Meotti Camila Degen, Piltcher Otávio Bejzman, Netto Bruno, Lemieszek Jaqueline, Lavinsky-Wolff Michelle, do Rego Monteiro Felipe Marques, Isolan Gustavo Rassier
Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
J Neurol Surg B Skull Base. 2017 Apr;78(2):152-157. doi: 10.1055/s-0035-1571203. Epub 2016 Nov 17.
This study aims to evaluate the difference in height between the floors of the posterior ethmoid and sphenoid sinuses with respect to the medial orbital floor (MOF) to confirm this difference as a landmark for identification of the posterior sinuses. It also aims to describe this difference regarding the type of pneumatization of the sphenoid sinus (conchal, presellar, and sellar). A cross-sectional study was conducted. The study was conducted at the Department of Radiology of Hospital de Clínicas de Porto Alegre, a tertiary care university hospital in Southern Brazil. A standardized and computerized analysis of 100 tomography scans of sinuses (200 sides), in patients older than 18 years, was carried out. Mean vertical distance (height) from the MOF to the floor of the posterior ethmoid and sphenoid sinuses was 0.72 ± 1.85 mm and 9.48 ± 3.81 mm, respectively. There was no statistically significant difference as compared with sex and side. We found conchal-type sphenoid sinus pneumatization in 1.5% ( = 3), presellar in 13.5% ( = 27), and sellar in 85% ( = 170), whereas the vertical distance between the MOF and the floor of the sphenoid sinus was 2.04 ± 0.81 in the conchal-type sinuses, 5.71 ± 2.49 in the presellar sinuses, and 10.21 ± 3.52 in the sellar sinuses. No sphenoid sinus showed its floor above the MOF, regardless of the type of pneumatization. The present study demonstrates that there is a difference between the floor of the posterior sphenoid and ethmoid sinuses in adults, which is more evident when the sphenoid sinus is well pneumatized. These data suggest that the difference in height between the floors of the sinus investigated in our study may be considered during endoscopic sinus surgery to guide adequate localization, but the surgeon should be aware of the type of pneumatization of the sphenoid sinus to use this landmark.
本研究旨在评估后筛窦和蝶窦底部相对于眶内侧壁（MOF）的高度差异，以确认该差异作为识别后鼻窦的一个标志。本研究还旨在描述蝶窦气化类型（鼻甲型、蝶鞍前型和蝶鞍型）方面的这种差异。进行了一项横断面研究。该研究在巴西南部一家三级护理大学医院阿雷格里港临床医院的放射科进行。对100例18岁以上患者的鼻窦断层扫描（200侧）进行了标准化的计算机分析。从MOF到后筛窦和蝶窦底部的平均垂直距离（高度）分别为0.72±1.85毫米和9.48±3.81毫米。与性别和侧别相比，差异无统计学意义。我们发现鼻甲型蝶窦气化占1.5%（n = 3），蝶鞍前型占13.5%（n = 27），蝶鞍型占85%（n = 170），而在鼻甲型鼻窦中，MOF与蝶窦底部之间的垂直距离为2.04±0.81，蝶鞍前型鼻窦中为5.71±2.49，蝶鞍型鼻窦中为10.21±3.52。无论气化类型如何，没有蝶窦的底部高于MOF。本研究表明，成人蝶窦和筛窦后部的底部存在差异，当蝶窦气化良好时，这种差异更为明显。这些数据表明，在鼻内镜鼻窦手术中考虑我们研究中所调查鼻窦底部的高度差异，可能有助于指导准确定位，但外科医生在使用这一标志时应了解蝶窦的气化类型。
