Variants in the superior attachment of uncinated process and their corresponding frontal sinus drainage pattern: a computed tomography-based retrospective clinical study
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20242647Keywords:
Uncinate process, Frontal sinus outflow, Frontal sinusitisAbstract
Background: Understanding the morphology and spatial relationships of the uncinate process and its associated spaces is crucial for diagnosing and treating conditions affecting sinus drainage and ventilation. This consistent anatomical structure is an important surgical landmark for endoscopic sinus surgery.
Methods: Computed tomography (CT) records of 100 patients over two years were extracted via the hospital's PACS system. The type of superior insertion of uncinate process (UP) was observed in coronal cuts of CT scan images, and classification was done based on the Friedmann and Landsberg classification system and tabulated. The corresponding variations in the frontal sinus outflow tract were noticed, and their effect on frontal sinusitis was recorded. Sinusitis of the frontal sinus was in guidance with EPOS 2020 (mucosal changes within the ostiomeatal complex or sinus).
Results: Type 2 was the most common of uncinate attachments (39.5%). The least common variant was type 5 (4%). Medial-type frontal sinus drainage pathway was observed in 78.5% of patients. Sinusitis was present in 23.5% of our study population. Type 2 had a 25% contribution to the occurrence of sinusitis. The medial frontal sinus drainage pathway contributes 24% to sinusitis with a significant p value of 0.010.
Conclusions: Uncinate process, with its varying superior attachment, influences the frontal sinus outflow tract and may contribute to the development of frontal sinusitis. Awareness of the possible variations in the attachment of the uncinate process is vital in the preoperative planning process, which will serve as a road map to surgeons and aid in preparedness for intraoperative complications.
References
Kumar NV, Kamala E, Priya TSG, NalinaKumari SD. A Computerized tomographic study of uncinate process of ethmoid bone. Int J Anat Res. 2015;3(1):917-21.
Arun G, Moideen SP, Mohan M, Khizer Hussain Afroze M, Thampy AS. Anatomical variations in superior attachment of uncinate process and localization of frontal sinus outflow tract. Int J Otorhinolaryngol Head Neck Surg. 2017;3:176-9.
Yoon JH, Kim KS, Jung DH, Kim SS, Koh KS, Oh CS, et al. Fontanelle and uncinate process in the lateral wall of the human nasal cavity. Laryngoscope. 2000;110(2 Pt 1):281-5.
Wormald PJ. Endoscopic Sinus Surgery: Anatomy, Three-Dimensional Reconstruction And Surgical Technique. 3rd edition. Thieme Medical Publishers Incorporated. 2013.
Fikir M, Treviño-González JL, González Andrade B, Morales Del Angel JA. Anatomical Variants of the Uncinate Process: A Challenge in the Endoscopic Surgery of the Nose and Paranasal Sinuses. Cureus. 2023;15(12):e50914.
Tuli IP, Sengupta S, Munjal S, Kesari SP, Chakraborty S. Anatomical variations of uncinate process observed in chronic sinusitis. Indian J Otolaryngol Head Neck Surg. 2013;65(2):157-61.
Landsberg R, Friedman M. A computer-assisted anatomical study of the nasofrontal region. Laryngoscope. 2001;111:2125-30.
Peter-John W. Endoscopic Sinus Surgery Anatomy, Three-Dimensional Reconstruction, and Surgical Technique. 3rd edition. 2013;468.
Arun G, Moideen SP, Mohan M, Khizer Hussain Afroze M, Thampy AS. Anatomical variations in superior attachment of uncinate process and localization of frontal sinus outflow tract. Int J Otorhinolaryngol Head Neck Surg. 2017;3:176-9.
Liu SC, Wang CH, Wang HW. Prevalence of the uncinate process, agger nasi cell and their relationship in a Taiwanese population. Rhinology. 2010;48:239-44.
Turgut S, Ercan I, Sayin I, Başak M. The relationship between frontal sinusitis and frontal sinus outflow tract localization: a computer-assisted anatomical and clinical study. Arch Otolaryngol Head Neck Surg. 2005;131(6):518-22.
Patla SDK, Rathnakar P, Bhat VS, Jayaramesh. A Radiological Study of Anatomical Variations of Uncinate Process. Clin Rhinol An Int J. 2016;9(2):59-61.
