Sinoliths are calculi found particularly in paranasal sinuses, the rarest location being the ethmoid air cells. There were previously reported only 4 cases of unilateral large ethmoidal sinoliths (ES), this one being the fifth report. We report here the incidental bilateral evidence in a 34-year-old female patient evaluated in Cone Beam Computed Tomography (CBCT) of minor ES. The left ES, of 1.6 mm2 sagittal size, occupied the suprabullar cell, in front of the ground lamella and behind the anterior ethmoidal canal. The right ES, of 7.6 mm2, was located behind the ground lamella. The radiodensity of each ES was about 1000 HU, their bone quality being thus assessed. This is the first evidence of bilateral and clinically silent ethmoidal sinoliths. Being small-sized and incidentally found, it seems reasonable to consider that ethmoidal sinoliths could have a higher incidence but they are overlooked due to the lack of clinical manifestations.
Mugurel Constantin Rusu, Andrei Leonid Chirita and Mihai Sandulescu
BACKGROUND. The infraorbital recess of the maxillary sinus can reach in front of the nasolacrimal duct to become prelacrimal recess. During a routine Cone Beam CT (CBCT) study of a male patient of 72 years old, there were bilaterally found infraorbital maxillary air cells (IMACs) resulted after the almost complete closure of infraorbital recesses of the maxillary sinuses. Only that on the left side was reaching in front of the nasolacrimal canal. The closure of each infraorbital recess leaded to a narrow draining passage opened in the terminal end of the maxillary infundibulum, thus proximal to the maxillary sinus ostium. On the left side, a small cell of the lacrimal bone was interposed between the IMAC drainage pathway and the nasolacrimal canal. On the right side, the nasolacrimal canal was communicating with the ethmoidal infundibulum. Such an anatomic variation in the infraorbital angle of the maxillary sinus can impede the endoscopic procedures which use the anterior lacrimal pathway.
Catalina Craiu, Mihai Sandulescu and Mugurel Constantin Rusu
BACKGROUND. The pneumatization pattern of the sphenoid sinus seems rather unpredictable, as resulted from previous studies. It is however extremely important for endoscopic approaches to target structures of the middle cranial fossa, such as the pituitary gland.
MATERIAL AND METHODS. We aimed at documenting by Cone Beam Computed Tomography (CBCT) the possibilities of anatomic variation of the sphenoid sinus. 25 randomly selected patients were retrospectively analyzed.
RESULTS. In 56%, the left and right sphenoidal sinuses were bilaterally symmetrical with respect to the sagittal pneumatization type: four patients had sellar types, one had presellar type and in nine cases the sphenoidal sinuses were reaching posteriorly to the sella turcica. Only in 8% of cases were found conchal types of pneumatization, but they were part of anatomical pictures including Onodi air cells. Such an Onodi cell presented a posterior (sphenoidal) recess reaching posteriorly and superiorly to the pterygopalatine fossa. The recesses of the sphenoid sinus were also documented: anterior or septal, ethmoidal, maxillary, clinoidal and lateral. In 32% was found a lateral recess only engaged between the vidian and maxillary nerve canals.
CONCLUSION. It appears that CBCT is a reliable tool for accurate anatomic identification of the sphenoid sinus pneumatization pattern, on a case-by-case basis.
Andreea – Ioana Derjac-Arama, Stefania Anca Mihai, Mihai Sandulescu and Mugurel Constantin Rusu
Background. Functional endoscopic sinus surgery may be indicated when certain anatomic variations impede the normal drainage of the paranasal sinuses through the ostiomeatal complex. We aimed at studying the drainage system of the maxillary sinus which consists of the maxillary infundibulum, the main ostium of the maxillary sinus, the ethmoidal infundibulum and the hiatus semilunaris inferior.
Material and methods. The study was performed retrospectively on cone beam computed tomography (CBCT) scans of 60 subjects (N=120 maxillary sinuses). The anatomical pattern of the maxillary sinus drainage was studied on coronal scans.
Results. As related to different morphological possibilities in the supero-lateral limit of the maxillary sinus drainage system, five different patterns were defined: in type I (55%) there was no pneumatization in that situs, in type II (18%) there was an infraorbital recess of the maxillary sinus placed above the sinus ostium, in type III (14%) an ethmoidal recess of the maxillary sinus was expanded within the ethmoid bone, above the ethmoidal infundibulum, in type IV (3%) there were Haller cells above the sinus ostium, while in type V (10%) there were non-infraorbital ethmoid air cells above and draining into the ethmoidal infundibulum.
Conclusion. It appears that CBCT is a reliable tool to make an anatomical distinction of the variable pattern of pneumatization impeding a normal drainage of the maxillary sinus, between maxillary sinus- and ethmoid-derived air-filled spaces.
Andreea-Ioana Derjac-Arama, Codrut Sarafoleanu, Mugurel Constantin Rusu and Anca Vereanu
Background. Few studies approached the process of blood vessels formation in the Schneiderian membrane. We aimed at investigating by immunohistochemistry the processes that are responsible for forming new blood vessels in the human Schneiderian membrane.
Material and methods. We applied CD31 and CD34 markers on bioptic samples gathered from eight adult patients negative for malignant pathologies. Filopodia-projecting endothelial tip cells (ETCs) were found and indicated processes of sprouting angiogenesis. Also, CD31-expressing monocyte-derived cells were found being involved in processes of vasculogenesis. These cells were projecting filopodia, thus being assessed as endothelial progenitor tip cells (EpTCs). Aggregates of CD31+ EpTCs were also analyzed. Further stages of lumen acquisition and large diameter vessels formation, specific for vasculogenesis, were evaluated.
Results. It resulted that, specifically within the maxillary sinus mucosa, vascular remodelling is equally ensured by adult vasculogenesis and sprouting angiogenesis.
Conclusion. This is, to our knowledge, the first evidence of adult vasculogenesis in the maxillary sinus mucosa, supported by bona fide bone marrow-derived CD31+ cells. The guidance mechanism of EpTCs protrusions needs further investigations for finding similarities, or dissimilarities, with the endothelial tip cells prolongations.