Patterns of Pneumatization of the Posterior Nasal Roof

Abstract

(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.

Anatomical identification of supraseptal posterior ethmoid cells and its significance for endoscopic sinus surgery

“…At present, the cell is described and named SPEC because it is a medially and superiorly extended PE that is located the posterior superior of the nasal septum between the SS/PE and the PPE. This air cell is also called the supraseptal ethmoid sinus cell, sphenoseptal cell or ethmoidal origin of nasal roof pneumatization [3,4,10].…”

“…Initially, the SPEC was a focus owing to the pneumatization seen in the posterior superior of the nasal septum on the coronal plane [2,11]. In fact, identification of the SPEC must be made using combined imaging from the sagittal and axial planes; indeed, there would be many erroneous judgments if the SPEC was confirmed based only on coronal plane observations [10]. Anterior-superior expansion of the SS and sphenoethmoidal cell can also appear in the posterior superior of the nasal septum on the coronal plane (Figure 5-7).…”

“…Therefore, we should recognize the possibility of isolated PE appearance in the central area under the sphenoid planum (5.88%) when reviewing CT before ESS. Furthermore, the presence of the SPEC may increase ESS difficulty and surgical risk [4,10]. The SPEC shows a small space and narrow drainage channels, and the anterior and superior regions of the SPEC are adjacent to the skull base, cribriform plate and PPE.…”

“…The SPEC shows a small space and narrow drainage channels, and the anterior and superior regions of the SPEC are adjacent to the skull base, cribriform plate and PPE. In the event that an SPEC appears and there are lesions or opacities in it (Figure 4), the SPEC should be opened inferiorly and posteriorly to avoid injury to the skull base and to allow adequate opening, which can also avoid residual lesions or poor drainage during ESS [4,10].…”

Computed tomography-based assessment of sphenoid sinus and sella turcica pneumatization analysis: a retrospective study

“…Sphenoid sinus morphology exhibits significant inter-individual variations, with differing size, pneumatization, and septation patterns leading to variations in sphenoid sinus segmentation. In some individuals, pneumatization may extend to the pterygoid process, the clivus, the major wing of the sphenoid, and occasionally the anterior clinoid process ( Hiremath et al, 2018 ; Jaworek-Troć et al, 2020 ; Mureșan et al, 2022 ).…”