open access

Vol 77, No 1 (2018)
ORIGINAL ARTICLES
Published online: 2017-07-06
Submitted: 2017-01-23
Accepted: 2017-04-02
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The supreme turbinate and the drainage of the posterior ethmoids: a computed tomographic study

T. Gotlib, M. Kuźmińska, J. Sokołowski, T. Dziedzic, K. Niemczyk
DOI: 10.5603/FM.a2017.0067
·
Pubmed: 28703849
·
Folia Morphol 2018;77(1):110-115.

open access

Vol 77, No 1 (2018)
ORIGINAL ARTICLES
Published online: 2017-07-06
Submitted: 2017-01-23
Accepted: 2017-04-02

Abstract

Background: It is generally acknowledged that the posterior ethmoidal cells drain under the superior nasal turbinate (SorNT) or, rarely, under the supreme nasal turbinate (SmeNT), and the sphenoid ostium (SO) opens to the sphenoethmoidal recess. However, detailed relations between these structures are variable, complex and still not clear. There is no reliable data on the prevalence of SmeNT and drainage of the posterior ethmoidal cells under this structure. The aim of this study was to re-evaluate the anatomy of the aforementioned region.

Materials and methods: Multiplanar and three-dimensional reconstruction analysis of 100 thin slice paranasal sinus computed tomography scans.

Results: SmeNT was identified in 77 subjects (136 sides). It formed the ostium to the posterior ethmoidal cell adjacent to the skull base or orbit in 58 subjects (91 sides). This cell drained independently from the remaining posterior ethmoidal cells. The sphenoethmoidal (Onodi) cell drained to supreme meatus in 41 subjects (54 sides), and to superior meatus in 37 subjects (49 sides). SO was always located medial to the posteroinferior attachment of SmeNT, or SorNT (in absence of SmeNT).

Conclusions: Patients with divergent drainage of the posterior ethmoids (with posterior ethmoidal cell draining to the supreme meatus) may require more extensive surgery to avoid persistence or recurrence of inflammatory disease. SmeNT is more common than thought, but due to its posterior and superior location to SorNT, it is rarely seen intraoperatively. If SmeNT is present, SO is always located medial to its posteroinferior attachment. (Folia Morphol 2018; 77, 1: 110–115)

Abstract

Background: It is generally acknowledged that the posterior ethmoidal cells drain under the superior nasal turbinate (SorNT) or, rarely, under the supreme nasal turbinate (SmeNT), and the sphenoid ostium (SO) opens to the sphenoethmoidal recess. However, detailed relations between these structures are variable, complex and still not clear. There is no reliable data on the prevalence of SmeNT and drainage of the posterior ethmoidal cells under this structure. The aim of this study was to re-evaluate the anatomy of the aforementioned region.

Materials and methods: Multiplanar and three-dimensional reconstruction analysis of 100 thin slice paranasal sinus computed tomography scans.

Results: SmeNT was identified in 77 subjects (136 sides). It formed the ostium to the posterior ethmoidal cell adjacent to the skull base or orbit in 58 subjects (91 sides). This cell drained independently from the remaining posterior ethmoidal cells. The sphenoethmoidal (Onodi) cell drained to supreme meatus in 41 subjects (54 sides), and to superior meatus in 37 subjects (49 sides). SO was always located medial to the posteroinferior attachment of SmeNT, or SorNT (in absence of SmeNT).

Conclusions: Patients with divergent drainage of the posterior ethmoids (with posterior ethmoidal cell draining to the supreme meatus) may require more extensive surgery to avoid persistence or recurrence of inflammatory disease. SmeNT is more common than thought, but due to its posterior and superior location to SorNT, it is rarely seen intraoperatively. If SmeNT is present, SO is always located medial to its posteroinferior attachment. (Folia Morphol 2018; 77, 1: 110–115)

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Keywords

turbinates, anatomy, computerised tomography, ethmoid sinus, sphenoid sinus, drainage

About this article
Title

The supreme turbinate and the drainage of the posterior ethmoids: a computed tomographic study

Journal

Folia Morphologica

Issue

Vol 77, No 1 (2018)

Pages

110-115

Published online

2017-07-06

DOI

10.5603/FM.a2017.0067

Pubmed

28703849

Bibliographic record

Folia Morphol 2018;77(1):110-115.

Keywords

turbinates
anatomy
computerised tomography
ethmoid sinus
sphenoid sinus
drainage

Authors

T. Gotlib
M. Kuźmińska
J. Sokołowski
T. Dziedzic
K. Niemczyk

References (11)
  1. Bolger WE, Keyes AS, Lanza DC. Use of the superior meatus and superior turbinate in the endoscopic approach to the sphenoid sinus. Otolaryngol Head Neck Surg. 1999; 120(3): 308–313.
  2. Christmas DA, Mirante JP, Yanagisawa E. Supreme nasal turbinate as a landmark during endoscopic sphenoid sinus surgery. Ear Nose Throat J. 2004; 83(2): 84–85.
  3. Eweiss AZ, Ibrahim AA, Khalil HS. The safe gate to the posterior paranasal sinuses: reassessing the role of the superior turbinate. Eur Arch Otorhinolaryngol. 2012; 269(5): 1451–1456.
  4. Fokkens WJ, Lund VJ, Mullol J, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012; 50(1): 1–12.
  5. Hopkins C. Nose, Nasal Cavity and Paranasal Sinuses. In: Susan Standring ed. Gray’s Anatomy. 561.The Anatomical Basis and Clinical Practice. Forty-first edition, Elsevier 2016.
  6. Kim HU, Kim SS, Kang SS, et al. Surgical anatomy of the natural ostium of the sphenoid sinus. Laryngoscope. 2001; 111(9): 1599–1602.
  7. Kim SS, Lee JG, Kim KS, et al. Computed tomographic and anatomical analysis of the basal lamellas in the ethmoid sinus. Laryngoscope. 2001; 111(3): 424–429.
  8. Millar DA, Orlandi RR. The sphenoid sinus natural ostium is consistently medial to the superior turbinate. Am J Rhinol. 2006; 20(2): 180–181.
  9. Orhan M, Govsa F, Saylam C. A surgical view of the superior nasal turbinate: anatomical study. Eur Arch Otorhinolaryngol. 2010; 267(6): 909–916.
  10. Orlandi RR, Lanza DC, Bolger WE, et al. The forgotten turbinate: the role of the superior turbinate in endoscopic sinus surgery. Am J Rhinol. 1999; 13(4): 251–259.
  11. Stammberger H. Functional Endoscopic Sinus Surgery. The Messerklinger technique 1991.

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