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Authors paid attention to anatomy and clinical implications which are associated with the variations of the sphenoid sinus. We discuss also anatomical structure of the sphenoid bone implementing clinical application of this bone to different invasive and miniinvasive procedures (i.e. FESS).
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Background
The surgical significance of the lingual process of the sphenoid bone (LPSB) has not been sufficiently addressed. The purpose of this study was to describe the anatomical details of the LPSB in relation to the quadrangular space. Moreover, the incidence of the LPSB and its correlation with the pneumatization of the sphenoid sinus and the...
Citations
... These variances might present difficulties in clinical and surgical applications, highlighting the need of having a complete grasp of the sphenoid sinus' anatomy (Jaworek et al., 2010). Previous research demonstrates the variability of the sphenoid sinus (Kapakin, 2016;Jaworek-Troć et al., 2018, 2019. ...
Background
A preoperative three-dimensional examination of the sphenoid sinus anatomy, its pneumatization pattern, and its relevance to neighboring neurovascular constructions is crucial to preventing possible complications. In this study, the aim was to evaluate the relationship between sphenoid sinus pneumatization types and the sella turcica using computed tomography (CT).
Methods
CT data from 420 patients referred to the Department of Dentomaxillofacial Radiology were evaluated retrospectively. Sella pneumatization types were classified as conchal, presellar, incomplete sellar, and complete sellar, and they were evaluated. Obtained data were evaluated using the IBM SPSS 25.0 (Armonk, New York, USA) package program.
Results
CT images of 420 individuals, including 174 women and 246 men with a mean age of 43.87 ± 17.58 years, were included in the study. When the sella turcica morphologies were evaluated, the most widespread morphological type was irregularity in the posterior part of the dorsum sella, in 51.2% of cases. In addition, a statistically significant correlation was found between the pneumatization of the sphenoid sinus and the morphological types of sella ( p < 0.05).
Conclusion
In this research endeavor, the predominant observation comprised the complete sellar sphenoid sinus pneumatization type, exhibiting irregularity in the posterior aspect of the dorsum sella, representing one of the sellar types. Notwithstanding, it is imperative to conduct additional investigations to establish the generalizability of the present study’s findings.
... The sphenoid bone, wedged between the frontal, temporal, occipital, and parietal bones, is an irregular, unpaired, and pneumatic (airfilled) bone within the neurocranium. It also articulates with the ethmoid bone, vomer, zygomatic, and palatine bones [1]. The sphenoid bone forms the central part of the cranial base (basicranium) and contributes to the formation of the anterior cranial fossa, the middle cranial fossa, the posterior cranial fossa, the orbit, the nasal cavity, the temporal fossa, the infratemporal fossa, and the pterygopalatine fossa. ...
... Developmentally, the sphenoid forms as the result of fusion of several bones, including the presphenoid, basisphenoid, orbitosphenoid, alisphenoid, and pterygoid [3][4][5]. After the fusion is complete, the sphenoid consists of a central body housing the sphenoidal sinus and three even processes: greater and lesser wings, and two pterygoid processes [1,2]. The sphenoid bone is a clinically important landmark due to its complex anatomy and its proximity to critical structures of the head. ...
... The base of the pterygoid process is pierced by the pterygoid (Vidian) canal (Fig. 1), located just above and medially to the scaphoid fossa [1,2]. The pterygoid canal runs sagittally through the root of the pterygoid process and opens anteriorly into the pterygopalatine fossa [29][30][31]. ...
The sphenoid bone, an unpaired, irregular, and pneumatic (air-filled) component of the neurocranium, is a clinically important landmark, particularly in surgery and radiology. This bone is often regarded as one of the most complex bones of the skull. This literature review aims to compile peer-reviewed articles concerning the anatomy of the sphenoid bone while briefly exploring its clinical relevance. The sphenoid bone consists of a centrally positioned body containing the sphenoidal sinus, as well as three pairs of processes projecting from the body, namely the greater wings, lesser wings, and pterygoid processes. The sphenoid is closely associated with five cranial nerves (CNs II, III, IV, V 1 , V 2 , and VI) and is adjacent to the pituitary gland. The cavernous sinus, housing the internal carotid artery, lies laterally to the body of the sphenoid. Various neurological conditions, such as injury, inflammation, vascular malformations, aneurysms, and tumors, can either directly impact the sphenoid or occur in close proximity to it. A comprehensive understanding of the anatomy of the sphenoid is indispensable for diagnosing and planning the treatment of these conditions. Therefore, a detailed knowledge of the anatomy of the head, including the sphenoid, is essential in clinical practice. It ensures accurate diagnoses, safe surgical procedures, and effective management of diverse conditions affecting the skull, sinuses, brain, and adjacent structures. Inaccuracies or errors in the diagnosis or treatment of such conditions can lead to adverse patient outcomes, including various complications and delayed management of serious neurological conditions.
... In the latter case, the bone covering the carotid artery, optic nerve, and nerve of the pterygoid canal (Vidian nerve) may be thin or even non-existent, making these vital structures susceptible to iatrogenic trauma (4). At present, endoscopic surgery of the sphenoid sinus is an acceptable technique for treatment of sinus problems and adenomas of the pituitary gland, and serves as an alternative to trans-cranial surgery, which is highly invasive and is associated with high rates of complications, morbidity and mortality (2,(4)(5)(6). However, all surgical approaches (trans-ethmoidal, trans-nasal, and trans-septal) access sella through the sphenoid sinus in microscopic or endoscopic surgical procedures (4,6,7), and therefore, are associated with high risk of injury to the internal carotid artery and uncontrolled bleeding, which would often result in indirect damage to the optic nerve due to poor visibility (8,9). ...
Background: The aim of the study was to determine the anatomical variations of the sphenoid sinus and its adjacent critical structures using Cone-Beam Computed Tomography (CBCT). Methods: This cross-sectional study was conducted on CBCT scans of 67 females and 84 males between 18 to 67 years. Presence/ absence of intersphenoid septa, sphenoid sinus pneumatization and its type (conchal, presellar, sellar, and postsellar a and b), protrusion of the optic canal and carotid canal into the sphenoid sinus, optic canal and carotid canal dehiscence, and Anterior Clinoid Process (ACP) pneumatization was evaluated on CBCT scans, and their prevalence and correlation were calculated. Data were analyzed by the Chi-square test (alpha=0.05). Results:The prevalence of intersphenoid septa was 98.68%. Postsellar type a was the most common type of sphenoid sinus pneumatization with a prevalence of 41.3%. The prevalence of conchal, presellar, sellar and postsellar b types was 0, 11, 30, and 17.7%, respectively. The prevalence of optic canal and carotid canal protrusion into the sphenoid sinus was 50 and 52.7%, respectively. The prevalence of optic canal and carotid canal dehiscence was 48.3 and 40.3%, respectively. The prevalence of ACP pneumatization was 45%. Optic canal and carotid canal protrusion had a significant correlation with ACP pneumatization (p<0.001). Also, carotid canal and optic canal protrusion and dehiscence were significantly correlated with degree of sphenoid sinus pneumatization (p<0.001). Conclusion: Sphenoid sinus pneumatization significantly increases the likelihood of carotid canal, optic canal protrusion into the sphenoid sinus and their dehiscence, therefore, a preoperative 3D imaging is strongly recommended prior to trans-sphenoidal surgical procedures.
... Other relevant structures mostly pertain to the lateral wall of the sphenoid sinus and ethmoid including the cavernous sinus and all its enclosed structures (cranial nerves III, IV, VI, V 1 , and V 2 ) and the vidian nerve, as well as even the brain stem behind the clival part of the sphenoid bone. Anatomic variants of the paranasal sinuses and nasal cavity may be more common, and may even overlap leading to complicated structure and function [7][8][9][10][11][12][13][14][15][16]. ...
Background: Onodi cell is a posterior ethmoid air cell with the optic canal bulging into it; the common position of the bulge is into the sphenoid sinus, usually immediately posterior to the posterior ethmoid air cells. Variable pneumatization patterns lead to various structures of lamellae and sinuses occasionally exposing important nerves and vessels, such as the optic and vidian nerves, internal carotid artery and cavernous sinus. In clinical practice, special imaging techniques are used to navigate through the paranasal sinuses and hence avoid injury to these structures. This study is aimed to determine the prevalence of
the Onodi cell in the Polish population and compare it with other reported occurrences.
Materials and methods: A retrospective analysis of 296 computed tomography (CT)
scans of patients treated in Cracow, Poland, using a Siemens Somatom Sensation 16 spiral CT scanner. No contrast medium was administered.
Results: The Onodi cell was found in 31 out of the 296 patients, or approximately 10.5%, consistent with the majority of research reporting on Onodi variants. Additionally, there was one presentation of a bilateral Onodi cell in a male patient. No statistically significant difference was found between the male and female populations with a positive identification of the variant (p = 0.095, Chi
2 test).
Conclusions: This study helped approximate the Onodi variant prevalence of 10.47%, falling within a commonly reported range 8-14%. This gives clinicians and surgeons a better understanding of this variant's structure and significance, and therefore an opportunity to improve treatment outcomes and research.
... Surgical access to the sella turcica and the surrounding neurovascular structures are determined by the degree of pneumatization. A highly pneumatized sphenoid sinus can cause anatomical distortion or impinge the sinuses which are defined as protrusion, so care should be taken during the operation to avoid damaging the ON or ICA [2,9]. For this purpose, there are many studies examining the changes in the pneumatization and protrusions of the sphenoid sinus [10][11][12][13]. ...
PurposeAccessory sphenoidal septum (ASS) is a septal variation that exists in addition to the primary septum of the sphenoid sinus and can be found in or near anatomically essential structures. This study aimed to investigate the relationships between protrusions of vital structures around the sphenoid sinus and the ASSs.Methods
This cross-sectional retrospective study is based on the analysis of CBCT scans of 314 patients in axial, coronal, and sagittal planes with 0.2–0.3 slice thicknesses. Optic nerve (ON), internal carotid artery (ICA), both ON and ICA, maxillary nerve (MN), vidian canal (VN) and ASSs were detected, and the relationship between protrusions of these vital anatomical structures and ASS was evaluated.ResultsStatistically significant relationship was observed between the right Type 1 ON protrusion (p < 0.05) and left Type 1 ON protrusion (p = 0.001); left Type 3 ON protrusion (p < 0.05); right Type 4 ON protrusion (p < 0.05) and ASS. Statistically significant relationship was also observed between the right ICA protrusion and ASS (p < 0.05). The right Type 1 VN protrusion (p = 0.001); left Type 2 VN protrusion (p < 0.001); right and left Type 3 VN protrusions (p < 0.001) were found to be significantly associated with the ASS.ConclusionsASSs have significant associations with some protrusions, and they tend to cause potentially severe complications in endoscopic sinus surgery. This variability requires a comprehensive understanding of regional sphenoid sinus anatomy with detailed three-dimensional tomographic imaging.
... In case of strongly aerated sinuses, the structures located in the nearest vicinity of the sinus may be separated only by very thin bony lamina. Additionally it may contain bony dehiscence [8]. The lumen of the cavernous sinus is traversed by the siphon of the internal carotid artery and the Abducens nerve (VI cranial nerve).While within the lateral wall of the sinus there are Oculomotor , Trochlear nerve, Ophthalmic nerve (first division of the trigeminal nerve), Maxillary nerve (second division of the trigeminal nerve). ...
... Sphenoid sinus masses can extend to the ethmoidal labyrinth and break the CPEB [6]. Moreover, as the CPEB is a thin portion of the skull base, it is susceptible to lesions [7,8]. Fractures in the anterior fossa usually cross the CPEB [9]. ...
... Such anterior supranasal recesses of the sphenoidal sinus are commonly observed in computed tomography scans but are overlooked [30]. A number of other studies have provided important details regarding the numerous anatomic possibilities of the sphenoidal sinuses [8,[31][32][33][34][35][36][37][38][39]. However, there is still a substantial amount of research that needs to be conducted on this aspect [31]. ...
(1) Background: For good surgical performance, sound knowledge of anatomy is required. Although the ethmoid air cells and sphenoid sinuses are subject to a high degree of variation, their possible extensions above the nasal fossa at the posterior end of the cribriform plate of the ethmoid bone (CPEB) were seemingly overlooked. (2) Methods: We retrospectively studied 162 case files from 55 male and 107 female cases, with ages varying from 42 to 80, which were scanned using Cone Beam Computed Tomography. (3) Results: In 56.17% of cases, an unpneumatized CPEB (type I) was found. Nasal roof recesses of ethmoidal origin (type II) were found at the posterior end of the CPEB in 20.37% of cases. Different types of sphenoidal pneumatizations of the posterior end of the CPEB (type III) were found in 22.83% of the cases. Onodi cells projected nasal roof recesses (type IV) in only 10 cases. In all types, nasal roof recesses were found either above the CPEB or within/underneath it. Moreover, such nasal roof recesses were found to be either unilateral, extended contralaterally, or bilateral. (4) Conclusions: As such recesses of the posterior CPEB, previously overlooked, belong to the posterior rhinobase, they should be carefully documented preoperatively to avoid unwanted surgical damage to the olfactory bulb or CSF fistula.
... Among the many structures of the skull, the sphenoid bone is located in the retro maxillary region, characterized by being single, noncompact and complex [12]. there are bilateral pterygoid processes that originate infra side from the sphenoid body Among the anatomical structures and accidents that form it, characterized by two bony plates that fuse above, thus forming a kind of angle [12,13]. ...
Objective
To obtain angular measurements formed from the junction of the bilateral pterygoid processes of the sphenoid bone through computed tomography scans of the conical beam of the sphenoid bone, in order to correlate them with the estimation of gender and age in a human identification process.
Materials and Methods
602 computed tomography (CBCT) scans were selected – 301 males and 301 females. The tomographic images were analyzed, in low light conditions, independently the using of the free access software Radiant DICOM Viewer and, within the program, an angle calculation tool was applied on top of the axial cut in the union of the pterygoid processes medial and lateral bilaterally. The collected data were quantified in tables according to their age and gender, in addition to being statistically analyzed.
Results
There was no correlation between increasing age and the angles formed by bilateral pterygoid processes. But there is a statistically significant difference between the values of the angles between males and females on the left and right sides, t(600)=2.6186 (p-value = 0.0091) and t(600)=3.3593 (p- value = 0.0008), respectively.
Conclusion
Based on our results, there are statistically significant differences between genders in relation to the angles formed by the pterygoid processes of the sphenoid bone, with higher descriptive values in men with older ages.
... Undoubtedly sphenoid sinuses are an anatomical entity with one of the most variant anatomy, con-cerning namely its septation, proximity to the nearby crucial neurovascular structures, pneumatisation patterns and others [19][20][21][22][23][24][25][26][27]34]. Notwithstanding, there is still a constant need for new reports regarding their variations due to the fact that they are of immense importance namely in functional endoscopic sinus surgery and transnasal transsphenoidal approaches for the pituitary surgery and medical professionals are still poorly acquainted with some of the anatomical features (e.g. the exact parasympathetic pathway of the ethmoid and sphenoid sinuses) [8]. ...
Background:
Sphenoid sinuses are pneumatic spaces within the body of the sphenoid bone. Their development begins in the prenatal life and continues until the adulthood. Agenesis of the sphenoid sinuses is a situation in which they are undeveloped. On the other hand, asingle sphenoid sinus lacks the presence of the main septum, leading to the formation of a single antrum. Contemporary use of transnasal transsphenoidal approaches for the pituitary surgery, as well as functional endoscopic sinus surgery urges medical professionals to be well acquainted with the aforementioned variant.
Materials and methods:
Paranasal sinuses of 300 patients (150 females, 150 males) were evaluated using computed tomography, without the use of contrast medium. Inclusion criteria involved absence of any identifiable pathology within the sphenoid sinuses and age over 18 years. Subgroup analysis involved probing for potential sources of heterogeneity, namely gender.
Results:
In the whole research material of 300 patients, agenesis of the sphenoid sinuses was noted in 1% of the patients. No statistically significant differences were noted between the absence of the sphenoid sinuses and gender (p = 0.999). A single sphenoid sinus was found in 0.33% of the patients. There were no statistically significant differences found between the presence of fully developed sphenoid sinuses and gender (p = 0.498).
Conclusions:
Both agenesis of the sphenoid sinuses, as well as a single sphenoid sinus are rare anatomical variants. Adequate planning for transsphenoidal surgeries with preoperative medical imaging is of essence in order to perform a safe and quality procedure.
... Notwithstanding, the sphenoid sinuses are to date assessed from every possible angle due to their vastly complicated and varied anatomy. Some of the most recognizable variants include their dimensions, extensive pneumatisation and hence presence of recesses, as well as relation to the neighboring neurovascular entities, namely the internal carotid canal [10][11][12][13][14][15][16]22]. ...
... Having identified the ostium, the anterior wall of the sphenoid sinus is typically excised around the both ostia, allowing for a facilitated access into the sinus [3]. In order to perform a safe transsphenoidal endoscopic or microscopic procedure, it is also imperative for the surgeon to be spatially orientated about the maximum diameter of the sinus, location of the carotid canal, the optic canal and other major surrounding neurovascular entities [1,11,13]. ...
Background:
The purpose of this research was to evaluate the size of the sphenoid sinuses' ostia, the distance between them and the distance between the medial margin of the ostia and the median line in the Polish adult population.
Materials and methods:
The analysis was undertaken as a retrospective study of 296 computed tomography (CT) scans of patients (147 females, 149 males) with no comorbidities in their sphenoid sinuses. The paranasal sinuses were investigated by using Spiral CT Scanner (Siemens Somatom Sensation 16), in the option Siemens CARE Dose 4D, without administering any contrast medium. Having obtained transverse planes, multiplans reconstruction tool was used in order to glean sagittal and frontal planes.
Results:
The average size of both sphenoid sinuses ostia was 0.31 cm for both genders (for females ranging from 0.1 to 0.5 cm and from 0.1 to 0.6 cm for males). The mean distance between both sphenoid sinuses ostia was 0.6 cm for both genders (the range for females was 0.1-1.4 cm, whereas 0.1-1.8 cm for males). The average distance between the medial margin of the ostium and the median line was 0.32 cm for both genders (0.31 cm for females in the range of 0-0.9 cm and 0.32 cm for males in the range of 0-1 cm).
Conclusions:
Intraoperative identification of the sphenoid sinus ostia might prove difficult and their inadequate excision could lead to potential iatrogenic complications, hence detailed anatomical descriptions are still warranted in specific populations in order to perform safe and effective procedures.
