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Evaluation of the Keros Classification of Olfactory Fossa by CT Scan in Qassim Region
Cureus, 2022
Endoscopic sinus surgery (ESS) is now the most often utilized surgical procedure for treating chronic sinonasal disorders. Therefore, anatomical knowledge of its variations is required to avoid serious postoperative complications. Thus, careful preoperative examination for patients with a paranasal sinus CT scan is necessary. Our study aims to evaluate Keros types and their incidence by evaluating the olfactory fossa (OF) depth according to the Keros classification on paranasal sinus CT scans in the Qassim region. Methods A cross-sectional study was conducted between January 2018 and January 2021 on 148 patients with an average age of 32.59 ± 6.1 who had a non-enhanced paranasal sinus CT scan evaluated by a consultant radiologist using the PACS (picture archiving and communication system) software. Statistical analysis was performed using the statistical software package SPSS version 25 (IBM Corp., Armonk, NY). The chi-square test was used to analyze the relationship between findings and patient characteristics. Also, a p-value of < 0.05 was kept in mind to indicate statistical significance. Results The average depth of the right olfactory fossa (OF) was 5.1 mm with a standard deviation of 1.756 while it was 5.28 on the left side with a standard deviation of 1.66. According to the Keros classification, out of a total of 296 OF, type 1 was found in 84 (28.4%), type 2 in 188 (63.5%), and type 3 in 24 (8.1%). Consequently, the majority of cases were of type 2. Also, we found that type 2 was the most common on both sides in males, whereas, in females, type 2 was the most common on the left side and type 1 on the right side. Conclusion The study of the Keros classification is significantly important to evaluate the anatomy of the anterior skull base and give the surgeon knowledge about the depth of the olfactory fossa. Thus, a preoperative CT scan of the paranasal sinus is critical to ensure that the surgical approach is properly planned and possible surgical complications related to the anatomy of this area can be prevented. Our study showed that Keros type II is the most common, followed by type I and then type III.
CT evaluation of anatomical variations of paranasal sinus region and their clinical importance
International Journal of Research in Medical Sciences, 2019
Background: Paranasal sinuses are air filled spaces present within the skull and facial bones. Paranasal sinuses region anatomy is highly variable. Knowledge of these variations is very important for radiologists as well as endoscopic surgeons for preoperative evaluation to avoid damage to adjacent vital structures. CT is the best modality to delineate the sinus anatomy as well as soft tissue structures. Thus, this study was undertaken to evaluate the anatomical variations of paranasal sinus region and ascertain their clinical importance.Methods: A total of 142 patients, those referred from various outdoor/indoor departments with the symptoms related to nose and paranasal sinuses were included. Detailed history, appropriate clinical examinations, biochemical investigations and X-ray PNS were recorded. Unenhanced CT scan of the PNS was performed for these patients in the axial planes and reformatted coronal planes. Observation was made and analysed using descriptive tools and scienti...
Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery
Auris Nasus Larynx, 1999
Chronic rhinosinusitis endoscopic surgery requires an accurate evaluation of diseases and paranasal sinus anatomic variations. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT). CT scans obtained 2 mm thickness in axial and coronal plane from a series of 200 patients with chronic sinusitis were examined to determine the prevalence of anatomic variants. Anatomical variations determined were supraorbital recess in 6%, concha bullosa in 30%, sphenomaxillary plate in 17%, infra-orbital ethmoid cells (Haller's cells) in 6%, spheno-ethmoid cells (Onodi's cells) in 12%, pneumatization of the anterior clinoid process in 6%, carotid artery bulging into the sphenoid sinus in 8%, pneumatization of the uncinate process in 2%, paradoxical curvature of the middle turbinate in 3% and septal deviation in 36%. Level difference between the ethmoid roof and nasal vault was an average of 8 mm in right side and 9.5 mm in left side. Awareness of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical procedures.
Journal of Marmara University Institute of Health Sciences, 2013
Fonksiyonel endoskopik sinüs cerrahisinde multidetektör bilgisayarlı tomografide paranasal sinüslerin anatomik varyasyonları Bilgisayarlı tomografi paranasal sinüslerin hastalıklarının ve fonksiyonel endoskopik sinüs cerrahisi ile tedavilerinin değerlendirilmesinde anatomik olarak sağladığı bilgi oldukça önemlidir. Paranasal sinüslerde izlenen anatomik varyasyonlar nadir değildir. Bu makalenin amacı paranasal sinüslerde izlenebilen bazı anatomik varyasyonları sunmaktır. Anahtar sözcükler: Paranasal sinüsler, anatomik varyasyonlar, bilgisayarlı tomografi, fonksiyonel endoskopik sinüs cerrahisi ABS TRACT Anatomic variations of paranasal sinus on multidetector computed tomography examinations for functional endoscopic sinus surgery Computed tomography is excellent means of providing anatomical information of paranasal sinuses, assessing disease and guiding treatment with functional endoscopic sinus surgery (FESS). Common anatomical variations are not rare in the paranasal sinuses. The aim of this article was presented radiological characteristics of some anatomic variation in paranasal sinuses.
2014
In this study, we aimed to evaluate the frequency of anatomic variations of the paranasal sinus region by using multidetector computerized tomography (MDCT). Methods: Between November 2009 and February 2012, 5832 adult patients (2980 females, 2852 males) with a mean age of 39.1±15.4 years (range; 19-85), who underwent MDCT imaging of the paranasal sinus region, were retrospectively evaluated by using the picture archiving and communication system (PACS). All the images were evaluated by three radiologists. Frequency distribution and descriptive statistics of the variants were analysed. Results: Nasal septal deviation was the most commonly detected variation (59.1%) and most were rightward (26.5%). Middle concha pneumatization was the second most commonly encountered variation (57.2%), whereas nasal septum pneumatization was the third most common one (34.8%). Maxillary sinus aplasia was detected in one patient and it was the least common variation (0.05%). Dehiscence of the maxillary nerve (0.4%) and internal carotid artery (0.5%) and sphenoid sinus aplasia (0.5%) were infrequently encountered variations in our study. Conclusion: It is important for the radiologist to know the anatomical variations of the paranasal sinus region in order to consider their possible pathological consequences. Guiding the surgeon in the preoperative period is essential to avoid potential complications.
The Eurasian Journal of Medicine, 2013
Objective: To determine the Keros classification and asymmetrical distribution rates of the ethmoid roof and the frequency of anatomic variations of the paranasal sinuses. Materials and Methods: Paranasal sinus scans of 500 patients obtained using computed tomography were evaluated retrospectively. Measurements were performed using a coronal plan with right-left comparison and with distance measurement techniques. The depth of the lateral lamella was calculated by subtracting the depth of the cribriform plate from the depth of the medial ethmoid roof. The results were classified according to their Keros classification. Any asymmetries in the ethmoid roof depth and fovea ethmoidalis configuration were examined. The anatomic variations frequently encountered in paranasal sinuses (pneumatized middle concha, paradoxical middle concha, agger nasi cells, Haller cells, Onodi cells, etc.) were defined. Results: The mean height of the lateral lamella cribriform plate (LLCP) was 4.92±1.70 mm. The cases were classified as 13.4% Keros Type I, 76.1% Keros Type II, and 10.5% Keros Type III. There was asymmetry in the LLCP depths of 80% of the cases, and a configuration asymmetry in the fovea in 35% of the cases. In 32% of the cases with fovea configuration asymmetry, there was also asymmetry in the height of the right and left LLCP. The most frequent variations were nasal septum deviation (81.8%), agger nasi cells (63.8%), intralamellar air cells (45%), and concha bullosa (30%). Conclusion: Using the Keros classification for LLCP height, higher rates of Keros Type I were found in other studies than in our study. The most frequent classification was Keros Type II. The paranasal sinus variations in each patient should be carefully evaluated. The data obtained from these evaluations can prevent probable complications by informing rhinologists performing endoscopic sinus surgery about preoperative and intraoperative processes.
Multi Detector Computed Tomographical Assessment of Anatomical Variants of Paranasal Sinuses
Journal of Pharmaceutical Research International, 2021
Multi detector computed tomography (MDCT) scan of paranasal sinuses has become mandatory for all patients undergoing functional endoscopic sinus surgery. It depicts the anatomical variations in much simpler way and acts as a roadmap for endoscopic sinus surgery. In this study the maximum of participants were in the age group of 41- 50 years (32 %). The mean age of the study participants was observed to be 43.8 ± 15.6 years. HRCT PNS results shows nasal septum was found to be the most common anatomical variant (DNS- 94%). Concha Bullosa in right side were seen in 37.5% and left side were 21.9% (total unilateral cases- 59.4%) and bilateral Concha Bullosa were seen in 40.6% of the cases. Agger nasi were found to be present in 58% of the CRS cases among which right AN was 41%, left side was 30.8%, and bilateral AN were seen in 28.2% of the cases and Paradoxical Middle Turbinate were seen in 42% of cases in our study. Medialised uncinate was seen in 22% of the cases.
CT of the Paranasal Sinuses: Normal Anatomy, Variants and Pathology
Journal of Optoelectronics and …, 2010
The place of computed tomography in the pre-operative assessment of patients prior to functional endoscopic sinus surgery is well established. A good knowledge of the anatomy of the paranasal sinuses, the clinical significance of anatomical variants, and the terminology used in functional endoscopic sinus surgery is basic to the correct interpretation of imaging studies. This article will review the anatomy of paranasal sinuses, Jami Karise the reader with the common terminology used in functional endoscopic sinus surgery and describe the patterns of inflammatory changes.
Remarkable anatomic variations in paranasal sinus region and their clinical importance
European Journal of Radiology, 2004
With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the preoperative work-up. To be in the known anatomical variants with some accompanying pathologies, directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. A review of 512 (1024 sides) paranasal sinus tomographic scans was carried out to expose remarkable anatomic variations of this region. We used only coronal sections, but for some cases to clear exact diagnosis, additional axial CT scan, magnetic resonance imaging (MRI) and nasal endoscopy were also performed. In this pictorial essay, rates of remarkable anatomic variations in paranasal region were displayed. The images of some interesting cases were illustrated, such as the Onodi cell in which isolated mucocele caused loss of visual acuity, agger nasi cell, Haller's cell, uncinate bulla, giant superior concha bullosa, inferior concha bullosa, bilateral carotid artery protrusion into sphenoid sinus, maxillary sinus agenesis, bilateral secondary middle turbinate (SMT) and sphenomaxillary plate. The clinical importance of all these variations were discussed under the light of the literature. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in the preoperative evaluation.
Journal of Evolution of Medical and Dental Sciences, 2016
The aim of the study is correlation of para nasal sinuses between operative endoscopic findings of Functional Endoscopic Sinus Surgery (FESS) and pre-operative Computed Tomography. STUDY DESIGN Time bound Cross-sectional study. METHODOLOGY A group of 50 patients attending the ENT OPD for sinus related problems at Santhiram General Hospital, Nandyal, were examined and clinically confirmed cases of chronic rhinosinusitis were selected for study. CT scan findings were discussed with consultant radiologist and intrasinus mucosal disease and anatomical variations were noted. Further patients underwent functional endoscopic sinus surgery, during which anatomical variations and intrasinus mucosal disease were noted. Both the findings were tabulated and correlated.