The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis

Abstract

The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.

The relationship between superior attachment of the uncinate process of the ethmoid and varying paranasal sinus anatomy: an analysis using computerised tomography

“…[17,18] Cheng et al reached somewhat similar conclusions, with no clear correlation between the existence of an AN cell and the way the UP attached superiorly. [16] Our study did, however, find just such a correlation: there was a statistically significant correlation between the attachment type of SAUP and the existence of an AN cell, when the sides with or without an AN cell were compared (29.9% vs 23.5%).…”

“…Cheng et al reported that CB was present in 30.9% of cases, whilst Krzeski et al put the figure at 37.5%. The corresponding value in Ozcan et al was 48.1% [16,22,25] . Fadda et al used CT imaging of the paranasal sinuses from 200 individuals to show a prevalence of CB of 49.5% (69 cases).…”

“…Cheng et al reported comparable findings. [16] These findings can be interpreted as showing that pneumatisation of the middle concha pushes the UP closer towards it and thus increases the chance that attachment will occur at that point.…”

“…In the latter case, the frontal sinus will drain straight into the ethmoid infundibulum in an anterior direction to the middle meatus. [16,17] Research looking into how the uncinate process inserts superiorly has produced varying conclusions. Landsberg and Friedman found that the SAUP could occur in the following ways: to the lamina papyracea; to the posteromedial aspect of the agger nasi cell; to the lamina papyracea and the area where the middle concha joins the cribriform plate; to the area where the middle concha and cribriform plate join; to the roof of the ethmoid; and to the middle concha.…”

Importance of Keros Classification in Surgery

“…If not examined properly, damage to the skull base and cerebrospinal fluid rhinorrhea may possibly result. 13 Pneumatized middle concha is another frequently observed variation in the sinonasal region, with a rate of incidence of 13-73%, [14][15] subsequently exerting pressure on the middle concha and ethmoid labyrinth. 16,17 An uncinate process may also come in contact with a pneumatized middle concha, which may require surgical intervention.…”