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Cone Beam Computed Tomography Analysis of Sphenoid Sinus Pneumatization and Relationship with Neurovascular Structures

  • Najmeh Movahhedian
  • Maryam PaknahadEmail author
  • Fatemeh Abbasinia
  • Leila Khojatepour
Original Article

Abstract

Background

The sphenoid sinus is considered as the most variable pneumatized structure of the skull.

Purpose

The aim of the present study was to determine the prevalence of the Onodi cell as well as to evaluate the relationship between the sphenoid sinus type of pneumatization and the presence of surrounding neurovascular protrusion using cone beam computed tomography (CBCT).

Methods

The CBCT images of 500 patients/996 sides [203 males (40.6%) and 297 females (59.4%)] were analyzed in this study. The type of sphenoid sinus pneumatization, prevalence of internal carotid artery (ICA) and optic nerve (ON) protrusion and dehiscence, and also the frequency of Onodi cell were assessed.

Results

The percentages of the conchal, presellar, sellar, postsellar (a), and postsellar (b) types of pneumatization were 1%, 11.5%, 35.5%, 38.9%, and 13.1%, respectively. The more the sphenoid sinuses pneumatized, the greater the frequency of ON and ICA protrusion and dehiscence of their wall to the sinus. The prevalence of Onodi cell was 38.8%. A significant correlation was found between ON dehiscence and the presence of Onodi cells.

Conclusion

The present study demonstrated a significant relationship between the sinus type and frequency of neurovascular protrusions. Therefore, the sphenoid sinus extent of pneumatization might be useful in predicting the risk of iatrogenic damage to the surrounding structures.

Keywords

Sphenoid sinus Internal carotid artery Optic nerve Pneumatization Cone beam computed tomography 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (sums12232) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Stokovic N, Trkulja V, Dumic-Cule I, Cukovic-Bagic I, Lauc T, Vukicevic S et al (2016) Sphenoid sinus types, dimensions and relationship with surrounding structures. Ann Anat 203:69–76PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Guldner C, Pistorius SM, Diogo I, Bien S, Sesterhenn A, Werner JA (2012) Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT). Acta Radiol 53:214–219PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Rahmati A, Ghafari R, AnjomShoa M (2016) Normal variations of sphenoid sinus and the adjacent structures detected in cone beam computed tomography. J Dent (Shiraz) 17:32–37Google Scholar
  4. 4.
    Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M (1992) How i do it: head and neck and plastic surgery: endoscopic pituitary Tumor surgery. Laryngoscope 102:198–202PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Stankiewicz JA (1987) Complications of endoscopic nasal surgery: occurrence and treatment. Am J Rhinol 1:45–49CrossRefGoogle Scholar
  6. 6.
    Buus DR, David TT, Farris BK (1990) Ophthalmic complications of sinus surgery. Ophthalmology 97:612–619PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Cappabianca P, Cavallo L, Colao A, De Caro MDB, Esposito F, Cirillo S et al (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45:193–200PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Simonetti G, Meloni F, Teatini G, Salvolini U, Rovasio S, Masala W et al (1987) Computed tomography of the ethmoid labyrinth and adjacent structures. Ann Otol Rhinol Laryngol 96:239–250PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Parks ET (2014) Cone beam computed tomography for the nasal cavity and paranasal sinuses. Dent Clin North Am 58:627–651PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Craiu C, Sandulescu M, Rusu MC (2015) Variations of sphenoid pneumatization: a CBCT study. Rom J Rhinol 5:107–113Google Scholar
  11. 11.
    Tomovic S, Esmaeili A, Chan NJ, Choudhry OJ, Shukla PA, Liu JK et al (2012) High-resolution computed tomography analysis of the prevalence of Onodi cells. Laryngoscope 122:1470–1473PubMedCrossRefGoogle Scholar
  12. 12.
    Driben JS, Bolger WE, Robles HA, Cable B, Zinreich SJ (1998) The reliability of computerized tomographic detection of the Onodi (Sphenoethmoid) cell. Am J Rhinol 12:105–111PubMedCrossRefGoogle Scholar
  13. 13.
    Yanagisawa E, Weaver EM, Ashikawa R (1998) The Onodi (sphenoethmoid) cell. Ear Nose Throat J 77:578–580PubMedCrossRefGoogle Scholar
  14. 14.
    Kasemsiri P, Thanaviratananich S, Puttharak W (2011) The prevalence and pattern of pneumatization of Onodi cell in Thai patients. J Med Assoc Thai 94:1122–1126PubMedGoogle Scholar
  15. 15.
    Van Alyea OE (1941) Sphenoid sinus: anatomic study, with consideration of the clinical significance of the structural characteristics of the sphenoid sinus. Arch Otorhinolaryngol 34:225–253Google Scholar
  16. 16.
    Eggers G, Klein J, Welzel T, Mühling J (2008) Geometric accuracy of digital volume tomography and conventional computed tomography. Br J Oral Maxillofac Surg 46:639–644PubMedCrossRefGoogle Scholar
  17. 17.
    Eggers G, Senoo H, Kane G, Mühling J (2009) The accuracy of image guided surgery based on cone beam computer tomography image data. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:e41–e48PubMedCrossRefGoogle Scholar
  18. 18.
    Lund H, Gröndahl K, Gröndahl H (2009) Accuracy and precision of linear measurements in cone beam computed tomography accuitomo® tomograms obtained with different reconstruction techniques. Dentomaxillofac Radiol 38:379–386PubMedCrossRefGoogle Scholar
  19. 19.
    Paknahad M, Shahidi S (2015) Association between mandibular condylar position and clinical dysfunction index. J Craniomaxillofac Surg 43:432–436PubMedCrossRefGoogle Scholar
  20. 20.
    Paknahad M, Shahidi S, Abbaszade H (2016) Correlation between condylar position and different sagittal skeletal facial types. J Orofac Orthop 77:350–356PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Shahidi S, Vojdani M, Paknahad M (2013) Correlation between articular eminence steepness measured with cone-beam computed tomography and clinical dysfunction index in patients with temporomandibular joint dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol 116:91–97PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Güldner C, Pistorius SM, Diogo I, Bien S, Sesterhenn A, Werner JA (2012) Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT). Acta Radiol 53:214–219PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Wang J, Bidari S, Inoue K, Yang H, Rhoton A Jr (2010) Extensions of the sphenoid sinus: a new classification. Neurosurgery 66:797–816PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Lu Y, Pan J, Qi S, Shi J, Zhang X, Wu K (2011) Pneumatization of the sphenoid sinus in Chinese: the differences from Caucasian and its application in the extended transsphenoidal approach. J Anat 219:132–42PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Tomovic S, Esmaeili A, Chan NJ, Shukla PA, Choudhry OJ, Liu JK et al (2013) High-resolution computed tomography analysis of variations of the sphenoid sinus. J Neurol Surg B Skull Base 74:82–90PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Liu S, Wang Z, Zhou B, Yang B, Fan E, Li Y (2002) Related structures of the lateral sphenoid wall anatomy studies in CT and MRI. Lin Chuang Er Bi Yan Hou Ke Za Zhi 16:407–409PubMedPubMedCentralGoogle Scholar
  27. 27.
    Hamid O, El Fiky L, Hassan O, Kotb A, El Fiky S (2008) Anatomic variations of the sphenoid sinus and their impact on trans-sphenoid pituitary surgery. Skull base 18:9–15PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Weinberger DG, Anand VK, Al-Rawi M, Cheng HJ, Messina AV (1996) Surgical anatomy and variations of the Onodi cell. Am J Rhinol 10:365–370CrossRefGoogle Scholar
  29. 29.
    Bansberg SF, Harner SG, Forbes G (1987) Relationship of the optic nerve to the paranasal sinuses as shown by computed tomography. Otolaryngol Head Neck Surg 96:331–335PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Batra PS, Citardi MJ, Gallivan RP, Roh H-J, Lanza DC (2004) Software-enabled CT analysis of optic nerve position and paranasal sinus pneumatization patterns. Otolaryngol Head Neck Surg 131:940–945PubMedCrossRefGoogle Scholar
  31. 31.
    Hardy J (1967) Surgery of the pituitary gland, using the trans-sphenoidal approach. Comparative study of 2 technical methods. L'unión Médicale du Canada 96:702–12PubMedGoogle Scholar
  32. 32.
    Muhr C, Bergström K, Grimelius L, Larsson S-G (1981) A parallel study of the roentgen anatomy of the sella turcica and the histopathology of the pituitary gland in 205 autopsy specimens. Neuroradiology 21:55–65PubMedCrossRefGoogle Scholar
  33. 33.
    Banna M, Olutola P (1983) Patterns of pneumatization and septation of the sphenoidal sinus. J Can Assoc Radiol 34:291–293PubMedGoogle Scholar
  34. 34.
    Idowu O, Balogun B, Okoli C (2009) Dimensions, septation, and pattern of pneumatization of the sphenoidal sinus. Folia morphologica 68:228–232PubMedGoogle Scholar
  35. 35.
    Dessi P, Moulin G, Castro F, Chagnaud C, Cannoni M (1994) Protrusion of the optic nerve into the ethmoid and sphenoid sinus: prospective study of 150 CT studies. Neuroradiology 36:515–516PubMedCrossRefGoogle Scholar
  36. 36.
    Erpek G (1998) Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery. Rhinology 36:162–167PubMedGoogle Scholar
  37. 37.
    Kazkayasi M, Karadeniz Y, Arikan OK (2005) Anatomic variations of the sphenoid sinus on computed tomography. Rhinology 43:109–114PubMedGoogle Scholar
  38. 38.
    Hewaidi G, Omami G (2008) Anatomic variation of sphenoid sinus and related structures in Libyan population: CT scan study. Libyan J Med 3:1–9CrossRefGoogle Scholar
  39. 39.
    Davoodi M, Saki N, Saki G, Rahim F (2009) Anatomical variations of neurovascular structures adjacent sphenoid sinus by using CT scan. Pak J Biol Sci 12:522–525PubMedCrossRefGoogle Scholar
  40. 40.
    Yeoh KH, Tan KK (1994) The optic nerve in the posterior ethmoid in Asians. Acta Otolaryngol 114:329–336PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Arslan H, Aydınlıoğlu A, Bozkurt M, Egeli E (1999) Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx 26:39–48PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Thanaviratananich S, Chaisiwamongkol K, Kraitrakul S, Tangsawad W (2003) The prevalence of an Onodi cell in adult Thai cadavers. Ear Nose Throat J 82:200–204PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Nitinavakarn B, Thanaviratananich S, Sangsilp N (2005) Anatomical variations of the lateral nasal wall and paranasal sinuses: A CT study for endoscopic sinus surgery (ESS) in Thai patients. J Med Assoc Thai 88:763–768PubMedPubMedCentralGoogle Scholar
  44. 44.
    Unal B, Bademci G, Bilgili YK, Batay F, Avci E (2006) Risky anatomic variations of sphenoid sinus for surgery. Surg Radiol Anat 28:195–201PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Wada K, Moriyama H, Edamatsu H, Hama T, Arai C, Kojima H et al (2015) Identification of Onodi cell and new classification of sphenoid sinus for endoscopic sinus surgery. Int Forum Allergy Rhinol 5:1068–1076PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2020

Authors and Affiliations

  1. 1.Oral and Maxillofacial Radiology Department, Dental SchoolShiraz University of Medical SciencesShirazIran
  2. 2.Oral and Dental Disease Research Center, Oral and Maxillofacial Radiology Department,Dental SchoolShiraz University of Medical SciencesShirazIran
  3. 3.Student Research Committee, Dental SchoolShiraz University of Medical SciencesShirazIran
  4. 4.Oral and Maxillofacial Radiology Department, Dental SchoolShiraz University of Medical SciencesShirazIran

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