Morphometric analysis of the maxillary sinus in patients with nasal septum deviation

Radiographic Association of Maxillary Sinus Volume in Patients with Deviated Nasal Septum: A Systematic Review and Meta-analysis

The nasal septum, composed of bone and cartilage, maintains nasal alignment and airflow. Deviation, common but potentially problematic, can lead to symptoms like congestion and sinusitis. Maxillary sinus, a key paranasal sinus, influences airflow and drainage. Nasal septum deviation can alter maxillary sinus volume, affecting airflow dynamics and drainage. Cone beam computed tomography (CBCT) and CT imaging are essential for assessing these conditions accurately, providing detailed 3D images and aiding in diagnosis and treatment planning. The study aims to review the radiographic association of maxillary sinus volume in patients with deviated nasal septum. The present review has been registered with PROSPERO-An international prospective register of systematic review CRD42023467988. Eligibility criteria: Studies from 2013 to 2022, in English, on maxillary sinus volume in deviated nasal septum patients. Exclusions: Animal studies, case reports, non-English articles. The Meta-analysis found that consistent association between nasal septum deviation and reduced maxillary sinus volume and no publication bias. The radiographic association of maxillary sinus volume in patients with deviated nasal septum was found to be statistically meaningful.

Investigation of nasal cavity alterations in individuals with neurofibromatosis type 1 using CBCT

OBJECTIVES

This study aimed to investigate nasal septum deviation (NSD), nasal bone length (NBL), and the morphology of the middle nasal conchae (MNC) and inferior nasal conchae (INC), as well as their correlations.

MATERIALS AND METHODS

The sample included 56 cone-beam computed tomography scans divided into two groups: a study group (SG; individuals with NF1; n = 28) and a control group (CG; individuals without NF1; n = 28). NSD, NBL, MNC, and INC classifications were assessed. MNC images were classified as normal, bullous, paradoxical, secondary, and accessory. INC images were classified as normal, lamellar, compact, combined, and bullous. Intra- and interobserver reliability were evaluated.

RESULTS

SG had a mean NSD of 11.6° (±4.5°) compared with 9.6° (±3.2°) for the CG, showing moderate deviations with no significant difference between groups. SG had a mean NBL of 22.4 mm (±3.4 mm) compared with 22.1 mm (±3.2 mm) for the CG, with a statistically significant difference. Both groups exhibited normal, bullosa, and accessory MNC classifications. SG INC were normal, lamellar, and combined, whereas CG INC were normal and lamellar. There was a weak correlation between NSD and NBL across groups.

CONCLUSION

Individuals with NF1 showed longer NBL. The weak correlation between NSD and NBL suggested multifactorial influences on these variations. These findings advance our understanding of craniofacial development in NF1 and highlight the need for further research into nasal cavity involvement in this complex genetic disorder.

Assessment of the Change in the Nasal Septum and Nasal Profile After Le Fort I With Cone Beam Computed Tomography

OBJECTIVE

This study aimed to determine the relationship between nasal changes and the amount of advancement, impaction, and downward movement of the maxilla after Le Fort I osteotomy.

METHODS

The study included 48 patients who underwent Le Fort I surgery and had pre- and postoperative cone-beam computed tomography records. Changes in the nasal septum were evaluated by measuring septal deviation angles and volumes. In addition, nasolabial angle and width of nasal and alar base were examined. Groups were determined according to the movement of point A (the deepest point on the curvature of the maxillary alveolar process), using a threshold of 1.5 mm for vertical movements and 4 mm for sagittal movements. This resulted in the comparison of 6 groups of 8 people each. Results are presented as mean and standard deviation or median and range depending on the data distribution. Significance level was accepted as P < 0.05.

RESULT

There were no significant differences for each group on its own septal deviation volume or angle values pre/postoperatively. Groups 3 and 5, which both had at least 1.5 mm of impaction, showed significant changes in both deviation angle and volume between the preoperative and postoperative measurements. Nasolabial angle did not show significant changes between groups. Alar base width and nasal width increase was significantly highest in Group 1, which has more than 4 mm sagittal movement and less than 1.5 mm vertical movement.

CONCLUSIONS

Le Fort I osteotomy may lead to undesirable changes in the spatial positioning of the nasal septum. The results of this study suggest that maxillary advancement does not significantly impact septal deviation, whereas maxillary impaction increases the amount of deviation. In addition, nasal width and alar base width tended to increase, and the nasolabial angle tended to decrease slightly, regardless of the direction of movement of the maxilla after orthognathic surgery.

CLINICAL RELEVANCE

Surgeons should consider increased nasal septal deviation risks when planning impaction of the maxilla. The soft tissue changes in the nose vary according to different directions and amounts of Le Fort I surgery.

Nasal anatomy and sniffing in respiration and olfaction of wild and domestic animals

Animals have been widely utilized as surrogate models for humans in exposure testing, infectious disease experiments, and immunology studies. However, respiratory diseases affect both humans and animals. These disorders can spontaneously affect wild and domestic animals, impacting their quality and quantity of life. The origin of such responses can primarily be traced back to the pathogens deposited in the respiratory tract. There is a lack of understanding of the transport and deposition of respirable particulate matter (bio-aerosols or viruses) in either wild or domestic animals. Moreover, local dosimetry is more relevant than the total or regionally averaged doses in assessing exposure risks or therapeutic outcomes. An accurate prediction of the total and local dosimetry is the crucial first step to quantifying the dose-response relationship, which in turn necessitates detailed knowledge of animals' respiratory tract and flow/aerosol dynamics within it. In this review, we examined the nasal anatomy and physiology (i.e., structure-function relationship) of different animals, including the dog, rat, rabbit, deer, rhombus monkey, cat, and other domestic and wild animals. Special attention was paid to the similarities and differences in the vestibular, respiratory, and olfactory regions among different species. The ventilation airflow and behaviors of inhaled aerosols were described as pertinent to the animals' mechanisms for ventilation modulation and olfaction enhancement. In particular, sniffing, a breathing maneuver that animals often practice enhancing olfaction, was examined in detail in different animals. Animal models used in COVID-19 research were discussed. The advances and challenges of using numerical modeling in place of animal studies were discussed. The application of this technique in animals is relevant for bidirectional improvements in animal and human health.

Maxillary sinus volume and mucosal thickening according to the septal deviation angle and age of the children

We examined the relationship between nasal septal deviation (SD) angle and maxillary sinus volumes by examining the paranasal sinus computed tomography (PNSCT) images in children. In this retrospective study, PNSCT images of 106 children with one-sided nasal SD were included. According to the SD angle, two groups were identified: Group 1 (n = 54): SD angle ≤ 11°, Group 2 (n = 52): SD angle > 11°. There were 23 children between 9 and 14 years and 83 children between 15 and 17 years. Maxillary sinus volume and mucosal thickening were evaluated. In 15- to 17-year age group, maxillary sinus volumes of males were higher than females bilaterally. For each of the males and females, ipsilateral maxillary sinus volume was significantly lower than the contralateral side in all children and in 15- to 17-year age group. In each of the SD angle values (≤11 or >11) separately, ipsilateral maxillary sinus volume was lower; and in the SD angle > 11° group, maxillary sinus mucosal thickening values were higher than those of the contralateral side. In young children in 9- to 14-year age group, bilateral maxillary sinus volumes decreased, in this group maxillary sinus volume was not affected according to the SD. However, in 15- to 17-year age groups, maxillary sinus volume was lower on the ipsilateral SD side; and ipsilateral and contralateral maxillary sinus volumes of the males were significantly higher than those in the females. SD should be treated at an appropriate time to prevent SD-related maxillary sinus volume shrinkage and rhinosinusitis.

Three-dimensional evaluation of the maxillary sinus in patients with different skeletal classes and cranio-maxillary relationships assessed with cone beam computed tomography

The objective was to evaluate the relationship between the dimensions of the maxillary sinuses (MSs) and various cephalometric parameters. MS volume (MSV), MS surface (MSS), linear maximum depth (LMD), linear maximum width (LMW), and linear maximum height (LMH) were calculated on CBCT scans of 99 adults. Two sets of two-way (ANOVA) assessed the influence respectively of ANB and SNA angles and of the gender on MS dimensions. Pearson's correlation was calculated between MS dimensions and different cephalometric variables. Reliability and accuracy of the proposed method was tested with intra-operator and inter-operator intraclass correlation coefficient (ICC). Two-way ANOVA showed no statistically significant difference in MSV, MSS and LMH between ANB groups, whilst males were associated with bigger sinuses. LMW showed statistically significant difference in both ANB and gender groups. LMD showed no statistically significant difference. The second Two-way ANOVA showed significantly larger MSV, MSS and LMD in patients with increased or reduced SNA angle but not between genders. LMW and LMH also showed a significant difference between genders. All linear measurements showed a significant interaction of the two factors. The intra-observer and inter-observer ICC scored high for all the tested measurements. MSV and MSS showed a positive correlation with S-N, PNS-A, S-Go, N-Me, N-Ans and the distance between Mx points. LMW had a negative correlation with Ba-S-N angle and N-Me, LMH with Ba-S-N angle, S-Go and Mx r-Mx l and LMD with N-Me and N-ANS. LMW had a positive correlation with Mx r-Mx l, LMH with S-N, S-N^Ans-Pns, N-Me, N-Ans and LMD with S-N, Ba-S-N, PNS-A, S-Go and distance between Mx points. In conclusion, MSV and MSS did not differ between the three skeletal classes, males showed significantly larger MS than in females. Concerning the influence of the cranio-maxillary relationship (SNA) and gender on MS dimension, subjects with a retrusion (SNA < 80°) or protusion (SNA > 84°) of the maxillary alveolar bone had larger MSV, MSS, LMW, LMH and LMD than subjects with a normal cranio-maxillary relationship (SNA 82 ± 2°). A statistically significant high positive correlation was observed between S-N, Pns-A, S-Go, Mx-R/Mx-r and MS dimension. Further studies that evaluate similar outcomes in different races may be able to enrich our knowledge on this topic.

Relationship Between Nasal Septal Deviation Angles and Turbinates: A Computed Tomography Study

Background This study aimed to evaluate inferior turbinate hypertrophy caused by nasal septum deviation, nasal septal deviation (SD) angles, and age differences with the help of paranasal computed tomography (CT) and to investigate the relationship between these parameters. Methodology The paranasal sinus CT images of 100 patients (50 males and 50 females) were retrieved from the hospital's picture archiving and communication system. In this retrospective study, patients were examined in two groups. There were 50 patients aged >35 years in group 1 and 50 patients aged <35 years in group 2. The SD side was determined using a coronal image and was mentioned as the ipsilateral side. The contralateral side of the SD side was mentioned as the contralateral side. Additionally, the SD curve angle (SDCA), superior SD angle (SSDA), and diameters and mucosal thicknesses of the inferior turbinates were measured. Concomitant ipsilateral sinusitis and ipsilateral concha bullosa (in the middle concha) were also noted as present or absent. Results In our study, the SDCA values of the ≥35-year age group were significantly higher than those of the <35-year age group (p < 0.05). Furthermore, the SSDA values of the ≥35-year age group were significantly lower than those of the <35-year age group (p < 0.05). In each of the age groups, ipsilateral inferior turbinate mucosal thickness and ipsilateral inferior turbinate diameter values were significantly higher than those of the contralateral sides (p < 0.05). Ipsilateral concha bullosa was present in 30.0% of the <35-year age group and 18.0% of the ≥35-year age group. Ipsilateral sinusitis was present in 34.0% of the <35-year age group and 52.0% of the ≥35-year age group. Conclusions SD and inferior turbinate hypertrophies should be evaluated together and measured with paranasal CT to provide more efficient nasal aeration. Studies with larger patient series are needed to elucidate the etiology.

Do closed reduction and fracture patterns of the nasal bone affect nasal septum deviation?

Background

Many severe nasal bone fractures present with septal fractures, causing postoperative septal deviation and negatively affecting the patients’ quality of life. However, when a septal fracture is absent, it is difficult to predict whether surgical correction can help minimize nasal septal deviation postoperatively. This study determined whether performing closed reduction on even mildly displaced nasal bone fracture could deter the outcome of septal deviation.

Methods

We retrospectively reviewed the data of 116 patients aged 21–72 years who presented at the outpatient clinic and emergency room with fractures of nasal bones only without any involvement of the septum from January 2014 to December 2020. Patients were classified into three fracture type groups: A (unilateral), B (bilateral), and C (comminuted with depression). The degree of septal deviation was calculated by measuring the angle between the apex of the most prominent point and the crista galli in the coronal view on computed tomography images. The difference between the angles of the initial septal deviation and that of the follow-up was calculated and expressed as delta (Δ).

Results

Closed reduction tended to decrease the postoperative septal deviation in all fracture types, but the values were significantly meaningful only in type A and B fractures. In the surgical group, with type A as the baseline, type B showed a significantly larger Δ value, but type C was not significantly different, although type C showed a smaller Δ value. In the conservative group, with type A as the baseline, the other fracture types presented significantly lower Δ values.

Conclusion

For all fracture types, closed reduction significantly decreased the extent to which the nasal septum likely deviated. Therefore, when a patient is reluctant to undergo closed reduction, physicians should address the possible outcomes and prognosis of untreated nasal bone fractures.

Pediatric Paranasal Sinuses- Development, Growth, Pathology & Functional Endoscopic Sinus Surgery

The paranasal sinuses (maxillary, frontal, ethmoid, and sphenoid sinuses) are complex anatomical structures. The development and growth of these have been investigated utilizing a number of different methods ranging from cadaveric analysis to modern cross sectional imaging with 3D modeling. An understanding of normal pediatric paranasal sinus embryology and development enables us to better determine when pathology may be affecting the normal developmental process. Cystic fibrosis, chronic sinusitis, deviated nasal septum and cleft lip and palate are some of the conditions which have been shown to effect paranasal sinus development to varying degrees. Functional endoscopic sinus surgery (FESS) is becoming increasingly common and an understanding of sinus anatomy together with when periods of rapid growth occur during childhood is important clinically. Although concerns have been raised regarding the impact of FESS on facial growth, there is limited evidence of this in regards to either changes in anthropomorphic measurements or clinical assessments of symmetry post operatively.

Associations between the severity of nasal septal deviation and nasopharynx volume in different ages and sexes: a cone-beam computed tomography study

Background

Nasal septum deviation (NSD) can cause serious anatomical and clinical complications. It can change the breathing pattern and thus alter the anatomy of the airway structures. Despite its importance, the association between NSD with the nasopharynx volume (NPV) has not been assessed before. Therefore, we aimed to investigate it for the first time.

Methods

Archival CBCTs of 202 patients older than 17 years and without any history of trauma or pathology of the nasopharynx and without any orthodontic/orthognathic treatments were evaluated (129 women, 73 men, mean age: 36.24 ± 14.61 years). All included CBCTs must have been taken with a 12 × 8 field of view and fully covered the nasopharynx areas. The extent of NSD (°) and NPV (mm³) were measured. NSDs were categorized as mild (NSD ˂ 9°), moderate (9 ≤ NSD ≤ 15°), and severe (NSD ˃ 15°). Associations between sex, age, NSD, and nasopharynx volume were assessed using independent-samples t test, chi-square, one-way ANOVA, Tamhane post hoc test, Pearson and point-biserial correlation coefficients, and multiple linear regressions (α = 0.05).

Results

Mean NSDs were 11.27 ± 4.69° (range 1–19.5), 11.58 ± 4.63°, and 10.70 ± 4.76° in the sample, females, and males, respectively (P > 0.05). Of females, 27.9%, 40.3%, and 31.8% had mild, moderate, and severe NSDs. These were 35.6%, 39.7%, and 24.7% in males (P > 0.05). Mean NPVs were 4.88 ± 1.49, 4.80 ± 1.43, and 5.04 ± 1.60 mm³ in the sample, females, and males, respectively (P > 0.05). Mean NPVs were 6.41 ± 1.21, 4.87 ± 0.73, and 3.30 ± 0.65 mm³ in mild, moderate, and severe NSD groups (all P values = 0.000). Mean ages were 27.06 ± 6.49, 29.80 ± 9.64, and 54.73 ± 8.45 years in mild, moderate, and severe NSD groups (severe group being older than the other two groups, P = 0.000). NSD was strongly, negatively correlated with NPV (R = − 0.793, P = 0.000). Sex was not correlated with NPV or NSD (P ≥ 0.189). Age was negatively and positively correlated with NPV and NSD, respectively (P = 0.000). Modeling NSD (β = −0.776, P = 0.000) as a predictor for NPV rendered age effect insignificant (P > 0.05).

Conclusions

It was found, for the first time, that the more deviated the nasal septum, the smaller the nasopharynx volume. Aging might increase NSD and through it, reduce the nasopharynx volume. Sex might not affect NSD or NPV.

Morphometric and volumetric evaluation of maxillary sinus in patients with chronic obstructive pulmonary disease using cone-beam CT

OBJECTIVES

The purpose of present study is to assess the maxillary sinuses patients with COPD morphometrically and volumetrically using cone-beam computed tomography (CBCT) images and compared these findings according to in age and gender of control groups.

METHODS

CBCT images of 80 individuals that exist from 40 patients with COPD and 40 healthy individuals (6 females, 34 males) in the tomography archive were retrospectively analyzed. The volume and surface area of maxillary sinuses in COPD and control group were measured by semi-automatic segmentation method and obtained findings were statistically examinated according to age, gender.

RESULTS

The study was observed that there was no statistically significant difference between the right maxillary sinus area and the groups, but left maxillary sinus and total sinus area of COPD group were observed to be significantly lower than the control group (p < 0.05). Maxillary sinus volume was found to be statistically significantly lower in patients with COPD than in healthy controls (p < 0.05).

CONCLUSIONS

CBCT is a practical and effective imaging method for the evaluation of maxillary sinuses. It is thought that inflammatory diseases that cause sinonasal changes such as COPD may affect maxillary sinus sizes.

The effect of anatomical variations of the sinonasal region on maxillary sinus volume and dimensions: a three-dimensional study

INTRODUCTION

Anatomical variations in the sinonasal region are remarkably common and these variations may have an impact on maxillary sinus development due to their close anatomical adjacency.

OBJECTIVE

The aim of this study was to investigate the effect of anatomical variations of the sinonasal region on the width, height, length, and volume of the maxillary sinus.

METHODS

Cone beam computed tomography records of 120 patients were evaluated. Nasal septum deviation angle was measured for each patient and patients were divided into three groups as mild, moderate, and severe. Sinonasal variations such as nasal septum deviation direction, septal spur, concha bullosa, uncinate process pneumatization, middle concha hypertrophy, inferior concha hypertrophy, paradoxical middle concha and presence of septa in the maxillary sinus were registered. Cone beam computed tomography images were transferred to the SimPlant software thus right and left maxillary sinus volumes and dimensions were measured separately.

RESULTS

There was a negative and statistically significant relationship between age and left maxillary sinus width (p = 0.015). The relationships between gender and maxillary sinus volumes and dimensions were statistically significant (p < 0.05). Although there were significant relationships between the nasal septum deviation severity, middle concha hypertrophy, inferior concha hypertrophy, paradoxical middle concha, and presence of septa and maxillary sinus dimensions; there was no significant relationship between septal spur, nasal septum deviation direction, concha bullosa, uncinate process pneumatization, and maxillary sinus dimensions. No statistically significant relationship could be determined between maxillary sinus volume and anatomical variations of the sinonasal region.

CONCLUSION

According to our findings, while certain the variations were found to affect the sinus dimensions; none of the variations was found to be related to the maxillary sinus volume.

Prevalence of maxillary sinus hypoplasia and association with variations in the sinonasal complex: a cone beam CT study

OBJECTIVE

Understanding of maxillary sinus hypoplasia (MSH) and associated sinonasal variants is paramount to the diagnostic and therapeutic success of maxillary sinus and maxillary dental implant surgery. The purpose of this work was to explore the prevalence of MSH, frequency of mucosal thickening, and anatomical variations in the sinonasal complex.

METHODS

Retrospective case-control design based on cone beam CT images of dental patients with MSH and matched for age and gender. MSH type and sinonasal variables were recorded.

RESULTS

One thousand three hundred seventy cone beam CT scans were analyzed for MSH. MSH prevalence was 6% (n=82), matched with 82 controls= 100 females and 64 males, mean age 37.1±14.1 years. Most MSH were type I, 69.5%, 80.5% unilateral, 65.9% associated with no or mild mucosal thickening. Associated sinonasal anatomical variations were <27% except for deviated/hyperplastic (DH) meatus, 48.8%. Within the MSH group, significant associations were presented between MSH type, mucosal thickening, and DH nasal meatus. MSH group vs controls showed a significant difference in mucosal thickening (OR 5.2, 95% CI 2.0-17.3) and DH meatus (OR 1.6, 95% CI 1.4-2.1).

CONCLUSIONS

A hypoplastic maxillary sinus with abnormal or absent uncinate process is associated with advanced mucosal thickening and may present with altered anatomy of the lateral wall of the nasal cavity causing its approximation to the orbital floor.

CLINICAL RELEVANCE

Pre-surgical knowledge of altered anatomy in the sinonasal complex is crucial in dental implant or sinus surgery.

Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate

OBJECTIVES

To determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP).

MATERIALS AND METHODS

A retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed.

RESULTS

No changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05).

CONCLUSIONS

Following RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.

The Relationship Between Nasal Septal Deviation and Paranasal Pneumatization

OBJECTIVE

To investigate the impact of the presence and the severity of the nasal septal deviation (NSD) on the paranasal pneumatization.

METHODS

Initially, the deviated and contralateral sides was compared to evaluate the impact of the presence of NSD on pneumatization. Then, NSD classification groups were categorized according to the severity of deviation degree; 1: mild (<9°), 2: moderate (9°-15°), and 3: severe (>15°). Pneumatization of all paranasal sinuses, osteomeatal complex (OMC), frontoethmoid recess (FER) and variant structures were compared according to the NSD classification groups separately both for the deviated and the contralateral sides.

RESULTS

Although there was no statistically significant difference in pneumatization of the paranasal sinuses between the deviated and contralateral sides, a significant difference was observed in OMC and FER diameters. In the deviated side, there was statistically significant difference in ethmoid sinus volume, in FER and OMC diameters between NSD classification groups. In the contralateral side, FER and OMC diameters were found to be significantly different between group 1 and group 2 and between group 1 and group 3, respectively (P = 0.04 and 0.06, respectively). Both the presence and severity of the NSD did not statistically significant influence the pneumatization of variant structures, air cells and vital structures.

CONCLUSION

The severity of NSD effects the ethmoid sinus volume. The relationship of FER and OMC with NSD is evident, however this may not always be in a proportional pattern. The paranasal pneumatization did not affect Keros type, bone integrity of carotid canal and optic canal.

An Analysis of Association Between Nasal Bone Morphology and Sinonasal Anatomical Variations

The goal of this study was to investigate the association between various sinonasal anatomical variations and the morphological features of lateral nasal bone, using paranasal computerized tomography (PNCT) sections. Two hundred and fifty patients who underwent a PNCT scan because of a prediagnosis of nasal septum deviation or sinusitis were included in the study. For each patient, presence of the following anatomical variations was determined on CT sections: length and thickness of nasal bone, thickness of intermediate nasal bone, pneumatized middle turbinate, paradox middle turbinate, Agger nasi cell, Haller cell, Onodi cell, supraorbital cell, pneumatized uncinate process, and nasal septal deviation. The effect of each anatomical variation on the length and thickness of the lateral nasal bone was investigated. The patients with bilateral pneumatized middle turbinate and the patients with bilateral Agger nasi cell had a thinner lateral nasal bone both on the right and the left sides compared to those without. The patients with bilateral Onodi cell and Agger nasi cell had a longer lateral nasal bone both on the right and the left sides compared to those without. The nasal bone thickness was significantly thicker on the deviation side than the contralateral nasal bone. The nasal bone length was significantly longer on the side of the septum deviation. In this study, we found that sex, presence of Agger nasi and Onodi cells, pneumatization of middle turbinate, and direction of nasal septal deviation influenced the morphology of the nasal bone. For successful nasal surgery, careful examination of preoperative anatomical variations is very important.

Three-Dimensional Evaluation of Maxillary Sinus Changes in Growing Subjects: A Retrospective Cross-Sectional Study

This study aims to evaluate changes of maxillary sinuses in growing subjects. Cone Beam Computed Tomography (CBCT) scans of 146 patients were divided according to gender and age (6–8, 9–11, 12–14 years old). Left, right and total maxillary sinus volume (MSV-R, MSV-L, MSV-Tot) and surface (MSS-R, MSS-L, MSS-Tot), left and right linear maximum width (LMW-L, LMW-R), depth (LMD-R, LMD-L) and height (LMH-R, LMH-R) were calculated using Mimics Research 22. Kruskal–Wallis Test and showed a statistically significant increase in both genders for all variables. Pairwise comparisons in females are always statistically significant in: LMH-R, LMH-R, MSS-Tot, MSV-Tot. All other variables showed a statistical significant increase between 9–11 and 12–14, and between 6–8 and 12–14 age groups, apart from LMSW-R, LMSW-L, LMSD-R, LMSD-L between 6–8 and 12–14 age groups. Pairwise comparisons in males are always and only statistically significant between 9–11 and 12–14, and between 6–8 and 12–14 groups. Symmetrical measurements (right and left) evaluated using Wilcoxon test retrieved no statistical significant difference. Comparisons between measurements on male and female subjects using Mann–Whitney test showed a statistical significant difference in 6–8 years group in MSV-R, MSV-L and MSV-Tot, and in 12–14 age group in MSV-R, MSV-L, MSV-Tot, MSS-r, MSS-l, MSS-Tot, MSW-R, MSW-L, MSD-R, MSD-L. Intraclass Correlation Coefficient (ICC) assessing inter-operator and intra-operator concordance retrieved excellent results for all variables. It appears that maxillary sinus growth resembles the differential peak of growth in male and female subjects. Sinuses starts to develop early in female subjects. However, in the first and last age group female sinuses are statistically significantly smaller compared to male ones. In male subjects, sinus growth occurs mainly between the second and third age group whilst in female subjects it starts between the first and second age group and continues between the second and the last. Sinus has a vertical development during the peak of growth, which is the main reason for its increase in volume.

Ventilation Modulation and Nanoparticle Deposition in Respiratory and Olfactory Regions of Rabbit Nose

The rabbit nose's ability to filter out inhaled agents is directly related to its defense to infectious diseases. The knowledge of the rabbit nose anatomy is essential to appreciate its functions in ventilation regulation, aerosol filtration and olfaction. The objective of this study is to numerically simulate the inhalation and deposition of nanoparticles in a New Zealand white (NZW) rabbit nose model with an emphasis on the structure-function relation under normal and sniffing conditions. To simulate the sniffing scenario, the original nose model was modified to generate new models with enlarged nostrils or vestibules based on video images of a rabbit sniffing. Ventilations into the maxilloturbinate and olfactory region were quantified with varying nostril openings, and deposition rates of inhaled aerosols ranging from 0.5 nm to 1000 nm were characterized on the total, sub-regional and local basis. Results showed that particles which deposited in the olfactory region came from a specific area in the nostril. The spiral vestibule played an essential role in regulating flow resistance and flow partition into different parts of the nose. Increased olfactory doses were persistently predicted in models with expanded nostrils or vestibule. Particles in the range of 5-50 nm are more sensitive to the geometry variation than other nanoparticles. It was also observed that exhaled aerosols occupy only the central region of the nostril, which minimized the mixing with the aerosols close to the nostril wall, and potentially allowed the undisruptive sampling of odorants. The results of this study shed new light on the ventilation regulation and inhalation dosimetry in the rabbit nose, which can be further implemented to studies of infectious diseases and immunology in rabbits.

Olfactory Bulb Microstructural Changes in Patients With Nasal Septum Deviation

OBJECTIVE

The aim of this study is to assess the microstructural changes to the olfactory bulb (OB) in patients with nasal septum deviation (NSD) using diffusion tensor imaging and to research the association between these changes and the degree of NSD.

METHODS

Ninety-six patients with NSD (46 males, 50 females) who received diffusion tensor imaging were assessed by 2 independent readers. The patients were separated into 3 groups according to the NSD angle. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the ipsilateral and contralateral OB were measured in all NSD patients by region of interest.

RESULTS

According to deviation side, there was significant difference between the right (R) and left (L) OB FA and ADC values across the 3 groups. In patients with left- and right- sided NSD, FA and ADC values for the left and right OB were significantly different between groups 1 and 3, and groups 2 and 3. There was negative correlation between L-FA (r = -0.481, P = 0.001; r = -0.496, P = 0.001) and R-FA (r = -0.705, P = 0.001; r = -0.286, P = 0.02) versus age and deviation angle. However, there was positive correlation between L-ADC versus age and deviation angle (r = 0.493, P = 0.001; r = 0.482, P = 0.001), as well as positive correlation between R-ADC versus age (r = 0.646, P = 0.001).

CONCLUSION

This is the first study showing ADC increase and FA decrease associated with axonal damage and microstructural integrity loss based on the side of deviation in NSD patients. It has also shown that this abnormality is directly proportional with NSD degree.

Morphometric Analysis of Sphenoid Sinus in Patients With Nasal Septum Deviation

This retrospective study aimed to assess the association of the volume and types of the sphenoid sinus with deviated nasal septum by analyzing multislice computed tomography images. A total of 93 patients with a deviated nasal septum and 70 healthy controls were included in the study. Patients with sinonasal morbidities other than deviation were excluded. Three-dimensionally reconstructed computed tomography images of the study participants were acquired. A total of 326 sphenoid sinus volumes from the patient and control groups were obtained and compared between the groups. Sphenoid sinus volumes and the angle of the deviation were measured for standardization and assessment of the severity. Deviated nasal septum was found on the right in 49.5% (n = 46) and on the left in 50.5% (n = 47) of the study participants. Deviation angles were in the range from 7.2° to 22.4° and the mean value was 13.2° ± 5.0°. The measured volumes were in the range from 1.8 cm to 9.6 cm with a mean of 4.8 ± 1.5 cm. In the control group, the median values for the sphenoid sinus volumes were 4.40 cm (0.80-8.90 cm) on the right and 4.20 cm (0.90-8.70 cm) on the left. In the study group, sphenoid sinus volumes were found to be statistically significantly different between those on the ipsilateral and contralateral side of the septal deviation. Sphenoid sinus volumes were significantly smaller on the same side with septal deviation compared with those on the contralateral side. There was no statistical relationship between the presence of septal deviation, age and gender, and the type of sphenoid sinus.

Is the maxillary sinus volume affected by concha bullosa, nasal septal deviation, and impacted teeth? A CBCT study

PURPOSE

Various mechanisms play an important role in the growth of maxillary sinus cavities. The purpose of this study was to investigate the correlations of maxillary sinus volume (MSV) with nasal septal deviation (NSD), concha bullosa (CB) and impacted teeth using cone-beam computed tomography (CBCT) images.

METHODS

From 55 patients, a total of 110 maxillary sinus images were obtained and examined. Data including age, gender, impacted third molar, canine teeth, NSD, and CB were examined. MSV was measured using the MIMICS software (Materialise HQ Technologielaan, Leuven, Belgium). All statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 21) software and p values < 0.05 were considered to indicate statistical significance.

RESULTS

Mean volume of the right maxillary sinus was 13.566 cm³, while the left was 13.882 cm³. The rate of patients with right and left impacted third molar teeth was 49.1% and 47.3%, respectively. The rate of right and left impacted canines was 1.8% and 5.5%, respectively. NSD was found in 56.4% of CBCT examinations and right and left CB were observed in 30.9% and 32.7% of the patients' examinations, respectively. Males had a significantly higher mean sinus volume than females for both sides (p < 0.05). There were no significant correlations between MSV and age (p > 0.05). No significant differences were found between MSV and impacted teeth, NSD and CB (p > 0.05).

CONCLUSION

NSD, CB, impacted teeth, and age were not found to be related to MSV. Gender had an effect on MSV and males had higher mean sinus volume than females.

Three-dimensional evaluation of maxillary sinus volume in different age and sex groups using CBCT

AIM

Sinus maxillaris is an important anatomical formation in many branches of dentistry due to its proximity to the field of work. Various methods have been used in literature to measure the maxillary sinus volume (MSV) such as cadavers, stereology, two-dimensional conventional radiographs, computed tomography (CT), magnetic resonance imaging (MRI). The aim of this study is to evaluate the change of maxillary sinus volume according to age and gender with MIMICS 19.0 (Materialise HQ Technologielaan, Leuven, Belgium) which is one of three-dimensional modeling software.

MATERIALS AND METHODS

This study was performed in 200 patients selected by a retrospective review of the archives of the Dicle University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology. Patients were divided into five age groups (18-24 years, 25-34 years, 35-44 years, 45-54 years, and ≥ 55 years) and by sex. Cone-beam computed tomography (CBCT) images of the patients were transferred to the MIMICS software and the MSV was measured. All statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 21) software.

RESULTS

There was no statistically significant difference between the right and left maxillary sinus volume according to the findings obtained from our study, and maxillary sinus volume in males was found to be significantly higher than that of females. Another finding of our study is that the maxillary sinus volume decreases with age increase. Especially it was also found that the sinus volume in males in the 18-24 age group was statistically significantly higher than females.

CONCLUSION

Consequently, maxillary sinus volume measurements can be made on CT, CBCT, MRI scans using reconstruction software.

Investigation of maxillary sinus volume relationships with nasal septal deviation, concha bullosa, and impacted or missing teeth using cone-beam computed tomography

OBJECTIVES

The aim of this retrospective study was to investigate the correlations of maxillary sinus volume with nasal septal deviation, concha bullosa, impacted teeth, and missing teeth in the maxillary posterior region on maxillary sinus volume using cone-beam computed tomography (CBCT) images.

METHODS

The study cohort comprised 252 CBCT images of 252 patients retrospectively selected from the records in our CBCT archive. All CBCT images were exported to 3D modeling software for calculation of maxillary sinus volumes. Nasal septal deviation cases were grouped as mild, moderate, and severe. Concha bullosa was classified as lamellar, bulbous, and extensive. Maxillary sinus volume differences were evaluated by comparing the bilateral sinus volumes in patients with nasal septal deviation, unilateral concha bullosa, and unilateral impacted or missing maxillary posterior teeth.

RESULTS

The findings revealed that males had a significantly higher mean sinus volume than females (p < 0.01) and that sinus volume tended to decrease with age (p < 0.05). In moderate and severe nasal septal deviation cases, the maxillary sinus volume was significantly smaller on the same side as the deviation than on the contralateral side (p < 0.05). There were no significant correlations between maxillary sinus volume and concha bullosa, unilateral impacted teeth, or unilateral missing teeth (p > 0.05).

CONCLUSIONS

The present findings suggest that maxillary sinus volume is smaller on the same side as the deviation in moderate and severe septal deviation cases and that the maxillary sinus volume tends to decrease with increasing age.

Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation

OBJECTIVE

Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging.

METHODS

The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age.

RESULTS

No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05).

CONCLUSION

A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.

Localization of orbit in patients with maxillary sinus hypoplasia: a radiological study

PURPOSE

We aimed to investigate the medial and inferior localization of orbit in patients with maxillary sinus hypoplasia using paranasal computerized tomography.

METHODS

We included 76 patients who had a hypoplastic maxillary sinus at least on one side, and 76 patients with normal maxillary sinuses (control group). To assess the localization of orbit, we measured the distances from middle meatal antrostomy point to medial border of orbital medial wall and to the lower border of orbital floor in all patients. We performed statistical comparisons between the groups.

RESULTS

Of 76 patients, 26 (34.2%) had unilateral and 50 (65.8%) had bilateral maxillary hypoplasia. Of 126 maxillary sinuses, 70 (55.6%) was type 1, 42 (33.3%) was type 2 and 14 (11.1%) was type 3 hypoplastic. The mean distance from antrostomy point to lamina papyracea was 4.36 ± 2.62 mm in the hypoplasia group, and 1.08 ± 1.7 mm in the control group. The mean distance from antrostomy point to orbital floor was 1.53 ± 1.73 mm in the hypoplasia group, and 1.87 ± 1.96 mm in the control group. Lamina papyracea showed a significant medial localization in the maxillary hypoplasia group as compared to the control group (p < 0.001).

CONCLUSION

The orbit has a medial localization in patients with maxillary sinus hypoplasia resulting in a higher complication risk during endoscopic sinus surgery.

Impact of Hard Palate Angulation Caused by Septal Deviation on Maxillary Sinus Volume

Objective

To investigate the effect of hard palate angulation caused by septal deviation on the volume of the maxillary sinus.

Methods

Coronal computed tomographic (CT) scans of 1568 patients aged from 18 to 60 were examined. CT scans of 402 patients were included in the study. On these scans, the maxillary sinus volume, the angle of the nasal septal deviation, and the angulation of the hard palate were calculated using the ImageJ software. Each maxillary sinus volume was statistically compared with each other and with those in the control group. Correlations between palatal angulation and septal deviation were determined.

Results

Deviated nasal septum whether with or without deflection of the hard palate was noted to have caused changes in the volume of the maxillary sinus in both female and male patients. The volume of the maxillary sinus on the deviated side was less than that of the opposite side, and the differences between the volumes of both sinuses were statistically significant (p<0.05). No significant differences were noted when compared with the control group. A positive correlation was observed between the nasal septal deviation angle and the angulation of the hard palate.

Conclusion

Regardless of whether or not it affects the hard palate, nasal septal deviation reduces the volume of the maxillary sinus on the deviated side but does not affect the total volume of the maxillary sinuses. Significant differences between the volumes on the two sides can lead to facial asymmetry.

Nasal Septal Deviation and Concha Bullosa - Do They Have an Impact on Maxillary Sinus Volumes and Prevalence of Maxillary Sinusitis?

Background

The aim of the study was to assess if the presence of nasal septal deviation and concha bullosa is connected with the development of sinuses and the incidence of inflammation within them.

Material/Methods

We retrospectively analysed 214 patients who underwent paranasal sinus computed tomography. There were 125 females and 89 males, the mean age being 47.67±16.74 years (range 18–97). Exclusion criteria included: age under 18 years, prior sinonasal surgery and S-shaped septum.

Results

Mean volume of the right maxillary sinus was 17.794 cm³, while for the left one it was 17.713 cm³. Nasal septal deviation was found in 79.9% of computed tomography examinations and concha bullosa was observed in 42.1% of the patients’ examinations. There was an association between the presence of unilateral or dominant concha bullosa and contralateral direction of septal deviation [right-sided (p=0.039), left-sided (p=0.003)]. There was higher incidence of bilateral maxillary sinusitis in patients with septal deviation (p=0.007). Bilateral concha bullosa did not influence the incidence of bilateral maxillary sinusitis (p=0.495). Neither septal deviation (right sided: p=0.962; left-sided: p=0.731), nor unilateral/dominant concha bullosa (right: p=0.512; left: p=0,430) affected the asymmetry in volumes of maxillary sinuses. Bilateral concha bullosa was connected with larger volume of maxillary sinuses (right sinus: p=0.005; left sinus: p=0.048).

Conclusions

Nasal septal deviation, contrary to concha bullosa, has influence on the development of maxillary sinusitis. There is a connection between the presence of concha bullosa and direction of septal deviation. Only bilateral concha bullosa affects maxillary sinus volumes.

Relationship between the degree and direction of nasal septum deviation and nasal bone morphology

BACKGROUND

Nasal septal deviation may affect nasal bone growth and facial morphology. Knowledge of nasal morphologic parameters may plays an important role in planning successful rhinoplasty and septoplasty operation. The aim of our study was to evaluate the relationship between the direction and degree of nasal septal deviation with nasal bone morphology, along with factors such as age and gender.

METHODS

Maxillofacial computed tomography (CT) of 250 patients with nasal septal deviation was analyzed retrospectively in this study. We excluded patients with factors that could affect their nasal bone morphology, and a total of 203 patients (111 males, 92 females; mean age, 36.23 years; age range, 18-79 years) were evaluated. The nasal deviation angle was measured on coronal CT images as the angle between the most deviated point of the septum, and the midline nasal morphology was determined by measuring nasal length, internasal angle and lateral and intermediate nasal thickness on both sides.

RESULTS

The deviation of nasal septum has been detected as to the right in 107 patients (52.7%) and to the left in 96 patients (47.3%). Lateral and intermediate nasal bone thickness and nasal bone length were significantly greater on the ipsilateral deviation side (Table 3). No significant correlation was found between the variation of the nasal deviation angle and nasal bone morphology (Table 4). There were significant differences between the sexes for all investigated parameters except for the nasal deviation angle (p = 0.660). We found that the only internasal angle increases with aging (p = 0.002).

CONCLUSION

The study shows that the direction of nasal septal deviation may be a factor that affects nasal bone morphology.

Anatomical Details of the Rabbit Nasal Passages and Their Implications in Breathing, Air Conditioning, and Olfaction

The rabbit is commonly used as a laboratory animal for inhalation toxicology tests and detail knowledge of the rabbit airway morphometry is needed for outcome analysis or theoretical modeling. The objective of this study is to quantify the morphometric dimension of the nasal airway of a New Zealand white rabbit and to relate the morphology and functions through analytical and computational methods. Images of high-resolution MRI scans of the rabbit were processed to measure the axial distribution of the cross-sectional areas, perimeter, and complexity level. The lateral recess, which has functions other than respiration or olfaction, was isolated from the nasal airway and its dimension was quantified separately. A low Reynolds number turbulence model was implemented to simulate the airflow, heat transfer, vapor transport, and wall shear stress. Results of this study provide detailed morphological information of the rabbit that can be used in the studies of olfaction, inhalation toxicology, drug delivery, and physiology-based pharmacokinetics modeling. For the first time, we reported a spiral nasal vestibule that splits into three paths leading to the dorsal meatus, maxilloturbinate, and ventral meatus, respectively. Both non-dimensional functional analysis and CFD simulations suggested that the airflow in the rabbit nose is laminar and the unsteady effect is only significantly during sniffing. Due to the large surface-to-volume ratio, the maxilloturbinate is highly effective in warming and moistening the inhaled air to body conditions. The unique anatomical structure and respiratory airflow pattern may have important implications for designing new odorant detectors or electronic noses. Anat Rec, 299:853-868, 2016. © 2016 Wiley Periodicals, Inc.

Silent sinus syndrome an acquired condition and the essential role of otorhinolaryngologist consultation: a retrospective study

The silent sinus syndrome (SSS) is a rare clinical entity characterized by painless spontaneous enophthalmos, hypoglobus, and facial deformities secondary to chronic maxillary sinus atelectasis. The aim of this study was to present an SSS diagnostic feature and evaluate the relationship between nasal septum deviation and maxillary sinus volume. A retrospective chart review of the clinical characteristics of 20 patients diagnosed with SSS between January 2013 and July 2014 were analyzed by the Department of Otorhinolaryngology of University Hospital Complex of Santiago de Compostela. 14 patients were females and six males. The mean age was 43 years (range 28-67 years). The right maxillary sinus was involved in 12 patients and the left maxillary sinus in eight patients. There was no statistical difference between gender and the presence of SSS. Maxillary sinus sizes were significantly smaller on the same side as the deviation (p < 0.01). 14 patients were treated with functional endoscopic sinus surgery (FESS) with maxillary antrostomy. We concluded that patients with SSS usually present with facial asymmetry, and the best approach to document and show all facial asymmetries for these patients are the frontal and craneo-caudal photographs. The present study demonstrates that, in adult patients, SSS generally presents a septal deviation to the affected maxillary sinus. We recommend performing a paranasal sinus CT scan when the patient has a deviated nasal septum, retraction of the malar eminence (evidenced from the viewpoint cranio-caudal facial) and hypoglobus. FESS performing postero-anterior uncinectomy and enlargement of the maxillary ostium is recommended to restore sinus pressure and prevent progression of the enophthalmos, hypoglobus and facial deformities.

The nasal septum deviation index (NSDI) based on CBCT data

OBJECTIVE

To assess whether three-dimensional morphometric parameters could be useful in nasal septal deviation (NSD) diagnosis and, secondarily, whether CBCT could be considered an adequate imaging technique for the proposed task.

METHODS

We analysed images of 46 subjects who underwent CBCT for reasons not related to this study. Two experienced operators divided all the images into healthy and NSD subjects. Subsequently, the images were segmented using ITK Snap in order to obtain the three-dimensional model of the nasal airways and compute four morphological parameters: septal deviation angle (SDA), percentage of volume difference between right and left side of the nasal airways, nasal airway total volume and a new synthetic septal deviation index (SDI). Principal component analysis (PCA) was used to unveil relationships between each variable and the global nasal airway variability.

RESULTS

Differences between the groups were found in SDA (p < 0.001), in volume percentage difference (p < 0.05) and in SDI (p < 0.001). PCA showed high correlation between the SDI and the first principal component (0.97, p < 0.001).

CONCLUSIONS

Among the analysed parameters, SDI seemed to be the most suitable for the quantitative assessment of NSD, and CBCT allowed accurate assessment of airway morphology.

The analysis of the maxillary sinus volumes and the nasal septal deviation in patients with antrochoanal polyps

The aim of this study was to evaluate the relationship between the maxillary sinus volumes and the nasal septal deviation angles in patients with antrochoanal polyps (ACP). 76 patients who underwent ACP surgery were included in the study. Of those 36 patients who had multislice computed tomography (MSCT) were evaluated to calculate maxillary sinus volume. The records of paranasal MSCT of 36 healthy people without any paranasal sinus diseases or surgery constituted age- and gender-matched healthy controls. Maxillary sinüs volumes and septal deviation angles were calculated using the paranasal MSCT volume-rendering technique. Thirty-six patients in the ACP group were compared with 36 polyp side-matched healthy people. The mean age was 16.6 ± 6.7 years in both groups. Statistically, the mean value of the maxillary sinus volume was significantly higher in the ACP group compared with the ACP side-matched control group (15.1 ± 4.6 versus 12.0 ± 3.5 mm(3)) (p = 0.002). Furthermore, the mean value of the maxillary sinus volume in the non-polyp side (14.2 ± 4.7 mm(3)) was statistically higher in the ACP group compared with the side-matched control group volume (11.9 ± 3.8 mm(3)) (p = 0.024). In addition, Fifty-three of 76 ACP patients had septal deviation. While the septal deviation was on the same side with the ACP in 17 patients, it was on the opposite side in 36 patients. In conclusion, the maxillary sinus volumes increased in ACP patients compared with the healthy control group. Many patients had nasal septal deviation on the opposite side of the ACP.