Sphenoid sinus: An anatomic and endoscopic study in Asian cadavers

Abstract

An anatomic and endoscopic study of 48 cadaveric heads (96 sphenoid sinuses) was undertaken to describe the anatomy of the sphenoid sinus in Asians. Sellar type of sphenoid sinus is the most common, present in 53 out of 96 sides (55%). Forty-five of the 48 heads had a dominant sphenoid cavity, of which 11 contained vital structures from both sides of the sphenoid sinus. The incidence of accessory septae, carotid artery, optic nerve, maxillary nerve, and vidian nerve bulges were 70.8%, 67.7%, 69.8%, 61.5%, and 64.6%, respectively. There is a significantly higher number of overriding ethmoid sinuses in Asian cadavers (46/96 sides) compared to western studies (P < 0.0005). Seven (15%) of these 46 sides were also Onodi positive. The rest of the overriding ethmoid cells were Onodi negative. Surgeons should be aware of the significantly higher number of overriding posterior ethmoid cells in Asian populations during functional endoscopic sinus surgery (FESS). The optic nerve is at risk during FESS surgery if the sphenoid sinus is sought behind the deepest point of these posterior ethmoid cells. These overriding posterior ethmoid cells may also confuse the unwary surgeon that he has entered the sphenoid sinus where in fact he is still operating in the posterior ethmoid cells.

Surgical Measurement of the Sphenoid Sinus on Sagittal Reformatted CT in the Turkish Population

“…In the studies performed, it was shown that the presence of Onodi cells was greater in Asian cadavers than in Western cadavers [10]. Therefore, during surgery, surgeons should be aware of the significantly greater presence of Onodi cells in Asian populations because the most common complication during transsphenoidal surgery is cerebrospinal fluid leak (CSF) leakage.…”

Study of the relationship between sphenoid sinus volume and protrusions in the sphenoid sinus

“…The prevalence of the protrusions is quite variable, which may affect the success of transsphenoidal endoscopic surgery [6,[8][9][10][11][12][13]. The prevalence of protrusion of ICA is not conclusive, ranging from 5.2% [14] -32.8% [15], 48.5% [16] and 67.7% [8], depending on the degree of individual pneumatization and the definition used in each study. From these results, the distances between these structures and the wall of SS and the prevalence of ptotrusions in SS were found proportion to the degree of SS pneumatization [7], but the quantitative evaluation SS volume was not indicated.…”

Role of the superior turbinate when performing endoscopic endonasal transsphenoidal approach

“…There is a major risk of adverse events when there is poor orientation and a blind operation is performed. There is marked projection of the posterior ethmoid cells over and into the sphenoid sinus in 8.4-25% of the cases [1,12,14,17,19]. This often makes sphenoid sinus identification even more difficult and at times dangerous.…”