos 2018 arasında kliniğimizde yapılan 18 yaş üstü septoplasti ve septorinoplasti ameliyatları retrospektif tarandı. 200 hasta çalışmaya dahil edildi. BT görüntüleri anatomik varyasyonlar ve etmoid lateral lamella yükseklikleri açısından değerlendirildi.
Bulgular: Çalışmaya dahil edilen 200 hastanın 158’ i septoplasti (%79), 42’ si (%21) septorinoplasti operasyonu geçirdi. Konka bülloza hastaların 95’ inde (%47,5) saptanarak en sık anatomik varyasyon olarak belirlendi. Onodi hücre varyasyonu hastaların 62’ sinde (%31) saptandı. Haller hücresi 37 hastada (%18,5) saptandı. Paradoks orta konka 19 hastada (%9,5), pnömatize anterior klinoid proses 17 hastada (%8,5) ve pnömatize krista galli 4 hastada (%2) saptandı. Lateral lamella ölçümlerinde; sağda lateral lamella yüksekliği median değeri 4,20 mm (0,40-7,40 mm) solda lateral lamella yüksekliği median değeri 4,20 mm (1,70-7,30 mm) olarak bulundu.
Sonuç: Septoplasti ve septorinoplasti operasyonları öncesi BT görüntülemede saptanabilecek anatomik varyasyonlar ve etmoid çatı anatomisi hakkında elde edilebilecek bilgiler vaka yönetiminde, cerrahi planlamasında ve komplikasyon yönetiminde faydalı olacaktır.

Anahtar Kelimeler

Sinonazal anatomi, Keros, etmoid çatı, septoplasti, septorinoplasti

Retrospective Radiological Analysis of Ethmoid Roof Depth and Sinonasal Anatomical Variations in Septoplasty and Septorhinoplasty Patients

Öz

Aim: Computed tomography (CT) provides an accurate assessment of sinonasal anatomy and osseocartilaginous pathologies in patients complaining of sinonasal symptoms. Although it is not a routine practice, CT is frequently used in preoperative screening of patients planned for septoplasty and septorhinoplasty. In this study, anatomical variations and ethmoid lateral lamella depths in preoperative CT images of septoplasty and septorhinoplasty operations performed in our clinic were analyzed retrospectively and discussed with current literature.
Material and Method: Septorhinoplasty and septoplasty surgeries performed in our clinic between January 2014 and August 2018 over the age of 18 years were reviewed retrospectively. Two hundred patients were included in the study. CT images were evaluated for anatomical variations and ethmoid lateral lamella depths.
Results: Of the 200 patients included in the study, 158 (79%) underwent septoplasty and 42 (21%) underwent septorhinoplasty. Concha bullosa was detected in 95 (47,5%) of the patients and was determined as the most common anatomical variation. Onodi cell variation was detected in 62 (31%) of the patients. Haller cell was detected in 37 patients (18,5%). Paradoxical middle turbinate was detected in 19 patients (9,5%), pneumatized anterior clinoid process in 17 patients (8,5%), and pneumatized crista galli in 4 patients (2%). In lateral lamella measurements; the median value of the lateral lamella depth on the right was 4,20 mm (0,40-7,40 mm) and the median value of the lateral lamella depth on the left was 4,20 mm (1,70-7,30 mm).
Conclusion: Anatomical variations that can be detected in CT imaging before septoplasty and septorhinoplasty operations and information about ethmoid roof anatomy will be useful in case management, surgical planning and complication management.

Anahtar Kelimeler

Sinonasal anatomy, Keros, ethmoid roof, septoplasty, septorhinoplasty

Kaynakça

• Graviero G, Guastini L, Mora R, Salzano G, Salzano FA. The role of three-dimensional CT in the evaluation of nasal structures and anomalies. Eur Arch Oto Rhino Laryngol 2011;268(8):1163-67.
• Günbey E, Günbey HP, Uygun S, Karabulut H, Cingi C. Is preoperative paranasal sinus computed tomography necessary for every patient undergoing septoplasty? Int Forum Allergy Rhinol 2015;5(9):839-45.
• Khojastepour L, Mirhadi S, Mesbahi SA. Anatomical Variations of Ostiomeatal Complex in CBCT of Patients Seeking Rhinoplasty. J Dent 2015;16(1):42-8.
• Kim SH, Oh JS, Jang YJ. Incidence and Radiological Findings of Incidental Sinus Opacifications in Patients Undergoing Septoplasty or Septorhinoplasty. Ann Otol Rhinol Laryngol 2020;129(2):122-7.
• Karataş D, Yüksel F, Şentürk M, Doğan M. The contribution of computed tomography to nasal septoplasty. J Craniofac Surg 2013;24(5):1549-51.
• Bolger MWE, Clement PAR, Kuhn FA, Lanza DC. Paranasal sinuses: anatomic terminology and nomenclature. Ann Otol Rhinol Laryngol Suppl 1995;167:7-16.
• Keros P. On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol 1962;41:809-13.
• Shama SAM, Montaser M. Variations of the height of the ethmoid roof among Egyptian adult population: MDCT study. Egypt J Radiol Nuclear Med 2015;46:929-36.
• Alazzawi S, Omar R, Rahmat K, Alli K. Radiological analysis of the ethmoid roof in the Malaysian population. Auris Nasus Larynx 2012;39(4):393-6.
• Paber JELB, Cabato MSD, Villarta RL, Hernandez JG. Radiographic Analysis of the Ethmoid Roof based on KEROS Classification among Filipinos. Philipp J Otolaryngol Head Neck Surg 2008;23(1):15-9.
• Arslan H, Aydinlioglu A, Bozkurt M, Egeli E. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx 1999;26(1):39-48.
• Kaplanoglu H, Kaplanoglu V, Dilli A, Toprak U, Hekimoğlu B. An Analysis of the Anatomic Variations of the Paranasal Sinuses and Ethmoid Roof Using Computed Tomography. Eurasian J Med 2013;45(2):115-25.
• Sari N, Cankal F, Uysal E. Are preoperative CT parameters predictive for the outcome of septoplasty? Niger J Clin Pract 2022; 25(4):531-40.