| Objective: Apply the radiological method, through compare the coronal CT scan reports between people who suffer chronic sinusitis and who don't suffer sinusitis, observe whether the incidence of anatomic variations of ostiomeatal complex in two groups is different, then draw the conclusion whether anatomic variations of ostiomeatal complex have relations with chronic sinusitis.Materials and Methods :1 Clinical MaterialsAccumulate 200 cases which are inspected sinus CT in our hospital from 2009 to 2010. Among them, 100 are involved in the process of sinusitis, they are selected into sinusitis group; 100 don't have sinusitis, polyp or accumulated liquid, they are selected into normal group.2 Parameters for Coronal CT ScansThe position of patients should be supine. Gantry angulation is perpendicular to infraorbitomeatal line. The scanning plane is vertical to the hard palate. The consecutive CT scans is then performed with thickness of 2mm every section from the anterior nasal spine to the posterior border of sphenoidal sinus. The scanner is set with a wide window setting of 400HU, centered at 40 HU, and with 120 kV peak and 200 mA. Intravenous contrast mediun was not applied in both groups.3 The Method of Measure and RecordMeasure the degree of uncinate process, and record the incidence of paradoxical curvature; observe and record the incidence of paradoxical middle turbinate, Haller's cell and agger nasi cell. Results: In all the uncinate process degrees which are measured, the normal group's degrees are distributed to 78.5°~of 170.5°, the average is for 133.5°. Among them, the people who have paradoxical curvature are 13, appear to lead to 13% (with 108°~180°for normal standard). The sinusitis group's degrees are distributed to 70.5°~of 175.5°, average for 118.5°. Therein, the people who have paradoxical curvature are 27, appear to lead to 27%.The discrepancy of the two sets of cases is been inspected byχ2, has already shown obvious meaning on the statistics (Ρ<0.05).In the two sets of cases, the incidence of pneumatization of middle turbinate are 9%and 25%,the discrepancy shows statistical meaning(Ρ<0.05); the incidence of paradoxical middle turbinate are 10% and 13%, the discrepancy doesn't show statistical meaning(Ρ>0.05); the incidence of Haller's cell are 12% and 27%, the discrepancy shows statistical meaning(Ρ<0.05); the incidence of agger nasi cell are 8% and 22%, the discrepancy shows statistical meaning(Ρ<0.05).Discussions: From all the results above, we can see some incidence of anatomic variation between the two groups are obviously different, especially the incidence of pneumatization of middle turbinate, uncinate process's paradoxical curvature, and Haller's cell. The incidence of paradoxical middle turbinate doesn't show big difference between two groups, which is accordance with reports. This makes us have new understanding again to the cause of disease of chronic sinusitis. Thus in the clinical operate, we should pay particular attention to these variations.1 Pneumatization of Middle Turbinate and Paradoxical Middle TurbinateMiddle Turbinate belongs to ethmoid bone, is divided into horizontal unit and perpendicular unit. The variations mainly are pneumatization of middle turbinate and paradoxical middle turbinate. Under the physical condition, the concave of middle turbinate faces outward. If it faces inside, we call this paradoxical middle turbinate. If there is an air cell in middle turbinate, we can call this pneumatization of middle turbinate. The air cell can exist in either horizontal unit or perpendicular unit, calling board of air cell or true concha bullosa. The incidence of true concha bullosa is much higher. The foreign professors think that the relation between paradoxical middle turbinate and sinusitis is not clear yet, but pneumatization of middle turbinate certainly affects streaming. Pneumatization of middle turbinate can even block the fissure between nasal septum and nasal cavity, stops liquid flowing and leads to inflammation in the long run.2 Uncinate Process's Paradoxical CurvatureUncinate process is a piece of new-moon-shape thin bone which belongs to ethmoid bone. It takes part in the structure of maxillary sinus and nasal fontanelles. The variation of uncinate process can surely lead to sinusitis. The variations mainly are uncinate process's paradoxical curvature, pneumatization of uncinate process, and fatty uncinate process. The degree of uncinate process has an average of 130°. If it curves inside, it will press middle turbinate, or go into middle nasal meatus and leads to the block of middle nasal meatus. If it curves outward, it will reduce the space of ethmoidal infundibulum and semilunar hiatus, finally brings about inflammation. Pneumatization of uncinate process, and fatty uncinate process are also serious, they can reduce the space which is already not enough in middle nasal meatus, limit streaming and lead to inflammation in the end.3 Haller's CellHaller's cell is firstly described by anatomist Albert Von Haller. It is the cell which is under the ethmoid, including the cell that outside the ethmoidal infundibulum. It will make the ethmoidal infundibulum much narrower, also affect the maxillary sinus around. It is not clear whether Haller's cell has relation with sinusitis, but it can surely press uncinate process and affect streaming of maxillary sinus. If the cell grows too big, it will become a factor of sinusitis of course.4 Agger Nasi CellAgger nasi cell exist in most people, it constitutes the former part of the frontal sinus's bottom. Ethmoidal infundibulum is at the back side of it. Huge Agger nasi cell can affect the streaming of frontal sinus, also can press ethmoid, block thmoidal infundibulum, and lead to frontal sinusitis, ethmoiditis, and maxillary sinusitis.Conclusions: The variations of Ostiomeatal complex have some relation with chronic sinusitis; uncinate process's paradoxical curvature, pneumatization of middle turbinate, Haller's cell and agger nasi cell can lead to chronic sinusitis; paradoxical middle turbinate has no relation with chronic sinusitis. |
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