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PubMed1996

[Volumetric measurement of the maxillary sinus by coronal CT scan].

The volume of the maxillary sinus was estimated by coronal CT scan. The purpose of this study was to compare the estimated volume of the normal maxillary sinus with that of the inflamed maxillary sinus. Patients were classified following evaluation by CT scan of the paranasal sinuses into 3 categories. Group A: Patients suffered from headache, facial pain and epistaxis, but CT scans of their nasal cavity and paranasal sinus were within normal limits without inflammatory change; 102 patients (40 males and 62 females, aged 15-80 years, mean 49.1). Group B: Patients with bilateral chronic maxillary sinusitis, CT scans of whom showed inflammatory changes in both maxillary sinuses. All of the patients in this group underwent sinus surgery after coronal CT scans; 69 patients (38 males and 31 females, aged 15-68 years, mean 44.7) Group C: Patients with unilateral chronic maxillary sinusitis, CT scans of whom showed inflammatory change in unilateral maxillary sinuses; 14 patients (6 males and 8 females, aged 16-71 years, mean 43.2) CT scans of these patients were measured by Plannimeter to take the area of each image of the maxillary sinus. Consecutively imaged areas were summated by integral calculus to obtain an estimate of the sinus volume. Group A normal cases had a mean maxillary sinus volume of 20.5 +/- 9.2 ml (M +/- SD), and Group B bilateral maxillary sinusitis patients had a volume of 17.3 +/- 7.6 ml. The mean maxillary sinus volume in the bilateral chronic maxillary sinusitis patients (group B) was significantly smaller than that in the normal cases (group A) (p < 0.01, t-test). In both groups A and B, the mean of the maxillary sinus volume in males was significantly greater than in females (p < 0.01, t-test), and patients aged from 20 to 29 years old had the largest volume of all the age group. Group C patients with unilateral maxillary sinusitis had a mean maxillary affected sinus volume of 24.2 +/- 7.7 ml, and contralateral normal sinuses with a mean volume of 26.9 +/- 9.3ml. The mean maxillary sinus volume in the affected sinuses was significantly smaller than those in the contralateral normal sinuses (p < 0.05, Wilcoxon-test). The various volumes of the maxillary sinuses and the developmental cause were discussed. Comparison of groups A with B suggested three distinct patterns; 1. the maxillary sinus volume has decreased due to inflammatory changes in the bone; 2. the small sinuses have a tendency to develop chronic inflammatory change; 3. the aeration in the maxillary sinus may be decreased when anatomic variations that may obstruct the ethmoid infundibulum exist.

Adolescent↗
PubMed1998

Tentorial venous sinuses: an anatomic study.

OBJECTIVE: Certain neurosurgical procedures require sectioning of the tentorium cerebelli. The presence of venous sinuses within the tentorium makes these procedures difficult. The aim of this study was to investigate the incidence, size, location, configuration, and pattern of venous drainage of these sinuses. METHODS: The tentorium cerebelli was studied in 80 fresh cadavers. After the skull cap and the supratentorial portion of the brain were removed, the tentorium was inspected for the presence of venous sinuses. Their location, size, configuration, and pattern of venous drainage were noted. Subsequently, the infratentorial structures were removed via the tentorial incisura. The tentorial sinuses were again studied. In certain cases, the sinus was opened and a probe passed inside to confirm its presence. RESULTS: The tentorium cerebelli was revealed to contain sinuses in 86% of the cadavers. These sinuses were classified into the following three types: Type I sinuses constituted 25% of the total and were most often located in the medial one-third of the tentorium. They were larger than the other types, frequently occurring with a branching "stag-horn" configuration and a tendency to drain into the straight sinus, the torcular herophili, and the medial one-third of the transverse sinus. Type II sinuses constituted 25% of the total and were most often located in the lateral one-third of the tentorium. They were smaller than the other types, and tended to drain into the duction of the transverse sinus and superior petrosal sinus and into the lateral one-third of the transverse sinus. Type III sinuses constituted 50% of the total and were located in the medial one-third of the tentorium. Their size ranged from small to medium. Unlike Type I sinuses, no branching pattern was observed. These sinuses tended to drain into the straight sinus, the torcular herophili, and the medial one-third of the transverse sinus. In the present study, the medial one-third of the tentorium was observed to be the most vascular part. No venous sinus was observed in the anterior part of the tentorium. CONCLUSION: Venous sinuses are common in the tentorium cerebelli. In this study, they were observed in 86% of the cases. They can be classified into three types, based on their location, size, configuration, and pattern of drainage. The medial one-third of the tentorium is the most vascular part. A knowledge of these sinuses may be helpful while sectioning the tentorium. The importance of these sinuses in treating vascular and neoplastic diseases of the brain is highlighted. A brief review of the embryology of these sinuses is also presented.

Cadaver↗
PubMed2000

Nasal cavity and paranasal sinus bony variations: a computed tomographic study.

Variations of the nasal cavity are very important for the otolaryngologist in functional endoscopic sinus surgery. To provide data on bony variations of this region, we performed high resolution computed tomography images of paranasal sinuses on 82 adult patients without sinus pathology and on 90 adult patients with sinus disease. We observed paradoxical curvature of the middle concha in 11 (12.22%) sinus patients and 6 (7.31%) in non-sinus patients. Concha bullosa was observed in 26 sinus patients (28.88%) and 22 (26.83%) in non-sinus patients, deviated nasal septum in 20 (22.22%) sinus and 10 (12%) non-sinus, Haller's cell in 5 (5.55%) sinus and in 3 (3.65%) non-sinus, agger nasi cell in 7 (7.77%) sinus and 4 (4.88%) non-sinus patients. Pneumatisation of cristae galli was observed in 8 (8.88%) sinus and 2 (2.44%) non-sinus, of the anterior clinoid process in 5 (5.55%) sinus and 1 (1.22%) non-sinus patients, pneumatisation of the nasal septum in 7 (7.77%) and of the pterygoid recess in 12 (13.33%) sinus patients. We did not find any correlation between age intervals and paranasal sinus variations, and also no statistically significant difference was observed between males and females. These data provide very important information to guide the otolaryngologist and/or radiologist in the evaluation of patients with coronal CT which guides functional endoscopic sinus surgery.

Adult↗
PubMed2003

Relationship between lymph node sinuses with blood and lymphatic metastasis of gastric cancer.

AIM: To elucidate the relationship between lymph node sinuses with blood and lymphatic metastasis of gastric cancer. METHODS: Routine autopsy was carried out in the randomly selected 102 patients (among them 100 patients died of various diseases, and 2 patients died of non-diseased reasons), their superficial lymph nodes locating in bilateral necks (include supraclavicle), axilla, inguina, thorax, and abdomen were sampled. Haematoxylin-Eosin staining was performed on 10 % formalin-fixed and paraffin-embedded lymph node tissue sections (5 um). The histological patterns of the lymph sinuses containing blood were observed under light microscope. The expression of CD31, a marker for endothelial cell, was detected both in blood and non-blood containing lymph node sinuses with the method of immunohistochemistry. RESULTS: Among the 1 322 lymph nodes sampled from the autopsies of 100 diseased cases, lymph node sinuses containing blood were found in 809 lymph nodes sampled from 91 cases, but couldn't be seen in the lymph nodes sampled from the non-diseased cases. According to histology, we divided the blood containing lymph node sinuses into five categories: vascular-opening sinus, blood-deficient sinus, erythrophago-sinus, blood-abundant sinus, vascular-formative sinus. Immunohistochemical findings showed that the expression of CD31 was strongly positive in vascular-formative sinuses and some vascular-opening sinuses while it was faint in blood-deficient sinuses, erythrophago-sinuses and some vascular-opening sinuses. It was almost negative in blood-abundant sinus and non-blood containing sinus. CONCLUSION: In the state of disease, the phenomenon of blood present in the lymph sinus is not uncommon. Blood could possibly enter into the lymph sinuses through the lymphaticovenous communications between the veins and the sinuses in the node. Lymph circulation and the blood circulation could communicate with each other in the lymph node sinuses. The skipping and distal lymphatic metastasis of gastric cancer may have some connection with the blood containing lymph node sinuses.

Adolescent↗
PubMed1996

Dental disease: a frequently unrecognized cause of maxillary sinus abnormalities?

OBJECTIVE: Periodontal disease may be a frequently unrecognized cause of maxillary sinus disease. The purposes of this study were to determine if maxillary sinus disease is more prevalent in patients with periodontal disease than in an age-and-sex-matched control group and to show radiographically an association of focal maxillary sinus disease with periodontal disease. MATERIALS AND METHODS: Maxillary DentaScans (General Electric Medical Systems, Milwaukee, WI) of 84 patients (168 maxillary sinuses) with periodontal disease were retrospectively evaluated for the simple presence or absence of maxillary sinus disease. This group was compared with an age-and-sex-matched control population of 84 patients who were referred for head or neck CT scans in which the maxillary sinuses (including their inferior aspects) were visualized. For the likelihood of sinus disease in patients compared with controls, an odds ratio and a 95% confidence interval were calculated using the SYSTAT version 5.2 (SYSTAT, Evanston, IL). In the second portion of the study, the subject population alone was graded in the following fashion to establish a causal relationship: grade 0, no sinus disease; grade 1, focal sinus disease not adjacent to periodontal disease (unlikely to be caused by periodontal disease); grade 2, nonfocal sinus disease (complete opacification, air-fluid levels, or diffuse mucoperiosteal thickening; indeterminate cause), and grade 3, focal sinus disease adjacent to periodontal disease (likely to be caused by periodontal disease). RESULTS: In the subject population--patients with periodontal disease who were referred for DentaScans--100 of 168 (60%) sinuses had sinus disease; in the control population, only 49 of 168 (29%) sinuses had sinus disease. The odds ratio for maxillary sinus disease in the patient population compared with controls was 3.6 (95% confidence interval, 2.3-5.6; p<.0001). The grading results of the subject population in the second portion of the study were grade 0, 68 sinuses (41%); grade 1, four sinuses (2%); grade 2, 32 sinuses (19%); and grade 3, 64 sinuses (38%). CONCLUSION: We have demonstrated a twofold increase in maxillary sinus disease in patients with periodontal disease and have shown a causal relationship. Recognition of this relationship may have an impact on the clinical management of patients, particularly those planning implant surgery.

Confidence Intervals↗
PubMed1998

Interleukin-4, interleukin-5, and granulocyte-macrophage colony-stimulating factor receptor expression in chronic sinusitis and response to topical steroids.

Chronic sinusitis and its associated eosinophilic infiltrate are believed to be mediated, at least in part, by the upregulation of Th-2 cytokines, including interleukin-4, interleukin-5, and granulocyte-macrophage colony-stimulating factor (GM-CSF). Interleukin-4 is involved in IgE production and in eosinophil recruitment through upregulation of vascular cell adhesion molecule-1. Interleukin-5 and GM-CSF are involved in eosinophil growth and survival. The aim of this study was to investigate the expression of receptors for these cytokines in the sinus mucosa of subjects with chronic sinusitis. Using the technique of in situ hybridization to detect specific cytokine receptor messenger RNA, we studied the sinus mucosa of subjects with nonallergic chronic sinusitis, subjects with allergic chronic sinusitis, subjects with allergic chronic sinusitis treated with topical steroids, and normal controls. Our data demonstrate higher expression of interleukin-4 receptor in subjects with allergic chronic sinusitis than in controls (p < 0.001) and higher expression of interleukin-5 receptor in both subjects with nonallergic chronic sinusitis and subjects with allergic chronic sinusitis than in controls (p < 0.001, p < 0.001). The expression of interleukin-4 receptor and interleukin-5 receptor was higher in subjects with allergic chronic sinusitis than in subjects with nonallergic chronic sinusitis (p < 0.001). GM-CSF receptor expression was also found to be higher in subjects with allergic chronic sinusitis and subjects with nonallergic chronic sinusitis than in controls (p < 0.001, p < 0.001). In contrast to interleukin-4 receptor and interleukin-5 receptor, however, expression of GM-CSF receptor was higher in subjects with nonallergic chronic sinusitis than in subjects with allergic chronic sinusitis (p < 0.001). In subjects with allergic chronic sinusitis treated with topical corticosteroids, the expression of interleukin-4 receptor and interleukin-5 receptor messenger RNA levels was significantly lower than levels in patients with allergic chronic sinusitis who were not taking topical steroids (p < 0.001, p < 0.001). Steroid treatment had no effect on GM-CSF receptor messenger RNA expression. In conclusion, our data support a role for Th-2 cytokine receptors in the pathophysiology of chronic sinusitis. Further, our data lend support to the theory that differential activation of distinct cytokine pathways mediates inflammation in chronic sinusitis depending on whether there is associated allergy. Finally, treatment with topical corticosteroids has been demonstrated in chronic sinusitis to downregulate receptors for interleukin-4 and interleukin-5.

Administration, Topical↗
PubMed1994

Radiographic imaging studies in pediatric chronic sinusitis.

BACKGROUND: The diagnosis of chronic sinusitis is dependent on the radiographic evidence of sinus disease. METHODS: We evaluated the performance of radiographs and computed tomographic (CT) scans for the examination of the paranasal sinuses of 91 patients of both sexes, ranging in age from 2 to 17 years, who had chronic upper respiratory tract symptoms for at least 3 months. The CT scan findings were categorized as no disease; minimal disease, and mild, moderate, and severe sinusitis. RESULTS: Fifty-eight patients (63%) had chronic sinusitis: CT scan abnormalities were minimal in 17%, mild in 19%, moderate in 21%, and severe in 43%. There was a statistically significant correlation between rhinorrhea (r = 0.25, p = 0.01), cough (r = 0.27, p = 0.009), and the severity of sinus abnormality as determined by CT scan. Clinical presentation in the mild, moderate, and severe sinusitis groups (p < 0.05) was significantly different from that of the no disease group, whereas the minimal disease group had subclinical presentation (p = 0.11). Clinically significant chronic sinusitis often occurred at multiple sites: 44% of patients had pansinusitis, 50% had disease involvement of at least two sinuses, and 6% had disease in a single sinus. When sinus radiographs were compared with CT scans (n = 70 cases), radiographs could not identify minimal disease. For clinically significant sinusitis, sinus radiographs detected disease in 1 of 5 (20%) frontal sinuses, 0 of 12 (0%) sphenoidal sinuses, and 17 of 31 (54%) ethmoidal sinuses. With the minimal criteria of 40% to 50% opacification or fluid level filling of the maxillary antrum, radiographs detected disease in 37 of 49 (75%) cases. The sensitivity and specificity for a Waters view to confirm clinically significant chronic sinusitis without specifying the sites and severity were acceptable at 76% and 81%, respectively. When limited sinus CT scans were compared with full CT evaluation (n = 49 cases), limited studies detected 5 of 5 (100%) frontal, 9 of 11 (82%) sphenoidal, 14 of 19 (73%) ethmoidal, and 39 of 40 (97%) cases of maxillary sinusitis. The overall agreement was 88%. CONCLUSIONS: A single Waters view is an acceptable part of the initial evaluation of pediatric chronic sinusitis; however, a limited CT scan is a better alternative.

Adolescent↗
PubMed1997

Formation and enlargement of the paranasal sinuses in normal and cleft lip and palate human fetuses.

OBJECTIVE: Comparisons of paranasal sinus morphology between humans with and without cleft lip and palate (CLP) have yielded conflicting opinions regarding size differences. Although postnatal samples have been investigated, no studies have compared paranasal sinus volumes between cleft and noncleft human fetuses. METHOD: The nasal cavities of 20 'normal' and 9 CLP human fetuses (8-21 weeks' postmenstrual age) were examined to assess prenatal volumetric changes of the maxillary sinuses, anterior and posterior ethmoidal air cells, and sphenoidal sinuses. Lengths and volumes of right and left maxillary and sphenoidal sinuses were calculated from histologically prepared sections using a computer reconstruction technique, and regression equations were generated to assess the enlargement rates. RESULTS: All paranasal sinuses were found among both normal and CLP specimens in the same locations and in similar age ranges. However, greater shape asymmetry was noted for all sinuses in CLP compared to normal specimens. In the normal sample, results indicated significant (p < .05) correlations between right or left maxillary sinus length (R2 = 0.49, 0.54) and volume (R2 = 0.67, 0.68), and increasing postmenstrual age, but no significant (p > .05) correlations were observed for right or left sphenoidal sinus length or volumes and postmenstrual age. Maxillary sinus length changes were best described by second-order polynomial regression equations, and volume changes were best described by logarithmic equations. When individual right or left sinuses of CLP specimens were compared to the mean of the normal sample, one maxillary sinus was significantly (p < .05) larger, and 9 maxillary sinuses were not significantly (p > .05) different. Sphenoidal sinus lengths and volumes of CLP specimens were within the same range compared to these dimensions for the normal sample. CONCLUSION: Results on normal specimens indicate that maxillary sinuses exhibit second-trimester length and volume increases, whereas sphenoidal sinuses are more variable. This study suggests a similar timing of sinus formation in normal and CLP fetuses, but shape asymmetries are frequently detected among CLP specimens. In particular, the sphenoidal sinuses may be altered in shape and size by adjacent, hypertrophic cartilaginous structures in CLP fetuses. These results indicate that the maxillary sinuses of CLP fetuses are not deficient in size compared to noncleft fetuses.

Cartilage↗