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PubMed2006

Frontal sinus cranialization using the pericranial flap: an added layer of protection.

OBJECTIVES: Extensive fractures involving the anterior and posterior tables of the frontal sinus are treated by frontal sinus cranialization. During this procedure, the disrupted posterior wall of the frontal sinus is removed, the sinus mucosa is drilled away, and the brain and dura are permitted to rest against the repaired anterior wall and sinus floor. Conventionally, the area originally occupied by the frontal sinus is left as dead space or filled with free adipose tissue. We describe a method of cranialization using a pericranial flap and report our experience with this technique. STUDY DESIGN: Retrospective study. METHODS: The medical records of patients who underwent frontal sinus cranialization using the pericranial flap at our institution were reviewed. Demographics, indications for cranialization, complications, and perioperative outcomes were examined. RESULTS: A total of 19 patients underwent (bilateral) frontal sinus cranialization with the pericranial flap between 2000 and 2005. Indications included extensive frontal sinus fractures involving the posterior table (78.9%), mucocele (10.5%), arteriovenous malformation (5.3%), and frontal bone osteomyelitis (5.3%). There were no intraoperative complications. A postoperative cerebrospinal fluid leak occurred in one patient with extensive skull base injuries. This was repaired endoscopically. Follow-up ranged from 9 to 55 months. CONCLUSIONS: The pericranial flap is easily harvested and versatile. Using this vascularized tissue during cranialization affords added protection by providing an extra barrier between the intracranial cavity and the frontal bone and sinonasal tract. This technique is inexpensive, safe, and effective and should be considered when cranialization of the frontal sinus is performed.

Adult↗
PubMed2004

Internal jugular vein sampling in adrenocorticotropic hormone-dependent Cushing's syndrome: a comparison with inferior petrosal sinus sampling.

OBJECTIVE: Distinguishing between pituitary-dependent Cushing's syndrome (CS) and occult ectopic ACTH syndrome can be extremely difficult. Bilateral inferior petrosal sinus sampling has been shown to have the highest diagnostic accuracy in this subtype evaluation. Internal jugular vein sampling (IJVS) has been reported as a potentially safer invasive alternative, but data are limited. Our objective was to compare the sensitivity and specificity of bilateral IJVS and bilateral inferior petrosal sinus sampling (IPSS) in patients with ACTH-dependent CS. DESIGN: We prospectively collected blood samples from the inferior petrosal sinus and internal jugular vein of consecutive patients with ACTH-dependent CS. PATIENTS: The study group included 35 patients: 32 with pituitary-dependent CS (positive immunohistochemical findings for ACTH pituitary tumour or biochemical cure after pituitary surgery) and three with histologically proven ectopic ACTH syndrome. MEASUREMENTS: Inferior petrosal sinus sampling and bilateral IJVS were performed simultaneously before and after administration of corticotropin-releasing hormone (CRH), and ratios of central-to-peripheral ACTH concentrations were calculated. RESULTS: The basal IJVS central-to-peripheral ACTH ratios were diagnostic for pituitary-dependent CS (> 2) in 15 patients (46.9%), as were basal inferior petrosal sinus sampling central-to-peripheral ACTH ratios in 29 patients (90.6%). The post-CRH IJVS central-to-peripheral ACTH ratios were diagnostic for pituitary-dependent disease (> 3) in 24 patients (75%), as were post-CRH inferior petrosal sinus sampling central-to-peripheral ACTH ratios in 28 patients (87.5%). In the three patients with ectopic ACTH CS, the IJVS and inferior petrosal sinus sampling pre- and post-CRH ACTH ratios were correctly negative. The overall sensitivity of combined pre- or post-CRH was 81.3% for IJVS and 93.8% for inferior petrosal sinus sampling. Because of the difference between mean ratios in the two techniques, new criteria for IJVS were mathematically calculated: a pre-CRH central-to-peripheral ACTH ratio of 1.59 and a post-CRH central-to-peripheral ACTH ratio of 2.47 maximized sensitivity and specificity when both of these are equally taken into consideration. CONCLUSION: In conclusion, IJVS is not superior to inferior petrosal sinus sampling for establishing the cause of ACTH-dependent CS. When new criteria of basal (> 1.6) and post-CRH (> 2.5) central-to-peripheral ACTH gradients were applied to ACTH ratios from IJVS, the sensitivity of this test was maximized. However, confirmatory inferior petrosal sinus sampling is recommended when there is a lack of a central-to-peripheral ACTH gradient and when there is only a gradient above the cut-off on basal (pre-CRH) sampling.

ACTH Syndrome, Ectopic↗
PubMed2006

Osteotome sinus floor elevation without grafting material: a 1-year prospective pilot study with ITI implants.

OBJECTIVE: The aim of the present pilot study was to evaluate: (1) the predictability of an osteotome sinus floor elevation procedure with ITI-SLA implants without placing a bone grafting material, and (2) the possibility to gain bone height without filling the created space with a bone grafting material. MATERIAL AND METHODS: Seventeen patients received 25 implants protruding in the sinus. Most implants (21/25) were 10 mm long, eight were inserted in type 2 bone, 12 in type 3 and five in type 4 bone. At implant placement, the mean residual bone height (RBH) under the maxillary sinus was 5.4+/-2.3 mm; it was 5.7+/-2.6 mm on the mesial side and 5.1+/-1.9 mm on the distal side. Nineteen implants had less than 6 mm of bone on at least one side and six implants had less than 6 mm on both sides. A healing period of 3-4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1-year control was calculated. The endo-sinus bone gain and the crestal bone loss (CBL) at the mesial and distal sides were measured. RESULTS: Abutments were tightened after 3.1+/-0.4 months. All implants but one (96%) resisted the applied 35 Ncm torque. At the 1-year control, all implants were clinically stable and supported the definitive prosthesis. All showed endo-sinus bone gain; the mean gain was 2.5+/-1.2 mm. The mean CBL was 1.2+/-0.7 mm. Endo-sinus bone gain and RBH showed a strong negative correlation (r=-0.78 on the mesial side and -0.80 on the distal side). A good correlation (r=0.73) was found between implant penetration in the sinus and endo-sinus bone gain. CONCLUSION: Elevation of the sinus membrane alone without addition of bone grafting material can lead to bone formation beyond the original limits of the sinus floor. Despite a limited RBH at implant placement, a healing period of 3 months was sufficient to resist a torque of 35 N cm and to lead to a predictable implant function at the 1-year control.

Adult↗
PubMed1981

The responses in renal nerves to stimulation of atrial receptors, carotid sinus baroreceptors and carotid chemoreceptors.

The reflex reduction in activity in renal sympathetic nerves in response to distension of small balloons in the pulmonary vein-atrial junctions was studied in dogs anaesthetized with chloralose; the carotid sinuses were isolated and perfused with blood. In the first group of dogs, the response to distension of the balloons was studied at different levels of carotid sinus pressure. In thirteen preparations of renal nerves in eight dogs the response was not significantly influenced when the mean carotid sinus pressure was changed from 9.5 kPa to 17.5 kPa, despite marked changes in control frequencies of activity in the nerves. In the second group of dogs, the response to distension of the balloons was studied when the carotid sinuses were perfused alternately with arterial and venous blood. In six preparations of renal nerves in five dogs the response was not significantly influenced when the blood perfusing the carotid sinuses was changed, despite marked changes in control frequencies of activity in the nerves. In a third group of dogs, the reflex reduction in activity in renal nerves in response to a step increase in pressure in one carotid sinus was examined at different levels of pressure in the contralateral carotid sinus. In six preparations of renal nerves in five dogs the response to an increase in pressure in one carotid sinus was significantly reduced when the mean pressure in the contralateral sinus was changed from 8.7 kPa to 17.1 kPa. It is concluded that there is no interaction between the projections of atrial receptors and carotid sinus baroreceptors or carotid chemoreceptors in their convergence on the same efferent renal neurones.

Animals↗
PubMed1985

Static and dynamic responses of carotid sinus baroreceptors in dogs with chronic volume overload.

In this study we determined if there are any alterations in carotid sinus baroreceptor discharge in a model of heart failure in the dog. The left carotid sinus was isolated and perfused at 100 mmHg with a modified Krebs-Henseleit solution. Two groups of dogs were used: a normal group and a group with a chronic aorto-caval fistula (a.v.f.) of up to 20 weeks duration. The a.v.f. group had a significantly elevated heart rate and left ventricular end diastolic pressure as well as an increased arterial pulse pressure compared to normals. However, mean arterial pressure measured in the aortic arch was not significantly different. Carotid sinus pressure-discharge curves were constructed during increases in carotid sinus pressure by steps and by ramps of pressure change up to 200 mmHg/s. Carotid sinus diameter was also measured using sonomicrometer crystals. In six dogs from each group the sodium, potassium and water content of the right carotid sinus was measured. Several parameters of second order polynomial curves that were fitted to the data were compared between the two groups for step and ramp increases in pressure. These included maximum baroreceptor gain, threshold pressure and plateau pressure. Baroreceptor gain was significantly lower in the a.v.f. group for the step and lowest ramp rate pressure changes. Threshold pressure was significantly higher for the a.v.f. group for steps and the three slowest ramp rates. Plateau pressures were significantly higher for the steps and lowest ramp rate. The carotid sinus strain that was produced at any given carotid sinus pressure was not significantly different between the two groups. In addition, there was no difference in the sodium, potassium or water content of the carotid sinus between the two groups. It was concluded that there is a depression of the static discharge characteristics in this model of heart failure which is not due to an alteration in electrolyte or water content or to the compliance of the carotid sinus.

Action Potentials↗
PubMed1987

Characteristics of C fibre baroreceptors in the carotid sinus of dogs.

1. We compared the pressure-response characteristics of C fibre and A fibre baroreceptors in the carotid sinus of anaesthetized dogs, recording impulses from the sinus nerve and varying mean pressure in the vascularly isolated sinus, which was distended with a pulsatile pressure. Functional stimulus-response curves were obtained by gradually increasing sinus pressure above and decreasing it below a set-point of 100 mmHg. Baroreceptors were identified by a pulsatile discharge synchronous with the pulsations in sinus pressure. A and C fibre baroreceptors were identified by the conduction velocities and blocking temperatures of their axons. 2. The pressure-response characteristics of C and A fibre baroreceptors differed in several respects. C fibres had a pulsatile firing threshold 50 mmHg higher than that of A fibres (105.8 +/- 1.8 and 54.6 +/- 2.9 mmHg, respectively), an average maximal sensitivity 35% of that of A fibres (0.39 and 1.12 impulses s-1 mmHg-1, respectively), and a maximal frequency (at 220 mmHg) 29% of that of A fibres (24.5 and 84.3 impulses/s, respectively). Although invariably pulsatile at pressures above threshold, the firing pattern of C fibre baroreceptors tended to be more irregular than that of their A fibre counterparts. 3. Impulses were also recorded from C fibres that were stimulated by increasing sinus pressure but had an irregular, non-pulsatile discharge, a high pressure threshold (averaging 154.1 +/- 7.2 mmHg), and a low maximum frequency (10.8 +/- 2.4 impulses/s). 4. Cooling the sinus nerve progressively attenuated conduction in both A and C fibres, A fibres being blocked between 12 and 4 degrees C (mean 6.8 degrees C) and C fibres between 4 and -1.5 degrees C (mean 1.0 degree C). Although cooling the sinus nerve to 7 degrees C did not block conduction in all A fibres, impulse activity in baroreceptor A fibres at a carotid sinus pressure of 200 mmHg was no greater than that at a pressure of 75 mmHg. By contrast, at 7 degrees C baroreceptor C fibres still provided a signal proportional to sinus pressure. 5. Our results suggest that A and C fibre baroreceptors subserve different reflex functions, the former signalling changes in arterial pressure both above and below the normal set-point, the latter only changes above. They also suggest that differential cold blockade may be a useful tool to determine the contribution of C fibre baroreceptors to cardiovascular reflexes.

Action Potentials↗
PubMed1996

Acoustic characteristics of the human paranasal sinuses derived from transmission characteristic measurement and morphological observation.

This paper reports on the acoustic characteristics of the paranasal sinuses as determined from transmission characteristic measurements and morphological examinations. A new experimental approach was developed to explore the correspondence between antiresonance frequencies and the causal resonators [J. Dang and K. Honda, J. Acoust. Soc. Jpn. (E) 17, 93-99 (1996)], and it was adopted to determine the antiresonance frequency of each sinus cavity. In this study, the antiresonance frequencies and the locations of the sinus openings were estimated from transmission characteristics of the nasal tract for three subjects, and then MRI-based morphological data for the subjects were used to relate each antiresonance frequency to its causal sinus cavity. The results indicate that each of the three major sinuses, i.e., the sphenoidal, maxillary, and frontal sinuses, contributes its own antiresonances to the transmission characteristics of the nasal tract. The estimated antiresonance frequencies were compared with computed natural frequencies of Helmholtz resonators, and the differences were within 10% for the sinuses. On the basis of the frequency distribution of the sinus antiresonance, the acoustic characteristics of the paranasal sinuses were modeled by four Helmholtz resonators. The simulation with the four-zero model showed that the paranasal sinuses not only introduce antiresonances in the transfer function, but also change the spectral shape of the nasal formants.

Glottis↗
PubMedDate not supplied

A longitudinal study of the growth pattern of the maxillary sinus in the pig-tailed macaque (Macaca nemestrina).

The ontogeny of sexual dimorphism in maxillary sinus size in a nonhuman primate was studied longitudinally for a period of 8 years in 25 female and 25 male Macaca nemestrina via lateral cephalograms. The maxillary sinus was traced and its area digitized. The growth of female maxillary sinuses was described with a Gompertz model; the best fit to the male data was obtained by the logistic model. Growth curves and confidence intervals revealed that the sinuses grew in a similar fashion for 3-4 years in both sexes. After this, female sinuses achieved a plateau in their development while male sinuses continued to grow. Confidence intervals suggested that size dimorphism appeared at the age of 6.3 years. Lowess regression indicated growth spurts in both sexes. Females experienced an earlier and smaller spurt than males. Sexual dimorphism in maxillary sinus size seems to represent a combination of differences in velocity and length of growth. This study indicates that growth of the maxillary sinus follows closely the growth in body size. Nevertheless, due to the variation in sinus size in Macaca, it is questionable if body size is the main determinant of maxillary sinus size. It is suggested that Macaca, with its wide geographic range and different environments, is an especially appropriate genus to use to test hypotheses about the evolution of skull pneumatization in primates.

Animals↗
PubMed2005

Microsurgical anatomy and approaches to the cavernous sinus.

OBJECTIVE: The aim of this article is to describe the anatomy of the cavernous sinus and to provide a guide for use when performing surgery in this complex area. Clinical cases are used to illustrate routes to the cavernous sinus and its contents and to demonstrate how the cavernous sinus can be used as a pathway for exposure of deeper structures. METHODS: Thirty cadaveric cavernous sinuses were examined using x3 to x40 magnification after the arteries and veins were injected with colored silicone. Distances between the entrance of the oculomotor and trochlear nerves and the posterior clinoid process were recorded. Stepwise dissections of the cavernous sinuses, performed to demonstrate the intradural and extradural routes, are accompanied by intraoperative photographs of those approaches. RESULTS: The anatomy of the cavernous sinus is complex because of the high density of critically important neural and vascular structures. Selective cases demonstrate how a detailed knowledge of cavernous sinus anatomy can provide for safer surgery with low morbidity. CONCLUSION: A precise understanding of the bony relationships and neurovascular contents of the cavernous sinus, together with the use of cranial base and microsurgical techniques, has allowed neurosurgeons to approach the cavernous sinus with reduced morbidity and mortality, changing the natural history of selected lesions in this region. Complete resection of cavernous sinus meningiomas has proven to be difficult and, in many cases, impossible without causing significant morbidity. However, surgical reduction of such lesions enhances the chances for success of subsequent therapy.

Adult↗
PubMed2006

Allergic rhinitis and sinusitis in asthma: differential effects on symptoms and pulmonary function.

BACKGROUND: Allergic rhinitis and sinusitis are frequently associated with asthma. The purpose of this study was to determine the impact of self-reported allergic rhinitis and sinusitis on lower airway disease in a large cohort of participants with well-characterized asthma. METHODS: A cohort study of participants in two trials of the American Lung Association-Asthma Clinical Research Centers: 2,031 asthmatics in the Safety of Inactivated Influenza Vaccine in Asthma in Adults and Children (SIIVA) trial and 488 asthmatics in the Effectiveness of Low Dose Theophylline as Add-on Treatment in Asthma (LODO) trial. At baseline, participants reported the presence of allergic rhinitis and sinusitis, and then lung function and asthma control were measured. During the trials, participants were monitored for asthma exacerbations. RESULTS: More than 70% of participants reported either allergic rhinitis or sinusitis. Sinusitis was more common in female patients (odds ratio, 1.46 [SIIVA]), those with gastroesophageal reflux disease (odds ratio, 2.21 [SIIVA]), and those of white race (odds ratio, 1.53 [SIIVA]). Similar associations were seen for allergic rhinitis. LODO participants with allergic rhinitis and sinusitis had increased asthma symptoms and a trend toward more sleep disturbance. Participants with allergic rhinitis had higher baseline lung function than those without allergic rhinitis measured by peak flow (91.2% vs 95.8% in the SIIVA trial). Participants with sinusitis had similar lung function to those without sinusitis. Participants with and without allergic rhinitis had similar exacerbation rates. In the LODO trial only, participants with sinusitis had increased asthma exacerbations (5.68 per patient per year vs 3.72 per patient per year). CONCLUSION: Allergic rhinitis and sinusitis are associated with more severe asthmatic symptoms and, in patients with poorly controlled asthma, more exacerbations but are not associated with low lung function.

Adolescent↗
PubMed2003

Treatment of sinus and nasal disorders in the 21st century.

In the modern history of the surgical treatment of sinus and nasal problems, there have been three revolutionary changes. The first was the introduction and refinement of endoscopic techniques in the 1980s. The second important development in the modern history of rhinology was the introduction of powered instrumentation in the 1990s. Now in the 21st Century we see a third turning point, which is the use of intraoperative image guidance in endoscopic sinus surgery. These three advances are being integrated to provide a new level of care for problems of the nose and sinuses and are the subject of this special section. In the first articles, the author provides an overview of sinusitis and reviews many of the medical treatments available for the management of sinusitis. When anatomic abnormalities of the nose and sinuses contribute to sinusitis, and when medical therapy has failed, these anatomic or structural abnormalities can be surgically corrected. In the article entitled "Minimally Invasive Approach to Endoscopic Sinus Surgery," we review this modern approach to the sinuses and discuss recent advances. We also provide an overview of rhinoplasty--surgery to reshape the nose--with special emphasis on the surgical anatomy and preoperative analysis of appearance. We conclude by reviewing some of the more common adjunctive cosmetic procedures performed with surgery of the nose and sinuses.

Humans↗
PubMed2006

Maxillary sinus septa: prevalence, height, location, and morphology. A reformatted computed tomography scan analysis.

BACKGROUND: The sinus lift technique may be difficult to perform if an aberrant sinus anatomy is encountered during surgical exposure, such as when a septum is present on the sinus floor. The objective of this study was to determine the prevalence, size, location, and morphology of maxillary sinus septa in the atrophic/edentulous and non-atrophic/dentate maxillary segments. METHODS: The sample population consisted of 100 patients (41 women and 59 men, with a mean age of 50 years, ranging between 19 and 87 years) for whom treatment was being planned for implant-supported restorations. Reformatted computerized tomograms (CT) from 200 sinuses were analyzed using imaging software. RESULTS: The prevalence of one or more septa per sinus was found to be 26.5% (53/200), 31.76% (27/85), and 22.61% (26/115) in the overall study population and the atrophic/edentulous and the non-atrophic/dentate maxillary segments, respectively. In the analysis of the anatomic location of the septa within the sinus, it was revealed that 15 (25.4%) were located in the anterior region, 30 (50.8%) in the middle region, and 14 (23.7%) in the posterior region. The measured heights of the septa varied among the different areas. The mean heights of the septa were 1.63 +/- 2.44, 3.55 +/- 2.58, and 5.46 +/- 3.09 mm in the lateral, middle, and medial areas, respectively. CONCLUSIONS: It can be inferred that there is a wide anatomical variation in the prevalence, size, location, and morphology of maxillary sinus septa, irrespective of the degree of atrophy. Therefore, to prevent the likelihood of complications arising during sinus augmentation procedures, a thorough and extensive understanding of the anatomic structures inherent to the maxillary sinus is indispensable.

Adolescent↗
PubMed2004

Acute sinusitis: guide to selection of antibacterial therapy.

Primary care doctors should be cautious in the diagnosis and treatment of sinusitis as acute bacterial sinusitis is currently over-diagnosed and over-treated in primary care practice. The clinical diagnosis of acute bacterial sinusitis is difficult in primary care practice; however, a history of purulent rhinorrhoea, purulent secretions in the nasal cavity on examination, tooth pain, worsening of symptoms following initial improvement, lack of effect of decongestants and an elevated erythrocyte sedimentation rate are supportive evidence of bacterial infection. Patients with symptoms for <7 days are not as likely to have bacterial infection. Acute sinusitis is over-treated in primary care practice for several reasons. Firstly, most cases of acute sinusitis are caused by viral infections and resolve without antibacterial treatment. Secondly, in clinical trials of antibacterial treatment, only about one-half of patients diagnosed with acute bacterial sinusitis by experienced primary care physicians have bacterial infection. Thirdly, antibacterial treatment of acute sinusitis is indicated only in patients with severe symptoms of sinusitis or in patients with moderate symptoms of >7 days duration. Symptomatic treatment is sufficient in patients with mild symptoms. Three recent meta-analyses have concluded that newer and broad-spectrum antibacterials are not significantly more effective than narrow-spectrum agents, such as amoxicillin or phenoxymethylpenicillin (penicillin V). However, because of the rapid increase in antibacterial resistance of Streptococcus pneumoniae and Haemophilus influenzae, treatment must take into account current recommendations for treating infections caused by these organisms. Fourthly, sinus imaging studies are not recommended in routine diagnosis but may be helpful in selected cases. Finally, other than pain medication, there is little evidence that use of adjunctive treatments, such as decongestants, is effective in symptom relief. However, a recent study in patients with recurrent sinusitis demonstrated that patients who received fluticasone propionate in addition to antibacterials had a higher rate of clinical success than did patients receiving placebo and antibacterials.

Acute Disease↗
PubMedDate not supplied

Effects of long-term induced ostial obstruction in the rabbit maxillary sinus.

One of the widely proposed theories for mucocele formation is sinus ostial obstruction. Accordingly, this study was undertaken to investigate the long-term effects of ostial obstruction in the rabbit maxillary sinus and its potential role in the pathogenesis of mucoceles. Maxillary sinus ostial obstruction was induced on one side in eight Pasteurella-free White New Zealand rabbits using Histoacryl. The rabbits were housed in a Pasteurella-free zone for 24 weeks. At re-exploration, only three of the eight maxillary sinuses where ostial obstruction was induced showed pressure recording consistent with ostial obstruction. Mucociliary clearance activity was assessed using India ink. Swabs for culture were taken from the infected maxillary sinuses. Mucosal specimens for histopathological examination were harvested from one of the maxillary sinuses with obstructed ostium as well as from another sinus with nonobstructed ostium. The three maxillary sinuses with obstructed ostia showed gross evidence of infection and deranged mucociliary clearance, but no mucocele formation. Based on the findings of this study it is concluded that long-term ostial obstruction indeed plays a role in the pathogenesis of chronic sinusitis, but it did not induce mucocele formation in the rabbit maxillary sinus.

Animals↗
PubMedDate not supplied

Development of the paranasal sinuses in children.

The development of computed tomography and functional endoscopic sinus surgery has improved diagnosis and management of sinusitis. It has also renewed interest in the developmental anatomy of the paranasal sinuses. There are significant differences between adult and pediatric sinus anatomy, and to safely perform functional endoscopic sinus surgery in children, the surgeon must be aware of these differences. To define the developmental anatomy of the paranasal sinuses, we analyzed 145 computed tomograms from patients under 18 years of age. The study emphasized landmarks at the level of the maxillary sinus ostium. In addition, distances and angles from the nasal spine to various points in the sinuses were determined. The structures were identified and traced on a digitizing tablet. Means and standard deviations were calculated for each measure as a function of age. This study can aid a better understanding of sinus development in children and provide guidance to the endoscopic sinus surgeon.

Adolescent↗
PubMedDate not supplied

Computed tomography evaluation of paranasal sinuses in asthma: is there a tendency of particular site involvement?

Although the precise mechanism is unclear, asthma and chronic sinusitis are associated frequently. Computed tomography (CT) is a sensitive modality for documenting sinonasal mucosal abnormalities. The aim of this study was to evaluate paranasal mucosal abnormalities in asthma and whether there was a relationship with asthma severity. One hundred fifty-five patients with asthma and 36 normal control subjects were assessed with coronal sinus CT. Asthma was classified as mild, moderate, or severe. Scoring of paranasal sinus abnormalities were assessed for total sinus, total mucosal, and individual sites. The mean scores of total mucosal changes (8.45 points versus 4.67 points, p < 0.001) and total sinus scores (5.50 versus 2.69, p < 0.005) were significantly higher in the asthmatic patients compared with controls. Nasal passage and frontal sinus involvements were not statistically different between groups, but all other individual scores were significantly higher in asthmatic patients. There was an involvement site tendency with respect to increasing severity of asthma. Mean total mucosal CT scores (12.57 points versus 7.33 points, p < 0.05) and individual site scores were statistically higher in asthmatic patients with high blood eosinophil levels compared with those patients with normal blood eosinophil counts except for nasal passage disease. There was no significant relationship between total IgE level and CT scores. Total mucosal and sinus scores were significantly related with asthma severity. There was an involvement tendency of sinuses and sites. Nasal passage involvement was unrelated with asthma. Ethmoidal sinuses and ostiomeatal complexes were involved significantly in patients with mild asthma, whereas maxillary, frontal, and sphenoidal sinuses were involved significantly in patients with severe asthma.

Adolescent↗
PubMedDate not supplied

Patency of the maxillary sinus ostium in healthy individuals.

In a group of 20 healthy subjects the patency of the maxillary ostium has been evaluated in 35 maxillary sinuses with three different techniques: simultaneous pressure recording in the sinus and the ipsi- and contralateral nasal cavity; simultaneous recording of differential pressure between the sinus and the ipsilateral nasal cavity and air-flow through the ostium during nasal breathing; recording of the pressure rise in the sinus with an artificial air-flow of 1 litre per minute applied to the sinus. The tests were carried out in sitting and recumbent positions. In 5 persons (10 sinuses) a retest was performed after 2 months. These subjects were also tested with an inflatable neck cuff in order to obtain an increased venous pressure. Rhinomanometry at rest and after physical effort was also performed. The pressure relationship between the maxillary sinus and the ipsilateral nasal cavity was 1:1 in both the sitting and the recumbent position, but less than 1 when the contralateral nasal cavity was measured. Pressure recording alone gives no quantitative information about the patency of the ostium. Determination of the ostial resistance during nasal breathing could be performed in 13 sinuses, but in the remaining 22 the ostia were too wide to give a measurable resistance. The equivalent ostial diameter during inspiration could be estimated in 12 of the sinuses from a diagram constructed from known ostial diameters in model experiments. With an artificial air-flow applied into the sinus, the equivalent ostial diameters could be estimated from the diagram in all cases. No statistical difference was found in comparable cases between the mean equivalent ostial diameters estimated with the two methods. The equivalent ostial diameters showed a statistically significant reduction in the recumbent position and after application of the neck cuff. A statistically significant relationship was also found between the airway resistance of the nasal cavity and the equivalent diameter of the ostium in sitting and recumbent positions. Such a relationship could not be found between the equivalent ostial diameters measured at rest and the nasal resistance recorded after physical effort.

Adult↗
PubMed1976

Anatomical features of the straight sinus and its tributaries.

The authors report a variety of arrangements of the venous channels comprising the straight sinus (sinus rectus) and its connections during a continuing study of the cerebral sinuses and their tributaries. In approximately 85% of 131 specimens of dura mater with enclosed venous sinuses derived from fresh cadavers, the straight sinus was represented by a single midline tentorial channel whereas in the remaining 15%, segments of it were doubled and in a few, tripled. In addition to these aberrations in the development of the main trunk of this sinus, the venous patterns at the junctions of the inferior sagittal sinus, vein of Galen and straight sinus showed comparable developmental inconstancies. Also in no specimens were the patterns of venous channels in the leaves of the tentorium cerebelli alike. The course, size, and connections of all the tributaries of the straight sinus have been studied and consideration given to their potentials as collateral pathways in the event either the vein of Galen or the straight sinus itself were occluded.

Adult↗