Effect of Septal Deviation, Concha Bullosa and Haller's Cell on Maxillary Sinus's Inferior Pneumatization; a Retrospective Study

Retrospective Study on the Prevalence of Haller Cells Using Cone Beam Computed Tomography

BACKGROUND AND OBJECTIVE

The paranasal sinuses are cavities filled with air located within specific bones, namely the frontal, ethmoidal, maxillary, and sphenoidal sinuses. The ethmoidal sinus is composed of three groups: anterior, middle, and posterior, which are found on both sides. Haller cells (HC), also known as infraorbital ethmoid cells, are projections of the anterior ethmoid sinus that extend into the floor of the orbit and the upper part of the maxillary sinus. Infraorbital ethmoid cells have been associated with several disease conditions and symptoms, such as sinusitis, headaches, orofacial pain, and mucoceles. Consequently, determining the frequency and form of HC is crucial. The objective of the study was to determine the frequency, form, and clinical significance of Haller cells (HC) using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

This retrospective study analyzed 100 cone beam computed tomographic (CBCT) images, with an equal distribution of 50 males and 50 females from the age range of 19 to 70 years. The images were randomly selected from the CBCT archives. The participants were chosen according to the specific criteria for inclusion and exclusion established for the study. The collected data were subjected to statistical analysis utilizing the Chi-square test, independent student t-test, one-way ANOVA test, Cohen's Kappa statistics, and intraclass correlation coefficients.

RESULTS

The occurrence of Haller cells (HC) was found to be 73%, with 32 cases observed in males and 41 in females. Among the 73 patients with HC, 52 (71%) had unilateral HC, while 21 (28.76%) had bilateral HC. Regarding the shape of the HCs, 31 (42.46%) were teardrop-shaped, 26 (35.61%) were oval-shaped, and 16 (21.91%) were round-shaped. Additionally, out of the 73 cases of HC, 69 (94.52%) were unilocular, and four (5.47%) were multilocular. Furthermore, the average dimensions of HC were greater in males than in females, regardless of whether the cells were distributed unilaterally or bilaterally. The interobserver agreement between observers one and two showed complete consistency, and our study found that the assessment of the dimension of HC had outstanding interrater reliability.

CONCLUSION

The findings of this study indicate that CBCT is highly effective in visualizing and accurately delineating Haller cells in a significant number of patients. It is essential for oral physicians and oral radiologists to be aware of these anatomical structures to accurately identify them. This awareness will enable them to provide a comprehensive differential diagnosis for individuals experiencing orofacial pain and discomfort that may be attributed to the presence of Haller cells.

Is There a Relationship Between Maxillary Sinus's Inferior Pneumatisation and Sinonasal Variations? A Retrospective CBCT Study

Objectives

This retrospective study aims to analyse alveolar and palatal process pneumatisation and their relationships with sinonasal variations using cone-beam computed tomography.

Material and Methods

The study included 500 patients aged 18 to 87 years, involving 1000 maxillary sinuses with cone-beam computed tomography scans. We examined the relationship between inferior maxillary pneumatisation and the following anatomic variations: Haller cell, concha bullosa, paradoxical concha, bifid concha, and septal deviation.

Results

Among the 1000 maxillary sinuses assessed, we found 223 (22.3%) with alveolar process pneumatisation (APP), 37 (3.7%) with palatal process pneumatisation (PPP), and 23 (2.3%) with the presence of both APP and PPP. Significant relationships were observed between the Haller cell (P = 0.005), nasal septum deviation (P = 0.000), and middle concha bullosa (P = 0.01) with APP. However, there were no significant relationships between the paradoxical middle concha (P = 0.07), bifid middle concha (P = 0.74), and APP. Similarly, significant relationships were observed between the Haller cell (P = 0.001), paradoxical middle concha (P = 0.009), bifid middle concha (P = 0.000), and PPP. However, there were no significant relationships between concha bullosa (P = 0.799) and PPP. Additionally, we found significant relationships between the Haller cell (P = 0.003) and the presence of both APP and PPP.

Conclusions

This study provides an anatomical basis for imaging diagnosis by investigating the frequency of inferior pneumatisation of the maxillary sinus and its relationship with certain sinonasal variations.

Cone-beam computed tomography-based analysis of maxillary sinus pneumatization extended into the alveolar process in different age groups

Objective

This study aimed to measure the amount of maxillary sinus pneumatization (MSP) extended into alveolar processes in different age groups via cone-beam computed tomography (CBCT) and its association with age.

Methods

The data of 293 adult patients (533 maxillary sinuses) who underwent CBCT at our hospital from January 2020 to October 2020 were analyzed and divided into the following age groups: group I (18–34 years old, youth group), group II (35–59 years old, middle-aged group) and group III (≥ 60 years old, elderly group). The distance between the lowest point of the maxillary sinus floor and nasal cavity floor in the central area of the maxillary posterior teeth was measured and recorded as the amount of MSP. Further, according to the positional relation between the maxillary posterior teeth and maxillary sinus floor, MSP was divided into type I (normal pneumatization) and type II (extensive pneumatization). The distribution of pneumatization types and degree and change of pneumatization for the different age groups were also analyzed. P < 0.05 was used as the threshold for statistical significance.

Results

The amount of MSP of group I [(3.75 ± 3.77) mm] was significantly higher than that of group II [(2.30 ± 4.48) mm] and group III [(2.09 ± 4.70) mm], but there was no significant difference between group II and group III. We also found that the amount decreased gradually with increasing age (rs = − 0.2), with the youth group showing a higher prevalence of extensive pneumatization (youth vs. middle-age vs. elderly: 66.44% vs. 36.81% vs. 22.28%, respectively). There was no statistically significant difference in the amount of MSP between males and females and between left and right maxillary sinus in each group (P > 0.05).

Conclusion

The amount of MSP was significantly higher in the 18–34 years old group compared to older age groups, showed a decreasing trend with age and was not associated with sex and maxillary sinus sides.

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.

The frequencies of different types of nasal septum deviation and their effect on increasing the thickness of maxillary sinus mucosa

Background. Diseases of the paranasal sinuses are very prevalent in East Azerbaijan Province, Iran, which is attributed to various reasons, including environmental and anatomical factors. This study investigated the prevalence of anatomical variations of nasal septum deviation and evaluated the effect of this factor on increasing the mucosal thickness of the sinuses.

Methods. The samples included all the patients referred to Tabriz Faculty of Dentistry, and the frequency of nasal septum deviation in the sample population was evaluated. The samples were re-examined to select the samples with a thickened mucosa of the maxillary sinus. The results were reported using descriptive statistical methods.

Results. Deviation of the nasal septum was seen in 75% of the cases. The results showed that 31.76 % of males and 56.67% of females had an increased maxillary sinus mucosa thickness.

Conclusion. There was a significant relationship between nasal septum deviation and thickening of the maxillary sinus mucosa.

The Possible Associations of Nasal Septal Deviation with Mastoid Pneumatization and Chronic Otitis

BACKGROUND:

The nasal septum deviation is the most common deformity of the nasal, and that can be congenital or acquired. Despite many studies exist about the impact of nasal septum deviation on chronic sinusitis and also association between chronic otitis and mastoid pneumatization; few studies exist about the impact of nasal septum deviation on chronic otitis and mastoid pneumatization.

AIM:

The aim of this study was to evaluate the associations of nasal septum deviation and mastoid pneumatization and chronic otitis.

METHODS:

In this study review, all CT scans of PNS and Mastoid View in the imaging section from Imam Ali hospital in 2016-2017 years and cases of nasal septum deviation were enrolled. The nasal septum deviation was recorded, and the degree of nasal septum deviation in the coronal plane that showed the maximum deviation of the nasal septum was recorded. The volume of the mastoid cells automatically and directly was calculated using three diameter measurements (2 coronal diameters and 1 axial diameter) by the program. The software of SPSS 22 was used for statistical analysis.

RESULTS:

There was no relationship between nasal septum deviation severity and incidence of mastoid pneumatization in patients with nasal septum deviation (P > 0.05). There was relationship between nasal septum deviation severity and chronic otitis in patients with nasal septum deviation (P < 0.05). In patients with moderate and severe intensity of nasal septum deviation, the volume of mastoid air cells in deviation side was lower than the front side (P < 0.05).

CONCLUSION:

Based on the results of the CT scan, in patients with moderate and severe nasal septum deviation intensity, the volume of mastoid air cells in deviation side was lower than the front side. Also, there was a relationship between nasal septum deviation severity and chronic otitis.

Evaluation of maxillary sinus expansion in children due to maxillary first molar extraction

Purpose:

This study is aimed at understanding the effects of maxillary first molar extraction on the expansion of maxillary sinus in children.

Subjects and methods:

119 patients (aged 11-17 years) who had only one extracted maxillary first molar were included in the study. The superoinferior differences of the sinus floor position were measured in both dentate and edentulous sites on panoramic radiographs. The expansion of the maxillary sinus after maxillary first molar extraction was investigated in relation to fixed anatomic structures. The interorbital line (IL) and two zygomatic process lines (IZ) were used as a reference. The vertical distances between the IL and the inferior border of the maxillary sinus (IS) in edentulous (ISX) and in dentate sites (IST) were measured. The data was analyzed statistically.

Results:

The amount of maxillary sinus expansion in ISX was statistically significant in comparison to IST (p<0.001). The most prominent sinus expansions were found in subjects with extractions over six months prior to analysis (p<0.001). A negative correlation was detected between the amount of maxillary sinus expansion and IST (r = -0.438, p<0.001). There was a positive correlation between the amount of maxillary sinus expansion and IZT (r = 23.8, p<0.009).

Conclusion:

This study showed that the extraction of one maxillary first molar resulted in a negligible amount of sinus expansion in children. The results could be attributed to there being only one tooth extraction and a transferring of functional forces to the area of the neighboring teeth.

Relationship between Anatomical Variations of Sinonasal Area and Maxillary Sinus Pneumatization

INTRODUCTION

Maxillary sinuses are among the largest paranasal sinuses with various shapes and volumes. The dimensions and volumes of maxillary sinuses play an important role in the surgical treatment plan. The higher levels of pneumatization of alveolar bone lead to the increase of odontogenic sinusitis which cause problems in dental implantation. Therefore, this study aimed to evaluate the relationship between maxillary sinus volume and pneumatization and anatomical factors.

MATERIALS AND METHODS

In this cross-sectional study, computed tomography (CT) images of the healthy maxillary sinuses of 199 adult patients were reviewed. Amira software was used for the measurement of sinus volume. Sinus pneumatization of the alveolar bone in coronal CT scan images in the posterior teeth areas was measured. Moreover, anatomical variations of the sinonasal region, such as nasal septal deviation, and size of the ostium were measured and recorded. The Kolmogorov-Smirnov test, the t-test, and the Pearson's and Spearman's correlation coefficients were applied for data analysis.

RESULTS

According to the obtained results, the mean value of the maxillary sinus volume and the alveolar bone pneumatization were 15.54 mm³ and 3.54 mm, respectively. The mean value of the maxillary sinus volume was statistically higher among males than females (P<0.001). The prevalence of nasal septal deviation, concha bullosa, and maxillary sinus septa were 14.6%, 14.6% and 6% respectively. There were no association between anatomical factors, including the nasal septal deviation, the size of the ostium, concha bullosa, and maxillary sinus septa and maxillary sinus volume and pneumatization. P-value less than 0.05 was statistically significant.

CONCLUSION

No correlation was observed between the anatomical variations of the sinonasal region and maxillary sinus volume and pneumatization.

Concha bullosa, nasal septal deviation, and their impacts on maxillary sinus volume among Emirati people: A cone-beam computed tomography study

Purpose

To determine the prevalence of concha bullosa (CB) and nasal septal deviation (NSD) and their impact on maxillary sinus volume (MSV).

Materials and Methods

Cone-beam computed tomographic (CBCT) images of 106 Emirati people were used in this study. The direction and angle of septal deviation were calculated. The presence of CB, which could be unilateral, contralateral, or bilateral in relation to the direction of NSD, was also recorded. MSV was measured using reconstructed Digital Imaging and Communication in Medicine images on Dolphin 3D imaging software version 11.8 premium (Dolphin Imaging, Chatsworth, CA, USA). P values <0.05 were considered to indicate statistical significance.

Results

CB was detected in 37.7% of the sample; 20.7% of the sample showed single unilateral CB and 16.6% had single bilateral CB. NSD was seen in 74.5% of the sample. In the participants with CB, 45.5% showed mild deviation, 34.4% showed moderate deviation, and only 12.5% showed severe septal deviation. CB, but not NSD, was associated with significantly higher MSV on the affected side (P=0.001).

Conclusion

Although NSD was observed in more than two-thirds of the sample and CB was present in more than one-third of the sample, only CB had a significant impact on MSV.

The Appearance of The Infraorbital Canal and Infraorbital Ethmoid (Haller's) Cells on Panoramic Radiography of Edentulous Patients

Objectives. The aim of the study is to detect the prevalence and the characteristics of infraorbital canal and Haller's cells on panoramic radiography of edentulous patients. Methods. The study group comprised 291 panoramic radiographs of edentulous patients. Radiographs were interpreted for the visibility and characteristics of infraorbital canal and Haller's cells. For classification of infraorbital canal, a method based on the image characteristics of the border of the canal (Types I, II, and III) was used. Haller's cells were grouped according to the number and the shape of loculations. Results. Infraorbital canal was observed in 246 (84.6%) radiographs. The most prevalent of the observed canals were Type III for both sides (39.9 % for right and 32.3% for left side). The visibility of Haller's cells was 23.7%. The frequencies of Haller's cells' visibility were approximately equal for both genders. There is no significant difference between genders for the visibility of infraorbital canal and Haller's cells. Conclusions. The surgeons, implantologists, and radiologists should take into consideration infraorbital canal and Haller's cell for planning implant surgery of maxillary anterior region and undefined orofacial pain for edentulous patients.

Classification of Naso Septal Deviation Angle and its Clinical Implications: A CT Scan Imaging Study of Palakkad Population, India

Computerized tomographic imaging of the nasal and paranasal regions has become an indispensable tool for the endoscopic sinonasal surgery. The case control study was carried out on 120 patients for pilot study and 800 patients for the main study. The cases were selected with a clinical diagnosis of chronic rhino sinusitis. They were referred for a sinus CT scan by otolaryngologists and controls from the normal population. The patients were separated into males and females and anatomical variations were assessed. Increased prevalence of left sided nasal septal deviation and type II nasal septal deviation was seen in males belonging to cases group in our study. Knowledge about the nasal septum anatomical variations provides understanding about the upper limit of surgical dissection and aids in road mapping the confident direction for the functional endoscopic surgeons.

Incidental Findings in Cone-Beam Computed Tomographic Images: Calcifications in Head and Neck Region

Background/Aim: The use of CBCT in dentistry has been increasing popularity nowadays. CBCT images provide valuable information from anatomic structures and pathologies. Images obtained with CBCT allow for more appropriate treatment planning. The purpose of this study was to assess the calcifications which were found incidentally on CBCT images and to reveal the frequency and characteristics. Material and Methods: A total of 691 CBCT images which obtained from the patients were assessed. Demographic data and calcifications which were found out of primarily interest area were noted. The incidental findings were categorized and analyzed using descriptive statistics. Results: 945 calcifications were discovered on 318(46.02%) of the 691 patients’ images. 373(53.98%) scans showed no calcificated findings. The age range of patients was from 5 to 84 years. The most common calcification was tonsillolith (86.03%), followed by stylohyoid calcifications (6.24%), antrolith and subdermal calcifications (2.33%). Conclusion: Calcified lesions in head and neck region were commonly seen in CBCT images. Although the most of the calcifications are asymptomatic and require no treatment but correct identification of these findings will reduce unnecessary further diagnostic assessments and will provide more appropriate treatment plans. It will also provide the ability comprehensively evaluation of underlying diseases and practitioners will have life-saving information by early diagnosis.

Frequency and volumetry of infraorbital ethmoid cells (Haller cells) on cone-beam computed tomograms (CBCT) of the mid-face

Objective: The aim of this study was to determine the frequency and morphology of Haller cells using a new radiological technique that allows examination of the facial skull.

Material and methods: In a single center retrospective cohort study the cone-beam computed tomography (CBCT) volume data of the maxillary sinus of 199 patients were analysed (398 paranasal sinuses). If Haller cells were found, their capacity was determined. If orthopantomograms (OPG) were taken in a narrow time frame around the CBCT investigation, the rate of correspondence of the radiological findings was determined. The correlation between frequency of Haller cells and age and gender was calculated.

Results: Out of 199 patients 47 showed at least one Haller cell (23.62%). The total number of Haller cells was 64. Correspondence was rare in the same case between the results from different examination procedures with respect to the target object.

Conclusions: Bony variants of paranasal sinuses can be analysed using CBCT as an alternative to computed tomography (CT), whereas OPG images do not reliably detect Haller cells.

Incidental findings on cone-beam computed tomographic images: paranasal sinus findings and nasal septum variations

OBJECTIVE

CBCT applications have received widespread acceptance in dentistry. CBCT scans provide three-dimensional information on anatomic structures and characteristics of pathologies, rather than the two-dimensional information obtained with the conventional techniques. The purpose of this study was to evaluate incidental findings in out-of-interest areas on CBCT images and to reveal their frequency and characteristics.

METHODS

A total of 691 CBCT scans from 691 patients were assessed. Demographic data, CBCT indications, and incidental findings outside the primary area of interest, such as anatomical variations and pathologies, were noted. The incidental findings were categorized and analyzed using descriptive statistics.

RESULTS

In total, 1109 incidental findings in paranasal sinuses were noted on 548 of the 691 CBCT scans. The highest rate of incidental findings was maxillary sinus findings, followed by concha bullosa and septum deviation. The most frequently observed pathology was mucosal thickening, followed by polypoid mucosal thickening in the maxillary sinus.

CONCLUSIONS

While most incidental findings require no treatment, some conditions will necessitate modification of the treatment plan. Therefore, dental practitioners should be aware of incidental findings and anatomical variations. Correct identification of these findings will reduce unnecessary further diagnostic assessments and allow selection of more appropriate treatment plans.