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Valenzuela-Fuenzalida JJ, Baez-Flores B, Sepúlveda RÁ, Medina CM, Pérez R, López E, Sanchis J, Orellana Donoso M, Silva JL, Rodriguez MC, Iwanaga J. Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis. Medicine (Baltimore) 2023; 102:e34510. [PMID: 37747000 PMCID: PMC10519516 DOI: 10.1097/md.0000000000034510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE The objective of this review is to investigate and analyze the anatomical variations present in the maxillary sinus (MS), through the examination of the prevalence of these variations, as well as the corresponding prevalence of clinically significant pathologies and complications associated with them. METHODS The search process was carried out in the following databases; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS, and GOOGLE SCHOLAR, using as search terms; "Maxillary bone," "Maxillary sinus," "Paranasal sinus," "Anatomical variations," "Sinusitis" and "Clinical anatomy." RESULTS A total of 26 articles and 12969 samples were included, from which 12,594 subjects had their sex recorded giving a total of 5802 males and 6792 females. The variants reported by the included were Haller cells, Concha Bullosa, Number of septa, Hypoplastic sinus, Agger Nasi, Thickening of the MS mucosa, Deviation of the nasal septum, Accessory ostium, and Onodi cells. Among the mentioned, the ones that presented the greatest number of studies (between 8 and 10 studies included) were: the Haller Cells, the Concha Bullosa, and the Number of septa, where prevalence was 0.30, 0.36, 0.39 respectively. These variations can lead to sinusitis, cause some types of tumors, or affect neighboring structures that could be compromised by this variation. CONCLUSION As a result, it is certainly complex to distinguish the presence of anatomical variations from pathological abnormalities. Therefore, knowledge of the different variations and their clinical relationships could be a useful asset for clinicians dedicated to this region.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
- Departamento de Ciencias Química y Biológicas Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago, Chile
| | - Belén Baez-Flores
- Departamento de Morfología, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
| | | | - Claudia Moya Medina
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de las Américas, Santiago, Chile
| | - Rubén Pérez
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de las Américas, Santiago, Chile
| | - Esteban López
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de las Américas, Santiago, Chile
| | - Juan Sanchis
- Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Mathias Orellana Donoso
- Departamento de Morfología, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Javiera Leyton Silva
- Departamento de Morfología, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
| | | | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA
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Mehta MP, Wise SK. Unified Airway Disease. Otolaryngol Clin North Am 2023; 56:65-81. [DOI: 10.1016/j.otc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Whyte A, Boeddinghaus R. The maxillary sinus: physiology, development and imaging anatomy. Dentomaxillofac Radiol 2019; 48:20190205. [PMID: 31386556 PMCID: PMC6951102 DOI: 10.1259/dmfr.20190205] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/27/2019] [Accepted: 07/31/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The maxillary sinus is of paramount importance for otolaryngologists, rhinologists, oral and maxillofacial surgeons, head and neck and dental and maxillofacial radiologists. A comprehensive review article concerning the physiology, development and imaging anatomy was undertaken. METHODS Relevant literature pertaining to the physiology of the sinonasal cavity, development of the paranasal sinuses and imaging anatomy of the maxilla and maxillary sinus from 2000 to 2019 was reviewed. Emphasis was placed on literature from the last 5 years. RESULTS Extensive recent research using imaging has provided new insights into the development of the maxillary sinus, the other paranasal sinuses and the midface. The fundamental physiological concept of mucociliary clearance and its role in sinus health is emphasized. The paranasal sinuses are an integral part of a common mucosal organ formed by the upper and lower airway.An in-depth understanding of the soft-tissue and neurovascular relationships of the maxillary sinus to the deep fascial spaces and branches of the trigeminal nerve and external carotid artery respectively is required to evaluate and report imaging involving the maxillary sinus.Sinusitis of rhinogenic, rather than odontogenic origin, originates from nasal inflammation followed by anterior ethmoid disease and secondary obstruction of the ostiomeatal unit. The role of anatomical variants that predispose to this pattern of disease is discussed in detail with illustrative examples.The maxillary sinus is intimately related to the roots of the posterior maxillary teeth; the high frequency of mucosal disease and sinusitis of odontogenic aetiology is now well recognized. In addition, an understanding of the anatomy of the alveolar process, morphology of the alveolar recess of the maxillary sinus and neurovascular supply are essential both for deliberate surgical intervention of the sinus and complications related to oral surgical procedures. CONCLUSIONS An understanding of the fundamental principles of the development, physiology, anatomy and relationships of the maxillary sinus as depicted by multi-modality imaging is essential for radiologists reporting imaging involving the paranasal sinuses and midface.
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Whyte A, Boeddinghaus R. Imaging of adult nasal obstruction. Clin Radiol 2019; 75:688-704. [PMID: 31515050 DOI: 10.1016/j.crad.2019.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/25/2019] [Indexed: 12/15/2022]
Abstract
The commonest causes of nasal obstruction are rhinitis and chronic rhinosinusitis, which affect up to 30% and 14% of the adult population, respectively. The global financial burden is huge, estimated at $5 billion for rhinitis and $8.6 billion for chronic rhinosinusitis per annum in the USA. On referral for imaging, computed tomography (CT) is indicated initially when there is a suboptimal response to medical treatment of these mucosal diseases or there are "red flags," such as persistent unilateral obstruction, epistaxis, pain, and orbital or neurological symptoms. A mass visible at rhinoscopy or endoscopy in the nose or nasopharynx and lymphadenopathy are further indications. The anterior (cartilaginous) nose plays a key role in the aetiology of nasal obstruction as it accounts for 50-75% of the total resistance to airflow in the upper airway. It has been ignored in the imaging literature, but extensively evaluated by clinicians using a range of methods, including CT. Oblique reconstructions perpendicular to the parabolic curve of lamellar airflow provide accurate assessment of the anterior nose. A thorough and systematic approach to assessing the nose addresses the discrepancy between imaging and clinical evaluation of structural causes of nasal obstruction, especially septal deviation, reported in the surgical literature. Nasal tumours are a very uncommon cause of nasal obstruction; magnetic resonance imaging is commonly performed to assess their full extent and improve the specificity of diagnosis.
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Affiliation(s)
- A Whyte
- Head and Neck Imaging, Perth Radiological Clinic, Subiaco, WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA 6009, Australia; Departments of Radiology and Medicine, University of Melbourne, Carlton, Victoria 3000, Australia.
| | - R Boeddinghaus
- Head and Neck Imaging, Perth Radiological Clinic, Subiaco, WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA 6009, Australia
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Rogers VE, Bollinger ME, Tulapurkar ME, Zhu S, Hasday JD, Pereira KD, Scharf SM. Inflammation and asthma control in children with comorbid obstructive sleep apnea. Pediatr Pulmonol 2018; 53:1200-1207. [PMID: 29862666 DOI: 10.1002/ppul.24074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/16/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES A bi-directional relationship exists between asthma and obstructive sleep apnea (OSA) in which presence of one is associated with increased prevalence and severity of the other. Our objective was to determine whether OSA accounted for differences in airway and systemic inflammation in asthmatic children and whether inflammation was associated with asthma control. We hypothesized that greater severity of SDB would correlate with increased upper airway and systemic inflammation and result in reduced asthma control. METHODS Non-obese children aged 4-12 years with persistent asthma, with or without OSA were recruited. Asthma control was measured with the Childhood Asthma Control Test. Children underwent polysomnography and blood sampling, and children with OSA underwent clinically indicated adenotonsillectomy. Tonsils and sera were analyzed for 11 cytokines. RESULTS Twenty-seven children (20 with OSA, seven without OSA) participated, mean age 7.9 years, 55.6% female, 92.6% African American. Levels did not differ for any cytokine between children with and without OSA. Lower nadir oxygen saturation was associated with higher levels of tonsil TNF-α (P < 0.001) and IL-10 (P < 0.05). Higher REM-related apnea-hypopnea index was associated with higher levels of tonsil TNF-α (P < 0.05). Children with uncontrolled asthma had significantly higher levels of serum IL-10, IL-13, and TNF-α, and tonsil TNF-α (all P < 0.05) than well-controlled asthmatic children. There was no association between OSA, or any polysomnography variable, and asthma control. CONCLUSIONS Despite the presence of OSA-associated airway inflammation, and asthma control-associated airway and systemic inflammation, OSA was not related to level of asthma control in this non-obese, largely minority, low income sample.
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Affiliation(s)
- Valerie E Rogers
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland
| | - Mary E Bollinger
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Mohan E Tulapurkar
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Shijun Zhu
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland
| | - Jeffrey D Hasday
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Kevin D Pereira
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Steven M Scharf
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland
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Abstract
PURPOSE OF REVIEW This article provides a thorough review of the literature highlighting the articles that have advanced our knowledge about the sensitivity of the larynx to allergens in the air or ones consumed. This area of inquiry requires continued interest and investigation. As the field of clinical laryngology changes, and more information is discovered about the possible causal association between allergy and vocal pathologies, practicing otolaryngologists, allergists, and other medical professionals may discover more comprehensive methods to evaluate and treat their allergic patients, particularly those who present with complaints of dysphonia, dysphagia, laryngopharyngeal reflux (LPR), and/or dyspnea. RECENT FINDINGS There continues to be epidemiological studies designed to describe the relationship of allergy to vocal symptoms and signs. Both population and smaller studies have recently attempted to link these two conditions. Unfortunately, the patient with chronic laryngeal complaints is often tagged by default with the diagnosis of LPR and treated with proton pump inhibitors, which are not always beneficial. The endoscopic assessment may not be as reliable to make the diagnosis of LPR as the examination is subjective and the inter-rater reliability is low. It has been demonstrated by direct laryngeal provocation studies that sticky-viscous endo-laryngeal mucous is the only reliable finding consistently associated with allergy potential allergic tissue reactivity. SUMMARY The interrelationship of allergic sensitivity and chronic laryngitis in certain individuals is becoming clearer because our knowledge of inquiry has increased and the available routine technology to diagnose these conditions has remarkably improved. Notwithstanding these advancements, much more research is needed on this subject to reduce the frequency of mis-diagnoses and mis-management of allergic patients.
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Hanshew AS, Jetté ME, Rosen SP, Thibeault SL. Integrating the microbiota of the respiratory tract with the unified airway model. Respir Med 2017; 126:68-74. [PMID: 28427552 DOI: 10.1016/j.rmed.2017.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/26/2017] [Accepted: 03/21/2017] [Indexed: 12/30/2022]
Abstract
The unified airway model has developed from indications that the upper and lower respiratory tracts share key elements of pathogenesis. These shared traits likely extend to similar niche characteristics that support bacterial communities, and as such, we suspect that similar microbes exist on upper and lower respiratory tract epithelium. Over the past decade and a half there have been significant improvements in microbiological identification and analysis due to the development of new molecular technologies, including next-generation sequencing. In this review, we provide an overview of the modern collection and sequencing methods involved in respiratory microbiota research, and outline the specific microbial communities that have been found to be associated with the healthy and diseased human respiratory tract. Demonstration of a remarkable similarity between the upper and lower respiratory tract in terms of microbiological presence adds further corroboration to the existence of a unified airway.
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Affiliation(s)
- Alissa S Hanshew
- Environmental Health and Safety, 6 Eisenhower Parking Deck, The Pennsylvania State University, University Park, PA, USA.
| | - Marie E Jetté
- Department of Otolaryngology, University of Colorado, 12631 E. 17th Avenue, Aurora, CO, USA.
| | - Sarah P Rosen
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, USA.
| | - Susan L Thibeault
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, USA.
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Stachler RJ. Comorbidities of asthma and the unified airway. Int Forum Allergy Rhinol 2016; 5 Suppl 1:S17-22. [PMID: 26335831 DOI: 10.1002/alr.21615] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/28/2015] [Accepted: 07/01/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Asthma is a comorbid condition that may be seen by otolaryngic allergists when treating their patients with allergic rhinitis (AR). Often asthma is overlooked when aggressive treatment could prevent the development or progression of early disease. METHODS This article is a retrospective review of the current literature on asthma as a comorbidity of the unified airway. The unified airway and asthma are clearly defined. The epidemiology, morbidity, mortality, pathophysiologic mechanisms, and the chronicity of asthma are reviewed. RESULTS The otolaryngic allergist will become familiar the unified airway concept and the close relationships between AR, chronic rhinosinusitis, and asthma. CONCLUSION Otolaryngologists should be aware of the unified airway in order to most effectively treat their patients with AR. Knowledge of the close relationships between asthma and AR will help prevent progression of disease, identify early asthma, and improve the outcomes and quality of life for our patients.
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Affiliation(s)
- Robert J Stachler
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Group, Detroit, MI
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI
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Belafsky PC, Peake J, Smiley-Jewell SM, Verma SP, Dworkin-Valenti J, Pinkerton KE. Soot and house dust mite allergen cause eosinophilic laryngitis in an animal model. Laryngoscope 2015. [DOI: 10.1002/lary.25467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Janice Peake
- Center for Health and the Environment, University of California Davis; Davis
| | - Suzette M. Smiley-Jewell
- Department of Otolaryngology; UC Davis Health System; Sacramento
- Center for Health and the Environment, University of California Davis; Davis
| | - Sunil P. Verma
- Department of Otolaryngology; University of California Irvine; Irvine California
| | | | - Kent E. Pinkerton
- Center for Health and the Environment, University of California Davis; Davis
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Abstract
BACKGROUND Severe facial injuries can compromise the upper airway by reducing airway volume, obstructing or obliterating the nasal passage, and interfering with oral airflow. Besides the significant impact on quality of life, upper airway impairments can have life-threatening or life-altering consequences. The authors evaluated improvements in functional airway after face transplantation. METHODS Between 2009 and 2011, four patients underwent face transplantation at the authors' institution, the Brigham and Women's Hospital. Patients were examined preoperatively and postoperatively and their records reviewed for upper airway infections and sleeping disorders. The nasal mucosa was biopsied after face transplantation and analyzed using scanning electron microscopy. Volumetric imaging software was used to evaluate computed tomographic scans of the upper airway and assess airway volume changes before and after transplantation. RESULTS Before transplantation, two patients presented an exposed naked nasal cavity and two suffered from occlusion of the nasal passage. Two patients required tracheostomy tubes and one had a prosthetic nose. Sleeping disorders were seen in three patients, and chronic cough was diagnosed in one. After transplantation, there was no significant improvement in sleeping disorders. The incidence of sinusitis increased because of mechanical interference of the donor septum and disappeared after surgical correction. All patients were decannulated after transplantation and were capable of nose breathing. Scanning electron micrographs of the respiratory mucosa revealed viable tissue capable of mucin production. Airway volume significantly increased in all patients. CONCLUSIONS Face transplantation successfully restored the upper airway in four patients. Unhindered nasal breathing, viable respiratory mucosa, and a significant increase in airway volume contributed to tracheostomy decannulation.
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Cayonu M, Acar A, Horasanlı E, Altundag A, Salihoglu M. Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications. Acta Otolaryngol 2014; 134:390-4. [PMID: 24512461 DOI: 10.3109/00016489.2013.878476] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The patients who underwent septoplasty with bilateral totally occlusive nasal packing had an increased risk of experiencing respiratory distress (RD). OBJECTIVE To compare the immediate RD rates during recovery from anesthesia and surgical complications of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique. METHODS A total of 150 patients were assigned to one of three groups according to the technique utilized following septoplasty: transseptal suturing, internal nasal splint, or Merocel (nasal dressing without airway). To determine RD related to anesthesia in the operating theatre, the criterion was defined as any unanticipated hypoxemia, hypoventilation or upper airway obstruction (stridor or laryngospasm) requiring an active and specific intervention. Postoperative hemorrhage, infection, synechia formation, and septal perforation were evaluated. RESULTS Patients in the Merocel group were 3.6 times more likely to have RD than patients in the transseptal suture and internal nasal splint groups. Also, patients who smoked had an increased risk of RD during the recovery phase of anesthesia after the septoplasty. In addition, all three techniques resulted in similar complication rates after septoplasty, with the exception of minor hemorrhage, which had a significantly higher rate in the transseptal suture group.
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Affiliation(s)
- Melih Cayonu
- Department of Otolaryngology and Head Neck Surgery, Amasya University Training and Research Hospital , Amasya
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