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Purpose: To analyse the degree of pneumatisation of the temporal bone when there is an association between dehiscence of the superior semicircular canal and dehiscence of the tegmen tympani., Materials and Methods: We analysed a retrospective CT study of 124 selected cases. A single inclusion criterion was applied: the presence of a dehiscence of the tegmen tympani. On the other hand, the degree of temporal pneumatisation was assessed by axial and coronal planes, and has been divided into the following grades O, I, II and III, according to the status and relationship of the mastoid, the bony labyrinth, the petrous segment of the carotid canal and sigmoid sinus., Results: Of the 124 cases studied, 35 (28.2%) presented both dehiscences. In 26 of the 35 (47.3%), grade II pneumatisation, 4 (14,8%), grade I, and 5 (11,9%) grade III was observed, with a statistically significant relationship (p < 0.001). On the other hand, we did not find a significant relationship when relating both dehiscences in any age or sex group. However, when relating the degree of pneumatisation to sex, among those with grade III pneumatisation, the proportion of men (52.4%) was significantly higher than that of women (47.6%) (p = 0.017)., Conclusion: We have detected a statistically significant relationship between the coexistence of grade II pneumatisation and the presence of both dehiscences in the temporal bone., (© 2023. The Author(s).)

Anatomical variations in the maxillary sinus pneumatisation are limited unlike the ethmoids. We present rare variations of the maxillary sinus along its floor other than septations and includes wide pneumatisation of alveolar and palatal recess with cell formation. An intra-maxillary cell that opens into the maxillary infundibulum well within the sinus is described here and our senior author has coined the new term-alveolar recess cell. Its involvement in the sinus pathologies and additional surgical approaches for the disease clearance is discussed here., Competing Interests: Disclosure of Potential Conflict of OnterestsAuthor 1, author 2, author 3 and author 4 declare that they have no conflict of interests., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Aims and Objectives: The aim of this prospective clinical study was to evaluate the success of one-stage direct (lateral) sinus lift procedure in severely atrophic posterior maxilla., Materials and Methods: One-stage direct (lateral) sinus lift procedure was carried out at 15 sites in 13 patients. All patients included in the study presented with partially edentulous posterior maxilla with one or more missing teeth and residual bone height less than 5 mm. Three months after surgery, patients were evaluated to access increase in residual bone height, density of new bone formed and implant stability. Patients were also evaluated after 3 months of prosthetic placement for the success of implant-supported prosthesis., Results: At 3 months post-operatively, increase in residual bone height was 8.31 ± 1.63 mm and the mean density of the newly formed bone around the implants was 417 ± 66.61 HU. All implants were stable and successfully osseointegrated, except one implant that was lost. The success rate of implant stability was 96.3% during the study period., Conclusion: Single-stage direct (lateral) maxillary sinus floor augmentation is a good treatment option with predictable outcome for patients with deficient alveolar bone in posterior maxilla., Competing Interests: None

In the present study, we investigated the relationship between sphenoid sinus, carotid canal, and optic canal on paranasal sinus computed tomography (PNSCT). This study was performed retrospectively. PNSCT images of 300 adult subjects (159 male, 141 female). Sphenoid sinus (pneumatisation, dominancy, septation, inter-sinus septa deviation), anterior clinoid process pneumatisation, Onodi cell, carotid and optic canals (width, dehiscence, classification) were measured. In males, type 3 pneumatised sphenoid sinus (in both sides) and in females type 2 pneumatised sphenoid sinus (right side) and type 3 pneumatised sphenoid sinus (left side) were detected more. Anterior clinoid pneumatisation was present 47.2% in males and 39.7% in females. In male group, more septation (i.e. 22.6%, ≥ 3 septa) in sphenoid sinus were detected. Onodi cell was present 26.6 and 19.1% in males and females, respectively. Carotid canal protrudation to the sphenoid sinus wall was present 23.9-32.1% in males and 35.5-36.2% in females. Dehiscence in carotid canal was detected more in females (34%) compared to males (22%). Optic canal protrudation was 33.3 and 30.5% in males and females. Type 4 optic canal was detected more in both gender. Optic canal dehiscence was detected 11.3 and 9.9% in males and females. Carotid and optic canal diameters were higher in males. In pneumatised sphenoid sinuses and in females, type 3 carotid canal (Protrudation to SS wall) (bilaterally) and type 1 optic canal type (No indentation) (ipsilateral side) were detected more. In elderly patients, carotid and optic canal width increased. When carotid canal protrudation was detected, there was no indentation in optic canals In pneumatised SS, carotid canal protrudation was observed with a greater risk in surgery. However, type 1 (non indentation) optic canal was present in highly pneumatised SS with lower risk for the surgery. In women, the risk of carotid canal protruding (about 1/3) is greater than that of males, and carotid canal dehiscence rates are also higher in females. Therefore, physicians should be very careful during the preparatory stages of the sphenoid sinus surgery. Otherwise, it may not be possible to prevent lethal carotid artery bleeds.

Objectives: To compare the dimensions of maxillary sinuses in dentate and edentulous patients using cone beam computed tomography (CBCT) scans and a customised software program., Materials and Methods: This study comprised CBCTs of 50 dentate and 50 edentulous posterior maxillae. The observers drew two planar curves in all included sinuses in the frontal, sagittal and axial planes of the respective CBCT scans. The volume (mm 3 ), surface (mm 2 ) and maximum diameter (mm) of the sinuses were calculated using a custom-made software program. The variables analysed were the influence of the state of dentition on sinus dimensions (primary outcome) and the influence of age, gender and side on sinus dimensions; the time needed for analysis; and the intra- and inter-observer agreement (secondary outcomes)., Results: There was no difference in sinus dimensions between dentate and edentulous posterior maxillae. Males had significantly (p < 0.05) greater volume, surface and diameter than females. Strong intra- and inter-observer agreement (Pearson correlation) was found for the calculated sinus dimensions. The time needed per analysis was less than 4 min for both observers., Conclusions: Being edentulous did not have an impact on the sinus dimensions, suggesting that there is no ongoing pneumatisation in the sinus after tooth loss. Males had larger sinuses than females in a population older than 30 years., Clinical Relevance: Following tooth loss in the posterior maxilla, vertical bone height is primarily lost due to resorption of the alveolar crest, and not due to pneumatisation of the maxillary sinus. The customised software program was found to be user-friendly and efficient.

Background: Pneumatisation of the inferior turbinate (PIT) is a rare abnormality of the paranasal sinus. It is very difficult to differentiate from the hypertrophia of the inferior turbinate clinically. Thus, it is important to be considered, especially in cases with no response to medical treatments. We aimed to investigate the presence and the frequency of PIT by computed tomography (CT)., Materials and Methods: A total of 2905 cases (1381 female, 1524 male) with an age range between 16 and 84 were included., Results: The pneumatisation of the inferior turbinate was observed in 1.72% of the cases with a percentage of 1.88% in women and 1.57% in men. In PIT (+) cases the bilaterality was found in 54% of them. According to the subtypes, 70% was lamellar, 28% was bullous and 2% was extensive. No statistically significant difference was found for age distribution. The most commonly associated variations were the pneumatisation of the middle and upper turbinate and the septal deviation., Conclusions: The pneumatisation of the inferior turbinate is a rare variation with a similar frequency among men and women. It is diagnosed by CT and when symptomatic, the optimal treatment is surgery.

Purpose: Assessment of sphenoid sinus (SS), posterior clinoid process (PCP), and dorsum sellae (DS) pneumatisation is significant when planning surgical approaches both to intra- and extrasellar pathologies. The authors analysed pneumatisation of the SS, with particular attention paid to pneumatisation of the PCP and DS., Material and Methods: The study was based on 100 computed tomography angiography examinations. SS, PCP, and DS pneumatisation grades were assessed using the classification system proposed by Hardy. The analyses were conducted in sagittal planes: midline plane (MP), sagittal posterior clinoid plane right (SPCP-R), and sagittal posterior clinoid plane left (SPCP-L). The occurrence of the highest pneumatisation grade (IVB according to Hardy), which encompasses DS and PCP, prompted the authors to conduct a further analysis in the coronal plane. In this way, seven DS and PCP pneumatisation symmetry types were identified., Results: In the MP and SPCP-R, the most frequent pneumatisation grade was grade III (41% and 38%, respectively). In the SPCP-L, grade IVA prevailed (41%). Grade IVB was found in 12% of the SPCP-R images, 10% of the SPCP-L images, and in 12% of the MP images. Consistent pneumatisation grades in all analysed planes were found for 64% of cases. This was usually grade III noted in 28% of cases., Conclusions: SS pneumatisation is characterised by considerable individual variability. There are a number of SS pneumatisation classification systems, but the system proposed by Hardy is the most useful for assessment of DS and PCP pneumatisation. Grade III of SS pneumatisation is the most common. Pneumatisation encompassing DS and PCP was found in 10-12% of cases.

Background: The anterior clinoid process (ACP) is usually removed during surgical procedures of the cellar region. The ACP may be different length and width in people; it may be also pneumatic. Therefore, we aimed to determine dimensions and rates of pneumatisation of the ACP in the large study group with clinically importance., Materials and Methods: One thousand and thirty-one (592 female, 439 male) cranial computed tomography (CT) of the middle Anatolian population was used in this study. The length and basal width of the ACP were measured on the cranial CT. Also; incidence and degree of ACP pneumatisation were identified., Results: The width of the right and left ACPs in females were 10.80 ± 2.27 mm and 10.53 ± 2.07 mm, respectively. The width of the right and left ACPs in males were 11.08 ± 2.39 mm and 10.98 ± 2.35 mm, respectively. The length of the right and left ACPs in females were 8.32 ± 2.40 mm and 8.34 ± 2.35 mm, respectively. The length of the right and left ACPs in males were 8.87 ± 2.62 mm and 8.93 ± 2.64 mm, respectively. There was statistically significant difference between males and females in ACP dimensions, except for the width of the right ACP. Pneumatisation of the ACP was observed on the right side in 46 (9.3%) cases, on the left side in 53 (10.6%) cases, and bilaterally in 32 (6.5%) cases. Incidence of pneumatisation of the ACP was decreased in the age group of 1 month to 20 years. While the incidence of bilateral pneumatisation of the ACP was higher in individuals aged 21-40., Conclusions: Radiologically recognising pneumatisation and anatomical variations of the ACP may be helpful in decreasing the incidence of surgical complications during anterior clinoidectomy.

The giant extinct marsupial Diprotodon optatum has unusual skull morphology for an animal of its size, consisting of very thin bone and large cranial sinuses that occupy most of the internal cranial space. The function of these sinuses is unknown as there are no living marsupial analogues. The finite element method was applied to identify areas of high and low stress, and estimate the bite force of Diprotodon to test hypotheses on the function of the extensive cranial sinuses. Detailed three-dimensional models of the cranium, mandible and jaw adductor muscles were produced. In addition, manipulations to the Diprotodon cranial model were performed to investigate changes in skull and sinus structure, including a model with no sinuses (sinuses 'filled' with bone) and a model with a midsagittal crest. Results indicate that the cranial sinuses in Diprotodon significantly lighten the skull while still providing structural support, a high bite force and low stress, indicating the cranium may have been able to withstand higher loads than those generated during feeding. Data from this study support the hypothesis that pneumatisation is driven by biomechanical loads and occurs in areas of low stress. The presence of sinuses is likely to be a byproduct of the separation of the outer surface of the skull from the braincase due to the demands of soft tissue including the brain and the large jaw adductor musculature, especially the temporalis. In very large species, such as Diprotodon, this separation is more pronounced, resulting in extensive cranial sinuses due to a relatively small brain compared with the size of the skull., (© 2016 Anatomical Society.)

The study was designed (1) to study the prevalence of pneumatisation of the superior turbinate in patients undergoing FESS, (2) to evaluate the role of superior turbinate pneumatisation in sinusitis involving the posterior sinuses. The study involved 50 patients being evaluated for FESS. Pre-operative CT scans were done and reviewed by a single observer with specific attention to superior turbinates. Record was also made for opacification/mucosal thickness of the sinuses. Each side of nasal cavity was examined separately. Therefore 50 patients had 100 sides. Of the 100 sides, superior turbinate was identified in 70 sides on CT scan. Of the 70 sides having an identifiable superior turbinate, 18.6 % i.e. thirteen sides had turbinates which were pneumatised. Pneumatised superior turbinates were seen in higher percentage in patients with diseased posterior sinuses. Pneumatised superior turbinate may contribute to posterior sinus disease and mandates attention during FESS.

The result of an inappropriate growth of the jaws is in many cases related to abnormalities in the rest of the facial skeleton. We present a 21-year-old patient with a possibly unique anomaly of the maxillary sinus in skeletal class III dentofacial deformity. This anatomical variant has not to our knowledge been previously reported and all clinicians should be aware of it. It presented not only as hypertrophy of the sinuses but also as a communication between the two maxillary sinuses, and might be associated with a severe III class deformity with an extremely narrow maxilla. We describe this as a narrowed maxillary canal with no septum or membrane., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)