Advertisement

Surgical Anatomy of the Paranasal Sinuses

  • Yeşim Başal
  • Sema Başak
  • Jeffrey C. Bedrosian
Chapter

Abstract

The paranasal sinuses are air-filled cavities, located inside the bones of the skull, with their ostia opening into the nasal cavity. The maxillary, ethmoid, sphenoid and frontal sinus, ethmoid sinus, and sphenoid sinus are named after the bone in which they are located. The anatomy of the paranasal sinuses is quite complex and prone to individual variation; however, basic surgical anatomy should be understood in order to avoid complications. The maxillary sinus is the largest paranasal sinus. Some variations of the maxillary sinus should be considered prior to surgery.

Other anatomic variations of the maxillary sinus include maxillary hypoplasia and atelectasis.

The ethmoid sinus is considered a labyrinthine structure, due to its complexity and individual variations. It consists of 3–18 cells, having a honeycomb appearance. The anteroposterior distance is 4–5 cm and it has a height of 2–3 cm, while its width is 0.5 cm anteriorly and 1.5 cm posteriorly, and its volume is 14 ml on average. The sphenoid sinus is located in the corpus of the sphenoid bone, located at the center of the skull base. The right and left sphenoid sinuses are separated from each other by the intersinus septum. Its vertical diameter is 20 mm, its transverse diameter is 18 mm, its anteroposterior diameter is 21 mm, and its volume is approximately 7.5 ml. The frontal sinus has close embryological and anatomic relationship with the ethmoid sinuses. The right and left frontal sinuses develop independently of one another, and they are frequently asymmetrical. Dominancy, hypoplasia, aplasia, or extensive pneumatization may be identified.

This chapter aims to present the anatomy of paranasal sinuses, emphasizing their surgical anatomic characteristics.

Keywords

Paranasal sinus Maxillary Ethmoid Sphenoid Frontal Pneumatization 

References

  1. 1.
    Çakır N. Otolaryngology head and neck surgery. Istanbul: Nobel Medical Bookstores; 1999.Google Scholar
  2. 2.
    Arıkan OK. Anatomy and physiology of the paranasal sinuses. In: Koç C, editor. Otolaryngology and head and neck surgery. Ankara: Güneş Bookstores; 2004.Google Scholar
  3. 3.
    Van Cauwenberge P, Sys L, De Belder T, et al. Anatomy and physiology of the nose and the paranasal sinuses. Immunol Allergy Clin N Am. 2004;24:1–17.CrossRefGoogle Scholar
  4. 4.
    Sargi ZB, Casiano RR. Surgical anatomy of the paranasal sinuses. In: Kountakis SE, Önerci M, editors. Rhinologic and sleep apnea surgical techniques. Heidelberg: Springer; 2007.Google Scholar
  5. 5.
    Van Alyae OE. Ostium maxillare: anatomic study of its surgical accessibility. Arch Otolaryngol Head Neck Surg. 1936;24:552–69.CrossRefGoogle Scholar
  6. 6.
    Kainz J, Braun H, Genser P. Haller's cells: morphologic evaluation and clinico-surgical relevance. Laryngorhinootologie. 1993;72:599–604.CrossRefGoogle Scholar
  7. 7.
    Bolger WE, Woodruff WW Jr, Morehead J, et al. Maxillary sinus hypoplasia: classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg. 1990;103:759–65.CrossRefGoogle Scholar
  8. 8.
    Bolger WE, Kennedy DW. Atelectasis of the maxillary sinus. J Respir Dis. 1992;13:1448–50.Google Scholar
  9. 9.
    Wang RG, Jiang SC, Gu R. The cartilaginous nasal capsule and embryonic development of human paranasal sinuses. J Otolaryngol. 1994;23:239–43.PubMedGoogle Scholar
  10. 10.
    Wood S, Sinus M. In: Youngs R, Evans K, Watson M, editors. The paranasal sinuses. London: Taylor & Francis; 2006.Google Scholar
  11. 11.
    Bolger E. Anatomy of the paranasal sinuses. In: Kennedy DW, Bolger WE, Zinreich SJ, editors. Sinus diseases. Istanbul: Nobel Medical Bookstores; 2003.Google Scholar
  12. 12.
    Karmody CS, Carter B, Vincent ME. Developmental anatomy of the maxillary sinus. Trans Am Acad Ophthalmol Otolaryngol. 1997;84:723–80.Google Scholar
  13. 13.
    Stammberger H. Functional endoscopic sinus surgery: the Messerklinger technique. Philadelphia: BC Decker; 1991.Google Scholar
  14. 14.
    Nauman H. Patholische anatomic der chronischen rhinitis und sinisitis. In: Proceedings VIII International Congress of Otorhinolaryngology, Amsterdam, 1965. Excerpta Medica, p 12.Google Scholar
  15. 15.
    Keros S. Uber die praktische beteudung der Niveau-Unterschiede der lamina cribrosa des ethmoids. In: Nauman HH, editor. Head and neck surgery. Philadelphia: WB Saunders; 1980.Google Scholar
  16. 16.
    Kainz J, Stammberger H. The roof of the anterior ethmoid: a place of least resistance in the skull base. Am J Rhinol. 1989;3:191–9.CrossRefGoogle Scholar
  17. 17.
    Basak S, Karaman CZ, Akdilli A, et al. Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery. Rhinology. 1998;36:162–7.PubMedGoogle Scholar
  18. 18.
    Wyllie JW, Kern EB, Djalilian M. Isolated sphenoid sinusitis of the nose. Bailliere. London: Tindalland Cox; 1910.Google Scholar
  19. 19.
    Sirikci A, Bayazit YA, Bayram M, et al. Variations of sphenoid and related structures. Eur Radiol. 2000;10:844–8.CrossRefGoogle Scholar
  20. 20.
    Kim HU, Kim SS, Kang SS, et al. Surgical anatomy of the natural ostium of the sphenoid sinus. Laryngoscope. 2001;111:1599–602.CrossRefGoogle Scholar
  21. 21.
    Lang J, Bressel S, Pahnke J. The sphenoid sinus, clinical anatomy of approaches to the pituitary region. Gegenbaurs Morphol Jahrb. 1988;134:291–307.PubMedGoogle Scholar
  22. 22.
    Dixon FN. A comparative study of the sphenoid sinus (a study of 1600 skulls). Ann Otol Rhinol Laryngol. 1937;46:687–98.CrossRefGoogle Scholar
  23. 23.
    Enatsu K, Takasaki K, Kase K, et al. Surgical anatomy of the sphenoid sinus on the CT using multiplanar reconstruction technique. Otolaryngol Head Neck Surg. 2008;138:182–6.CrossRefGoogle Scholar
  24. 24.
    Sethi DS, Stanley RE, Pillay PK. Endoscopic anatomy of the sphenoid sinus and Sella turcica. J Laryngol Otol. 1995;109:951–5.CrossRefGoogle Scholar
  25. 25.
    Wormald PJ. Endoscopic Sinus surgery, anatomy, three-dimensional reconstruction, and surgical technique. New York: Thieme Medical Publishers; 2009.Google Scholar
  26. 26.
    Skinner D, White P. Anterior ethmoid sinus and frontal sinus. In: Youngs R, Evans K, Watson M, editors. The paranasal sinuses. London: Taylor & Francis; 2006.Google Scholar
  27. 27.
    Stammberger HR, Bolger WE, Clement PAR, et al. Anatomic terminology and nomenculature in sinusitis. Ann Otol Rhinol Laryngol Supp. 1995;104:7–19.CrossRefGoogle Scholar
  28. 28.
    Casiano RR. A stepwise surgical technique using the medial orbital floor as the key landmark in performing endoscopic sinus surgery. Laryngoscope. 2001;111(6):964–74.CrossRefGoogle Scholar
  29. 29.
    Floreani SR, Nair SB, Switajewski MC, et al. Endoscopic anterior ethmoidal artery ligation: a cadaver study. Laryngoscope. 2006;116:1263–7.CrossRefGoogle Scholar
  30. 30.
    Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101(1. Pt 1):56–64.CrossRefGoogle Scholar
  31. 31.
    Bent JP, Cuilty-Siller C, Kuhn FA. The frontal cell as a cause of frontal cell obstruction. Am J Rhinol. 1994;8:185–91.CrossRefGoogle Scholar
  32. 32.
    Kuhn FA. Surgery of the frontal sinus in disease of the sinuses; diagnosis and management. In: Kennedy DW, editor. Diseases of the sinuses. London: BC Decker; 2001.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Yeşim Başal
    • 1
  • Sema Başak
    • 1
  • Jeffrey C. Bedrosian
    • 2
  1. 1.Department of Otorhinolaryngology, Medical FacultyAdnan Menderes UniversityAydınTurkey
  2. 2.Rhinology and Skull Base SurgerySpecialty Physician Associates, St. Luke’s Medical CentreBethlehemUSA

Personalised recommendations