Anatomical Measurement as a Reference for Functional Endoscopic Sinus Surgery Based on CT Scans and Dissections

Zanuncio, Andressa Vinha; Amaral, Flávia Gontijo; Pereira, Marcell de Barros Duarte; Nunes, Flávio Barbosa; Guimarães, Roberto Eustáquio Santos

doi:10.1055/s-0043-1777447

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Original Research • Int Arch Otorhinolaryngol 28 (3) • 2024 • https://doi.org/10.1055/s-0043-1777447 copy

Anatomical Measurement as a Reference for Functional Endoscopic Sinus Surgery Based on CT Scans and Dissections

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Diseases of the paranasal sinuses, nasal cavities, and those related to the skull base can be treated with nasal endoscopic surgery. Anatomical references are essential to safely perform these surgeries.

Objective

To measure and compare the distance from the posterior wall of the maxillary sinus to the anterior skull base in cadavers and on computed tomography (CT) scans to determine a measurement as an anatomical reference in imaging exams for sinus and anterior skull base surgery.

Methods

In dissections and CT scans, we took measurements from the most upper and medial point of the posterior wall of the maxillary sinus (point A) to the point where the skull base deflects and the anterior sphenoid wall is formed (Δ 90°; point B), in the right and left nasal cavities. We used 51 cadavers aged ≥ 18 years in the present research.

Results

The measurements obtained from CT scans and dissections were greater than 1.5 cm in all cadavers, and they were positively correlated. The 1-cm increase in the AB-tomography measurement corresponded to the 1.08-cm increase to the right and 1.07-cm to the left in the AB-dissection measurement.

Conclusion

The CT measurements may be considered a reliable tool to promote safe and effective access to the paranasal sinuses, matching the distance that should be dissected until the anterior base of the skull.

Keywords
endoscopic surgery; FESS; skull base; paranasal CT scans; paranasal sinuses

ICC	Rating
≥ 0.75	Excellent
0.40 to 0.75	Moderate
< 0.40	Poor

Aspects analyzed		Frequency (%)
		< 1.5 cm	≥ 1.5 cm
Right side
	AB-dissection	0 (0.0%)	51 (100.0%)
	AB-tomography: radiologist 1	0 (0.0%)	51 (100.0%)
	AB-tomography: radiologist 2	0 (0.0%)	51 (100.0%)
Left side
	AB-dissection	0 (0.0%)	51 (100.0%)
	AB-tomography: radiologist 1	0 (0.0%)	51 (100.0%)
	AB-tomography: radiologist 2	0 (0.0%)	51 (100.0%)

Item	N	Mean	Standard deviation	Minimum	1st Q	3rd Q	Maximum
Right side
AB-dissection	51	2.1	0.2	1.6	2.0	2.0	2.8
AB-radiologist 1	51	1.9	0.2	1.6	1.8	2.0	2.6
AB-radiologist 2	51	1.9	0.2	1.6	1.8	2.0	2.6
Left side
AB-dissection	51	2.0	0.2	1.8	2.0	2.0	2.5
AB-radiologist 1	51	1.9	0.2	1.6	1.8	2.0	2.5
AB-radiologist 2	51	1.9	0.2	1.6	1.8	2.0	2.5

Side	ICC	95%CI	Classification	p-value
Right	0.92	0.8–0.96	Excelent	< 0.001
Left	0.90	0.83–0.94	Excelent	< 0.001

Side	AB-measure								p-value
	Radiologist 1				Radiologist 2
	n	Mean	Standard deviation	Median	n	Mean	Standard deviation	Median
Right	51	1.9	0.2	1.8	51	1.9	0.2	1.9	0.547
Left	51	1.9	0.2	1.9	51	1.9	0.2	1.9	0.176

Nasal cavity	Coefficient^a	95% confidence interval	p-value
Right	0.88	0.80–0.93	< 0.001
Left	0.76	0.62–0.86	< 0.001

Nasal cavity	Mean of the differences	Standard deviation of differences	95% confidence interval
Right	0.15	0.11	− 0.08–0.37
Left	0.14	0.12	− 0.09–0.36

Settings	Coefficient	Standard error	p-value	95% confidence interval
Mean (right side)	0.12	0.07	0.112	− 0.02–0.26
Mean (left side)	− 0.06	0.10	0.555	− 0.26–0.14

Settings	Coefficient	Standard error	p-value	95% confidence interval
AB-tomography (right side)	1.08	0.01	< 0.001	1.06–1.10
AB-tomography (left side)	1.07	0.01	< 0.001	1.05–1.09

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[1] Address for correspondence Andressa Zanuncio Assistant Professor, Department of Medicine, Universidade Federal de São João del-Rei, Campus Centro Oeste, Dona Lindu Rua Cel. João Nottini 303/404, Divinopolis, MG, 35501-296 Brazil(e-mail: zandressa@gmail.com; zandressa@ufsj.edu.br).