Evans Sean S, Banks Catherine, Richman Joshua, Woolley Audie, Cho Do Yeon, Woodworth Bradford
Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Surgery, University of Alabama, Birmingham, AL, USA.
Ann Otol Rhinol Laryngol. 2020 Jan;129(1):12-17. doi: 10.1177/0003489419867967. Epub 2019 Aug 9.
To define a new anatomic relationship in pediatric sinus surgery, assessing the maxillary roof as a constant safe landmark to avoid skull base injury in the pediatric population.
Retrospective analysis.
Tertiary care children hospital.
A retrospective analysis was performed of all computed tomography scans of the sinuses and facial bones at the emergency department of a tertiary children's hospital over the course of a year. Radiographic measurements included the lowest cribriform plate and planum sphenoidale (PS) heights, or posterior skull base when not yet pneumatized, as well as the highest maxillary roof height. The nasal floor was used for reference. Statistics were performed via Shapiro-Wilks test with a -value of .05 indicating statistical significance.
Three hundred and seven unique scans were reviewed (38.9% female; n = 122; = .58). Age stratification was based on previously described sinus growth patterns. In all patients, the maximum maxillary height was inferior to the lowest measured cribriform lamella and PS ( < .001; CI, 98.5%-99%). Inter- and intrarater reliability and accuracy were verified through blinded review and re-review (ρ = .99 and .98 respectively, ≤ .001). The validity of sole coronal measurements due to incomplete sagittal reformatting was also confirmed (ρ = 1.00, ≤ .001).
Despite variation in sinus growth and development in children, the current study demonstrated the validity of the maxillary sinus roof as a constant safe landmark in the pediatric population, offering a novel anatomic relationship for teaching safety in performing pediatric sinus surgery.
定义小儿鼻窦手术中的一种新解剖关系，评估上颌窦顶作为恒定安全标志以避免小儿人群颅底损伤。
回顾性分析。
三级儿童医院。
对一家三级儿童医院急诊科一年内所有鼻窦和面部骨骼的计算机断层扫描进行回顾性分析。影像学测量包括最低筛板和蝶骨平台（PS）高度，或未气化时的后颅底高度，以及最高上颌窦顶高度。以鼻底作为参照。通过Shapiro-Wilks检验进行统计学分析，P值为.05表示具有统计学意义。
共回顾了307例独立扫描（女性占38.9%；n = 122；P = 0.58）。年龄分层基于先前描述的鼻窦生长模式。在所有患者中，上颌窦的最大高度低于所测量的最低筛板和PS（P <.001；可信区间，98.5% - 99%）。通过盲法回顾和重新回顾验证了观察者间及观察者内的可靠性和准确性（ρ分别为0.99和0.98，P ≤.001）。还证实了由于矢状面重建不完整导致的单纯冠状面测量的有效性（ρ = 1.00，P ≤.001）。
尽管儿童鼻窦生长发育存在差异，但本研究证明了上颌窦顶作为小儿人群恒定安全标志的有效性，为小儿鼻窦手术教学中的安全性提供了一种新的解剖关系。
4级。
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