0:00

Let's continue our discussion

0:03

of the different normal variants associated

0:05

with the perinasal sinuses.

0:07

One of the most common is a hypoplastic maxillary sinus

0:12

in this case, in the upper side, you see the small size

0:17

of the left maxillary sinus.

0:19

Here on the lower image, you'll see the small size

0:22

of the right maxillary sinus.

0:25

Usually you will see some deviation

0:27

of the nasal cavity towards that size.

0:30

It's a little bit wider here on the left than it is on the

0:32

right hand side as it sort of compensates

0:36

for a symmetrical face.

0:38

I'll be talking shortly about another entity, which is not

0:42

a congenital variant, known as the silent sinus syndrome,

0:47

which is an inflammatory process, which also is associated

0:51

with a smaller maxillary sinus.

0:53

Sometimes you'll have an ATE process, which is

0:59

opposed to the inferior orbital wall.

1:04

This is known as ate process atelectasis.

1:07

So in this example, we have the normal ATE process

1:13

on the left side, vertically oriented.

1:16

There is some inflammatory disease at the maxillary science

1:19

osteum and the infundibulum on the contralateral side.

1:25

Where is that uncinate process?

1:26

Well, it's, as you can see, it's kind of opposed

1:30

to the inferior wall of the right orbit,

1:34

and you also see a distortion of the width of the

1:39

ipsilateral cy nasal cavity.

1:42

This is what is known as ate process atelectasis,

1:46

and as you can see, it often will narrow the maxillary

1:50

science osteum leading to chronic sinusitis,

1:55

ipsilateral a few other normal variants.

1:58

We mentioned the agar na cells,

2:00

which are those far anterior ethmoid cells,

2:03

which sometimes will protrude into the frontal sinus.

2:06

There is a sinus that is also named called the sinus laters.

2:11

This is a sinus that is an air cell, which resides

2:15

between the ethmoidal bulla

2:17

and the basal lamella of the middle turbinate.

2:20

Remember I said that the middle turbinate has an attachment

2:23

laterally to the medial orbital wall.

2:27

This creates an air cell that is

2:31

posterior to the ethmoidal bullah,

2:34

but anterior to that basal lamella,

2:36

and that is known as the sinus laterals.

2:38

Why is it special?

2:40

Not so special, but it is a potential area

2:42

where you can have residual chronic sinusitis, even

2:46

after doing an ethmoidal bullah removal.

2:49

Another very important air cell

2:51

that's named is called the odie cell.

2:54

This is an ethmoid air cell, which protrudes

2:57

above the sphenoid

2:58

Science. So normally you

2:59

think of the sphenoid science as the most

3:02

posterior and superior of the perinasal sinuses.

3:05

Well, that's not necessarily the case

3:07

because the ethmoid air cells can protrude actually

3:11

above the sphenoid science in something known

3:13

as the annoy cell.

3:14

And I'm gonna show that on this slide.

3:17

So here, let's look at this diagram.

3:19

In the center here we have our sphenoid sinus.

3:23

And you notice that there is an air cell with a extension

3:27

above the sphenoid sinus.

3:29

So you have that little red asterisk,

3:31

and you have that ethmoid air cell, which is protruding

3:33

above the sphenoid sinus.

3:35

That's what's known as the anod cell.

3:38

The ON here is actually not for anod.

3:41

The ON is for the optic nerve, and that's very important

3:44

because if the sinus surgeon thinks that

3:48

he's got another air cell above the ethmoid air cell,

3:52

that being the sphenoid sinus,

3:54

and he can pop into that, he will, with the presence

3:59

of annoy cell, not have that sphenoid science above it,

4:02

and in point, in fact, might pop into the optic nerve

4:06

and injure the optic nerve.

4:07

So this is a very important anatomic variant,

4:10

the annoy cell,

4:11

because it can be the air cell that is just

4:15

below the optic nerve,

4:16

or even just below the pituitary fossa,

4:19

which you see in this example here.

4:22

So again, on the bottom right hand side,

4:24

we have the anod cell above the sphenoid science

4:27

and what's right behind it, this is the cell.

4:31

So if the surgeon thinks he's down here

4:33

and he's got another air cell above

4:35

and he can go into the sphenoid sinus,

4:36

but in point of fact, he's actually above,

4:39

he could pop intracranial,

4:40

he could pop into the pituitary phos,

4:42

he could pop into the cavernous sinus.

4:44

He can injure the optic nerve on this coronal image.

4:47

What we're seeing here is the sphenoid sinus here

4:52

and the anodes cell is actually above

4:56

the sphenoid sinus.

4:58

So this is that potential anatomic variant that could lead

5:02

to injury intracranial to the optic nerves,

5:06

to the carotid arteries,

5:07

to the cavernous sinus if it's not well recognized.

5:13

I had mentioned previously the presence of the howler cells

5:18

and mentioned that they have several different names.

5:21

Some people call them the maxo ethmoidal cells.

5:23

Some people call 'em infraorbital eth mortal cells.

5:26

But suffice it to say that these are air cells

5:29

that are from the ethmoid complex that can project

5:33

below the orbital floor.

5:36

And in this situation, they may lead

5:40

to narrowing of the maxillary science osteum

5:44

and the in fum.

5:46

Sometimes they will be even as close

5:50

to the infraorbital nerve canal, which is

5:53

what we see here and here.

5:54

So they may migrate even more

5:56

Further laterally.

5:58

But these air cells here are what we refer to

6:02

as the howler cells.

6:03

And in order to open up the airway

6:09

osteum, the normal mucus ciliary clearance is possible

6:13

that they will take down the walls of these howler cells,

6:18

these maxi ethmoidal cells, as well as the ethmoidal bah,

6:23

as well as the ate process in order

6:25

to create a wider channel

6:27

for the normal mucociliary clearance.

6:30

You notice in this case, another anatomic variant.

6:34

I mentioned that occasionally your ate process

6:37

can be aerated in what's called an ate bulla.

6:40

Yet another of the very many anatomic variants

6:43

that we have in the Cy Nasal cavity.