Skip to main content
Log in

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

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Wigand ME (1981) Transnasal ethmoidectomy under endoscopical control. Rhinology 19:7–15

    CAS  PubMed  Google Scholar 

  2. Stammberger H, Hawke M (1991) Functional endoscopic sinus surgery: the Messerklinger technique. Decker, Philadelphia, pp. 61–90.

    Google Scholar 

  3. Landsberg R, Friedman M (2001) A computer-assisted anatomical study of the nasofrontal region. Laryngoscope 111:2125–2130

    Article  CAS  PubMed  Google Scholar 

  4. Ercan I, Cakir BO, Sayin I, Başak M, Turgut S (2006) Relationship between the superior attachment type of uncinate process and presence of agger nasi cell: a computer-assisted anatomic study. Otolaryngol Head Neck Surg 134:1010–1014

    Article  PubMed  Google Scholar 

  5. Zhang L, Han D, Ge W, Xian J, Zhou B, Fan E et al (2006) Anatomical and computed tomographic analysis of the interaction between the uncinate process and the agger nasi cell. Acta Otolaryngol 126:845–852

    Article  PubMed  Google Scholar 

  6. Liu SC, Wang CH, Wang HW (2010) Prevalence of the uncinate process, agger nasi cell and their relationship in a Taiwanese population. Rhinology 48:239–244

    PubMed  Google Scholar 

  7. Wormald PJ (2003) The agger nasi cell: the key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg 129:497–507

    Article  PubMed  Google Scholar 

  8. Angelico FV Jr, Rapoport PB (2013) Analysis of the Agger nasi cell and frontal sinus ostium sizes using computed tomography of the paranasal sinuses. Braz J Otorhinolaryngol 79:285–292

    Article  Google Scholar 

  9. Bolger WE, Butzin CA, Parsons DS (1991) Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 101:56–64

    Article  CAS  PubMed  Google Scholar 

  10. Perez-Piñas, Sabaté J, Carmona A, Catalina-Herrera CJ, Jiménez-Castellanos J (2000) Anatomical variations in the human paranasal sinus region studied by CT. J Anat 197:221–227

    Article  PubMed  PubMed Central  Google Scholar 

  11. Unlu HH, Akyar S, Caylan R, Nalca Y (1994) Concha bullosa. J Otolaryngol 23:23–27

    CAS  PubMed  Google Scholar 

  12. Maru YK, Gupta Y (1999) Concha bullosa: Frequency and appearances on sinonasal CT. Indian. J Otolaryngol Head Neck Surg 52:40–44

    CAS  Google Scholar 

  13. Keros P (1962) On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol 41:809–813

    CAS  PubMed  Google Scholar 

  14. Mahmutoglu AS, Celebi I, Akdana B, Bankaoglu M, Çakmakçi E, Çelikoyar MM, Basak M (2015) Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis. J Craniofac Surg 26:87–90

    Article  PubMed  Google Scholar 

  15. Freitas AP, Boasquesvisque EM (2008) Anatomical variants of the ostiomeatal complex: tomographic findings in 200 patients. Radiol Bras J 41:149–154

    Article  Google Scholar 

  16. Basak S, Akdilli A, Karaman CZ, Kunt T (2000) Assessment of some important anatomical variations and dangerous areas of the paranasal sinuses by computed tomography in children. Int J Pediatr Otorhinolaryngol 55:81–89

    Article  CAS  PubMed  Google Scholar 

  17. Neskey D, Eloy JA, Casiano RR (2009) Nasal, septal, and turbinate anatomy and embryology. Otolaryngol Clin North Am 42:193–205

    Article  PubMed  Google Scholar 

  18. Uygur K, Tuz M, Dogru H (2003) The correlation between septal deviation and concha bullosa. Otolaryngol Head Neck Surg 129:33–36

    Article  PubMed  Google Scholar 

  19. Uzun L, Aslan G, Mahmutyazicioglu K, Yazgan H, Savranlar A (2012) Is pneumatization of middle turbinates compensatory or congenital? Dentomaxillofac Radiol 41:564–570

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Chaiyasate S, Baron I, Clement P (2007) Analysis of paranasal sinus development and anatomical variations: a CT genetic study in twins. Clin Otolaryngol 32:93–97

    Article  CAS  PubMed  Google Scholar 

  21. Badia L, Lund VJ, Wei WI, Ho WK (2005) Ethnic variation in sinonasal anatomy on CT-scanning. Rhinology 43:210–214

    PubMed  Google Scholar 

  22. Yeoh KH, Tan KK (1994) The optic nerve in the posterior ethmoid in Asians. Acta Otolaryngol 114:329–336

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cheng-Ping Shih.

Ethics declarations

Conflict of interest

There is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheng, SY., Yang, CJ., Lee, CH. et al. The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis. Eur Arch Otorhinolaryngol 274, 1905–1910 (2017). https://doi.org/10.1007/s00405-016-4441-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-016-4441-3

Keywords

Navigation