Matteo Alicandri-Ciufelli1,2, Matteo Fermi1, Marco Bonali1, Livio Presutti1, Daniele Marchioni3, Alessandra Todeschini4, Lukas Anschuetz5. 1. Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena. 2. Neurosurgery Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara, Italy. 3. Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona. 4. Neuroradiology Department, New Civil Hospital Sant'Agostino-Estense, Baggiovara, Italy. 5. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Abstract
OBJECTIVES: To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classification. METHODS: Facial sinus was studied by endoscopy and high-resolution computed tomography (HRCT) scan in 39 temporal bones that underwent exclusive transcanal endoscopic approach. A radiomorphologic classification based on the relationship between the facial sinus and the mastoid portion of the facial nerve is created as follows. In type A facial sinus, the pneumatization of the facial sinus did not extend medially or posteriorly to the mastoid portion of the facial nerve. In type B facial sinus, the pneumatization extended posteriorly to the mastoid portion of the facial nerve. In type C facial sinus, the pneumatization extended posteriorly and medially to the mastoid portion of the facial nerve. RESULTS: In all the specimens that underwent HRCT (n = 31), facial sinus could be identified, and its depth classified, in relation to the facial nerve. In this group, 58% type A, 29% type B, and 13% type C facial sinuses were identified. In all the specimens (n = 39), the facial sinus could be assessed by means of an exclusive endoscopic transcanal approach, and anatomical variants of the chordiculus, previously known as chordal ridge, could be described: ridge (39%), bridge (18%), incomplete (15%), and absent (28%). CONCLUSION: Endoscopic exploration of the retrotympanum guarantees a very good exposure of the facial sinus, allowing detailed anatomic descriptions of its conformation and relationships with other structures. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery. Angled endoscopes (e.g. 45 °, 70 °) can guarantee a better view of the facial sinus. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:2397-2402, 2018.
OBJECTIVES: To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classification. METHODS: Facial sinus was studied by endoscopy and high-resolution computed tomography (HRCT) scan in 39 temporal bones that underwent exclusive transcanal endoscopic approach. A radiomorphologic classification based on the relationship between the facial sinus and the mastoid portion of the facial nerve is created as follows. In type A facial sinus, the pneumatization of the facial sinus did not extend medially or posteriorly to the mastoid portion of the facial nerve. In type B facial sinus, the pneumatization extended posteriorly to the mastoid portion of the facial nerve. In type C facial sinus, the pneumatization extended posteriorly and medially to the mastoid portion of the facial nerve. RESULTS: In all the specimens that underwent HRCT (n = 31), facial sinus could be identified, and its depth classified, in relation to the facial nerve. In this group, 58% type A, 29% type B, and 13% type C facial sinuses were identified. In all the specimens (n = 39), the facial sinus could be assessed by means of an exclusive endoscopic transcanal approach, and anatomical variants of the chordiculus, previously known as chordal ridge, could be described: ridge (39%), bridge (18%), incomplete (15%), and absent (28%). CONCLUSION: Endoscopic exploration of the retrotympanum guarantees a very good exposure of the facial sinus, allowing detailed anatomic descriptions of its conformation and relationships with other structures. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery. Angled endoscopes (e.g. 45 °, 70 °) can guarantee a better view of the facial sinus. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:2397-2402, 2018.
Authors: L Anschuetz; M Alicandri-Ciufelli; W Wimmer; M Bonali; M Caversaccio; L Presutti Journal: Acta Otorhinolaryngol Ital Date: 2019-10 Impact factor: 2.124