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ORIGINAL ARTICLE
Year : 2016  |  Volume : 23  |  Issue : 1  |  Page : 12-15

Normal anatomical variations of maxillary sinus septa using computerized tomography from Sokoto Northwestern Nigeria


1 Department of Anatomy, College of Health Sciences Usmanu Danfodiyo University, Sokoto, Nigeria
2 Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Web Publication6-Jan-2016

Correspondence Address:
Aliu Abdul-Hameed
Department of Anatomy, College of Health Sciences, Usmanu Danfodiyo University, PMB 2346, Sokoto
Nigeria
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DOI: 10.4103/1115-3474.155741

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  Abstract 

Background/Aim: The maxillary sinus is the largest paranasal sinus and represents a complex anatomical structure with significant inter-individual variation. Computerized Tomography (CT) in the assessment of the maxillary sinus yields much more information. The aim of this study is to determine the prevalence, number and location of maxillary sinus septa using CT. Materials and Methods: One hundred and thirty subjects (79 males and 51 females), between 20–80 years, with normal maxillary sinus CT anatomy, from head CT scans carried out at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, over a period of 5 years, were studied. Head CT scans were obtained from the local data base of the CT machine and back up compact disc from the CT library. Images were taken with Neusoft Dual Slide Helical CT machine, and films were viewed on the computer monitor. Septa were identified as bony projections from the sinus walls into its cavity on axial and coronal slides. Results: In this study, septa were present in 14.23% (37 septa out of 158) males sinuses, while in females, 10.34% (27 out of 102) had septa. The overall prevalence of maxillary sinus septa was 24.62%. Conclusion: Maxillary sinus septa appear common and are capable of complicating sinus membrane surgeries. CT may be useful in surgical evaluation and planning.

Keywords: Anatomical variations; computerized tomography; maxillary sinus; Nigeria; septa; prevalence; Sokoto


How to cite this article:
Abdul-Hameed A, Daudu ZA, Mohammad MS, Abubakar B, Shiitu BS, Danjuma UJ, Abdo Aziz MM. Normal anatomical variations of maxillary sinus septa using computerized tomography from Sokoto Northwestern Nigeria. West Afr J Radiol 2016;23:12-5

How to cite this URL:
Abdul-Hameed A, Daudu ZA, Mohammad MS, Abubakar B, Shiitu BS, Danjuma UJ, Abdo Aziz MM. Normal anatomical variations of maxillary sinus septa using computerized tomography from Sokoto Northwestern Nigeria. West Afr J Radiol [serial online] 2016 [cited 2021 Mar 4];23:12-5. Available from: https://www.wajradiology.org/text.asp?2016/23/1/12/155741


  Introduction Top


Maxillary sinus septa are bony crests within the sinuses and are referred to as Underwood's septa, because they were first described in detailed anatomy of the maxillary sinus by Underwood in 1910.[1] They may give rise to multiple posterior recesses or extend from the base to the roof, producing two separate sinuses.[1],[2],[3] Etiologically, according to Underwood,[3] they arise from an area between two adjacent teeth and are usually found in three specific sections (anterior, middle, or posterior) that correspond to the three defined periods of tooth activity, separated by intervals of time. However, Neivert [4] proposed that septa were derived from finger-like projections produced by the embryonic out-pouching of the ethmoidal infundibulum.

Krenmair [5] classified sinus septa into primary and secondary; the primary septa occur along with the development of the maxilla, while the secondary arises as a result of irregular pneumatization of the sinus floor after tooth loss. The presence of anatomic variations within the maxillary sinus, such as septa, may increase the risk of schneiderian membrane perforation during sinus operations and this represents the most common complication.[6],[7],[8] It may also limit the creation of a window in the anterior-lateral wall and the reflection of a hinged door when elevating the sinus membrane from an alveolar recess.[8],[9] As such, a detailed knowledge of the anatomy of the sinuses is critical in performing procedures such as functional endoscopic sinus surgery.[10]

According to Donal,[11] from the University of British Columbia, Vancouver, Canada, 50% of cadaveric models had septa, whose position, number, and depth were extremely variable. Ulm [7] reported 18.3% prevalence from School of Dentistry, University of Vienna, Austria, while in two separate studies, Krenmair [5],[12] reported a prevalence of 26.8% and 14.3%, respectively using sinus computerized tomographys (CTs) of Austrians in Wels. Velasquez-Plata [13] found 24% prevalence at the University of Detroit, Michigan, USA, and from the College of Dentistry, Yonsei University, Seoul; among Koreans, Kim [14] reported a prevalence of 31.7% and 22.6% in edentulous and dentate maxillas, respectively by CT scan imaging. Maryam [15] at Leuven, Belgium, found prevalence of 47%. There is dearth of data on the prevalence, and locations of maxillary sinus septa using CT among Nigerians (Africans), and most of these results were obtained from Caucasian subjects. The aim of this study is therefore to compliment their findings and to establish a baseline data for values in our environment.


  Materials and Methods Top


This study involved 130 subjects (79 males and 51 females), between 20–80 years, with normal maxillary sinus CT anatomy, from head CT scans carried out at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, over a period of 5 years. Head CT scans were obtained from the local data base of the CT machine and back up compact disc from the CT library. Images were taken with Neusoft Dual Slide Helical CT machine, (2005 model, 15 cm FOV, 200 mA, 120 kV, scanning at high resolution bone algorithm at 1 second and slice thickness of 5 mm). Films were viewed on the computer monitor. Septa were identified as bony projections from the sinus walls into its cavity on axial and coronal slides while the number and location of septa per sinus was noted. Data was manually sorted out, tabulated, entered into computer using Microsoft word, and Excel, and comparison was done using Chi-square with Yates correction.


  Results Top


All observed septa were located on the anterior and anterolateral walls of the maxillary sinus [Figure 1]. Among males, septa was present in 14.23% of maxillary sinus, [Table 1] while of the 19 male right maxillary septa, had each maxillary sinus being completely divided into two halves [Figure 2] and the other had a doubled septum [Figure 3]. Double septa were not seen in any left maxillary sinus of either males or females in the studied population. However, in females, 10.34% had sinus septa. Two of the 13 right septa were doubled. Th e overall prevalence of maxillary sinus septa was 24.62%.
Figure 1: Axial computerized tomography (CT) of a 45-year-old male showing arrows pointing toward septa on the anterior and anterolateral sinus walls. A = anterior, P = posterior, R = right side, L = left side

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Table 1: The frequency of maxillary sinus septa in the studied population

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Figure 2: Axial computerized tomography (CT) slide of a 55-year-old male showing bilateral septa (arrows) completely dividing each maxillary sinus anteroposteriorly into two compartments. R = right side, L = left side, A = anterior, P = posterior

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Figure 3: Axial computerized tomography (CT) slide of a 70-year-old female showing doubled septa (arrow) on the anterior wall of the right maxillary sinus. R = right side, L = left side, A = anterior, P = posterior

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  Discussion Top


Maxillary sinus septa appear common, they are capable of precipitating and complicating sinus membrane perforation during sinus operations, and this may be minimized by complete CT evaluation and adequate pre-operative planning for sinus surgery. The range of normal anatomical variations of the maxillary sinus in different studies is a reflection of the influential effects of human variability and the different degrees of pneumatisation.[16],[17] In this study, the prevalence of maxillary sinus septa was 24.62%; of these, 1.15% were doubled septa, and all septa were located on the anterior and anterolateral walls of the maxillary sinus. The incidence of septa from this study was lower than the estimated prevalence of antral septa among Canadians by Donal,[11] where 50% of cadaveric models had septa, by Ella,[18] in France with 38.6% prevalence; by Maryam,[15] in Leuven, Belgium, with prevalence of 47%; and among Italians by Gabriele,[1] who reported a prevalence of 40% in a cadaveric study of the maxillary sinus septa. However, the results of this study compared favorably with the works of Krenmair,[5] in Austria, and Kim,[14] in Seoul, Korea, where the prevalence of maxillary sinus septa were 26.8% and 22.6%, respectively.

Our results were essentially the same with the report of Velasquez-Plata,[13] from the University of Detroit, Michigan, USA, who found 24% prevalence of antral septa on CT scan analysis of maxillary sinuses, and Won-Jin,[19] who reported a prevalence of 24.6%, among Koreans in Jeonju. However, our results were higher than the septal prevalence reported by Ulm,[7] (18.3%), from the University of Vienna, Austria, and Krenmair,[12] (14.3%), from the University of Vienna, Austria, while Amusa,[20] who worked on south-western Nigerians at the Obafemi Awolowo University Teaching Hospital, Ile Ife, recorded no antral septa in 24 dried human skulls.

Concerning double septa, our results were lower and different from the findings by Won-Jin,[19] from Chonbuk National University School of Dentistry, Jeonju, Korea, that, 8 out of 236 sinuses had double septa, and that no sinus had septa completely dividing it into two or more compartments. In agreement with most studies on the location of sinus septa,[1],[2],[3],[20],[21],[22] this study found that, the maxillary sinus septa were located on the anterior and anterolateral walls of the maxillary sinus.

 
  References Top

1.
Rosano G, Taschieri S, Gaudy JF, Lesmes D, Del Fabbro M. Maxillary sinus septa: A cadaveric study. J Oral Maxillofac Surg 2010;68:1360-4.  Back to cited text no. 1
    
2.
Miles AE. The maxillary antrum. Br Dent J 1973;134:61-3.  Back to cited text no. 2
    
3.
Underwood AS. An inquiry into the anatomy and pathology of the maxillary sinus. J Anat Physiol 1910;44:354-69.  Back to cited text no. 3
    
4.
Neivert H. Surgical anatomy of the maxillary sinus. Laryngoscope 1930;40:1.  Back to cited text no. 4
    
5.
Krenmair G, Ulm CW, Lugmayr H. Maxillary sinus septa: Incidence, morphology and clinical implications. J Craniomaxillofac Surg 1997;25:261-5.  Back to cited text no. 5
    
6.
Betts NJ, Miloro M. Modification of the sinus lift procedure for septa in the maxillary antrum. J Oral Maxillofac Surg 1994;52:332-3.  Back to cited text no. 6
    
7.
Ulm CW, Solar P, Krennmair G, Matejka M, Watzek G. Incidence and suggested surgical management of septa in sinus lift procedures. Int J Oral Maxillofac Implants 1995;10:462-5.  Back to cited text no. 7
    
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Maestre-Ferrín L, Galán-Gil S, Rubio-Serrano M, Peñarrocha-Diago M, Peñarrocha-Oltra D. Maxillary sinus septa: A systematic review. Med Oral Patol Oral Cir Bucal 2009;15:e383-6.  Back to cited text no. 8
    
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Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am 1986;30:207-29.  Back to cited text no. 9
[PUBMED]    
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Karakas S, Kavakli A. Morphormetric examination of the paranasal sinuses and mastoid air cells using computed tomography. Ann Saudi Med 2005;25:41-5.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.
McDonnell D, Esposito M, Todd ME. A teaching model to illustrate the variation in size and shape of the maxillary sinus. J Anat 1992;181:377-80.  Back to cited text no. 11
    
12.
Krenmair G, Ulm CW, Lugmayr H, Solar P. The incidence, location and height of maxillary sinus septa in the edentulous and dentate maxilla. J Oral Maxillofac Surg 1999;57:667-71.  Back to cited text no. 12
    
13.
Velasquez-Plata D, Hovey LR, Peach CC, Alder ME. Maxillary sinus septa: A 3 dimensional computerized tomographic scan analysis. Int J Oral Maxillofac Implants 2002;17:854-60.  Back to cited text no. 13
    
14.
Kim MJ, Jung UW, Kim CS, Kim KD, Choi SH, Kim CK, et al. Maxillary sinus septa: Prevalence, height, location, and morphology, A reformatted computed tomography scan analysis. J Periodontol 2006;77:903-8.  Back to cited text no. 14
    
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Shahbazian M, Xue D, Hu Y, van Cleynenbreuge J, Jacobs R. Spiral computed tomography based maxillary sinus imaging in relation to tooth loss, implant placement and potential grafting procedure. J Oral Maxillofac Res 2010;1:e7.  Back to cited text no. 15
    
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Ariji Y, Ariji E, Yoshiura K, Kanda S. Computed tomographic indices for maxillary sinus size in comparison with the sinus volume. Dentomaxillofac Radiol 1996;25:19-24.  Back to cited text no. 16
    
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Koppe T, Weigel C, Bärenklau M, Kaduk W, Bayerlein T, Gedrange T. Maxillary Sinus pneumatization of an adult skull with an untreated bilateral cleft palate. J Craniomaxillofac Surg 2006;34:91-5.  Back to cited text no. 17
    
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Ella B, Noble Rda C, Lauverjat Y, Sédarat C, Zwetyenga N, Siberchicot F, et al. Septa within the sinus: Effect on elevation of the sinus floor. Br J Oral Maxillofac Surg 2008;46:464-7.  Back to cited text no. 18
    
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Lee WJ, Lee SJ, Kim HS. Analysis of location and prevalence of maxillary sinus septa. J Periodontal Implant Sci 2010;40:56-60.  Back to cited text no. 19
    
20.
Amusa YB, Eziyi JA, Akinlade O, Famurewa OC, Adewole SA, Nwoha PU, et al. Volumetric measurements and anatomical variants of paranasal sinuses of Africans (Nigerians) Using Dry Crania. Int J Med Med Sci 2011;3:299-303.  Back to cited text no. 20
    
21.
Jensen OT, Greer R. Immediate placement of osseointegrating implants into the maxillary sinus augmented with mineralized cancellous allograft and gore-tex, second-stage surgical and histologic findings. In: Laney WR, Tolman DE, editors. Tissue Integration in Oral Orthopedic and Maxillofacial Reconstruction. Chicago: Quintessence; 1992. p. 321-33.  Back to cited text no. 21
    
22.
Ariji Y, Kuroki T, Moriguchi S, Ariji E, Kanda S. Age changes in the volume of the human maxillary sinus: A study using computed tomography. Dentomaxillofac Radiol 1994;23:163-8.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]


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