The literature data on the incidence of pneumatization of the crista galli based on patients' computed tomography (CT) scans ranges from 3 to 37.5%. This study investigated for the first time the incidence of crista galli pneumatization based on CT scans of human skulls. The study examined 102 randomly selected human skulls (≥20 years of age; 76 males, 26 females). Skulls were scanned in a fixed position using cone beam computed tomography (CBCT) with a field of view of 145 × 130 mm and an isotropic voxel size of 0.25 mm. The scans were recorded in Digital Images and Communications in Medicine format. The CBCT images were analyzed using OnDemand3DTM software. A 2-mm contiguous slice thickness was used in the axial and coronal planes. The width, length, and height (cranial-caudal dimension) of the pneumatized space within the crista galli were measured. The crista galli was found to be pneumatized in even 68 (66.6%) of the 102 skulls. Two types of pneumatized crista galli (PCG) were identified: PCG alone (surrounded by bony walls) and PCG + spongiosis (surrounded by spongy bone). Of the 68 pneumatized skulls, 31 were PCG alone (45.58%) and 37 were PCG + spongiosis (54.42%). The pneumatized regions had a width of 0.9-6.6 mm, length of 2.8-12.9 mm, and height of 3.6-17.1 mm. No statistically significant differences have been found regarding the sex and age. Regarding the proportions of pneumatization, the three types of crista galli have been determined resulting in new, practical classification: type S (small), type M (moderate), and type L (large). The crista galli is not always a compact bone; in some cases, it is filled with spongy bone or pneumatized. In respect of proportions of pneumatization, there are three types of pneumatized crista galli: small, moderate, and large. Pneumatized crista galli can play an important role in clinical work, both as an inflamed sinus or other pathologies (sinusitis cristae galli, mucocoelae) or as a morphologic barrier in neurosurgical approaches to some tumors of the anterior skull base.
The aim of this study was to show clinical outcome in 56 patients with tympanic membrane perforation operated on by total endoscopic transcanal myringoplasty. Out of the total of 74 patients operated on exclusively endoscopically, we identified 56 patients in whom tympanoplasty type I (myringoplasty) was performed. In 43 patients (45 ears), myringoplasty was performed in a standard transcanal fashion with lifting of the tympanomeatal flap, and in 13 patient butterfly myringoplasty was performed. The size and position of perforation, surgery duration, hearing status and closure of the perforation were evaluated. Perforation closure was obtained in 50 of 58 ears (86.21%). The mean surgery duration was 62.69±22.56 minutes in both groups. Hearing improved significantly, with the preoperative mean air-bone gap of 20.41±9.29 dB improving to the postoperative mean airbone gap of 9.05±7.77 dB. No major complications were recorded. Our results of graft success rate and hearing outcomes are comparable with those of microscopic myringoplasties but without the need for external incisions and with reduced surgical morbidity. Hence, we recommend total endoscopic transcanal myringoplasty as the method of choice for tympanic membrane perforation regardless of its size and location.
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