Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches

Açar, Gülay; Büyükmumcu, Mustafa; Güler, İbrahim

doi:10.1016/j.bjorl.2018.04.008

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Brazilian Journal of Otorhinolaryngology

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Original articles • Braz. j. otorhinolaryngol. 85 (5) • Sep-Oct 2019 • https://doi.org/10.1016/j.bjorl.2018.04.008 copy

Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches^☆ ☆ Please cite this article as: Açar G, Büyükmumcu M, Güler İ. Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches. Braz J Otorhinolaryngol. 2019;85:551-9.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Radiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit.

Objective:

The goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry.

Methods:

This retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations.

Results:

Lamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14 mm, 147.88º and 9.6 mm, 152.72º, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3 mm, 7.2 cm², 6.89 cm², 4.51 cm² and 12.46 cm² respectively. The orbital height and width were measured as 35.9 mm and 39.2 mm respectively. The mean orbital cavity depth was 46.3 mm from optic foramen to the orbital entrance and the orbital volume was 19.29 cm³. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types.

Conclusion:

Precise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.

KEYWORDS
Computed tomography; Endoscopic approach; Lamina papyracea; Orbital morphometry; Reconstructive surgery

Definitions
Orbital entrance height	The distance from the infraorbital canal to superior orbital rim
Orbital entrance width	The distance from the frontoethmoidal suture to midpoint of the lateral rim
Orbital cavity depth	The distance from the orbital foramen to the plane passing across the orbital entrance
Orbital entrance area	The area of an octagonal polygon which is formed by anatomical landmarks; supraorbital foramen, frontoethmoidal suture, infraorbital foramen, zygomaticofrontal suture and midpoints between them
Orbital floor area	The triangular area from the orbital foramen to the plane passing across the orbital entrance
Orbital medial wall area	The triangular area from the orbital foramen to the plane passing across the orbital entrance
Anterior orbital medial wall height and inferiomedial angle	The distance from the AEF to the ethmoidomaxillary suture and inferomedial angle between the orbital medial and inferior walls
Posterior orbital medial wall height and inferiomedial angle	The distance from the AEF to the ethmoidomaxillary suture and inferomedial angle between the orbital medial and inferior walls
Lamina papyracea length	The distance from the posterior lacrimal crest to junction point between sphenoid and ethmoid sinuses

Morphometric measurements	Female	Male	Total
	Mean ± SD	Mean ± SD	Mean ± SD
Orbital entrance height (mm)	35.0 ± 1.3^b b p < 0.001.	36.2 ± 1.8^b b p < 0.001.	35.9 ± 1.7
Orbital entrance width (mm)	38.5 ± 1.6^a a p < 0.05.	39.4 ± 2.1^a a p < 0.05.	39.2 ± 2.0
Orbital entrance area (mm ² )	1205 ± 66^b b p < 0.001.	1258 ± 67^b b p < 0.001.	1246 ± 70
Orbital cavity depth(mm)	45.5 ± 2.4^a a p < 0.05.	46.5 ± 2.0^a a p < 0.05.	46.3 ± 2.2
Orbital volume (mm ³ )	1878 ± 167^b b p < 0.001.	1997 ± 150^b b p < 0.001.	1929 ± 161
Orbital floor area (mm ² )	659 ± 57^b b p < 0.001.	698 ± 57^b b p < 0.001.	689 ± 59
Orbital medial wall area (mm ² )	688 ± 56^b b p < 0.001.	730 ± 59^b b p < 0.001.	720 ± 60
Orbital medial wall height (mm)
Anterior	16.2 ± 3.4^a a p < 0.05.	17.6 ± 2.4^a a p < 0.05.	17.4 ± 2.7
Posterior	9.0 ± 2.5^a a p < 0.05.	9.8 ± 2.4^a a p < 0.05.	9.6 ± 2.5
Orbital inferiomedial angle (º)
Anterior	147.82 ± 8.45	147.89 ± 7.28	147.88 ± 7.54
Posterior	151.92 ± 8.11	152.96 ± 10.02	152.72 ± 9.61
Lamina papyracea length (mm)	32.5 ± 2.9^a a p < 0.05.	33.5 ± 2.9^a a p < 0.05.	33.3 ± 2.9
Lamina papyracea area (mm ² )	418 ± 75^a a p < 0.05.	460 ± 81^a a p < 0.05.	451 ± 81

Morphometric measurements	Total	18-39 y	40-59 y	60-90 y
Orbital entrance height (mm)	35.9 ± 1.7	35.3 ± 3.0^a a p < 0.05.	36.4 ± 2.1^a a p < 0.05.	36.1 ± 0.6
Orbital entrance width (mm)	39.2 ± 2.0	38.8 ± 2.3^a a p < 0.05.	39.4 ± 0.6^a a p < 0.05.	39.0 ± 0.4
Orbital entrance area (mm²)	1246 ± 70	1185 ± 11	1266 ± 11	1254 ± 20
Orbital cavity depth (mm)	46.3 ± 2.2	45.7 ± 1.2^a a p < 0.05.	46.4 ± 1.0^a a p < 0.05.	46.2 ± 0.3
Orbital volume (mm³)	1929 ± 161	1851 ± 13	1957 ± 14	1933 ± 20
Orbital floor area (mm²)	689 ± 59	673 ± 10^a a p < 0.05.	699 ± 46^a a p < 0.05.	686 ± 64
Orbital medial wall area (mm²)	720 ± 60	689 ± 39^a a p < 0.05.	726 ± 17^a a p < 0.05.	710 ± 48
Anterior	17.4 ± 2.7	16.4 ± 1.0^a a p < 0.05.	17.7 ± 1.2^a a p < 0.05.	17.5 ± 1.5
Posterior	9.6 ± 2.5	9.5 ± 3.3	10.1 ± 0.3	9.8 ± 0.7
Anterior	147.88 ± 7.54	148.70 ± 14.6	147.39 ± 13.6	147.33 ± 21.0
Posterior	152.72 ± 9.61	152.88 ± 3.70	152.56 ± 10.3	152.45 ± 3.81
Lamina papyracea length (mm)	33.3 ± 2.9	33.7 ± 3.5	33.5 ± 3.5	33.0 ± 2.6
Lamina papyracea area (mm²)	451 ± 81	460 ± 32	455 ± 68	446 ± 10

Morphometric measurements	Lamina Papyracea-inferior nasal turbinate attachment type
	Type A	Type B	Type C
Orbital entrance height (mm)	36.0 ± 1.8^a a p < 0.05.	35.7 ± 1.3	34.8 ± 2.4^a a p < 0.05.
Orbital entrance width (mm)	39.5 ± 1.9^a a p < 0.05.	39.2 ± 1.8	38.2 ± 4.3^a a p < 0.05.
Orbital entrance area (mm ² )	1267 ± 68	1244 ± 66	1225 ± 128
Orbital cavity depth (mm)	46.3 ± 2.1	45.9 ± 2.5	46.9 ± 1.9
Orbital volume (mm ³ )	1943 ± 154	1924 ± 177	1923 ± 257
Orbital floor area (mm ² )	694 ± 55^a a p < 0.05.	670 ± 73	646 ± 53^a a p < 0.05.
Orbital medial wall area (mm ² )	725 ± 61	710 ± 49	701 ± 71
Orbital medial wall height (mm)
Anterior	17.4 ± 2.8	17.7 ± 2.2^a a p < 0.05.	15.7 ± 1.7^a a p < 0.05.
Posterior	9.6 ± 2.6	9.8 ± 1.9^a a p < 0.05.	9.0 ± 2.1^a a p < 0.05.
Orbital inferior-medial angle (º)
Anterior	147.51 ± 7.55	150.87 ± 6.78^a a p < 0.05.	142.73 ± 6.77^a a p < 0.05.
Posterior	152.66 ± 10.11	152.71 ± 7.46	152.17 ± 6.75
Lamina papyracea length (mm)	33.4 ± 2.9	32.2 ± 2.8^a a p < 0.05.	34.9 ± 3.4^a a p < 0.05.
Lamina papyracea area (mm ² )	453 ± 84	444 ± 73	431 ± 54

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
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[1] * Corresponding author. E-mail:gulayzeynep73@gmail.com (G. Açar).