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Cunha BS, Equiterio BSN, Duarte A, Boasquevisque G, Cruz AAV. Implications of the olfactory fossa anatomy in intracranial complications of inferomedial orbital decompression. Orbit 2024; 43:136-139. [PMID: 35670333 DOI: 10.1080/01676830.2022.2084556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
Two patients with thyroid eye disease underwent inferomedial orbital decompression complicated by a cerebrospinal fluid (CSF) leak. One of the cases developed a postoperative pneumocephalus resolved with conservative measures. In the second case, the CSF leak was managed intraoperatively. In both patients, a computed tomography (CT) scan revealed a pronounced slope of the lateral lamella of the cribriform plate, forming an obtuse angle with its lateral bony extension. When this anatomical disposition of the olfactory fossa (OF) is present, the course of the anterior ethmoidal artery (AEA) is usually embedded in the skull base, and its foramen should not be taken as the upper limit of the transconjunctival ethmoidectomy. The shape and relative height of the olfactory fossa and fovea ethmoidalis, and the course of the AEA should always be assessed before transconjunctival medial decompressions.
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Affiliation(s)
- Barbara S Cunha
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Bruna S N Equiterio
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Ana Duarte
- Oculoplastics, Orbit and Lacrimal Division, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
- Oculoplastics, Orbit and Lacrimal Division, Centro Hospitalar Universitário Lisboa Central, Portugal
- Ophthalmology Department, Hospital Cuf Descobertas, Lisboa, Portugal
| | - Gustavo Boasquevisque
- Department of Radiology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio A V Cruz
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
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Kolak M, Kızılgöz V, Kantarci M. Examination of ethmoidal roof regarding Keros and Yenigun classifications in a Turkish population: a computerized tomography study. Surg Radiol Anat 2024; 46:19-25. [PMID: 38062267 DOI: 10.1007/s00276-023-03270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/14/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Understanding ethmoid roof morphology is crucial to prevent complications in endoscopic sinus surgery. This study aimed to evaluate the morphological properties of the ethmoidal roof regarding gender and age differences using Keros and Yenigun classifications on high-resolution computed tomography images. METHODS We retrospectively analyzed 891 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in coronal sections and the anterior-posterior length in axial planes. The study retrospectively examined CT images of paranasal sinuses of patients living in the eastern Anatolian region of Turkey. RESULTS In both Keros and Yenigun Classifications, the most common class was type 2, and the least common class was type 3. According to Keros et al.'s method, no significant difference was observed between men and women (p = 0.698). However, according to Yenigun et al., the average values of women in terms of the anterior-posterior distance of the ethmoid roof were significantly higher than men (p = 0.001). When examined according to age, a very low, negative correlation was revealed regarding Keros and Yenigun classifications (p = 0.047 and p < 0.001 retrospectively). According to Keros and Yenigun's classification, there was no significant difference between the left and right sides (p = 0.488 and p = 0.919, respectively). CONCLUSION The morphological properties of the ethmoidal roof have importance to be considered for preoperative planning. Studying larger patient groups and meta-analyses that gather various research results about this subject might help better understand the ethmoidal roof morphology among populations.
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Affiliation(s)
- Merve Kolak
- Oral and Dental Health Training and Research Hospital, Erzincan Binali Yıldırım University, 24100, Erzincan, Turkey.
| | - Volkan Kızılgöz
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100, Erzincan, Turkey
| | - Mecit Kantarci
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100, Erzincan, Turkey
- Department of Radiology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
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Cruz AAV, Cunha BS. Position of the anterior ethmoidal foramen and trauma to the cranial base during transconjunctival medial orbital decompression: a systematic literature review. Orbit 2023:1-9. [PMID: 37942625 DOI: 10.1080/01676830.2023.2274866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE To review the literature on the location of the anterior ethmoidal foramen (AEF) and trauma during transconjunctival medial wall decompression. METHODS A comprehensive literature search was conducted using the PubMed, Embase, and Scopus databases, combining the terms "olfactory fossa" and "fovea ethmoidalis" with "trauma," "cerebrospinal fluid leak," "pneumocephalus," "orbital decompression," and "anterior ethmoidal artery" (AEA). All cases of cranial base trauma during medial orbital decompression and the anatomical studies on the location of the AEF and the course of the AEA were reviewed. RESULTS Ninety-four articles were identified, of which 37 were related to the AEF, 41 reported the course of the AEA, and 16 to reported cases of cranial base trauma. Out of these cases, 10 were related to transconjunctival medial orbital decompression, affecting 11 patients. Most AEFs are situated at the frontoethmoidal suture, but up to 38.15% of AEFs are located above the suture on the frontal bone. Most AEFs are adjacent to the roof of the ethmoidal sinus. The distance of the AEF to the cranial base increases in the presence of supraorbital ethmoidal cells (SOEC). CONCLUSIONS The position of the AEF is variable and should not be considered a safe landmark for all patients.
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Affiliation(s)
- Antonio A V Cruz
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Barbara S Cunha
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Cunha BSA, Garcia DM, Cruz AAV. The Relation of the Anterior Ethmoidal Foramen to the Cranial Base. Ophthalmic Plast Reconstr Surg 2023; 39:617-620. [PMID: 37450648 DOI: 10.1097/iop.0000000000002456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE To perform a radiological analysis of the relation of the anterior ethmoidal foramen (AEF) to the cranial base and olfactory fossa (OF). METHODS Retrospective analysis of computed tomography coronal scans of 35 orbits of 35 patients with Graves orbitopathy. Following a standard multiplanar reconstruction of the orbit, the authors measured the vertical and the horizontal distances of the AEF to the cranial base and to the lateral border of the OF, respectively. The height of the OF was measured at the level of the AEF and at the position of Keros classification. The presence of supraorbital ethmoid cells (SOEC) was also recorded. RESULTS The vertical distance of the AEF to the cranial base ranged from 0.1 to 7.3 mm with a mean = 2.5 mm (SD = 2.17). In 47.5% of the orbits the foramen was adjacent (<1 mm) to the cranial base. The horizontal distance of the AEF to the lateral border of the OF ranged from 2.3 to 9.5 mm (mean = 5.4 mm, SD = 1.98). The presence of an SOEC (n = 12) increased significantly both the distance from the AEF to the cranial base and to the lateral border of the OF. The height of the OF at the level of AEF is not correlated with the depth of the OF at the level of Keros classification. CONCLUSIONS In the absence of supraorbital pneumatization, the AEF location is a dangerous landmark for the upper limit of the transconjunctival medial wall decompression.
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Affiliation(s)
- Barbara Salomao A Cunha
- Department of Ophthalmology, School of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
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CBCT Assessment of Ethmoid Roof Variations through Keros, Gera, and TMS Classifications. Int J Otolaryngol 2022; 2022:3708851. [PMID: 36046764 PMCID: PMC9424035 DOI: 10.1155/2022/3708851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study is designed to assess the variations of the ethmoid roof through the Keros, Gera, and Thailand-Malaysia-Singapore (TMS) classifications by means of Cone-Beam Computed Tomography (CBCT). Materials and Methods 372 CBCT scans were reviewed. The depth of the olfactory fossa (OF) was defined by the height of the lateral lamella (LL). The degree of the angle formed by the LL and the continuation of the horizontal plane passing through the cribriform plate was calculated. The risk of injury to the skull base was assessed by TMS classification. Results The distribution of Keros types 1, 2, and 3 was 20.43%, 66.26%, and 13.31%, respectively. No significant difference was seen in the Keros classification among males and females, and asymmetry in the depth of the cribriform plate was seen in 33.3% of patients. 29.57% of the cases had type I, 61.42% had type II, and 9.01% had type III of Gera classification. 33.9% of the patients had asymmetry in the Gera classification. There was not significant difference in the Gera classification among males and females. 95.43%, 4.17%, and 0.40% of patients were of types 1, 2, and 3 of TMS classification, respectively. Conclusion The most prevalent variations of the ethmoid roof were Keros type II, Gera type II, and TMS type 1. Although the prevalence of the dangerous types (Keros type 3, Gera type III, and TMS type 3) was low, preoperative assessment is essential in reducing surgical complications. CBCT is beneficial in evaluating these variations due to its low radiation dose.
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A computed tomography study on the olfactory fossa in dried skulls. Surg Radiol Anat 2022; 44:925-932. [PMID: 35543750 DOI: 10.1007/s00276-022-02949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The computed tomography (CT) study investigates the olfactory fossa (OF) morphometry and morphology. METHODS Fifty Greek adult dried skulls were macroscopically investigated for the detection of the OF morphological patterns and after a multiplanar CT reconstruction, the OF morphometry was accurately calculated using a digital ruler. RESULTS Types I and II surface contour patterns were the most frequently identified (36 and 32%), followed by types III, IV, and V (16, 12, and 4%). Crista galli mean length, height, and width were 19.46 ± 2.34 mm, 12.69 ± 2.7 mm, and 5.18 ± 1.11 mm. The OF mean maximum length was 22.29 ± 2.16 mm on the right and 22.10 ± 2.44 mm on the left side, and symmetry was detected. The OF median values of the maximum depth for its anterior, middle, and posterior third were 4.91 mm, 4.72 mm, and 2.78 mm on the right and 4.55 mm, 4.75 mm, and 2.55 mm on the left side. Symmetry was observed in any third of the OF. The OF median values of the surface maximum width for the anterior, middle, and posterior thirds were 9.29 mm, 11.48 mm, and 13.07 mm. A significant gradual increase of the OF surface maximum width was detected in the anteroposterior direction in the total sample (p < 0.001), with the highest value (23.12 mm) in the posterior third. A significant (p < 0.001) very strong (rs = -0.798) and a moderate (rs = -0.524) negative linear correlation in the OF anterior and middle third were, respectively, identified between its maximum depth and width. No gender impact was identified. CONCLUSIONS The study helps to familiarize with the calculation of the OF dimensions and simplifies the understanding of its complex anatomy, to reach successful surgical planning and minimize perioperative complications.
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Salgado-Lopez L, Leonel LCPC, O'brien M, Adepoju A, Graffeo CS, Carlstrom LP, Link MJ, Pinheiro-Neto CD, Peris-Celda M. Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Endoscopic Endonasal Approach to the Orbit. J Neurol Surg B Skull Base 2022; 84:79-88. [PMID: 36743715 PMCID: PMC9897906 DOI: 10.1055/a-1723-1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Although endonasal endoscopic approaches (EEA) to the orbit have been previously reported, a didactic resource for educating neurosurgery and otolaryngology trainees regarding the pertinent anatomy, techniques, and decision-making pearls is lacking. Methods Six sides of three formalin-fixed, color latex-injected cadaveric specimens were dissected using 4-mm 0- and 30-degree rigid endoscopes, as well as standard endoscopic equipment, and a high-speed surgical drill. The anatomical dissection was documented in stepwise three-dimensional (3D) endoscopic images. Following dissection, representative case applications were reviewed. Results EEA to the orbit provides excellent access to the medial and inferior orbital regions. Key steps include positioning and preoperative considerations, middle turbinate medialization, uncinate process and ethmoid bulla removal, complete ethmoidectomy, sphenoidotomy, maxillary antrostomy, lamina papyracea resection, orbital apex and optic canal decompression, orbital floor resection, periorbita opening, dissection of the extraconal fat, and final exposure of the orbit contents via the medial-inferior recti corridor. Conclusion EEA to the orbit is challenging, in particular for trainees unfamiliar with nasal and paranasal sinus anatomy. Operatively oriented neuroanatomy dissections are crucial didactic resources in preparation for practical endonasal applications in the operating room (OR). This approach provides optimal exposure to the inferior and medial orbit to treat a wide variety of pathologies. We describe a comprehensive step-by-step curriculum directed to any audience willing to master this endoscopic skull base approach.
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Affiliation(s)
- Laura Salgado-Lopez
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States,Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States
| | - Luciano C. P. C. Leonel
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States,Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael O'brien
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States,Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States
| | - Adedamola Adepoju
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | | | - Lucas P. Carlstrom
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States,Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos D. Pinheiro-Neto
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States,Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States,Department of Neuroscience and Experimental Therapeutics, Northeast Skull Base Dissection Laboratory, Albany Medical Center, Albany, New York, United States,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States,Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States,Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States,Address for correspondence María Peris-Celda, MD, PhD Department of Neurosurgery, Mayo ClinicRochester, Minnesota 55905United States
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Güven M, Elden H, Yaylacı A, Güven EM, Kara A, Orha AT. Age-dependent differences of the depth of olfactory fossa in children. Braz J Otorhinolaryngol 2021; 88 Suppl 5:S52-S56. [PMID: 34799268 PMCID: PMC9801024 DOI: 10.1016/j.bjorl.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE With this radio-anatomical study, we aimed to describe the distribution of the depth of the olfactory fossa based on the Keros classification in the pediatric population in our region and to reduce complication rates by providing normative data. METHODS This was a retrospective study conducted with computed tomography imaging of the paranasal sinuses of 390 pediatric patients referred over a six-year period in Sakarya and Kocaeli University Faculty of Medicine. Patients were divided into 3 groups as 1-6, 6-12, and 12-18 years old. The depth of the olfactory fossa was measured and classified according to the Keros classification. The incidence of Keros asymmetries was also investigated. RESULTS The distribution of the depth of a total of 780 olfactory fossa according to the Keros classification was 24.7% Keros I, 65.9% Keros II, and 9.4% Keros III. When the groups were evaluated with each other and within each group, it was seen that the prevalence of Keros I type was significantly higher in the first group (p<0.05), and the prevalence of Keros type II was significantly higher in the second and third groups (p<0.05). Apart from this, the number of Keros type III increased in the third group compared to the first two groups and showed a statistically significant difference (p<0.05). Among all patients, asymmetry of the olfactory fossa was detected in 29 patients (7.4%). Although the number of olfactory fossa asymmetry was low in group I, it was not significantly different between the groups (p>0.05). CONCLUSION In our study, high Keros I rate and low Keros III rate in children aged 1-6 were remarkable. Especially for children under the age of six, questions arise about the validity of the Keros classification. More detailed studies in larger populations, in different ethnicities, and with various age groups are needed. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Mehmet Güven
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey
| | - Halil Elden
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey,Corresponding author.
| | - Atılay Yaylacı
- Kocaeli University, Faculty of Medicine, Department of Otorhinolaryngology, Kocaeli, Turkey
| | - Ebru Mihriban Güven
- Sakarya University, Faculty of Medicine, Department of Anatomy, Sakarya, Turkey,Kocaeli University, Faculty of Medicine, Department of Anatomy, Kocaeli, Turkey
| | - Ahmet Kara
- Sakarya University, Faculty of Medicine, Department of Otorhinolaryngology, Sakarya, Turkey
| | - Ayla Tekin Orha
- Kocaeli University, Faculty of Medicine, Department of Anatomy, Kocaeli, Turkey
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Chan MA, Ibrahim F, Kumaran A, Yong K, Chan ASY, Shen S. Ethnic variation in medial orbital wall anatomy and its implications for decompression surgery. BMC Ophthalmol 2021; 21:290. [PMID: 34325667 PMCID: PMC8320059 DOI: 10.1186/s12886-021-02009-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background To describe the inter-ethnic variation in medial orbital wall anatomy between Chinese, Malay, Indian and Caucasian subjects. Methods Single-centre, retrospective, Computed Tomography (CT)-based observational study. 20 subjects of each ethnicity, were matched for gender and laterality. We excluded subjects younger than 16 years and those with orbital pathology. OsiriX version 8.5.1 (Pixmeo., Switzerland) and DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) were used to measure the ethmoidal sinus length, width and volume, medial orbital wall and floor angle and the relative position of the posterior ethmoid sinus to the posterior maxillary wall. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (IBM, USA). Results There were 12 males (60 %) in each group, with no significant difference in age (p = 0.334–0.994). The mean ethmoid sinus length in Chinese, Malay, Indian and Caucasian subjects, using the Chinese as reference, were 37.2, 36.9, 38.0 and 37.4mm, the mean width was 11.6, 10.5, 11.4 and 10.0mm (p = 0.020) and the mean ethmoid sinus volume were 3362, 3652, 3349 and 3898mm3 respectively. The mean medial orbital wall and floor angle was 135.0, 131.4, 131.0 and 136.8 degrees and the mean relative position of posterior ethmoid sinus to posterior maxillary wall were − 2.0, -0.2, -1.5 and 1.6mm (p = 0.003) respectively. Conclusions No inter-ethnic variation was found in decompressible ethmoid sinus volume. Caucasians had their posterior maxillary sinus wall anterior to their posterior ethmoidal walls unlike the Chinese, Malay and Indians. Awareness of ethnic variation is essential for safe orbital decompression.
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Affiliation(s)
| | | | | | - Kailing Yong
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Anita Sook Yee Chan
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Sunny Shen
- Singapore National Eye Centre, Singapore, Singapore. .,Singapore Eye Research Institute, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.
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Abstract
Background: Olfactory fossa (OF) is a depression in anterior cranial cavity whose floor is formed by cribriform plate of ethmoid. Lateral lamella, which forms its lateral boundary, is a thin plate of bone and is at risk of injury during functional endoscopic sinus surgery, especially when fossa is deep/asymmetric. Aims: To measure the variations in the depth of OF and categorize Kerala population as per Keros classification using computed tomography (CT). Settings and Design: This study was conducted in our institution from January 2016 to August 2017. Patients >16 years of age undergoing CT scan of paranasal sinuses (PNS) were included. Materials and Methods: Coronal PNS CT scan studies of 1200 patients were reviewed. The depth of OF was measured from vertical height of lateral lamella. Statistical Methods: Results were analyzed according to gender and laterality using independent sample t-test and Chi-square test. Results: The mean depth of OF was 5.26 ± 1.69 mm. Statistically significant difference was seen in the mean depth of OF between males and females but not between right and left sides. Keros type I was found on 420 sides (17.5%), type II in 1790 (74.6%), and type III on 190 sides (7.9%). Type III Keros was more on the right (9%) than left (6.8%) side, more in males (9.5%) than females (5.9%), and more among males on the right side (11.4%). Asymmetry in OF depth between two sides was seen in 75% of subjects. Conclusion: Prevalence of the dangerous type III OF, even though low, is significant especially among males and on the right side. Therefore, preoperative assessment of OF depth must be done to reduce iatrogenic complications.
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Affiliation(s)
- Ashok Chirathalattu Babu
- Department of Radiodiagnosis, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
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Ullas LY, Patil D, Chaithanya A, Dhanvarsha S, Sai Nikhilendra Reddy A, Srinivasa H. Evaluation of olfactory fossa depth using computed tomography in South Indian population: A retrospective study. JOURNAL OF ORAL AND MAXILLOFACIAL RADIOLOGY 2021. [DOI: 10.4103/jomr.jomr_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Orbital Decompression for Thyroid-Related Orbitopathy During the Quiescent Phase. Ophthalmic Plast Reconstr Surg 2018; 34:S90-S97. [PMID: 29771754 DOI: 10.1097/iop.0000000000001119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To describe historical and modern surgical approaches to orbital decompression in patients with thyroid-related orbitopathy in the quiescent phase. METHODS A literature review of published techniques using the National Institutes of Health PubMed database. RESULTS Historically, orbital decompression has been accomplished via transantral, transcranial, transnasal, and orbital approaches. Current techniques use predominately periocular incisions to achieve effective decompression and proptosis reduction. Based on exophthalmometry and desired proptosis reduction, the authors propose a graded surgical approach to decompression for thyroid orbitopathy beginning with fat reduction, followed by deep lateral orbit via a superior eyelid crease incision, then medial wall by retro-caruncular approach, then posterior medial orbital floor either via transconjunctival or swinging eyelid approach, and finally with lateral orbital rim removal by superior eyelid crease incision as needed. These approaches can result in a range of proptosis reduction of up to 10 mm. CONCLUSIONS A structured approach to orbital decompression results in predictable and effective outcomes in proptosis reduction.
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Anatomical variations of the ethmoidal roof: differences between men and women. Eur Arch Otorhinolaryngol 2018; 275:1831-1836. [PMID: 29744636 DOI: 10.1007/s00405-018-4992-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
AIM During the paranasal sinuses surgery different complications may occur, both vascular and bony. The objective of the present study was to evaluate the ethmoidal roof configuration through the Keros and Yenigun classifications, analyzing results stratified by gender and side. MATERIALS AND METHODS We retrospectively analyzed 120 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in a coronal view and the anterior-posterior length in a cross section. RESULTS The Keros Type II was the most frequent and no statistically significant difference was found when comparing by gender. Yenigun type I was more prevalent, and a statistically significant difference was found between men and women in types I and II (p = 0.010 and p = 0.049, respectively). Statistical difference was observed in anterior-posterior means in the comparison between both classifications. In both, right and left side for men (p = 0.003 and p = 0.05) and women (p = 0.029 and p = 0.039). CONCLUSION We demonstrate the morphological variability that exists in this region. Gender differences that must be considered by the surgeon to avoid complications. Further studies are needed to evaluate the value of these findings when predicting surgical complications. A CT before PNS surgery is already widely accepted.
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V. AM, Santosh B. A Study of Clinical Significance of the Depth of Olfactory Fossa in Patients Undergoing Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2017; 69:514-522. [PMID: 29238684 PMCID: PMC5714917 DOI: 10.1007/s12070-017-1229-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 10/06/2017] [Indexed: 11/25/2022] Open
Abstract
The endoscope has revolutionized the diagnosis and treatment of diseases of the nose and paranasal sinuses. Endoscopic sinus surgery (ESS), like all minimally invasive surgery, is designed to combine an excellent outcome with minimal patient discomfort. Successful outcome with minimal complications can only be achieved with good knowledge of the endoscopic anatomy, appropriate training in the procedure and the understanding of the anatomical variations. The intraoperative complications of ESS are bleeding and injury to surrounding structures commonly the orbital structures and fovea ethmoidalis. This is a hospital based prospective observational study with an objective to define the distribution of Keros classification of the depth of olfactory fossa and its asymmetrical distribution rates based on Keros type. Prospective study in a tertiary rural based hospital. 100 patients above the age of 10 years from October 2013 to March 2015 for a period of one year six months undergoing endoscopic sinus surgery in the Department of ENT, P.E.S. Institute of Medical Sciences and Research, Kuppam were chosen randomly. The data was collected from these patients who will met the inclusion criteria of the study and before undergoing endoscopic sinus surgery by subjecting them to CT scan of paranasal sinuses. It is observed that a total of 100 patients had been studied in which the mean age of the population is 36.65 + 13.36 years. Youngest patient was 12 years old and eldest patient was 70 years old. Among the patients 50(50%) were males and remaining 50(50%) were females with a female to male ratio is 1:1. In the present study, the depth of olfactory fossa ranged from 2.1 to 8.3 mm inclusive of both sides in 200 CT images with a mean height of 5.21 mm. Of the 200 sides measured, the distribution of Keros classification is as the following-Keros type I 39(19.5%), Keros type II 143(71.5%) and Keros type III 18(9%) sides. Based on these observations, type II is the most common Keros type prevalent followed by type 1 Keros type and the least prevalent is the type III Keros type in the studied population. In the present study, on considering sides separately, the right side olfactory fossa depth ranged from 2.1 to 8.3 mm with a mean height of 5.43 mm and the left side olfactory fossa depth ranged from 2.1 to 8.1 mm with a mean height of 4.98 mm. On the right side, of 100 sides measured, the distribution of Keros classification is as the following-Keros type I 19(19%), Keros type II 68(68%) and Keros type III 13(13%) sides. On the left side, of 100 sides measured, the distribution of Keros classification is as the following-Keros type I 25(25%), Keros type II 70(70%) and Keros type III 5(5%) sides. Based on these observations, type II is the most common Keros type prevalent followed by type 1 Keros type and the least prevalent is the type III Keros type in the studied population on both sides. In the present study, out of 100 patients 23 patients were having asymmetric olfactory fossa between right and left sides based on Keros type, where as remaining 77% had symmetric Keros type on right and left sides. Out of 23 patients, 16 patients were having lower or deep olfactory fossa on right side, where as remaining 7 patients were having lower or deep olfactory fossa on left side. Based on these observations, a lower or deep ethmoid roof occurred more frequently on the right side than on the left side. Wilcoxon matched pair signed rank test is applied to see the significant difference between depth of right and left olfactory fossae. Since P value is < 0.001 the depth of olfactory fossa is significantly different from each other. The present study presents a precise, quantitative analysis of the olfactory fossa and ethmoid roof position as well as individual asymmetry. This information may be useful during pre-operative evaluation of CT images, as well as intraoperatively. The surgeon's understanding of the anatomy of a patient's ethmoid roof and its possible variations is crucial for countering possible complication risks during endoscopic sinus surgery.
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Affiliation(s)
- Ashok Murthy V.
- Department of ENT, PES Institute of Medical Science and Research, Kuppam, 517 425 India
| | - Bollineni Santosh
- Department of ENT, PES Institute of Medical Science and Research, Kuppam, 517 425 India
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Svider PF, Setzen M, Baredes S, Liu JK, Eloy JA. Overview of Sinonasal and Ventral Skull Base Malignancy Management. Otolaryngol Clin North Am 2017; 50:205-219. [DOI: 10.1016/j.otc.2016.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Skorek A, Tretiakow D, Szmuda T, Przewozny T. Is the Keros classification alone enough to identify patients with the 'dangerous ethmoid'? An anatomical study. Acta Otolaryngol 2017; 137:196-201. [PMID: 27608833 DOI: 10.1080/00016489.2016.1225316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION By means of three-dimensional display of the critical measurements, the authors suggest a novel definition of 'dangerous ethmoid'. Parallel to Keros type III, the proposed determining factors include: olfactory fossa width >6 mm, its distance to the medial nasal concha (turbinate) <20 mm and to the orbit interval of <10 mm. Clinical evaluation of these preliminary criteria based only on radiological data is required and underway. OBJECTIVES Detailed pre-operative assessment of sinus computer tomography (CT) scans reduces the frequency of severe complications in patients undergoing endoscopic sinus surgery (ESS). The authors aimed to identify a sub-set of anatomical features pre-disposing to major post-operative complications. METHOD Sinus computer tomography (CT) scans of patients of a single institution qualified for ESS were examined. Besides the Keros classification, authors focused on the anatomic measurements as follows: the olfactory fossa depth, width, and its distance from the medial nasal concha and the medial wall of the orbit (referred to as 'critical measurements'). The sample comprised 120 consecutive CT exams, without clinical validation. RESULTS Keros type I, II, and III was noted in 9.2%, 75.8%, and 15.0% of cases, respectively. Despite some statistically significant correlations, it was not possible to identify the patient age, sex, and side of body clearly correlating with the critical measurements.
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Affiliation(s)
- Andrzej Skorek
- Department of Otolaryngology, Medical University of Gdańsk, Gdansk, Poland
| | - Dmitry Tretiakow
- Department of Otolaryngology, Medical University of Gdańsk, Gdansk, Poland
| | - Tomasz Szmuda
- Department of Neurosurgery, Medical University of Gdańsk, Gdansk, Poland
| | - Tomasz Przewozny
- Department of Otolaryngology, Medical University of Gdańsk, Gdansk, Poland
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Abstract
PURPOSE OF REVIEW Classical orbital approaches in skull base surgery have involved large incisions with extensive bone removal resulting in prolonged recovery with associated morbidity and mortality. The purpose of this review is to explore recent advances in skull base surgery that are applicable to the orbital surgeon. RECENT FINDINGS Transnasal endoscopic surgery provides access to the medial 180 degrees of the orbit. Access to the lateral 180 degrees may be obtained using transmaxillary and transcranial techniques. Transorbital approaches and multiport techniques further expand the reach of the skull base surgeon. These minimally invasive techniques are supplanting the classical pterional, frontotemporal, frontotemporal orbitozygomatic, frontal, and subfrontal approaches. SUMMARY The role of the orbital surgeon in skull base surgery is changing. Transnasal and transcranial approaches to orbital disorders using minimally invasive techniques are becoming more common. In addition, transorbital access to the skull base, paranasal sinuses, and anterior and middle cranial fossa is offering new opportunities for the orbital surgeon.
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Svider PF, Baredes S, Eloy JA. Pitfalls in Sinus Surgery: An Overview of Complications. Otolaryngol Clin North Am 2015; 48:725-37. [PMID: 26117302 DOI: 10.1016/j.otc.2015.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a potential for significant complications from the medical and surgical treatment of rhinosinusitis because of the intimate relationship between the paranasal sinuses and surrounding vital structures. Familiarity with the complex anatomic relationships between the skull base and other critical structures and knowledge of pharmacologic properties of commonly used medical therapies are essential for preventing serious and harmful seqsuelae. The authors hope that this review represents a valuable addition to the otolaryngologist-in-training's therapeutic armamentarium, and also serves as a reminder of the potential pitfalls for the experienced sinus surgeon.
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Affiliation(s)
- Peter F Svider
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ 07103, USA.
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Is There an Association Between Olfactory Bulb Volume and the Keros Type of Fossa Olfactoria? J Craniofac Surg 2014; 25:1273-6. [DOI: 10.1097/scs.0000000000000579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Clinical pearls in endoscopic sinus surgery: key steps in preventing and dealing with complications. Am J Otolaryngol 2014; 35:324-8. [PMID: 24602458 DOI: 10.1016/j.amjoto.2014.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/26/2014] [Indexed: 11/21/2022]
Abstract
Increasing prevalence of patients undergoing endoscopic sinus surgery (ESS) makes understanding methods to preventing complications important to otolaryngologists. This commentary details clinical pearls and perioperative strategies that may minimize complications and increase preparedness for appropriate decision making in the event of a complication. Preoperative preparation is an important factor in preventing adverse events in ESS. This includes ensuring the presence of objective radiographic findings before pursuing operative management, both for patients' safety as well as medicolegal reasons, and providing adequate preoperative patient education. Appreciating variants in skull base and orbital wall anatomy through preoperative imaging is crucial for avoidance of intracranial and orbital complications. The importance of optimal visualization intraoperatively and the appropriate role of CT-guided imaging are also discussed. Finally, strategies for dealing with postoperative sequelae of more common complications are noted. This article represents a brief review for introductory sinus surgeons and is not meant as an all encompassing review.
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Manjila S, Cox EM, Smith GA, Corriveau M, Chhabra N, Johnson F, Geertman RT. Extracranial ligation of ethmoidal arteries before resection of giant olfactory groove or planum sphenoidale meningiomas: 3 illustrative cases with a review of the literature on surgical techniques. Neurosurg Focus 2013; 35:E13. [DOI: 10.3171/2013.10.focus13327] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
There are several surgical techniques for reducing blood loss—open surgical and endoscopic—prior to resection of giant anterior skull base meningiomas, especially when preoperative embolization is risky or not technically feasible. The authors present examples of an institutional experience using surgical ligation of the anterior and posterior ethmoidal arteries producing persistent tumor blush in partially embolized tumors.
Methods
The authors identified 12 patients who underwent extracranial surgical ligation of ethmoidal arteries through either a transcaruncular or a Lynch approach. Of these, 3 patients had giant olfactory groove or planum sphenoidale meningiomas. After approval from the institution privacy officer, the authors studied the medical records and imaging data of these 3 patients, with special attention to surgical technique and outcome. The variations of ethmoidal artery foramina pertaining to this surgical approach were studied using preserved human skulls from the Hamann-Todd Osteological Collection at the Museum of Natural History, Cleveland, Ohio.
Results
The extracranial ligation was performed successfully for control of the ethmoidal arteries prior to resection of hypervascular giant anterior skull base meningiomas. The surgical anatomy and landmarks for ethmoidal arteries were reviewed in anthropology specimens and available literature with reference to described surgical techniques.
Conclusions
Extracranial surgical ligation of anterior, and often posterior, ethmoidal arteries prior to resection of large olfactory groove or planum sphenoidale meningiomas provides a safe and feasible option for control of these vessels prior to either open or endoscopic resection of nonembolized or partially embolized tumors.
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Affiliation(s)
| | | | | | | | - Nipun Chhabra
- 3Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Freedom Johnson
- 2Otolaryngology-Head & Neck Surgery, MetroHealth Hospital, Case Western Reserve University, Cleveland, Ohio; and
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Czyż M, Tabakow P, Gheek D, Miś M, Jarmundowicz W, Raisman G. The supraorbital keyhole approach via an eyebrow incision applied to obtain the olfactory bulb as a source of olfactory ensheathing cells – radiological feasibility study. Br J Neurosurg 2013; 28:234-40. [DOI: 10.3109/02688697.2013.817534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Savvateeva DM, Güldner C, Murthum T, Bien S, Teymoortash A, Werner JA, Bremke M. Digital volume tomography (DVT) measurements of the olfactory cleft and olfactory fossa. Acta Otolaryngol 2010; 130:398-404. [PMID: 19883175 DOI: 10.3109/00016480903283741] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Preoperative imaging is important, because of the small size of the cribriform plate, different anatomical variants of the olfactory fossa in varied patients and unequal width of the cribriform plate in the anterior and posterior third. OBJECTIVE Digital volume tomography (DVT) is a rather new imaging technique for the diagnosis of diseases of paranasal sinuses. This technology is dedicated to the evaluation of the distinctive structures of the anterior skull base due to the high resolution of the DVT. Based on the Keros classification this anatomic area was analyzed radiologically and also in relation to the uncinate process. METHODS The investigation was performed on 111 patients. The Accu-I-tomo F17 was used. Patients with total nasal polyposis and patients who had undergone sinus surgery were excluded from the study. RESULTS Keros type I was found in 11.25% of the patients, type II in 68.05% and type III in 20.7%. Significant asymmetry of the olfactory fossa was identified in nine patients (8.1%). The width of the olfactory cleft varied from 0 to 3.25 mm. No relation between Keros type and a particular onset of the uncinate process to orbit, skull base or middle turbinate could be detected.
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Affiliation(s)
- Daria M Savvateeva
- Department of Otorhinolaryngology, Head and Neck Surgery, 35035 Marburg, Germany
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