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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(04): e548-e555
DOI: 10.1055/s-0042-1742325
Original Research

The Relationship between an Accessory Maxillary Ostium and Variations in Structures Adjacent to the Maxillary Sinus without Polyps

Gozde Serindere 
1   Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hatay Mustafa Kemal University, Hatay, Turkey.
,
Kaan Gunduz 
2   Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey.
,
Hakan Avsever 
3   Department of Dentomaxillofacial Radiology, Gulhane Faculty of Dentistry, Health Sciences University, Ankara, Turkey.
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Abstract

Introduction The maxillary sinus and its variations are very important to dentistry and rhinology.

Objective To investigate the effect of the accessory maxillary ostium (AMO) on the variations of adjacent structures of the maxillary sinus.

Methods The computed tomography (CT) images of 400 patients were retrospectively evaluated. The prevalence of AMO was calculated. The relationship between morphological variations of adjacent structures of maxillary sinus such as agger nasi cell (ANC), Haller cell (HC), nasal septum deviation (NSD), hypertrophy of inferior concha (HIC), pneumatization of middle concha (PMC), mucus retention cyst (MRC), mucosal thickening (MT), and maxillary sinusitis (MS), as well as the presence of AMO, were investigated.

Results Presence of AMO was diagnosed in 42 patients (10.5%), having been found in 4.5% of the patients only on the right side, in 1.25% of the patients only on the left side, and in 4.75% of the patients on both sides. There is an increasing incidence of ANC, HC, NSD, HIC, and PMC in the presence of AMO and MS. There is a decreasing incidence of MRC in the presence of AMO. Furthermore, AMO does not affect the incidence of MT.

Conclusion This study showed that most parameters, except for MRC and MT, had increasing incidence in the presence of AMO. It is important for radiologists and rhinologists to have knowledge about the location of AMO and the presence of variations of MS adjacent structures to avoid surgical complications.

Keywords

computed tomography - paranasal sinuses - sinus anatomy - sinusitis


Publication History

Received: 18 May 2021

Accepted: 17 October 2021

Article published online:
28 January 2022

© 2022. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Stammberger H. Functional endoscopic sinus surgery. The Messerklinger technique.; Philadelphia: BC Decker: 1990. 247. 63-7
    Google Scholar
  • 2 Hollinshed WH, Rosse C. Text book of Anatomy. 4th edn.. Herper and Row; Philadelphia: 1985: 976-85
    Google Scholar
  • 3 Na Y, Kim K, Kim SK, Chung SK. The quantitative effect of an accessory ostium on ventilation of the maxillary sinus. Respir Physiol Neurobiol 2012; 181 (01) 62-73 DOI: 10.1016/j.resp.2012.01.013.
    CrossrefPubMedGoogle Scholar
  • 4 Joe JK, Ho SY, Yanagisawa E. Documentation of variations in sinonasal anatomy by intraoperative nasal endoscopy. Laryngoscope 2000; 110 (2 Pt 1): 229-235 DOI: 10.1097/00005537-200002010-00008.
    CrossrefPubMedGoogle Scholar
  • 5 Jones NS. CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings. Clin Otolaryngol Allied Sci 2002; 27 (01) 11-17 DOI: 10.1046/j.0307-7772.2001.00525.x.
    CrossrefPubMedGoogle Scholar
  • 6 Matthews BL, Burke AJ. Recirculation of mucus via accessory ostia causing chronic maxillary sinus disease. Otolaryngol Head Neck Surg 1997; 117 (04) 422-423 DOI: 10.1016/S0194-5998(97)70139-6.
    CrossrefPubMedGoogle Scholar
  • 7 Parsons DS, Wald ER. Otitis media and sinusitis: similar diseases. Otolaryngol Clin North Am 1996; 29 (01) 11-25
    CrossrefPubMedGoogle Scholar
  • 8 Yenigun A, Fazliogullari Z, Gun C, Uysal II, Nayman A, Karabulut AK. The effect of the presence of the accessory maxillary ostium on the maxillary sinus. Eur Arch Otorhinolaryngol 2016; 273 (12) 4315-4319 DOI: 10.1007/s00405-016-4129-8.
    CrossrefPubMedGoogle Scholar
  • 9 Yegin Y, Çelik M, Şimşek BM, Olgun B, Canpolat S, Kayhan FT. Relationship Between the Presence of Agger Nasi Cells and the Development of Frontal Sinusitis: a Computer-Assisted Anatomic Study. Bezmialem Science 2017; 5: 112-115 DOI: 10.14235/bs.2017.1087.
    CrossrefGoogle Scholar
  • 10 Mathew R, Omami G, Hand A, Fellows D, Lurie A. Cone beam CT analysis of Haller cells: prevalence and clinical significance. Dentomaxillofac Radiol 2013; 42 (09) 20130055 DOI: 10.1259/dmfr.20130055.
    CrossrefPubMedGoogle Scholar
  • 11 Vig KW. Nasal obstruction and facial growth: the strength of evidence for clinical assumptions. Am J Orthod Dentofacial Orthop 1998; 113 (06) 603-611 DOI: 10.1016/s0889-5406(98)70219-7.
    CrossrefPubMedGoogle Scholar
  • 12 Hatipoğlu HG, Cetin MA, Yüksel E. Concha bullosa types: their relationship with sinusitis, ostiomeatal and frontal recess disease. Diagn Interv Radiol 2005; 11 (03) 145-149
    PubMedGoogle Scholar
  • 13 Chiesa Estomba C, Rivera Schmitz T, Ossa Echeverri CC, Betances Reinoso FA, Osorio Velasquez A, Santidrian Hidalgo C. Compensatory hypertrophy of the contralateral inferior turbinate in patients with unilateral nasal septal deviation. A computed tomography study. Otolaryngol Pol 2015; 69 (02) 14-20 DOI: 10.5604/00306657.1149568.
    CrossrefPubMedGoogle Scholar
  • 14 Fehrenbach MJ, Herring SW. Illustrated Anatomy of the Head and Neck. Elsevier Health Sciences; 2012. page 67
    Google Scholar
  • 15 Bhattacharyya N. Do maxillary sinus retention cysts reflect obstructive sinus phenomena?. Arch Otolaryngol Head Neck Surg 2000; 126 (11) 1369-1371 DOI: 10.1001/archotol.126.11.1369.
    CrossrefPubMedGoogle Scholar
  • 16 Kolo ES. The role of plain radiographs in the diagnosis of chronic maxillary rhinosinusitis in adults. Afr Health Sci 2012; 12 (04) 459-463 DOI: 10.4314/ahs.v12i4.10.
    CrossrefPubMedGoogle Scholar
  • 17 Ren S, Zhao H, Liu J, Wang Q, Pan Y. Significance of maxillary sinus mucosal thickening in patients with periodontal disease. Int Dent J 2015; 65 (06) 303-310 DOI: 10.1111/idj.12186.
    CrossrefPubMedGoogle Scholar
  • 18 Kumar H, Choudhry R, Kakar S. Accessory Maxillary Ostia: Topography and Clinical Application. J Anat Soc India 2001; 50 (01) 3-5
    Google Scholar
  • 19 Jog M, McGarry GW. How frequent are accessory sinus ostia?. J Laryngol Otol 2003; 117 (04) 270-272 DOI: 10.1258/00222150360600869.
    CrossrefPubMedGoogle Scholar
  • 20 May M, Sobol SM, Korzec K. The location of the maxillary os and its importance to the endoscopic sinus surgeon. Laryngoscope 1990; 100 (10 Pt 1): 1037-1042 DOI: 10.1288/00005537-199010000-00002.
    CrossrefPubMedGoogle Scholar
  • 21 Kennedy DW, Zinteich J. Otolaryngology, Head and Neck, Vol III. W.B. Saunders Company; 1991: 1861-71
    Google Scholar
  • 22 Singhal MD, Singhal DM. Anatomy of accessory maxillary sinus ostium with clinical application. Int J Med Sci Public Health 2014; 3: 327-329 DOI: 10.5455/ijmsph.2013.301220131.
    CrossrefGoogle Scholar
  • 23 Van Alyea OE. The Ostium Maxillare anatomic study of its surgical accessibility. Arch Otolaryngol 1936; 24 (05) 553-569
    CrossrefGoogle Scholar
  • 24 Schaeffer JP. The Nose, Paranasal Sinuses, Nasolacrimal Passageways, and Olfactory Organ in Man. Philadelphia: P. Blakiston's Son; 1920
    Google Scholar
  • 25 Yeung AWK, Colsoul N, Montalvao C, Hung K, Jacobs R, Bornstein MM. Visibility, location, and morphology of the primary maxillary sinus ostium and presence of accessory ostia: a retrospective analysis using cone beam computed tomography (CBCT). Clin Oral Investig 2019; 23 (11) 3977-3986 DOI: 10.1007/s00784-019-02829-9.
    CrossrefPubMedGoogle Scholar
  • 26 Hung K, Montalvao C, Yeung AWK, Li G, Bornstein MM. Frequency, location, and morphology of accessory maxillary sinus ostia: a retrospective study using cone beam computed tomography (CBCT). Surg Radiol Anat 2020; 42 (02) 219-228 DOI: 10.1007/s00276-019-02308-6.
    CrossrefPubMedGoogle Scholar
  • 27 Avsever H, Gunduz K, Karakoç O, Akyol M, Orhan K. Incidental findings on cone-beam computed tomographic images: paranasal sinus findings and nasal septum variations. Oral Radiol 2018; 34 (01) 40-48 DOI: 10.1007/s11282-017-0283-y.
    CrossrefPubMedGoogle Scholar
  • 28 Arslan İB, Uluyol S, Demirhan E, Kozcu SH, Pekçevik Y, Çukurova İ. Paranasal Sinus Anatomic Variations Accompanying Maxillary Sinus Retention Cysts: A Radiological Analysis. Turk Arch Otorhinolaryngol 2017; 55 (04) 162-165 DOI: 10.5152/tao.2017.2759.
    CrossrefPubMedGoogle Scholar
  • 29 Özdemir A, Arslan S. Incidence of agger nasi and frontal cells and their relation to frontal sinusitis in a Turkish population: a CT study. Anatomy 2018; 12 (02) 71-75 DOI: 10.2399/ana.18.050.
    CrossrefGoogle Scholar
  • 30 Orhan M, Saylam CY. Anatomical analysis of the prevalence of agger nasi cell in the Turkish population. Kulak Burun Bogaz Ihtis Derg 2009; 19 (02) 82-86
    PubMedGoogle Scholar
  • 31 Liu SC, Wang CH, Wang HW. Prevalence of the uncinate process, agger nasi cell and their relationship in a Taiwanese population. Rhinology 2010; 48 (02) 239-244 DOI: 10.4193/Rhin09.118.
    CrossrefPubMedGoogle Scholar
  • 32 Stackpole SA, Edelstein DR. The anatomic relevance of the Haller cell in sinusitis. Am J Rhinol 1997; 11 (03) 219-223 DOI: 10.2500/105065897781751910.
    CrossrefPubMedGoogle Scholar
  • 33 Shin HS. Clinical significance of unilateral sinusitis. J Korean Med Sci 1986; 1 (01) 69-74 DOI: 10.3346/jkms.1986.1.1.69.
    CrossrefPubMedGoogle Scholar
  • 34 Lebowitz RA, Brunner E, Jacobs JB. The agger nasi cell: radiological evaluation and endoscopic management in chronic frontal sinusitis. Operative techniques. Otolaryngol Head Neck Surg 1995; 6: 171-175
    Google Scholar
  • 35 Wanamaker HH. Role of Haller's cell in headache and sinus disease: a case report. Otolaryngol Head Neck Surg 1996; 114 (02) 324-327 DOI: 10.1016/s0194-5998(96)70196-1.
    CrossrefGoogle Scholar
  • 36 Özkırış M, Mutlu C. Kulak burun boğaz polikliniğine başvuran hastalarda nazal septum deviasyonu sıklığı. J Kartal TR 2010; XXI (02) 72-76
    Google Scholar
  • 37 Yildirim I, Okur E. The prevalence of nasal septal deviation in children from Kahramanmaras, Turkey. Int J Pediatr Otorhinolaryngol 2003; 67 (11) 1203-1206 DOI: 10.1016/j.ijporl.2003.07.005.
    CrossrefPubMedGoogle Scholar
  • 38 Oliveira AKP, Elias Jr E, Santos LV, Bettega SG, Mocellin M. Prevalence of deviated nasal septum in Curitiba, Brasil. Int Arch Otorhinolaryngol 2005; 9 (04) 288-292
    Google Scholar
  • 39 Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am J Neuroradiol 2004; 25 (09) 1613-1618
    PubMedGoogle Scholar
  • 40 Clark DW, Del Signore AG, Raithatha R, Senior BA. Nasal airway obstruction: Prevalence and anatomic contributors. Ear Nose Throat J 2018; 97 (06) 173-176 DOI: 10.1177/014556131809700615.
    CrossrefPubMedGoogle Scholar
  • 41 Cury R, Gioseffi C, Andrade E, Cury M, Cury SE. The incidence of inferior turbinate hypertrophy in a Brazilian population. Webmed central. Rhinology 2013; 4 (06) WMC004276
    Google Scholar
  • 42 Aktas D, Kalcioglu MT, Kutlu R, Ozturan O, Oncel S. The relationship between the concha bullosa, nasal septal deviation and sinusitis. Rhinology 2003; 41 (02) 103-106
    PubMedGoogle Scholar
  • 43 Arslan H, Aydinlioğlu A, Bozkurt M, Egeli E. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx 1999; 26 (01) 39-48 DOI: 10.1016/s0385-8146(98)00024-8.
    CrossrefPubMedGoogle Scholar
  • 44 Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991; 101 (1 Pt 1): 56-64 DOI: 10.1288/00005537-199101000-00010.
    CrossrefPubMedGoogle Scholar
  • 45 Albu S. Symptomatic maxillary sinus retention cysts: should they be removed?. Laryngoscope 2010; 120 (09) 1904-1909 DOI: 10.1002/lary.21040.
    CrossrefPubMedGoogle Scholar
  • 46 Ritter L, Lutz J, Neugebauer J. et al. Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 111 (05) 634-640 DOI: 10.1016/j.tripleo.2010.12.007.
    CrossrefPubMedGoogle Scholar
  • 47 Raghav M, Karjodkar FR, Sontakke S, Sansare K. Prevalence of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic images. Contemp Clin Dent 2014; 5 (03) 361-365 DOI: 10.4103/0976-237X.137949.
    CrossrefPubMedGoogle Scholar
  • 48 Drumond JPN, Allegro BB, Novo NF, de Miranda SL, Sendyk WR. Evaluation of the prevalence of maxillary sinuses abnormalities through spiral computed tomography (CT). Int Arch Otorhinolaryngol 2017; 21 (02) 126-133 DOI: 10.1055/s-0036-1593834.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 49 Gracco A, Incerti Parenti S, Ioele C, Alessandri Bonetti G, Stellini E. Prevalence of incidental maxillary sinus findings in Italian orthodontic patients: a retrospective cone-beam computed tomography study. Korean J Orthod 2012; 42 (06) 329-334 DOI: 10.4041/kjod.2012.42.6.329.
    CrossrefPubMedGoogle Scholar
  • 50 Wang JH, Jang YJ, Lee BJ. Natural course of retention cysts of the maxillary sinus: long-term follow-up results. Laryngoscope 2007; 117 (02) 341-344
    CrossrefPubMedGoogle Scholar
  • 51 Hong SL, Cho KS, Roh HJ. Maxillary sinus retention cysts protruding into the inferior meatus. Clin Exp Otorhinolaryngol 2014; 7 (03) 226-228 DOI: 10.3342/ceo.2014.7.3.226.
    CrossrefPubMedGoogle Scholar
  • 52 Mehra P, Murad H. Maxillary sinus disease of odontogenic origin. Otolaryngol Clin North Am 2004; 37 (02) 347-364 DOI: 10.1016/S0030-6665(03)00171-3.
    CrossrefPubMedGoogle Scholar
  • 53 Bani-Ata M, Aleshawi A, Khatatbeh A. et al. Accessory maxillary ostia: prevalence of an anatomical variant and association with chronic sinusitis. Int J Gen Med 2020; 13: 163-168 DOI: 10.2147/IJGM.S253569.
    CrossrefPubMedGoogle Scholar
  • 54 Nouraei SA, Elisay AR, Dimarco A. et al. Variations in paranasal sinus anatomy: implications for the pathophysiology of chronic rhinosinusitis and safety of endoscopic sinus surgery. J Otolaryngol Head Neck Surg 2009; 38 (01) 32-37
    Google Scholar
  • 55 Campbell Jr PD, Zinreich SJR, Aygun N. Imaging of the paranasal sinuses and in-office CT. Otolaryngol Clin North Am 2009; 42 (05) 753-764 , vii
    CrossrefPubMedGoogle Scholar
  • 56 Clayman GL, Adams GL, Paugh DR, Koopmann Jr CF. Intracranial complications of paranasal sinusitis: a combined institutional review. Laryngoscope 1991; 101 (03) 234-239 DOI: 10.1288/00005537-199103000-00003.
    CrossrefPubMedGoogle Scholar
  • 57 Giannoni C, Sulek M, Friedman EM. Intracranial complications of sinusitis: a pediatric series. Am J Rhinol 1998; 12 (03) 173-178 DOI: 10.2500/105065898781390127.
    CrossrefPubMedGoogle Scholar