Frontal Sinus Pneumatization Affects Height of the Lateral Lamella and Position of Anterior Ethmoidal Artery

Abstract

Preoperative evaluation of the frontal sinus (FS) and associated anatomical structures may reduce the risk of intraoperative complications and facilitate the management of potential complications. In this study, the authors aimed to evaluate relationship between FS pneumatization and critical anatomical structures. Paranasal sinus computerized tomography scans of 350 sides of 175 patients were evaluated. The pneumatization pattern of the FS, FS dimensions (on the axial, coronal, and sagittal slices), anterior ethmoidal artery, and depth of the of olfactory fossa were evaluated for every patient on both sides. There were 111 (63.4%) male and 64 (36.6%) female patients. The authors found a statistically significant correlation between the depth of olfactory fossa and the anterior ethmoidal artery position (P <0.001). As the FS pneumatization increases, the likelihood of the anterior ethmoid artery to run separately from the skull base also increases. Also, there was a statistically significant difference among the types in terms of the depth of the olfactory fossa (Kruskal-Wallis P = 0.002). The depth of the olfactory fossa increases depending on the increase of FS pneumatization.Our study shows that the olfactory fossa depth (skull-base depth) increases as FS pneumatization increases. In light of this information, the evaluation of the preoperative sinus computerized tomography scans will help in performing safer endoscopic sinus surgeries.

Does paranasal sinus development affect olfactory fossa depth and lateral lamella length?

“…The effects of the pneumatization pattern of FS on olfactory fossa depth are still a matter of debate. Comoglu et al reported a deeper olfactory fossa in overpneumatized FSs, which was in contrast to our study. In their study, they also investigated the association of the anterior ethmoid artery; however, their data did not include the other paranasal sinus types with pneumatization defect.…”

“…In addition, medial displacement of orbit in patients with MS hypoplasia was evident in the report by Ozcan et al In these recent studies, the touchstone of the method was evaluation of the structures upon paranasal CT scans because paranasal CT was suggested to be the gold standard technique for evaluation of paranasal sinuses . The association between FS pneumatization and olfactory fossa was at the center of several prior studies, but we also focused on olfactory fossa depth and lateral lamella length in patients with MS and SS hypoplasia.…”

“…As previously classified by Keros, individuals with deeper olfactory fossa have longer lateral lamellas, resulting in an increased risk of iatrogenic injury. Studies focused on olfactory fossa depth regarding frontal sinus (FS) pneumatization are available in the prior literature . However, to the best of our knowledge, thus far no studies have investigated olfactory fossa depth, Keros type, and lateral lamella length of patients with pneumatization defects of the maxillary sinus (MS) and sphenoid sinus (SS).…”

Sinonasal Anatomic Variations According to Frontal Sinus Pneumatization in a Korean Population

“…5) A few studies have reported a direct relationship between the pneumatization of FS and the LLL. 1,2) In contrast, another study has reported that lesser the pneumatization of the FS, greater is the LLL. 3) These results could be a matter of contention.…”

“…There is limited literature between the relation of the degree of FS pneumatization and the development of the PNS structures. [1][2][3][4] Lateral lamella length (LLL) and olfactory fossa depth are important anatomical parameters to be considered in preventing surgical complications like skull base injury. Greater LLL increases the possibility of lateral lamella injury during the surgery.…”