WORLD JOURNAL OF PLASTIC SURGERY
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Volume 15, Issue 1 (2026)
WJPS 2026, 15(1): 37-47 |
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Mirshekari A, Haghnegahdar A, Mirbaba S G, Dargah S H. Investigating the Relationship between Pneumatized Middle Turbinate and Anterior Ethmoid Roof Dimensions Using CBCT Images. WJPS 2026; 15 (1) :37-47
URL: http://wjps.ir/article-1-1601-en.html
URL: http://wjps.ir/article-1-1601-en.html
1- Department of Pediatric Dentistry, School of Medical Science, Kerman University of Medical Sciences, Kerman, Iran
2- Department of Oral and Maxillofacial Radiology, School of Medical Science, Shiraz University of Medical Sciences, Shiraz, Iran
3- Department of Oral and Maxillofacial Surgery, School of Medical Science, Kerman University of Medical Sciences, Kerman, Iran
2- Department of Oral and Maxillofacial Radiology, School of Medical Science, Shiraz University of Medical Sciences, Shiraz, Iran
3- Department of Oral and Maxillofacial Surgery, School of Medical Science, Kerman University of Medical Sciences, Kerman, Iran
Abstract: (587 Views)
Background: Understanding the anatomical relationship between the pneumatized middle turbinate (PMT) and ethmoid roof structures is crucial for minimizing complications in endoscopic sinus surgery. We aimed to evaluate the association between PMT and the dimensions of the anterior ethmoid roof using cone-beam computed tomography (CBCT) imaging.
Methods: A retrospective, cross-sectional study was conducted on 249 CBCT scans obtained at a maxillofacial radiology center. All images were acquired using a NewTom VGi scanner (QRsrl, Verona, Italy) with a 15 × 15 cm field of view and 1-mm slice thickness. Measurements were taken from coronal sections displaying the infraorbital nerve canal. Key anatomical points, including the medial and lateral ethmoid roof points (MERP and LERP) and the cribriform plate (CP), were identified. The width and height of these structures were measured. PMT was classified as lamellar, bulbous, or extensive. Statistical analyses included chi-square, t-test, and Pearson correlation tests.
Results: A significant relationship was found between the axial dimensions of PMT and the anterior ethmoid roof width (AER) in both genders (P<0.05). Differences in ethmoid roof dimensions were statistically significant between PMT types. In males, vertical PMT dimensions were correlated with CP and AER height. AER width was greater in males than females, particularly in cases with PMT.
Conclusion: A close anatomical relationship exists between PMT and ethmoid roof dimensions, especially AER width. Recognition of these variations is essential for surgical planning and avoiding complications in sinus and skull base surgery.
Methods: A retrospective, cross-sectional study was conducted on 249 CBCT scans obtained at a maxillofacial radiology center. All images were acquired using a NewTom VGi scanner (QRsrl, Verona, Italy) with a 15 × 15 cm field of view and 1-mm slice thickness. Measurements were taken from coronal sections displaying the infraorbital nerve canal. Key anatomical points, including the medial and lateral ethmoid roof points (MERP and LERP) and the cribriform plate (CP), were identified. The width and height of these structures were measured. PMT was classified as lamellar, bulbous, or extensive. Statistical analyses included chi-square, t-test, and Pearson correlation tests.
Results: A significant relationship was found between the axial dimensions of PMT and the anterior ethmoid roof width (AER) in both genders (P<0.05). Differences in ethmoid roof dimensions were statistically significant between PMT types. In males, vertical PMT dimensions were correlated with CP and AER height. AER width was greater in males than females, particularly in cases with PMT.
Conclusion: A close anatomical relationship exists between PMT and ethmoid roof dimensions, especially AER width. Recognition of these variations is essential for surgical planning and avoiding complications in sinus and skull base surgery.
References
1. Sirikçi A, Bayazit YA, Bayram M, Ozer E, Kanlikama M. Ethmomaxillary sinus: a particular anatomic variation of the paranasal sinuses. Eur Radiol 2004; 14:281-5. [DOI:10.1007/s00330-003-1993-6]
2. Lee S, Choi H, Cho HJ, Kim DY. Pediatric paranasal sinuses-development, growth, pathology, and functional endoscopic sinus surgery. Clin Anat 2022; 35:745-61. [DOI:10.1002/ca.23888]
3. Arredondo de Arreola G, Arredondo Garcia JL, Ortega A. Morphogenesis of the lateral nasal wall from 6 to 36 weeks. Otolaryngol Head Neck Surg 1996; 114:54-60. [DOI:10.1016/S0194-59989670283-8]
4. Derin S, Sahan M, Baykal B, Tekdogan UY. Giant concha bullosa. BMJ Case Rep 2014; 2014:bcr2013200524. [DOI:10.1136/bcr-2013-200524]
5. Alsaied A. Paranasal Sinus Anatomy: What the Surgeon Needs to Know. Springer; 2017. [DOI:10.5772/intechopen.69089]
6. Swain SK. Middle turbinate concha bullosa and its relationship with chronic sinusitis: a review. Int J Otorhinolaryngol Head Neck Surg 2021; 7:1062-7. [DOI:10.18203/issn.2454-5929.ijohns20212136]
7. Klimenko KE, Gurov AV, Ermoshchenkova MV, Volkova AA. [Pneumatization of the middle turbinate and chronic sinusitis: current state of the problem and review of surgical correction]. Vestn Otorinolaringol 2025; 90:69-74. [DOI:10.17116/otorino20259001169]
8. Dayal A, Rhee JS, Garcia GJ. Impact of middle versus inferior total turbinectomy on nasal aerodynamics. Otolaryngol Head Neck Surg 2016; 155:518-25. [DOI:10.1177/0194599816644915]
9. Kaplanoglu H, Kaplanoglu V, Bilgin G. An analysis of the anatomic variations of the paranasal sinuses and ethmoid roof using computed tomography. Eurasian J Med 2013; 45:115-21. [DOI:10.5152/eajm.2013.23]
10. Gibelli D, Cellina M, Cerutti S, Cattaneo C, Sforza C. Anatomical variations of anterior ethmoidal foramen and cribriform plate: relations with sex. J Craniofac Surg 2022; 33:e2-4. [DOI:10.1097/SCS.0000000000007789]
11. El Taher M, Ahmed MA, Saleh HA, Ahmed YH. Coincidence of concha bullosa with nasal septal deviation: radiological study. Indian J Otolaryngol Head Neck Surg 2019; 71:1918-22. [DOI:10.1007/s12070-018-1311-x]
12. Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am J Neuroradiol 2004; 25:1613-8.
13. Gun R, Ozcan I, Ozturk A, Yildiz A, Dogan M. The relationship between pneumatized middle turbinate and the anterior ethmoid roof dimensions: a radiologic study. Eur Arch Otorhinolaryngol 2013; 270:1365-71. [DOI:10.1007/s00405-012-2232-z]
14. Pérez P, Sabaté J, Carmona A, Catalina Herrera CJ, Jiménez Castellanos J. Anatomical variations in the human paranasal sinus region studied by CT. J Anat 2000; 197:2217. [DOI:10.1017/S0021878299006500]
15. Hatipoglu HG, Cetin MA, Yuksel E. Nasal septal deviation and concha bullosa coexistence: CT evaluation. B ENT 2008; 4:227-32.
16. Kar M, Altıntaş M. The incidence of concha bullosa: a retrospective radiologic study. Eur Arch Otorhinolaryngol 2023; 280:731-5. [DOI:10.1007/s00405-022-07552-y]
17. El Din WAN, Soliman NA, Mohamed SA, Abdelkhalek A, Elsayed AB. Prevalence of the anatomical variations of concha bullosa and its relation with sinusitis among Saudi population: a computed tomography scan study. Anat Cell Biol 2021; 54:193-201. [DOI:10.5115/acb.20.247]
18. Kalaiarasi R, Ramakrishnan V, Poyyamoli S. Anatomical variations of the middle turbinate concha bullosa and its relationship with chronic sinusitis: a prospective radiologic study. Int Arch Otorhinolaryngol. 2018; 22:368-73. [DOI:10.1055/s-0038-1625978]
19. Cukurova I, Yaz A, Gumussoy M, Yigitbasi OG. A patient presenting with concha bullosa in another concha bullosa: a case report. J Med Case Rep 2012; 6:87. [DOI:10.1186/1752-1947-6-87]
20. Güler C, Özkırış M, Kapusuz Z, Saydam L. Analysis of ethmoid roof and skull base with coronal section paranasal sinus computed tomography. J Craniofac Surg 2012; 23:1460-4. [DOI:10.1097/SCS.0b013e31825755b2]
21. Uzun L, Savranlar A, Baskan Z, Aslan K, Aksoy F, Karasen RM. Is pneumatization of middle turbinates compensatory or congenital? Dentomaxillofac Radiol 2012; 41:564-70. [DOI:10.1259/dmfr/31644208]
22. Güldner C, Diogo I, Windfuhr JP, Bien S, Sesterhenn AM, Schick B. Potential of dosage reduction in cone beam computed tomography for diagnostics of the paranasal sinuses. Eur Arch Otorhinolaryngol 2013; 270:1307-15. [DOI:10.1007/s00405-012-2177-2]
23. Acikalin RM, Ceylan M, Celik H, Karadag M. Is there a relationship between middle concha bullosa and ethmoid roof asymmetry? Braz J Otorhinolaryngol 2022; 88:101-4. [DOI:10.1016/j.bjorl.2020.06.003]
24. De Cock J, Devriendt D, Demaerel P, Lemmerling M, Van Cauteren M, Hermans R. A comparative study for image quality and radiation dose of a cone beam computed tomography scanner and a multislice computed tomography scanner for paranasal sinus imaging. Eur Radiol 2015; 25:1891-900. [DOI:10.1007/s00330-015-3593-7]
25. Dasar U, Gokce E. Evaluation of variations in sinonasal region with computed tomography. World J Radiol 2016; 8:98-104. [DOI:10.4329/wjr.v8.i1.98]
26. Acikalin RM, Bayram O, Haci C, Yanik HT, Ozturkcu Y, Kocak A, Insan A. Is there a relationship between middle concha bullosa and ethmoid roof asymmetry? Braz J Otorhinolaryngol 2022;88:101-104. [DOI:10.1016/j.bjorl.2020.06.003]
27. Gun R, Yorgancilar E, Bakir S, Ekici F, Akkus Z, Ari S, Topcu I. The relationship between pneumatized middle turbinate and the anterior ethmoid roof dimensions: a radiologic study. Eur Arch Otorhinolaryngol 2013 ;270:1365-71. [DOI:10.1007/s00405-012-2232-z]
28. Kajan ZD, Sigaroudi AK, Ebrahimipour S. Effects of septal deviation, concha bullosa, and their combination on posterior palatal arch depth using cone beam computed tomography. J Dent Shiraz 2016; 17:26-32.
29. Roman RA, Neagoe RM, Roman SD, Popovici RE, Vlădan CI. Assessing prevalence of paranasal sinus anatomical variants in patients with sinusitis using cone beam computed tomography. Clujul Med 2016; 89:423-9. [DOI:10.15386/cjmed-598]
30. Damar M, Dinç AE, Eliçora SS, Bişkin S, Yıldırım M, Uslu S. Does the degree of septal deviation affect cribriform plate dimensions and middle turbinate length? J Craniofac Surg 2016; 27:51-5. [DOI:10.1097/SCS.0000000000002220]
31. Saylisoy S, Bayram M, Kantarci M, Calik M, Karazincir S, Alper F. Is there a relationship between cribriform plate dimensions and septal deviation angle? Eur Arch Otorhinolaryngol 2014; 271:1067-71. [DOI:10.1007/s00405-013-2661-3]
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