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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effect of Septal Deviation, Concha Bullosa and Haller’s Cell on Maxillary Sinus’s Inferior Pneumatization; a Retrospective Study</title><author><name sortKey="Gocmen, Gokhan" sort="Gocmen, Gokhan" uniqKey="Gocmen G" first="Gökhan" last="Göçmen">Gökhan Göçmen</name></author><author><name sortKey="Borahan, Mehmet O Uz" sort="Borahan, Mehmet O Uz" uniqKey="Borahan M" first="Mehmet O Uz" last="Borahan">Mehmet O Uz Borahan</name></author><author><name sortKey="Aktop, Sertac" sort="Aktop, Sertac" uniqKey="Aktop S" first="Sertac" last="Aktop">Sertac Aktop</name></author><author><name sortKey="Dumlu, As M" sort="Dumlu, As M" uniqKey="Dumlu A" first="As M" last="Dumlu">As M Dumlu</name></author><author><name sortKey="Pekiner, Filiz Namdar" sort="Pekiner, Filiz Namdar" uniqKey="Pekiner F" first="Filiz Namdar" last="Pekiner">Filiz Namdar Pekiner</name></author><author><name sortKey="Goker, Kamil" sort="Goker, Kamil" uniqKey="Goker K" first="Kamil" last="Göker">Kamil Göker</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26464596</idno><idno type="pmc">4598377</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598377</idno><idno type="RBID">PMC:4598377</idno><idno type="doi">10.2174/1874210601509010282</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000408</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000408</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effect of Septal Deviation, Concha Bullosa and Haller’s Cell on Maxillary Sinus’s Inferior Pneumatization; a Retrospective Study</title><author><name sortKey="Gocmen, Gokhan" sort="Gocmen, Gokhan" uniqKey="Gocmen G" first="Gökhan" last="Göçmen">Gökhan Göçmen</name></author><author><name sortKey="Borahan, Mehmet O Uz" sort="Borahan, Mehmet O Uz" uniqKey="Borahan M" first="Mehmet O Uz" last="Borahan">Mehmet O Uz Borahan</name></author><author><name sortKey="Aktop, Sertac" sort="Aktop, Sertac" uniqKey="Aktop S" first="Sertac" last="Aktop">Sertac Aktop</name></author><author><name sortKey="Dumlu, As M" sort="Dumlu, As M" uniqKey="Dumlu A" first="As M" last="Dumlu">As M Dumlu</name></author><author><name sortKey="Pekiner, Filiz Namdar" sort="Pekiner, Filiz Namdar" uniqKey="Pekiner F" first="Filiz Namdar" last="Pekiner">Filiz Namdar Pekiner</name></author><author><name sortKey="Goker, Kamil" sort="Goker, Kamil" uniqKey="Goker K" first="Kamil" last="Göker">Kamil Göker</name></author></analytic><series><title level="j">The Open Dentistry Journal</title><idno type="eISSN">1874-2106</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><underline>Purpose</underline>: Maxillary sinus’s inferior pneumatization is a physiological process, which increase with time and accelerates following extraction. The aim of this study was to determine the prevalence of nasal septal deviation (NSD), concha bullosa (CB), and Haller’s cells (HC) and to examine the correlation of maxillary sinus inferior pneumatization (MSIP) with these anatomical variations. <italic><underline>Material and Methods</underline> :</italic> 300 (150 m, 150 f) CBCT scans taken at the Marmara University School of Dentistry from 2011 to 2014 were retrospectively reviewed for the presence of CB, NSD, HC and MSIP. The correlation between pneumatization to the anatomic variants was then compared. Data were analyzed with a Chi-square test. <italic><underline>Results</underline> :</italic> Of the 300 CBCT scans, 44.3% have CB, 37.3% NSD, 19.3% HC and 27.7% MSIP. There was no statistical significancewhen comparing the relationship of patients with CB, NSD, HC and pneumatization. <italic><underline>Conclusion</underline> :</italic> NSD, CB and HC do not have a definite role on sinus’s inferior pneumatization. Further studies should be conducted including potential factors related pneumatization with more sample size for further correlation with NSD, CB,HC.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Thomas, A" uniqKey="Thomas A">A. Thomas</name></author><author><name sortKey="Raman, R" uniqKey="Raman R">R. Raman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nowak, R" uniqKey="Nowak R">R. Nowak</name></author><author><name sortKey="Mehlis, G" uniqKey="Mehlis G">G. Mehlis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lawson, W" uniqKey="Lawson W">W. Lawson</name></author><author><name sortKey="Patel, Z M" uniqKey="Patel Z">Z.M. Patel</name></author><author><name sortKey="Lin, F Y" uniqKey="Lin F">F.Y. Lin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shapiro, R" uniqKey="Shapiro R">R. Shapiro</name></author><author><name sortKey="Schorr, S" uniqKey="Schorr S">S. Schorr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sharan, A" uniqKey="Sharan A">A. Sharan</name></author><author><name sortKey="Madjar, D" uniqKey="Madjar D">D. Madjar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stallman, J S" uniqKey="Stallman J">J.S. Stallman</name></author><author><name sortKey="Lobo, J N" uniqKey="Lobo J">J.N. Lobo</name></author><author><name sortKey="Som, P M" uniqKey="Som P">P.M. Som</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, S K" uniqKey="Kim S">S.K. Kim</name></author><author><name sortKey="Heo, G E" uniqKey="Heo G">G.E. Heo</name></author><author><name sortKey="Seo, A" uniqKey="Seo A">A. Seo</name></author><author><name sortKey="Na, Y" uniqKey="Na Y">Y. Na</name></author><author><name sortKey="Chung, S K" uniqKey="Chung S">S.K. Chung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kantarci, M" uniqKey="Kantarci M">M. Kantarci</name></author><author><name sortKey="Karasen, R M" uniqKey="Karasen R">R.M. Karasen</name></author><author><name sortKey="Alper, F" uniqKey="Alper F">F. Alper</name></author><author><name sortKey="Onbas, O" uniqKey="Onbas O">O. Onbas</name></author><author><name sortKey="Okur, A" uniqKey="Okur A">A. Okur</name></author><author><name sortKey="Karaman, A" uniqKey="Karaman A">A. Karaman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Berenholz, L" uniqKey="Berenholz L">L. Berenholz</name></author><author><name sortKey="Kessler, A" uniqKey="Kessler A">A. Kessler</name></author><author><name sortKey="Lapinsky, J" uniqKey="Lapinsky J">J. Lapinsky</name></author><author><name sortKey="Segal, S" uniqKey="Segal S">S. Segal</name></author><author><name sortKey="Shlamkovitch, N" uniqKey="Shlamkovitch N">N. Shlamkovitch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wanamaker, H H" uniqKey="Wanamaker H">H.H. Wanamaker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liu, X" uniqKey="Liu X">X. Liu</name></author><author><name sortKey="Zhang, G" uniqKey="Zhang G">G. Zhang</name></author><author><name sortKey="Xu, G" uniqKey="Xu G">G. Xu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smith, Kd" uniqKey="Smith K">KD Smith</name></author><author><name sortKey="Edwards, Pc" uniqKey="Edwards P">PC Edwards</name></author><author><name sortKey="Saini, Ts" uniqKey="Saini T">TS Saini</name></author><author><name sortKey="Norton, Ns" uniqKey="Norton N">NS Norton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Collet, S" uniqKey="Collet S">S. Collet</name></author><author><name sortKey="Bertrand, B" uniqKey="Bertrand B">B. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Open Dent J</journal-id><journal-id journal-id-type="iso-abbrev">Open Dent J</journal-id><journal-id journal-id-type="publisher-id">TODENTJ</journal-id><journal-title-group><journal-title>The Open Dentistry Journal</journal-title></journal-title-group><issn pub-type="epub">1874-2106</issn><publisher><publisher-name>Bentham Open</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26464596</article-id><article-id pub-id-type="pmc">4598377</article-id><article-id pub-id-type="publisher-id">TODENTJ-9-282</article-id><article-id pub-id-type="doi">10.2174/1874210601509010282</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group><series-title>Suppl 2: M5</series-title></article-categories><title-group><article-title>Effect of Septal Deviation, Concha Bullosa and Haller’s Cell on Maxillary Sinus’s Inferior Pneumatization; a Retrospective Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Göçmen</surname><given-names>Gökhan</given-names></name><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Borahan</surname><given-names>Mehmet Oğuz</given-names></name></contrib><contrib contrib-type="author"><name><surname>Aktop</surname><given-names>Sertac</given-names></name></contrib><contrib contrib-type="author"><name><surname>Dumlu</surname><given-names>Asım</given-names></name></contrib><contrib contrib-type="author"><name><surname>Pekiner</surname><given-names>Filiz Namdar</given-names></name></contrib><contrib contrib-type="author"><name><surname>Göker</surname><given-names>Kamil</given-names></name></contrib></contrib-group><aff>Marmara University, Faculty of Dentistry, Department of Oral & Maxillofacial Surgery, Istanbul, Turkey</aff><author-notes><corresp id="cor1"><label>*</label>Address correspondence to this author at the Marmara University Oral and Maxillofacial Surgery Department, Büyük Çiftlik Sk. No: 6 34365 Nisantasi, Turkey; Tel: 902122319120; Fax: 902122465247;
E-mail: <email xlink:href="gocmengokhan@hotmail.com">gocmengokhan@hotmail.com</email>, <email xlink:href="gokhangocmen@gmail.com">gokhangocmen@gmail.com</email></corresp></author-notes><pub-date pub-type="epub"><day>31</day><month>7</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>9</volume><fpage>282</fpage><lpage>286</lpage><history><date date-type="received"><day>10</day><month>10</month><year>2014</year></date><date date-type="rev-recd"><day>17</day><month>11</month><year>2014</year></date><date date-type="accepted"><day>25</day><month>5</month><year>2015</year></date></history><permissions><copyright-statement> © Göçmen <italic>et al.</italic>; Licensee <italic>Bentham Open.</italic></copyright-statement><copyright-year>2015</copyright-year><copyright-holder>Göçmen</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (<uri xlink:type="simple" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</uri>) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.</license-p></license></permissions><abstract><p><underline>Purpose</underline>: Maxillary sinus’s inferior pneumatization is a physiological process, which increase with time and accelerates following extraction. The aim of this study was to determine the prevalence of nasal septal deviation (NSD), concha bullosa (CB), and Haller’s cells (HC) and to examine the correlation of maxillary sinus inferior pneumatization (MSIP) with these anatomical variations. <italic><underline>Material and Methods</underline> :</italic> 300 (150 m, 150 f) CBCT scans taken at the Marmara University School of Dentistry from 2011 to 2014 were retrospectively reviewed for the presence of CB, NSD, HC and MSIP. The correlation between pneumatization to the anatomic variants was then compared. Data were analyzed with a Chi-square test. <italic><underline>Results</underline> :</italic> Of the 300 CBCT scans, 44.3% have CB, 37.3% NSD, 19.3% HC and 27.7% MSIP. There was no statistical significancewhen comparing the relationship of patients with CB, NSD, HC and pneumatization. <italic><underline>Conclusion</underline> :</italic> NSD, CB and HC do not have a definite role on sinus’s inferior pneumatization. Further studies should be conducted including potential factors related pneumatization with more sample size for further correlation with NSD, CB,HC.</p></abstract><kwd-group><title>Keywords</title><kwd>Concha bullosa</kwd><kwd>Haller’s cell</kwd><kwd>nasal septal deviation</kwd><kwd>maxillary sinus pneumatization</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Themaxillary sinus enlarges variably and greatly until it reaches the adult size by the eruption of permanent teeth. Although its growth slows down with the decline of the facial growth during puberty but continues throughout life. This physiological process is called maxillary sinus pneumatization [<xref rid="R1" ref-type="bibr">1</xref>]. Inferior pneumatization, extension of maxillary sinus into the alveolar process, is a common encountered situation which is clinically important considering tooth extraction or insertion of dental implants in to the region</p><p>Sinus pneumatization might be affected from craniofacial configuration, density of the bone, age, sinus air pressure, and sinus surgery. It is generally accepted that pneumatization increases with fume and extraction accelerates this process [<xref rid="R2" ref-type="bibr">2</xref>,<xref rid="R4" ref-type="bibr"> 4</xref>].</p><p>Some studies describe resumption of maxillary sinus’s inferior pneumatization following tooth extraction increase over time [<xref rid="R5" ref-type="bibr">5</xref>]. Maxillary sinus extends further by osteoclast activity in the Schneiderian membrane, causing pneumatization of the sinus by resorbing bone [<xref rid="R5" ref-type="bibr">5</xref>]. However, other studies have produced contradictory findings, which present alveolar extension of maxillary sinus between teeth with displacement of their roots [<xref rid="R3" ref-type="bibr">3</xref>].</p><p>Several authors have assessed the relationship between sinonasal anatomic variants and the incidence of sinus pathology. The incidence of Haller’s cells (HC) has been reported to vary from 2-45% and some reports have found statistically significant relationship between maxillary sinusitis and Haller Cells. Concha Bullosa (CB) is a common anatomic variant and there is a strong association between the presence of CB and contralateral NSD [<xref rid="R6" ref-type="bibr">6</xref>]. NSD, the presence of CB, NSD or HC can be listed as common anatomical variations leading sinonasal obstructions [<xref rid="R7" ref-type="bibr">7</xref>]. It is widely believed that osteomeatal obstructions may impede ventilation and mucociliary clearance from the sinuses [<xref rid="R1" ref-type="bibr">1</xref>]. Less is understood about the role of NSD, HC and CB as potential contributors to the development of ınferior pneumatization of maxillary sinus.Alterations in sinus air pressure due to these obstructions might lead to pneumatization [<xref rid="R8" ref-type="bibr">8</xref>]. </p><p>The purpose of this study is to determine the presence of CB, NSD and HC on occurrence of maxillary sinus inferior pneumatization (MSIP) measured on CBCT scan. CBCT scan is an essential investigation to delineate the intricate anatomy of the sinuses of each individual patient [<xref rid="R9" ref-type="bibr">9</xref>]. In the current literature, the effect of these anatomic variations on MSIP is not reported. </p></sec><sec sec-type="materials|methods"><title>MATERIAL AND METHODS</title><p>The subjects for this retrospective study consisted of all 300 patients who visited the Marmara University Faculty of Dentistry, and underwent a single CBCT examination picked up from the picture archiving and communications system (PACS) from 2011 to 2014.</p><p>The CBCT examinations were performed using a ProMax 3D Mid machine (Planmeca Oy, Helsinki, Finland). The ProMax 3D Mid CBCT machine was operated at 90 kVp and 10 mA with a 9x16cm field of view. Assessment of CBCT scans was performed directly on a 1920x1080 pixel and 23-inch Acer monitor screen (Acer Inc., Taipei, Taiwan). Voxel edge length was 0.2 mm and slice thickness was 1 mm. Patients with a history of trauma and/or surgery involving the maxillofacial region, systemic diseases affecting growth and development, or clinical and/or radiographic evidence of developmental anomalies/ pathologies affecting the maxillofacial region were excluded from the study. The study protocol was approved by the Local Committee of Research and Ethics of Medipol University with the number of 10640098-58. </p><p>One oral and maxillofacial surgeon (GG) and one oral and maxillofacial radiologist (MOB) independently interpreted all of the images. A second oral and maxillofacial radiologist reviewed any contradictory findings. Scans were reviewed for any nasal cavity and/or paranasal anatomical abnormalities, with specific evaluation on the presence of CB, NSD and HC. For defining them coronal images were selected. They were cropped in the slice in which their widest size was apparent. CB was defined as the presence of pneumatization of any size in the left or right within in the superior, middle, or inferior conchae. NSD was defined as a deviation of greater than 4mm from the midline to the left or right. We used criteria for defining HC as air cells, of any size, located along the medial portion of the orbital floor and/or the lamina papyracea inferior to the bulla ethmoidalis, and continuous with the ethmoid capsule.</p><p>It is determined as pneumatized for dentate patients when the apices are surrounded by the sinus mucosa and for edentulous patients if the alveolar bone is less than 10mm in vertical height.</p><p>Results were statistically analyzed using SPSS software (version 12; SPSS Inc, Chicago, Illinois). <italic>P </italic>values < 0.05 were considered statistically significant. Data was analyzed with a Chi-square test. </p></sec><sec sec-type="results"><title>RESULTS</title><p>Of the 300 scans evaluated, 150 were from male patients and 150 were female patients: mean age 32.46 ± 11.89 years age ; range 20–70 years. 44,3% of the patient scans reviewed had evidence of CB (Fig. <bold><xref ref-type="fig" rid="F1">1</xref></bold>). From the 300 scans, 12.7% were located in one of the right concha, 9% involving the left concha, and 22.6% bilaterally distributed. There was no statistical difference between gender and the presence of CB. 48.7% female; 40% were male; <italic>P </italic>= <italic>.</italic>352) (Table <bold><xref ref-type="table" rid="T1">1</xref></bold>) There was no statistical significance when comparing the relationship of patients with CB (44.3%) and those with pneumatization (27.7%). 14.7% of patients had a combination of both, 29.7% had CB without evidence of pneumatization, and 13% had pneumatization in the absence of CB. (Table <bold><xref ref-type="table" rid="T2">2</xref></bold>) The relationship between CB and ipsilateral or contralateral pneumatization was not statistically significant. (<italic>P < .</italic>005) (Table <bold><xref ref-type="table" rid="T5">5</xref></bold>) 37.3% of the patient scans reviewed had evidence of NSD (Fig. <bold><xref ref-type="fig" rid="F2">2</xref></bold>). From the 300 scans, 23% showed right side deviation, 14.3% presented left side deviation. There was a statistically significant higher prevalence of NSD in males (54.7%) compared to females (20 %; P < .005) (Table <bold><xref ref-type="table" rid="T1">1</xref></bold>) </p><p>There was no statistical significance when comparing the relationship of patients NSD (37.3%) and those with pneumatization (27.7%). 16% of patients had a combination of both, 46.7% had NSD without evidence of pneumatization, and 11.7% had pneumatization in the absence of NSD. (<italic>P< .</italic>005) (Table <bold><xref ref-type="table" rid="T3">3</xref></bold>) The relationship between septal deviation and ipsilateral or contralateral pneumatization was not statistically significant. (<italic>P < .</italic>005) (Table <bold><xref ref-type="table" rid="T5">5</xref></bold>) 19.3% of the patient scans reviewed had evidence of HC (Fig. <bold><xref ref-type="fig" rid="F3">3</xref></bold>). From the 300 scans, 2.7% were showed HC on the right, 9.3% presented on the left and 7.3% showed bilaterally. There was a statistically significant higher prevalence of HC in males (28.7%) compared to females (10 %; <italic>P < .</italic>005) (Table <bold><xref ref-type="table" rid="T1">1</xref></bold>) There was no statistical significance when comparing the relationship of HC (19.3%) and those with pneumatization (27.7%). 4.7% of patients had a combination of both, 14.7% had HC without evidence of pneumatization, and 23% had pneumatization in the absence of HC.(<italic>P < .</italic>005) (Table <bold><xref ref-type="table" rid="T4">4</xref></bold>) The relationship between HC and ipsilateral or contralateral pneumatization was not statistically significant. (<italic>P < .</italic>005) (Table <bold><xref ref-type="table" rid="T5">5</xref></bold>)</p></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>The relations between the dental roots apices, alveolar bone and the sinus floor are critical for the diagnosis and management during teeth removal or placement of dental implants. Pneumatization of the sinus can lead to various complications, during these procedures. It is known that anatomical variations adjacent to maxillary sinus come along with changes in its morphology. Pneumatization is known to be affected from several factors, however it is unclear that if there is correlation with these variations. The aim of this study was to answer the question: “Is there any relationship between these anatomic variations and inferior pneumatization of maxillary sinus and so they predispose to future pneumatization?” We hypothesized that CB, HC and NSD might effect pneumatization in the same way that they affect sinus pathology and morphology. </p><p>The clinical significance of HC gains importance considering its possible predisposing for chronic sinusitis [<xref rid="R10" ref-type="bibr">10</xref>]. They might be seen in isolation or in association with NSD and CB. Depending on the size and location of these anatomical variations, they may narrow the infundibular area and maxillary sinus ostium that these areas are easily occluded by even minor inflammation of the mucosa [<xref rid="R11" ref-type="bibr">11</xref>]. CB and NSD’s relation with alterations in maxillary sinus morphology is well studied in current literature. Extreme hypertrophy of the inferior turbinates has been seen to remodel the medial wall in the inferior meatus into the sinus. Smith KD, <italic>et al.</italic> reviewed 883 CT scans for prevalence of CB and NSD and their potential relationships to maxillary sinusitis. They reported there was no statistically significant relationship between the presence of CB or NSD and maxillary sinusitis [<xref rid="R12" ref-type="bibr">12</xref>]. Collet S, <italic>et al.</italic> reported a literature review that cannot establish a definite role to the nasal septum neither as the pathogenesis of chronic sinusitis nor as a contributing factor [<xref rid="R13" ref-type="bibr">13</xref>]. In our study, we selected these three anatomic variations because they commonly studied for their influence on alteration in maxillary sinus [<xref rid="R6" ref-type="bibr">6</xref>,<xref rid="R8" ref-type="bibr"> 8</xref>]. Caughey RJ, <italic>et al.</italic> reviewed 250 consecutive studies (500 sides), similar to our study, for NSD, CB and HC andtheir association with maxillary sinus disease. They reported that anatomical variations, which contribute to the narrowing of the osteomeatal complex, are associated with sinus disease. However, in our study, there was no statistically significant relationship between them and pneumatization. </p><p>Frequently encountered variations in antral volume and configuration involve posterior extension toward the zygoma (zygomatic recess), and inferior pneumatization into the dental alveolus about the roots of the posterior teeth, or between them in edentulous areas. Histologic examinations had shown that the pneumatization process occurs by osteoclastic resorption of the cortical walls of the sinus and the layering of osteoid inferior to it [<xref rid="R14" ref-type="bibr">14</xref>]. Physiological appositional growth of bone may eventuate pneumatization and tooth extraction accelerates this process. However, hereditary factors, density of the bone, factors fluctuating sinus air pressure might have efficiency on pneumatization. Consequently, sinus pneumatization process is under unclear and multifactorial mechanism. In our study we aimed to clarify in particular, the potency of these three anatomic variations on sinus pneumatization. Pneumatization might be affected from narrowing of osteomeatal complex and accompanying maxillary sinus disease. However, we could not find any statistically significant relationship between ipsilateral or contralateral pneumatization with these anatomical variations.</p><p>In conclusion, we could not establish a definite role of septal deviation, concha bullosa and Haller’s cell on sinus pneumatization. They do not indicate a direct influence on sinus pneumatization like they might do in sinus pathology. Their absence or presence does not offer a statistically significant change with sinus pneumatization. The outcomes of this study did not clarify the query, that should we consider inferior pneumatization in a case of encountering these anatomical variations and support the hypothesis of potential correlation. Sinus pneumatization is affected from various physiological, anatomical and environmental factors. Further studies are necessary to understand associated factors and the mechanism of this process.</p></sec></body><back><ack><title>ACKNOWLEDGEMENTS</title><p>Declared none.</p></ack><sec><title>CONFLICT OF INTEREST</title><p>The authors confirm that this article content has no conflict of interest. </p></sec><ref-list><title>REFERENCES</title><ref id="R1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thomas</surname><given-names>A.</given-names></name><name><surname>Raman</surname><given-names>R.</given-names></name></person-group><article-title>A comparative study of the pneumatization of the mastoid air cells and the frontal and maxillary sinuses.</article-title><source>AJNR Am. J. 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Review of literature.</article-title><source>Acta Otorhinolaryngol. Belg.</source><year>2001</year><volume>55</volume><issue>4</issue><fpage>299</fpage><lpage>304</lpage><pub-id pub-id-type="pmid">11859650</pub-id></element-citation></ref><ref id="R14"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wehrbein</surname><given-names>H.</given-names></name><name><surname>Diedrich</surname><given-names>P.</given-names></name></person-group><article-title>[The initial morphological state in the basally pneumatized maxillary sinus--a radiological-histological study in man].</article-title><source>Fortschr. Kieferorthop.</source><year>1992</year><volume>53</volume><issue>5</issue><fpage>254</fpage><lpage>262</lpage><pub-id pub-id-type="doi">10.1007/BF02325074</pub-id><pub-id pub-id-type="pmid">1427537</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="F1" position="float"><label>Fig. (1)</label><caption><p>Coronal CBCT scan demonstrating bilateral maxillary pneumatization (arrows). (a) Right middle concha bullosa (asterisk). Left
nasal septal deviation (arrow). Left maxillary pneumatization (arrow) (b) Bilateral middle concha bullosa (asterisk). </p></caption><graphic xlink:href="TODENTJ-9-282_F1"></graphic></fig><fig id="F2" position="float"><label>Fig. (2)</label><caption><p>Coronal CBCT scans demonstrating bilateral middle concha bullosa (arrows). (b) Right nasal septal deviation (asterisk)
(a) Left nasal septal deviation (asterisk). No concha bullosa or Haller's cells is evident. </p></caption><graphic xlink:href="TODENTJ-9-282_F2"></graphic></fig><fig id="F3" position="float"><label>Fig. (3)</label><caption><p>Coronal CBCT images showing bilateral (b) and unilateral (a, c) Haller's cells (arrows). </p></caption><graphic xlink:href="TODENTJ-9-282_F3"></graphic></fig><table-wrap id="T1" position="float"><label>Table 1.</label><caption><p>Prevalence and gender distribution of concha bullosa, nasal septal deviation, Haller’s cells and maxillary pneumatization.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th align="center" rowspan="1" colspan="1"> </th><th colspan="2" rowspan="1">Concha Bullosa </th><th colspan="2" rowspan="1">Septal Deviation </th><th colspan="2" rowspan="1">Haller Cells </th><th colspan="2" rowspan="1">Maxillary Pneumatization </th></tr><tr><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1">Present </th><th align="center" rowspan="1" colspan="1">Absent </th><th align="center" rowspan="1" colspan="1">Present </th><th align="center" rowspan="1" colspan="1">Absent </th><th align="center" rowspan="1" colspan="1">Present </th><th align="center" rowspan="1" colspan="1">Absent </th><th align="center" rowspan="1" colspan="1">Present </th><th align="center" rowspan="1" colspan="1">Absent </th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">Total </td><td align="center" rowspan="1" colspan="1">133(44.3%) </td><td align="center" rowspan="1" colspan="1">167(55.7%) </td><td align="center" rowspan="1" colspan="1">112(37.3%) </td><td align="center" rowspan="1" colspan="1">188(62.7%) </td><td align="center" rowspan="1" colspan="1">58(19.3%) </td><td align="center" rowspan="1" colspan="1">242(80.7%) </td><td align="center" rowspan="1" colspan="1">83(27.7%) </td><td align="center" rowspan="1" colspan="1">217(72.3%) </td></tr><tr><td colspan="9" rowspan="1">Gender </td></tr><tr><td align="center" rowspan="1" colspan="1">Male </td><td align="center" rowspan="1" colspan="1">60(40%) </td><td align="center" rowspan="1" colspan="1">90(60%) </td><td align="center" rowspan="1" colspan="1">82(54.7%) </td><td align="center" rowspan="1" colspan="1">68(45.3%) </td><td align="center" rowspan="1" colspan="1">43(28.7%) </td><td align="center" rowspan="1" colspan="1">107(71.3%) </td><td align="center" rowspan="1" colspan="1">43(28.7) </td><td align="center" rowspan="1" colspan="1">107(71.3%) </td></tr><tr><td align="center" rowspan="1" colspan="1">Female </td><td align="center" rowspan="1" colspan="1">73(48.7%) </td><td align="center" rowspan="1" colspan="1">77(51.3%) </td><td align="center" rowspan="1" colspan="1">30(20%) </td><td align="center" rowspan="1" colspan="1">120(80%) </td><td align="center" rowspan="1" colspan="1">15(10%) </td><td align="center" rowspan="1" colspan="1">135(90%) </td><td align="center" rowspan="1" colspan="1">40(26.7) </td><td align="center" rowspan="1" colspan="1">110(73.3%) </td></tr></tbody></table></table-wrap><table-wrap id="T2" position="float"><label>Table 2.</label><caption><p>Relationship of concha bullosa and pneumatization.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1"> </th><th colspan="2" rowspan="1">Concha Bullosa </th></tr><tr><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1">Present</th><th align="center" rowspan="1" colspan="1">Absent</th></tr></thead><tbody><tr><td rowspan="2" colspan="1">Pneumatization </td><td align="center" rowspan="1" colspan="1">Present</td><td align="center" rowspan="1" colspan="1">44(14.7%)</td><td align="center" rowspan="1" colspan="1">39(13%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Absent</td><td align="center" rowspan="1" colspan="1">89(29.7%)</td><td align="center" rowspan="1" colspan="1">128(42.7%)</td></tr></tbody></table></table-wrap><table-wrap id="T3" position="float"><label>Table 3.</label><caption><p>Relationship of nasal septal deviation and pneumatization.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1"> </th><th colspan="2" rowspan="1">Nasal Septal Deviation</th></tr><tr><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1">Present</th><th align="center" rowspan="1" colspan="1">Absent</th></tr></thead><tbody><tr><td rowspan="2" colspan="1">Pneumatization</td><td align="center" rowspan="1" colspan="1">Present</td><td align="center" rowspan="1" colspan="1">48(16%)</td><td align="center" rowspan="1" colspan="1">35(11.7%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Absent</td><td align="center" rowspan="1" colspan="1">140(46.7%)</td><td align="center" rowspan="1" colspan="1">77(25.7%)</td></tr></tbody></table></table-wrap><table-wrap id="T4" position="float"><label>Table 4.</label><caption><p>Relationship of Haller’s cell and pneumatization.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1"> </th><th colspan="2" rowspan="1">Haller’s Cell</th></tr><tr><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1">Present</th><th align="center" rowspan="1" colspan="1">Absent</th></tr></thead><tbody><tr><td rowspan="2" colspan="1">Pneumatization</td><td align="center" rowspan="1" colspan="1">Present</td><td align="center" rowspan="1" colspan="1">14(4.7%)</td><td align="center" rowspan="1" colspan="1">69(23%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Absent</td><td align="center" rowspan="1" colspan="1">44(14.7%)</td><td align="center" rowspan="1" colspan="1">173(57.7%)</td></tr></tbody></table></table-wrap><table-wrap id="T5" position="float"><label>Table 5.</label><caption><p>Relationship of Haller’s cell, septal deviation and concha bullosa with ipsilateral and contralateral pneumatization.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1">Ipsilateral Pneumatization Present</th><th align="center" rowspan="1" colspan="1">Contralateral Pneumatization Present</th></tr></thead><tbody><tr><td rowspan="3" colspan="1">Concha Bullosa</td><td align="center" rowspan="1" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">4/16 (25%)</td><td align="center" rowspan="1" colspan="1">0/15(0%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Left</td><td align="center" rowspan="1" colspan="1">1/15(6.6%)</td><td align="center" rowspan="1" colspan="1">2/16(12.5%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Bilateral</td><td align="center" rowspan="1" colspan="1">14/52(26.9%)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td rowspan="2" colspan="1">Septal Deviation</td><td align="center" rowspan="1" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">4/16(25%)</td><td align="center" rowspan="1" colspan="1">6/15(40%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Left</td><td align="center" rowspan="1" colspan="1">2/15(13.3%)</td><td align="center" rowspan="1" colspan="1">3/16(18.7%)</td></tr><tr><td rowspan="3" colspan="1">Haller’s Cell</td><td align="center" rowspan="1" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">0/16(0%)</td><td align="center" rowspan="1" colspan="1">0/15(0%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Left</td><td align="center" rowspan="1" colspan="1">1/15(6.6%)</td><td align="center" rowspan="1" colspan="1">2/16(12.5%)</td></tr><tr><td align="center" rowspan="1" colspan="1">Bilateral</td><td align="center" rowspan="1" colspan="1">3/52(5.7%)</td><td align="center" rowspan="1" colspan="1"> </td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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