Frontal sinus asymmetry: Is it an effect of cranial asymmetry? X-ray analysis of 469 normal adult human frontal sinus

Frontal Sinus Volume in Normocephalic Nonsyndromic Sagittal Craniosynostosis: A Comparative Study

PURPOSE

This study aimed to investigate frontal sinus volume as a potential indicator of cranial compensatory growth in unoperated normocephalic nonsyndromic sagittal craniosynostosis (NNSC) patients compared with age-matched and sex-matched controls. Previous studies have suggested that frontal sinus volume is suppressed in unoperated craniosynostosis and may be an intracranial space conservation phenomenon.

METHODS

Head computed tomographies (CTs) from 22 unoperated NNSC patients at our institution were utilized in this study and matched with age-matched and sex-matched control subjects. Frontal sinus volumes were measured using Syngo.Via, and statistical analysis was performed. Inclusion criteria for patients included the presence of a frontal sinus with unoperated sagittal craniosynostosis, whereas inclusion criteria for controls included the presence of a frontal sinus and no craniofacial trauma. Pearson correlation coefficient and significance values were calculated to evaluate the relationship between frontal sinus volume and craniosynostosis.

RESULTS

Six of 22 patients with NNSC were found to have the presence of a frontal sinus volume, compared with controls where all patients had the presence of a frontal sinus. When compared with age-sex matched controls, our analysis revealed a Pearson correlation coefficient of 0.993 and a high significance of P < 0.001, indicating a strong association between decreased-to-absent frontal sinus volume in unoperated NNSC patients.

CONCLUSION

The findings of this study demonstrate a correlation between decreased-to-absent frontal sinus volume in patients with NNSC in comparison to normal controls. These findings highlight the potential utility of frontal sinus volume as a diagnostic tool in identifying the degree of compensation that the skull has undergone in nonsyndromic sagittal craniosynostosis.

The gender-related volumetric side asymmetries in sphenoid sinuses and their clinical significance

BACKGROUND

The sphenoid sinus (SS) is important in neurosurgical practice because it is surrounded by numerous critical neurovascular structures. Using helical computerized tomography (CT) scanning, we investigated the gender-related volumetric asymmetric nature of the SS.

MATERIALS AND METHODS

CT scans of SS of 49 (21 females, 28 males) patients admitted to the hospital between 1 October 2018 and 1 June 2019 were analyzed retrospectively. The volumes of SSs were calculated using a secondary reconstruction tool.

RESULTS

The mean age was 33,81 for females, 41,107 and in males patients which was not statistically significant. The mean right and left SS volume was 3,03 cm3 and 3,.57cm3 in females, but 4,28cm3 and 4,70cm3 in males, respectively. The difference in side asymmetry between men and women was statistically significant (p < 0.05).

CONCLUSION

In this study, the gender-related side differences of the SS have been the first time reported in this study. The reason for this gender-related asymmetric size of the SSs may be related to the pneumatization process.

Investigating the link between frontal sinus morphology and craniofacial characteristics with sex: A 3D CBCT study on the South Indian population

Background: Measurement of craniofacial parameters plays an important role in sex determination in forensic science. The present study was done using cone beam computed tomography (CBCT) scans to evaluate the morphologic structure of the frontal sinuses and compare it with the width of nasal, cranial, maxillary and mandibular width which might help us in sex determination. Methods: A cross-sectional retrospective study was conducted using 142 full field of view (FOV) scans of patients archived from the department. The width of the nose, cranium, maxilla, and mandibular width was measured and compared with the frontal sinus between the two sexes. Results: A paired t-test was done to compare the linear measurements for both sexes' right and left frontal sinuses. The measurements were higher in males when compared to females. There was a statistically significant asymmetry (larger dimension on the left side) of the anterioposterior (p-value of 0.012) and superior-inferior dimensions in males (p-value of 0.135). Spearman's correlation showed that frontal sinus correlated with other craniofacial parameters like nasal, cranial, maxillary and mandibular width among both sexes. The frontal sinus, nasal, cranial, maxillary and mandibular widths were higher in males when compared to females (independent t-test). Discriminant function scores showed 66-68% accuracy to discriminate sex, using the anteroposterior dimension and mandibular width. Conclusions: The measurement of craniofacial parameters using CBCT can aid in determining the sex of unidentified and decomposed bodies.

Three-dimensional linear and volumetric computed tomography analysis of the frontal sinus

The frontal sinus is one of the four paranasal sinuses in humans, and knowledge of its anatomy is important when performing surgery involving the frontal bone or sinus. Although many studies have measured the frontal sinus using radiography and computed tomography (CT), few studies have evaluated by using three-dimensional (3D) analysis. The purpose of this study was to analyze the frontal sinus using 3D reconstruction analysis and determine the differences in linear and volumetric measurements between sexes, sides, and ages. The sample comprised 281 facial CT scans: 173 and 108 from males and females, respectively. The width, height, and length of each frontal sinus and total volume were all larger in males than in females. Almost all linear and volumetric measurements were larger in young adults than in older for both sexes, but not all of the differences were statistically significant. Linear and volumetric measurements were larger for males than females regardless of age group. There were no statistically significant differences between the right and left sides except the width in males. The size of the frontal sinus was strongly influenced by sex and age. The measurements reported here might be useful for improving surgical procedures involving the frontal sinus.

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

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

Introducing a new possible predisposing risk factor for odontoid type 2 fractures after cervical trauma; Ponticulus posticus anomaly of C1 vertebra

OBJECTIVE

Ponticulus posticus is an anomaly of the atlas. Odontoid fracture type 2 fracture occurs by hyperflexion, hyperextension, lateral flexion, and a combination of these movements. The presence of Ponticulus Posticus anomaly may affect the occurrence of odontoid fractures of the C2 vertebra. In this study, the relationship between the presence of PP anomaly and occurring of the odontoid type 2 fracture was investigated.

PATIENTS AND METHODS

Cervical CTs of a total of 14 patients with odontoid type 2 fracture were retrospectively evaluated for PP, and compared with 13 patients with cervical trauma without odontoid type 2 fracture.

RESULTS

Ponticulus posticus anomaly was noted in 7 of 14 patients with odontoid type 2 fractures on the upper cervical CT; therefore, the prevalence was 50.%, but only 3 cases (23.07%) were seen in 13 patients of the control group. In binominal regression analysis showed that the presence of PP anomaly increases 12,075 times to occur odontoid type 2 fracture after cervical trauma.

CONCLUSION

Ponticulus posticus is often not recognized, but this study shows that ponticulus posticus is a risk factor for odontoid type 2 fracture after cervical trauma.

What Are We Missing From Asymmetric Relationship Between the Retinal Nerve Fiber Layer Thickness Profiles and Sphenoid Sinus Volume?

PURPOSE/AIM OF THE STUDY

Detailed analysis of retinal structure such as the retinal nerve fiber layer can be performed by spectral-domain optical coherence tomography (OCT). There are no published studies concerning a relationship between retinal nerve fiber layer and human sphenoid sinus volumes. We investigated this relationship.

MATERIAL AND METHODS

Spectral-domain OCT. The peripapillary retinal nerve fiber layer (RNFL) thickness and sphenoid sinus volume estimation of both sides of sex-matched patients were retrospectively analyzed.

RESULTS

The mean RNFL thicknesses at the left side (91.8 μm) were significantly smaller than the right side (94.5 μm) (P = 0.040). However, the mean left sinus volume (44.5 cm) is larger than the right side, (34.5 mm) (P < 0.005). Left and right differences of both parameters are statistically significant (P < 0.05).

CONCLUSION

There is a negative correlation between mean RNFL thicknesses and mean sinus volumes. To our knowledge, this article is the first report demonstrating the asymmetry relationship between RNFL and sphenoid sinus volumes.

Controversy about the protective role of volume in the frontal sinus after severe head trauma: larger sinus equates with higher risk of death

The "crumple zone" hypothesis suggests that the paranasal sinuses protect the brain as a zone to distribute and absorb energy after trauma to the head. We investigated the relation between the size of the frontal sinus and mortality in patients with cranial trauma. All patients with head trauma admitted to the ICU between 1 January 2016 and 20 December 2017 were reviewed retrospectively. They were divided into two groups (according to their outcome) : died and survived. The volumes of the frontal sinuses and other trauma-related variables were assessed on computed tomographs (CT) on admission. Admission CT of 33 patients (24 male, and nine female, aged between 18-92 years, mean 43) were obtained. Male patients had significantly larger frontal sinuses than female (10.24 compared with 6.6cm³). Larger sinuses were significantly associated with a worse outcome (p=0.005). The size of the frontal sinus correlates with mortality after cranial trauma. Our findings do not confirm the "crumple zone" hypothesis, and suggest that the larger the sinus, the greater the risk of death. To our knowledge this is a new finding that warrants further validation.

The effects of gender and age on forensic personal identification from frontal sinus in a Turkish population

Objectives:

To define the dimensions of the frontal sinus in groups standardized for age and gender and to discuss the reasons and the effects of the variations.

Methods:

Frontal sinus measurements were obtained from paranasal CT scans of 180 males and 180 females in the Radiology Department of Dursun Odabas Medical Center of Yuzuncu Yil University, Van, which is located in Eastern Turkey, between February and March 2016. The width and height of sinuses were measured on a coronal plane, and the anteroposterior length was measured on an axial plane. Volumes were calculated using the Hospital Information Management Systems and Image Archiving and Management System program. The Statistical Package of the Social Science version 13 was used for statistical analyses.

Results:

We determined differences in the frontal sinus measurements of different age groups in a Turkish adult population. Frontal sinus dimensions were usually higher in females and lower in males after 40-49 years of age than their younger counterparts, but the measurements were lower in females and higher in males in 70≤ years of age group than 60-69 years of age. Left frontal sinus was dominant in young age groups but right frontal sinus was dominant in groups 40-49 years of age or older.

Conclusion:

We observed crossing of the measurements between the different age groups, which we could not find clear explanations. The results of such studies may affect forensic identification from frontal sinus measurements.

Sudden death and cervical spine: A new contribution to pathogenesis for sudden death in critical care unit from subarachnoid hemorrhage; first report - An experimental study

Context:

Sudden death from subarachnoid hemorrhage (SAH) is not uncommon.

Aims:

The goal of this study is to elucidate the effect of the cervical spinal roots and the related dorsal root ganglions (DRGs) on cardiorespiratory arrest following SAH.

Settings and Design:

This was an experimental study conducted on rabbits.

Materials and Methods:

This study was conducted on 22 rabbits which were randomly divided into three groups: control (n = 5), physiologic serum saline (SS; n = 6), SAH groups (n = 11). Experimental SAH was performed. Seven of 11 rabbits with SAH died within the first 2 weeks. After 20 days, other animals were sacrificed. The anterior spinal arteries, arteriae nervorum of cervical nerve roots (C6–C8), DRGs, and lungs were histopathologically examined and estimated stereologically.

Statistical Analysis Used:

Statistical analysis was performed using the PASW Statistics 18.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Intergroup differences were assessed using a one-way ANOVA. The statistical significance was set at P < 0.05.

Results:

In the SAH group, histopathologically, severe anterior spinal artery (ASA) and arteriae nervorum vasospasm, axonal and neuronal degeneration, and neuronal apoptosis were observed. Vasospasm of ASA did not occur in the SS and control groups. There was a statistically significant increase in the degenerated neuron density in the SAH group as compared to the control and SS groups (P < 0.05). Cardiorespiratory disturbances, arrest, and lung edema more commonly developed in animals in the SAH group.

Conclusion:

We noticed interestingly that C6–C8 DRG degenerations were secondary to the vasospasm of ASA, following SAH. Cardiorespiratory disturbances or arrest can be explained with these mechanisms.

Inequality in leg length is important for the understanding of the pathophysiology of lumbar disc herniation

Objective:

Inequality in leg length may lead to to abnormal transmission of load across the endplates and degeneration lumbar spine and the disc space. There has been no study focusing on lumbar disc herniation (LDH) and leg length discrepancy. This subject was investigated in this study.

Materials and Methods:

Consecutive adult patients with leg length discrepancy and low back pain (LBP) admitted to our department were respectivelly studied.

Results:

A total number of 39 subjects (31 women and eight men) with leg length discrepancy and LBP and 43 (25 females and 18 males) patients with LBP as a control group were tested. Occurrence of disc herniation is statistically different between patients with hip dysplasia and control groups (P < 0.05).

Conclusion:

The results of this study showed a statistically significant association between leg length discrepancy and occurrence of LDH. The changes of spine anatomy with leg length discrepancy in hip dysplastic patients are of importance in understanding the nature of LDH.

Ligamentum flavum hematomas: Why does it mostly occur in old Asian males? Interesting point of reported cases: Review and case report

Hematoma of the ligamentum flavum (LF) is a rare cause of neural compression and sciatica. Currently, the etiology and epidemiological characteristics of ligamentum flavum hematoma (LFH) are unknown and epidemiological investigations using rewieving of reported cases have not been performed. We report the case of a 63-year-old man with a LFH compressing the spinal canal at the left L2-L3 level, rewieved relevant literature. In Medline research, wefound a total of 50 reported cases with LFHs, and the interesting point of these cases were analyzed. Many of cases were old males. Interestingly, 39 of the 50 cases were reported from Asian countries. The ages of 42 patients could be verified. The youngest age was 45 years, oldest age was 81 years, and mean age was 66.07 years. Thirty-three out of these 42 patients (78.53%) were older than 60 years. An important aspect of the present review is to bring attention for occurrence in older Asian males. With an increasing number of elderly people in the general population, there is a need to investigate risk factors such as sexual gender, age, and geographic location for LFH.