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Oral Radiology

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18-01-2024 | Computed Tomography | Original Article

Clinically relevant morphometric analysis of pterygopalatine fossa and its volumetric relationship with adjacent paranasal sinuses: a CT-based study

Authors: Betül Digilli Ayaş, Aynur Emine Çiçekcibaşı, Ahmet Safa Gökşan, Gülay Açar, Demet Aydoğdu

Published in: Oral Radiology | Issue 2/2024

Abstract

Objectives

This study aimed to perform morphometric measurements of the pterygopalatine fossa (PPF), the transition zone to critical neurovascular structures. The second aim was to investigate the relationship between the volumes of the PPF and the paranasal sinuses and the effect of nasal septum deviation (NSD) types on all these measurements.

Methods

We performed PPF’s morphometry and all volume measurements on the CT images of 260 patients (130 male and 130 female, age range 18–79).

Results

All volumetric measurements and the angle between foramen rotundum (FR) and pterygomaxillary fissure (PMF) were significantly higher in males than females. In contrast, the distance between sphenopalatine foramen (SPF) and PMF was considerably higher in females than in males. The PPF volume, the distance between the pterygoid canal (PC) and maxillary sinus, and the angle between FR and PMF were significantly higher on the right side than on the left. In contrast, the angle between PC and SPF and between greater palatine canal and PPF were considerably higher on the left side than on the right. The angle between PC and SPF decreased markedly with age. Only sphenoidal sinus volume was significantly smaller on the same side as the septal deviation. There was no correlation between PPF volume with maxillary and sphenoid sinus volumes from adjacent paranasal sinuses.

Conclusions

Volumetric and morphometric data obtained from PPF and paranasal sinuses can aid clinicians in diagnosing and treating patients by guiding them in selecting the right surgical approach or tools, especially in endoscopic procedures.

Derinkuyu BE, Boyunaga O, Oztunali C, Alimli AG, Ucar M. Pterygopalatine fossa: not a mystery! Can Assoc Radiol J. 2017;68:122–30. https://doi.org/10.1016/j.carj.2016.08.001.CrossRefPubMed

Roberti F, Boari N, Mortini P, Caputy AJ. The pterygopalatine fossa: an anatomic report. J Craniofac Surg. 2007;18:586–90. https://doi.org/10.1097/scs.0b013e31805343c2.CrossRefPubMed

Fortes FS, Sennes LU, Carrau RL, Brito R, Ribas GC, Yasuda A, et al. Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model. Laryngoscope. 2008;118:44–9. https://doi.org/10.1097/MLG.0b013e318155a492.CrossRefPubMed

Von Arx T, Lozanoff S, von Arx T, Lozanoff S. Pterygopalatine Fossa. Clin Oral Anat Compr Rev Dent Pract Res. 2017;2017:251–70.

Janfaza P. Surgical anatomy of the head and neck. Cambridge: Harvard University Press; 2011.CrossRef

Tashi S, Purohit BS, Becker M, Mundada P. The pterygopalatine fossa: imaging anatomy, communications, and pathology revisited. Insights Imaging. 2016;7:589–99. https://doi.org/10.1007/s13244-016-0498-1.CrossRefPubMedPubMedCentral

Vuksanovic-Bozaric A, Vukcevic B, Abramovic M, Vukcevic N, Popovic N, Radunovic M. The pterygopalatine fossa: morphometric CT study with clinical implications. Surg Radiol Anat. 2019;41:161–8. https://doi.org/10.1007/s00276-018-2136-8.CrossRefPubMed

Gibelli D, Cellina M, Gibelli S, Cappella A, Panzeri MM, Oliva AG, et al. Anatomy of the pterygopalatine fossa: an innovative metrical assessment based on 3D segmentation on head CT-scan. Surg Radiol Anat. 2019;41:523–8. https://doi.org/10.1007/s00276-018-2153-7.CrossRefPubMed

Hwang SH, Joo YH, Seo JH, Kim SW, Cho JH, Kang JM. Three-dimensional computed tomography analysis to help define an endoscopic endonasal approach of the pterygopalatine fossa. Am J Rhinol Allergy. 2011;25:346–50. https://doi.org/10.2500/ajra.2011.25.3638.CrossRefPubMed

10.

Mohebbi A, Rajaeih S, Safdarian M, Omidian P. The sphenoid sinus, foramen rotundum and vidian canal: a radiological study of anatomical relationships☆. Braz J Otorhinolaryngol. 2017;83:381–7. https://doi.org/10.1016/j.bjorl.2016.04.013.CrossRefPubMed

11.

Hwang SH, Seo JH, Joo YH, Kim BG, Cho JH, Kang JM. An anatomic study using three-dimensional reconstruction for pterygopalatine fossa infiltration via the greater palatine canal. Clin Anat. 2011;24:576–82. https://doi.org/10.1002/ca.21134.CrossRefPubMed

12.

Lentzen M-P, Safi A-F, Riekert M, Visser-Vandewalle V, Grandoch A, Zirk M, et al. Volumetric analysis of the pterygopalatine fossa by semiautomatic segmentation of cone beam computed tomography. J Craniofac Surg. 2020;31:1334–7. https://doi.org/10.1097/SCS.0000000000006387.CrossRefPubMed

13.

Stajčić LS, Gačić B, Popović N, Stajčić Z. Anatomical study of the pterygopalatine fossa pertinent to the maxillary nerve block at the foramen rotundum. Int J Oral Maxillofac Surg. 2010;39:493–6. https://doi.org/10.1016/j.ijom.2009.11.002.CrossRefPubMed

14.

Pallanch JF, Yu L, Delone D, Robb R, Holmes DR III, Camp J, et al. Three-dimensional volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: clinical correlations and comparison to Lund-Mackay scoring. Int Forum Allergy Rhinol. 2013;3:963–72. https://doi.org/10.1002/alr.21219.CrossRefPubMedPubMedCentral

15.

Alaettin K. Are maxillary and sphenoid sinus volumes predictors of gender and age? A cone beam computed tomography study. Cumhur Dent J. 2020;23:348–55. https://doi.org/10.7126/cumudj.795870.CrossRef

16.

Cohen O, Warman M, Fried M, Shoffel-Havakuk H, Adi M, Halperin D, et al. Volumetric analysis of the maxillary, sphenoid and frontal sinuses: a comparative computerized tomography based study. Auris Nasus Larynx. 2018;45:96–102. https://doi.org/10.1016/j.anl.2017.03.003.CrossRefPubMed

17.

Kucybala I, Janik KA, Ciuk S, Storman D, Urbanik A. Nasal septal deviation and concha bullosa–do they have an impact on maxillary sinus volumes and prevalence of maxillary sinusitis? Pol J Radiol. 2017;82:126–33. https://doi.org/10.12659/PJR.900634.CrossRefPubMedPubMedCentral

18.

Orhan I, Ormeci T, Bilal N, Sagiroglu S, Doganer A. Morphometric analysis of sphenoid sinus in patients with nasal septum deviation. J Craniofac Surg. 2019;30:1605–8. https://doi.org/10.1097/SCS.0000000000005443.CrossRefPubMed

19.

Al-Rawi NH, Uthman AT, Abdulhameed E, Al Nuaimi AS, Seraj Z. Concha bullosa, nasal septal deviation, and their impacts on maxillary sinus volume among Emirati people: a cone-beam computed tomography study. Imaging Sci Dent. 2019;49:45–51. https://doi.org/10.5624/isd.2019.49.1.45.CrossRefPubMedPubMedCentral

20.

Avcı D, Tiryaki Ş. Does nasal septum deviation with different locations and different angular features affect maxillary sinus volumes? ENT Update. 2021. https://doi.org/10.5152/entupdates.2021.21035.CrossRef

21.

Kapusuz Gencer Z, Özkırış M, Okur A, Karaçavuş S, Saydam L. The effect of nasal septal deviation on maxillary sinus volumes and development of maxillary sinusitis. Eur Arch Otorhinolaryngol. 2013;270:3069–73. https://doi.org/10.1007/s00405-013-2435-y.CrossRefPubMed

22.

Bannon R, Parihar S, Skarparis Y, Varsou O, Cezayirli E. 3D printing the pterygopalatine fossa: a negative space model of a complex structure. Surg Radiol Anat. 2018;40:185–91. https://doi.org/10.1007/s00276-017-1916-x.CrossRefPubMed

23.

Singh P, Hung K, Ajmera DH, Yeung AWK, von Arx T, Bornstein MM. Morphometric characteristics of the sphenoid sinus and potential influencing factors: a retrospective assessment using cone beam computed tomography (CBCT). Anat Sci Int. 2021;96:544–55. https://doi.org/10.1007/s12565-021-00622-x.CrossRefPubMedPubMedCentral

24.

Frautschi RS, Halasa B, Orra S, Mlynek K, Steiner CP, Papay FA. Pterygopalatine fossa anatomy for a surgical approach to sphenopalatine ganglion. J Craniofac Surg. 2016;27:1866–9. https://doi.org/10.1097/SCS.0000000000003053.CrossRefPubMed

25.

Borsody MK, Sacristan E. Facial nerve stimulation as a future treatment for ischemic stroke. Brain Circ. 2016;2:164. https://doi.org/10.4103/2394-8108.195281.CrossRefPubMedPubMedCentral

26.

Standring S. Gray’s anatomy e-book: the anatomical basis of clinical practice. Amsterdam: Elsevier Health Sciences; 2021.

27.

El-Anwar MW, Eldib DB, Haggag MS, Almolla RM, Abd Elbary ME-S, Abdelaal TM, et al. Pterygopalatine fossa: a computed tomography analysis and classification. Pan Arab J Rhinol. 2021;11:145. https://doi.org/10.4103/pajr.pajr_25_21.CrossRef

28.

Javan R, Rao A, Jeun BS, Herur-Raman A, Singh N, Heidari P. From CT to 3D printed models, serious gaming, and virtual reality: Framework for educational 3D visualization of complex anatomical spaces from within—the pterygopalatine fossa. J Digit Imaging. 2020;33:776–91. https://doi.org/10.1007/s10278-019-00315-y.CrossRefPubMedPubMedCentral

29.

Gibelli D, Cellina M, Gibelli S, Oliva AG, Codari M, Termine G, et al. Volumetric assessment of sphenoid sinuses through segmentation on CT scan. Surg Radiol Anat. 2018;40:193–8. https://doi.org/10.1007/s00276-017-1949-1.CrossRefPubMed

30.

Kalabalık F, Tarım EE. Investigation of maxillary sinus volume relationships with nasal septal deviation, concha bullosa, and impacted or missing teeth using cone-beam computed tomography. Oral Radiol. 2019;35:287–95. https://doi.org/10.1007/s11282-018-0360-x.CrossRefPubMed

31.

Shrestha B, Shrestha R, Lin T, Lu Y, Lu H, Mai Z, et al. Evaluation of maxillary sinus volume in different craniofacial patterns: a CBCT study. Oral Radiol. 2021. https://doi.org/10.1007/s11282-020-00506-2.CrossRefPubMed

Title: Clinically relevant morphometric analysis of pterygopalatine fossa and its volumetric relationship with adjacent paranasal sinuses: a CT-based study
Authors: Betül Digilli Ayaş
Aynur Emine Çiçekcibaşı
Ahmet Safa Gökşan
Gülay Açar
Demet Aydoğdu
Publication date: 18-01-2024
Publisher: Springer Nature Singapore
Keywords: Computed Tomography
Computed Tomography
Published in: Oral Radiology / Issue 2/2024
Print ISSN: 0911-6028
Electronic ISSN: 1613-9674
DOI: https://doi.org/10.1007/s11282-023-00735-1

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Clinically relevant morphometric analysis of pterygopalatine fossa and its volumetric relationship with adjacent paranasal sinuses: a CT-based study

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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