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- Title
Classification of lateral pneumatization of the sphenoid sinus: a comparison of anatomical and surgical perspectives.
- Authors
Tellioğlu, Ayfer Metin; Şener, Umut; Polat, Yasemin Durum; Tuncer, Işık
- Abstract
Objective: Sinus sphenoidalis (SS) provides access to midline ventral skullbase structures along with middle cranial fossa (FCM) laterally. The surgical window to FCM is bordered by for.rotundum (FR) and vidiancanal (VC). This study aims to compare two classification systems that evaluating lateral extension of SS pneumatization based on the size of surgical window to FCM and anatomical location. Methods: A total of 200 temporal bone computed tomography images (0.5 mm) were examined (18-54 years, avg. 35±9 years). Pneumazation was classified based on anatomical location as pterygoid, ala major, and full lateral. In surgical window based classification, pneumatization was recorded as pre-vidian, prerotundum, and post-rotundum depending on its association with FR and VC. The depth (Pd), length (Pl), and area (Pa) of pneumatization, distance and angle between maxillary (V2) and vidian (VN) nerves were recorded. Data was analyzed by Kruskall-Wallis, Anova, and Pearson-Spearman correlation tests Results: Pneumatization was at mostly full lateral (right: 38.5%, left: 41.5%) and post-rotundum (right: 44%, left: 46%) types. In surgical classification, smaller V2-VN angle and greater distance (right: 7.99±1.71 mm; left: 8.48±1.93 mm) were observed in postrotundum type, in comparison with the pre-vidian (right: 3.82±1.62 mm; left: 4.23±1.59 mm) and pre-rotundum (right: 4.5±2.12 mm; left: 4.97±2 mm) types (p<0.01). However, in anatomical classification, V2-VN angle did not alter between sinus types (p>0.05). Additionally, V2-VN distance didn't alter between full lateral (right: 7.99±1.71 mm; left: 8.21±2.1 mm) and alamajor type (right: 6.5±2.3 mm; left: 6.1±1.8 mm, p>0.05). Pa (r=0.85, p<0.001), Pl (r=0.816; p<0.001), and Pd (r=0.84, p<0.001) were strongly correlated with surgical classification, while Pa (r=0.658, p<0.001) and Pd (r=0.651, p<0.001) had moderate and Pl (r=0.463, p<0.001) weak association with anatomical classification. Conclusion: FR-VC based classification shows that extensive pneumatization is associated with increase in VC-V2 distance, and therefore increase in surgical window. Evaluating pneumatization relative to FR and VC may provide more insight for preoperative planning and iatrogenic injury risk.
- Subjects
SPHENOID sinus; PTERYGOID muscles; TEMPORAL bone; CLASSIFICATION; IATROGENIC diseases
- Publication
Anatomy: International Journal of Experimental & Clinical Anatomy, 2024, Vol 18, pS11
- ISSN
1307-8798
- Publication type
Article