Auswahl der wissenschaftlichen Literatur zum Thema „Ostiomeatal complex“

Abnormalities in the ostiomeatal complex (OMC) constitute a major factor in the pathogenesis of sinusitis. They may be appreciated by the classical anterior rhinoscopy, the endoscopic examination, and/or the coronal computed tomographic (CT) scan. Cases are seen, however, with clinical and radiological evidence of blockage of the OMC with no clinical sinusitis. Conversely, cases with definite sinusitis may have negative clinical examination and CT scans. Some patients continue to have sinusitis despite anatomically successful endoscopic surgery. It should be remembered that sinusitis may be caused by or facilitated by factors other than obstructions of the OMC. The decision to surgically treat sinusitis remains a clinical one based on a comprehensive evaluation.

<p class="abstract"><strong>Background:</strong> Anatomical variations like nasal septal deviations, concha bullosa, paradoxical middle turbinate, pneumatized or medially bent uncinate etc. can encroach upon the ostiomeatal unit and narrow ostiomeatal channels. The aim of the study was to study the anatomical variations of ostiomeatal complex commonly associated with paranasal sinus disease among patients with chronic sinusitis using computed tomography.</p><p class="abstract"><strong>Methods:</strong> A prospective longitudinal study was conducted in the ENT department of our hospital for a period of one year. All the adult patients with complaints suggestive of chronic rhinosinusitis for a period of more than 12 weeks, patients with acute exacerbation of chronic rhinosinusitis and with persistent chronic rhinosinusitis requiring surgical intervention are included in our study. Based on our inclusion and exclusion criteria a total of 138 patients were involved in the study. </p><p class="abstract"><strong>Results:</strong> In our study we saw the association between various sinusitis and the anatomic variations of the ostiomeatal complex and we found that concho bullosa found to have a strong significant association with maxillary sinusitis (43.6%) and anterior ethmoid sinusitis (42.1%). Most of the patients with posterior ethmoid sinusitis (53.8%) had a statistical significant association in developing deviated nasal septum type of anatomical variant and majority of the patients with sphenoidal sinusitis had a onodi cell type of anatomical variant and their association was found to be statistical significant (p&lt;0.05).</p><p><strong>Conclusions:</strong> The importance of CT scan and nasal endoscopy is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease. </p>

The aim: Was to evaluate the anatomical variability of the frontal and maxillary sinuses, ostiomeatal complex components (OMC) and to identify factors that contribute to complications of inflammatory processes and development of odontogenic maxillary sinusitis. Materials and methods: The study involved assessment of 100 spiral computed tomograms (SCT) of human patients without pathological processes in the PNS area. The basic parameters of the anatomical structure of the ostiomeatal complex (the area of the hooked process and the middle nasal conch, their transverse dimensions, the density and dimensions of the natural connection), the thickness and the density of the lower wall of the maxillary and frontal sinuses were determined. These parameters were investigated by the method of uncertainty calculation. Results: The findings showed that the bone density of the maxillary sinus on the left was 57.713 ± 440.356 Hu (minimum), 1101.507 ± 613.4882 Hu (maximum); 96.2752 ± 395.0 and 1028.691 ± 620.4051 on the right, respectively, the density of the inferior frontal sinus wall on the right was 5.5179 ± 276.43 and 831.1607 ± 732.274, on the left 12.069 ± 310.56 and 898.293 ± 748, respectively. In the same way, the probable OMC structure parameters, in the range ± U at the confidence level p = 0.95, were calculated. Conclusions: Thus, some variants of the anatomical structure of the ostiomeatal complex can be a prerequisite for hypoventilation of PNS and, as a consequence, lead to inflammatory processes in them. Features of the same structure of the walls of the PNS are a prerequisite for the propagation of the inflammatory process in the surrounding tissues and the development of complications.

Introdução. O estudo da anatomia da região naso-sinusal e de suas variações é de grande importância diagnóstica e para a definição de condutas de tratamento nas áreas da Odontologia e da otorrinolaringologia, principalmente em relação aos seios maxilares, regiões anatômicas diretamente relacionadas com os dentes superiores. Objetivos. Avaliar por meio da tomografia computadorizada de feixe cônico (TCFC) a prevalência das seguintes variações anatômicas do complexo ostiomeatal: concha bolhosa, células de Haller, desvios de septo nasal e aerações do processo uncinado e, ainda, avaliar a prevalência das afecções inflamatórias dos seios maxilares. A presença das variações anatômicas supramencionadas e de alterações apicais de dentes posteriores superiores serão correlacionadas com a presença das afecções inflamatórias dos seios maxilares. Material e Métodos. Foram avaliados 100 exames de TCFC de pacientes odontológicos escolhidos de forma aleatória de acordo com protocolos de aquisição que abrangiam as regiões anatômicas de interesse ao estudo. Todas as tomografias do estudo foram adquiridas através do tomógrafo i-Cat, modelo Classic e as imagens em formato DICOM foram visualizadas e analisadas através do software i-Cat Vision. Resultados. Os exames tomográficos avaliados eram de 100 pacientes, 43 do gênero masculino (média de idade de 23,7anos) e 57 do gênero feminino (média de idade de 25,8 anos). Todas as variações anatômicas em estudo foram visualizadas nos exames analisados. Oitenta e cinco indivíduos apresentaram uma ou mais de uma variação concomitantemente, enquanto 15 indivíduos não apresentaram qualquer tipo de variação anatômica. A maior prevalência foi de indivíduos que apresentaram duas variações anatômicas (38%). Desvio de septo nasal ocorreu em 67% dos pacientes. Considerando-se a possibilidade de ocorrência bilateral em cada paciente, concha média bolhosa, células de Haller e aeração do processo uncinado apresentaram, respectivamente, as seguintes prevalências: 31,5%; 20%; e 9%. As afecções inflamatórias dos seios maxilares apresentaram as seguintes distribuições e taxas de prevalências considerando-se análises bilaterais: em 74 seios maxilares não foram visualizadas afecções inflamatórias (37%); espessamento da mucosa sinusal foi visualizado em 97 seios maxilares (48,5%); e cistos de retenção / pseudocistos estavam presentes em 29 seios maxilares (14,5%). O grau de espessamento da mucosa dos seios maxilares foi estabelecido através de medidas milimétricas e, considerando-se análises bilaterais sem incluir cistos de retenção/pseudocistos, as seguintes distribuições e taxas de prevalência foram encontradas: classe I (mucosa sem alterações) foi vista em 74 seios maxilares (43,27%); espessamento tipo classe II (até 2mm) foi visualizado em 30 seios maxilares (17,54%); classe III (entre 2mm e 4mm) em 13 seios maxilares (7,60%); classe IV (entre 4mm e 10mm) em 30 seios maxilares (17,54%); e classe V (maior que 10mm) em 24 seios maxilares (14,03%). Na análise bilateral das condições dentárias / ósseas na região posterior da maxila encontrou-se que em 162 situações (81%) todos os dentes apresentavamse hígidos, enquanto em 11 situações (5,5%) havia a presença de hipodensidades ósseas compatíveis com lesões apicais. Aplicando-se o teste estatístico exato de Fisher (p<0,05) avaliou-se a correlação entre as hipodensidades ósseas apicais e a presença de afecções inflamatórias dos seios maxilares e os resultados mostraram que os achados foram casuais, sem significância estatística. Aplicando-se o mesmo teste estatístico para avaliar a correlação entre as variações anatômicas objetos da presente pesquisa e as afecções inflamatórias dos seios maxilares, os resultados foram estatisticamente significativos. Conclusão. A TCFC permitiu identificar todas as variações anatômicas do complexo ostiomeatal objetos do estudo e os diferentes tipos de afecções inflamatórias dos seios maxilares, assim como determinar as suas taxas de prevalência. As variações anatômicas apresentaram prevalência de 85% e o desvio de septo nasal foi a mais comum (67%). As afecções inflamatórias dos seios maxilares apresentaram taxa de prevalência de 65% e espessamento da mucosa sinusal foi a mais comum (47,5%). Enquanto as variações anatômicas do complexo ostiomeatal foram correlacionadas com as afecções inflamatórias dos seios maxilares, o mesmo não ocorreu em relação às hipodensidades apicais.
Introduction. The study of anatomy nasal-sinus and its variations is of great importance for the diagnosis and definition of behavior treatment in the areas of dentistry and otolaryngology, particularly in relation to the maxillary sinuses, anatomical regions directly related to the upper teeth. Objectives. Evaluate by beam computed tomography (CBCT) the prevalence of the following complex anatomical variations ostiomeatal: concha bullosa, Haller cells, nasal septum deviation and airings of the uncinate process, and also to assess the prevalence of inflammatory diseases of the sinuses jaws. The presence of anatomical variations above and apical changes of maxillary posterior teeth will be correlated with the presence of inflammatory diseases of the maxillary sinuses. Materials and Methods. We evaluated 100 CBCT examinations of dental patients chosen at random according to acquisition protocols covering the anatomical regions of interest to the study. All scans were acquired through the study of the tomograph i-Cat, Classic model and the images in DICOM format were viewed and analyzed using the software i-Cat Vision. Results. CT scans were evaluated for 100 patients, 43 males (mean age 23.7 years) and 57 females (mean age 25.8 years). All anatomical variations in the study were displayed in the images analyzed. Eightyfive subjects had one or more concomitant variation, while 15 subjects did not show any anatomical variation. The highest prevalence was individuals who had two anatomical variations (38%). Septal deviation occurred in 67% of patients. Considering the possibility of bilateral occurrence in each patient, concha bullosa, Haller cells and aeration of the uncinate process showed, respectively, the following rates: 31.5%, 20% and 9%. The inflammatory diseases of the maxillary sinuses showed the following distributions and prevalence rates considering bilateral analysis: in 74 maxillary sinuses were not visualized inflammatory disorders (37%), thickening of the Sinus mucosa was seen in 97 maxillary sinuses (48.5%) , retention cysts and / pseudocysts were present in the maxillary sinus 29 (14.5%). The degree of mucosal thickening of the maxillary sinuses was established through measures millimeter and considering bilateral analyzes excluding retention cysts / pseudocysts, the following distributions and prevalence rates were found: class I (unchanged mucosa) was seen in 74 maxillary sinuses (43.27%), thickened class II (up to 2mm) was seen in 30 maxillary sinuses (17.54%), Class III (2mm to 4mm) in 13 maxillary sinuses (7.60%); Class IV (between 4mm and 10mm) in 30 maxillary sinuses (17.54%) and Class V (greater than 10 mm) at 24 maxillary sinuses (14.03%). In the analysis of bilateral dental conditions / bone in the posterior maxilla was found that in 162 cases (81%) had all teeth are healthy, while in 11 cases (5.5%) had the presence of bone hipodensidades compatible apical lesions. Applying the Fisher exact test statistic (p <0.05) assessed the correlation between hipodensidades apical bone and the presence of inflammatory diseases of the maxillary sinuses and the results showed that the findings were casual, without statistical significance. Applying the same statistical test to evaluate the correlation between anatomical variations objects of this research and inflammatory diseases of the maxillary sinuses, the results were statistically significant. Conclusion. The CBCT identified all variations osteomeatal complex anatomical objects of study and the different types of inflammatory diseases of the maxillary sinuses, as well as determine their prevalence rates. Anatomical variations showed a prevalence of 85% and a deviated nasal septum was the most common (67%). The inflammatory diseases of the maxillary sinuses showed a prevalence rate of 65% and thickening of the sinus mucosa was the most common (47.5%). While the complex anatomical variations ostiomeatal were correlated with inflammatory diseases of the maxillary sinuses, this did not occur in relation to apical hipodensidades.

Rhinosinusitis is inflammation of the nasal passages and paranasal sinuses, commonly caused by allergies or viral infection. Sinusitis occurs after the development of rhinitis or inflammation of the nasal passages. Rhinitis is most commonly caused by allergens, but it also can be to the result of an infectious or autoimmune process. For rhinitis to progress to rhinosinusitis, there must be obstruction within the ostiomeatal complex, which is the draining center for the maxillary, anterior ethmoid, and frontal sinuses. History and physical exam are more specific than imaging for diagnosis. Complications arising from sinusitis can cause extensive morbidity if not recognized early. The most common complication is periorbital cellulitis arising from ethmoidal sinusitis. Evaluate for severe complications in immunocompromised patients. Adjunctive therapies to relieve nasal obstruction include medications that decrease mucosal edema as well as increase clearance of congestion. Consider avoiding antibiotics if symptoms are of short duration and are consistent with viral sinusitis.