|Year : 2021 | Volume
| Issue : 3 | Page : 146-150
Three-dimensional evaluation of maxillary sinuses in the Turkmen population, North of Iran
Arash Mollaali1, Mohammad Hadi Gharib2, Jahangir Ghorbani3, Mohammad Jafar Golalipour4
1 MSc in Anatomy, Department of Anatomical Science, Golestan University of Medical Science, Tehran, Iran
2 Assistant Professor of Radiology, Department of Radiology, Golestan University of Medical Sciences, Tehran, Iran
3 Assistant Professor of Otorhinolaryngology, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Professor of Embryology, Gorgan Congenital Malformations Research Center, Department of Anatomical Science, Golestan University of Medical Science, Tehran, Iran
|Date of Submission||15-Jul-2019|
|Date of Acceptance||25-Jul-2021|
|Date of Web Publication||23-Sep-2021|
Prof. Mohammad Jafar Golalipour
Department of Anatomical Sciences, Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan
Source of Support: None, Conflict of Interest: None
Introduction: Understanding the variation in the size and shape of the paranasal sinuses in detail is a clinically relevant matter for sinusitis patients. This study was performed to determine the right and left maxillary sinus dimensions by computed tomographic (CT) scan based on gender in the Turkmen ethnic groups in Gorgan, northern Iran. Material and Methods: In this descriptive-analytical study, 100 Turkmen subjects (50 males and 50 females) aged 18–45 were measured with 2 mm and 3 mm slices in the coronal and Axial Planes by the CT scanner SOMATOM Emotion of the multi-slice from the SIEMENS model and using the “Syngo software Siemens.” Results: Maximum width, height, and volume of right and left maxillary sinuses in the Turkmen ethnic group were more in males than females (P < 0.05). In the right maxillary sinus; the mean maximum of width in males and females was 29.6 ± 4.91 mm and 26.53 ± 5.26 mm, respectively (P < 0.05). The mean maximum height in males and females was 40.5 ± 4.27 mm and 38.16 ± 5.96 mm, respectively (P < 0.05). In the left maxillary sinus, the mean maximum width in males and females was 29.61 ± 4.31 mm and 26.79 ± 5 mm, respectively (P < 0.05). The mean maximum height in males and females was 40.46 ± 4.55 mm and 38.03 ± 5.4 mm, respectively (P < 0.05). Discussion and Conclusion: Understanding the dimensions of the maxillary sinuses helps for better diagnosis and treatment of patients with maxillary sinuses diseases.
Keywords: Anthropometry, computed tomographic scan, dimensions, ethnicity, gender, maxillary sinus
|How to cite this article:|
Mollaali A, Gharib MH, Ghorbani J, Golalipour MJ. Three-dimensional evaluation of maxillary sinuses in the Turkmen population, North of Iran. J Anat Soc India 2021;70:146-50
|How to cite this URL:|
Mollaali A, Gharib MH, Ghorbani J, Golalipour MJ. Three-dimensional evaluation of maxillary sinuses in the Turkmen population, North of Iran. J Anat Soc India [serial online] 2021 [cited 2022 Jan 23];70:146-50. Available from: https://www.jasi.org.in/text.asp?2021/70/3/146/326431
| Introduction|| |
In anthropometric studies, the determination of the size and shape of the paranasal sinuses has been detailed, although the clinical significance of these studies is very important. Computed tomographic (CT scan) is used in anthropometric, legal, and endoscopic sinuses.
Maxillary sinuses are the largest paranasal sinuses that are located within the maxillary bone and its duct opens to the middle meatus of the nose. The maxillary sinus begins to grow in the tenth of the fetal stage, and its pneumatization ends with the appearance of the third molar tooth.
Maxillary sinus has several forms that are most commonly triangular; also maxillary sinus has different shapes, sizes, and positions on the right and left sides of the different people that can be used to diagnose the gender in people. Maxillary sinuses reach their maximum growth in 20 years old, the time of fully development of permanent teeth.
In adults, the maxillary sinus has a pyramid-shaped cavity in the viscerocranium with its base at the lateral nasal wall and its apex extending into the zygomatic process of the maxilla. The vicinity of the maxillary sinus to the alveolar crest is enhanced by sinus pneumatization, as well as resorption of the alveolar ridge due to tooth extraction, trauma, or pathology. The process of pneumatization varies greatly in humans and it may be different from side to side.
However, few volumetric studies have been performed worldwide,,, but there is no documented report in the north of Iran. Gorgan, the capital city of Golestan province, is located in South-East of Caspian Sea border. In spite of a variety of ethnicities, no study, so far, has been conducted on the role of ethnicity and gender in determining the anthropometric dimensions of the maxillary sinus in this region.
Due to the importance of this research in anthropometry, forensic anthropology, and sinus surgeries such as sinus endoscopy, the purpose of the current study was determined the parameters of right and left maxillary sinuses by CT scan according to gender in the Turkmen ethnic groups in Gorgan, northern Iran.
| Material and Methods|| |
This descriptive-analytical study was carried out on 100 Turkmen subjects (50 males and 50 females) aged 18–45 in Gorgan, northern Iran. This study was approved by the Ethics Committee and all the ethical principles of working on the medical records of patients were carried out (Ethical code: IR.GOUMS.REC.1396.125).
Fars, Turkmen, and Sistani are the three main ethnic groups, in Gorgan. Native Fars is the predominant group of inhabitants and has the most members, Turkmen is the ethnic group that emigrated from Central Asia more than three centuries ago, and the Sistani group emigrated from southeastern Iran half a century ago.
The inclusion criteria were the people with acute sinusitis and exclusion criteria were the people who have a history of sinus surgery and people with a history of facial bone fractures.
The parameters was included maximum anterior-posterior, width, and maximum height. The volume was obtained on the right and left side with 2 mm and 3 mm slices in the coronal and Axial Planes by the computed tomographic (CT) scanner SOMATOM Emotion of the multi-slice from the SIEMENS model and using the “Syngo software Siemens” [Figure 1] and [Figure 2].
|Figure 1: The right image is related to the method of measuring the maximum width of the right and left maxillary sinuses in the coronal view; the left image is related to the method of measuring the maximum anterior-posterior length of the left maxillary sinus in the sagittal view|
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|Figure 2: Maximum height of right and left maxillary sinus in the coronal view|
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Data were analyzed using SPSS version 18 (SPSS Inc., IL, USA) and independent t-test for quantitative variables. The significance level was <0.05.
| Results|| |
The right maxillary sinus parameters
The mean maximum of anterior-posterior (AP) length in males and females was 39.08 ± 3.15 mm and 38 ± 3.3 mm, respectively. This difference was not significant. The mean of a maximum of width in males and females was 29.6 ± 4.91 mm and 26.53 ± 5.26 mm, respectively (P < 0.05). The mean of a maximum of height in males and females was 40.5 ± 4.27 mm and 38.16 ± 5.96 mm, respectively (P < 0.05). The volume in males and in females was 2.23 ± 7.75 cc and 2.44 ± 6.42 cc, respectively (P < 0.05) [Table 1].
|Table 1: The right maxillary sinus dimensions in Turkmen population according to gender|
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The left maxillary sinus parameters
The mean maximum of AP length in males and females was 38.96 ± 3.5 mm and 38.95 ± 3.33 mm, respectively. This difference was not significant. The mean of a maximum of width in males and females was 29.61 ± 4.31 mm and 26.79 ± 5 mm, respectively (P < 0.05). The mean maximum of height in males and females was 40.46 ± 4.55 mm and 38.03 ± 5.4 mm, respectively (P < 0.05). The volume in males and females was 2.46 ± 7.47 cc and 2.11 ± 6.25 cc, respectively (P < 0.05) [Table 2].
|Table 2: The left maxillary sinus dimension in the Turkmen population according to gender|
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| Discussion|| |
This study has shown that a CT scan is a robust method in the estimation of different dimensions of the maxillary sinuses as the inter-observer agreement ranges from substantial to almost perfect dependent on the measurement in question.
The maxillary sinuses are pyramidal shape and the largest of the paranasal sinuses. The anterior wall of the mitral stenosis (MS) is formed by the facial surface of the maxilla and is internally grooved by the canalis sinuosus. The posterior wall is formed by the infratemporal surface of the maxilla. The superior wall is formed by the fragile, triangular orbit floor, with the infraorbital groove running through it. The roof of the sinus thickens toward the orbital margin, with a mean thickness of 0.4 mm medial to the infraorbital canal and 0.5 mm thick lateral to it.
The medial wall of the MS separates the sinus from the nasal cavity. It is smooth on the sinus side and carries the inferior nasal conchae on the nasal side. The medial wall is rectangular in shape and is slightly deficient at the maxillary hiatus.
The formation of maxillary sinuses begins during the 10th week of intrauterine life. The mucosa located at the deeper anterior end of the ethmoid infundibulum presents invaginations toward the surrounding mesenchyme. These invaginations fuse during the 11th week of development, giving rise to a single cavity representing the primordium of the maxillary sinuses. The primordial shape of the sinus is characterized as an oval cavity with smooth walls. Rapid growth of the maxillary sinuses has been observed during two periods of development: from the 17th to the 20th week and from the 25th to the 28th week.
Ossification of the sinus begins during the 16th week of development, beginning in the lateral wall of the sinus and during 20th week extends to the anterior wall by the, and during the 21st week extends to the posterior wall. The medial wall shows signs of ossification by the 37th week of development.
The floor of the sinus is related to the roots of the first premolar teeth at age 4 years and the second molar teeth at age 5 years, and may extend to the third molar teeth and/or to the first premolar teeth, and sometimes to the canine teeth.,
At birth, the maxillary sinuses measures <7.0 mm in anteroposterior depth, <4.0 mm in height, and <2.7 mm in width. Several factors have including pressure from the eyeball against the orbit wall, the traction on the inferior portion of the maxilla by the facial muscles, and the eruption of permanent blockage affect the height of sinus development. Between ages 1 and 8 years, the maxillary sinuses grow most rapidly, this growth extend laterally past the infraorbital canal and inferiorly to the middle aspect of the inferior meatus. The downward pull of the facial muscles continues to pull on the maxillary bones, at age 3 years. The roof of the sinus presents a more inferolateral position in childhood, before assuming its more horizontal position in adulthood due to progressing pneumatization. At the end of the 2nd year of life, the floor of the sinus lies lower than the insertion of the inferior nasal conchae.
At birth, transverse and sagittal maxillary dimensions are greater than vertical. In adults, the vertical dimension is greatest, owing to the development of the alveolar process and enlargement of the sinus.
Due to thickness of sinus walls, a tumor may push up the orbital floor and displace the eyeball, project into the nasal cavity, protrude on the cheek, or spread back into the infratemporal fossa or down into the mouth. The extraction of molar teeth may damage the floor, and impact may fracture its walls.
In this study, parameters of all variables of right and left maxillary sinuses in Turkmen ethnic group were more in males than females. Our results are similar to Teke et al.'s study, in Turkey showing that the parameters of maxillary sinuses in males were more than females.
Furthermore, there was no significant difference between males and females in the mean maximum of AP length in right and left maxillary sinuses. Our results are in consistent with the result of a study in Sweden, while they are not in agreement with the results of two studies in India, Turkey., and studies from Iraq and South Africa [Table 3] and [Table 4].
|Table 3: Comparison between right maxillary sinus variables in the studied populations in different regions of the world by gender|
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|Table 4: Comparison between left maxillary sinus variables in the studied populations in different regions of the world by gender|
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Similarly, there was a significant difference between males and females (P < 0.05) regarding the width of the right maxillary sinus in comparison with a study in India [Table 3].
Furthermore, in our study, there was a significant difference between males and females regarding the width wide of the left maxillary sinus and height of the right and left maxillary sinuses (P < 0.05), these results were similar to Turkish population [Table 3] and [Table 4].
In Tambawala et al.'s study, overall values of the parameters were significantly greater in the males in comparison with to the females with the right height (90.0%) and the left height (83.3%) being the best predictors. Indeed, our results regarding the volume of right and left maxillary sinuses were similar to Swedish population [Table 3] and [Table 4].
Furthermore, in a study in southern France, the whole cranial surface was significantly different between males and females in size. Also, according to their results, sexual dimorphism was significantly lower in senile skulls.
Moreover, Amin's and Hassan's study on the maxillary sinus of the Egyptian population using a multidetector computed tomography scan, showed significant differences in the size of the left maxillary sinus.
| Conclusion|| |
The results of this study were presented to gender affects the anthropometric parameters of the right and left maxillary sinuses in the Turkmen ethnic group in northern Iran. Environmental factors, genes, racial factors, and various environmental conditions are important factors that may cause changes in sinuses dimensions. Also, understanding the dimensions of the maxillary sinuses helps for better diagnosis and treatment of patients with maxillary sinuses diseases.
We have no limitation in this study.
Financial support and sponsorship
This study has funded by the Deputy of Research of Golestan University of Medical Sciences, Gorgan, Iran. (Grant No: 960628168).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Park IH, Song JS, Choi H, Kim TH, Hoon S, Lee SH, et al.
Volumetric study in the development of paranasal sinuses by CT imaging in Asian: A pilot study. Int J Pediatr Otorhinolaryngol 2010;74:1347-50.
Putz R, Pabst R. Sobotta-Atlas of Human Anatomy: Head, Neck, Upper Limb, Thorax, Abdomen, Pelvis, Lower Limb; Two-Volume Set. Urban & Fischer; Churchill Livingstone, 2006. P61-65.
Bangi BB, Ginjupally U, Nadendla LK, Vadla B. 3D evaluation of maxillary sinus using computed tomography: A sexual dimorphic study. Int J Dent 2017;2017:9017078.
Teke HY, Duran S, Canturk N, Canturk G. Determination of gender by measuring the size of the maxillary sinuses in computerized tomography scans. Surg Radiol Anat 2007;29:9-13.
McGowan DA, Baxter PW, James J. The Maxillary Sinus and Its Dental Implications. Oxford: Wright, Butter-Worth-Heinemann; 1993. p. 1-25.
Orhan K, Kusakci Seker B, Aksoy S, Bayindir H, Berberoğlu A, Seker E. Cone beam CT evaluation of maxillary sinus septa prevalence, height, location and morphology in children and an adult population. Med Princ Pract 2013;22:47-53.
Mirfazeli A, Kaviany N, Hosseinpoor K, Aryaie M, Golalipour MJ. Birth defects in Northern Iran (2008-2013). Iran J Public Health 2018;47:413-7.
Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st
ed. London: Elsevier Health Sciences; 2015.
Iwanaga J, Wilson C, Lachkar S, Tomaszewski KA, Walocha JA, Tubbs RS. Clinical anatomy of the maxillary sinus: Application to sinus floor augmentation. Anat Cell Biol 2019;52:17-24.
Chanavaz M. Maxillary sinus: Anatomy, physiology, surgery, and bone grafting related to implantology – Eleven years of surgical experience (1979-1990). J Oral Implantol 1990;16:199-209.
Nuñez-Castruita A, López-Serna N, Guzmán-López S. Prenatal development of the maxillary sinus: A perspective for paranasal sinus surgery. Otolaryngol Head Neck Surg 2012;146:997-1003.
Duncavage J. The Maxillary Sinus: Medical and Surgical Management. New York: Thieme Medical Publishers; 2011.
Williams PL, Warwick R, Dyson M, Bannister LH. Gray's Anatomy 37th ed, Edinburgh: Churchill Livingstone; International Edition. 1997: pp 389-390.
Čechová M, Dupej J, Brůžek J, Bejdová Š, Horák M, Velemínská J. Sex estimation using external morphology of the frontal bone and frontal sinuses in a contemporary Czech population. Int J Legal Med 2019;133:1285-94.
Sharma SK, Jehan M, Kumar A. Measurements of maxillary sinus volume and dimensions by computed tomography scan for gender determination. J Anat Soc India 2014;63:36-42.
Uthman AT, Al-Rawi NH, Al-Naaimi AS, Al-Timimi JF. Evaluation of maxillary sinus dimension in determine using helical CT scaning. J Forensic Sci 2011;56:403-8.
Lee F. Forensic ethnic identification of cranial the role of the maxillary sinus. Am J Forensic Med Pathol 2004;25:302-13.
Tambawala SS, Karjodkar FR, Sansare K, Prakash N. Sexual dimorphism of maxillary sinus using cone beam computed tomography. Egypt J Forensic Sci 2016;6:120-5.
Sahlstrand-Johnson P, Jannert M, Strömbeck A, Abul-Kasim K. Computed tomography measurements of different dimensions of maxillary and frontal sinuses. BMC Med Imaging 2011;11:8.
Musilová B, Dupej J, Velemínská J, Chaumoitre K, Bruzek J. Exocranial surfaces for sex assessment of the human cranium. Forensic Sci Int 2016;269:70-7.
Amin MF, Hassan EI. Sex identification in Egyptian population using multidetector computed tomography of the maxillary sinus. J Forensic Leg Med 2012;19:65-9.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]