Development Of Paranasal Air .Sinuses--A Roentgenographic Planimetric Study
CHANDER MALHOTRA YOGINDER N. MEHRA J. S. SODHI Chandigarh
The development of paranasal sinuses as described by Turner (1901) from an anatomical study on the English skulls holds good to this day with little alteration. Schaeffer (1936), Murai (1937), Naatanen and Paatero (1938) and Stern (1939) made a radiological study of American, Japanese, Finish and German skulls respectively for the paranasal sinuses. Except "Turner (1901) and Schaeffer (1936) no author has described the complete development of paranasal sinus. Considering the lack of data available on North Indian skulls it was decided to undertake this investigation to study the development of paranasal sinuses. It is based on planimetric measurement of roentgenograms of one-hundred subjects at
These subjects belonged to general public, local schools and the wards of Nehru Hospital, Chandigarh. They have no history of any disorders of ear, nose and throat and were of good nutrition and normal in all respects. These subjects were equally divided into males and females and grouped into 3-4 years, 11-12 years, 15-16 years and 24-25 years. The x-ray of paranasal sinuses in two views (1) 10 degree occipitomental position and (2) lateral position, were taken. The distance between the film and the tube was fixed at forty inches for all cases in both positions.
Dr. Chander Malhotra, Resident in Otolaryngology, Dr. Yoginder N. Mehra, Associate professor and Head Dept. of Otolaryngology, Dr. J. S. Sodhi, Assistant Professor and Head Dept. of Radio-diagnosis, Postgraduate Institute of Medical Education & Research, Chandigarh (India). Read at 21st annual conference of association of Otolaryngologists of India, 29-31 May, 1969.
With the film fixed on a viewingbox the following measurements were taken with a planimeter (Fig. 1) used to measure the areas of irregular figures (Fig. 2 & 3). 1. The whole area of skull in the occipitomental and Iateral view.
different age groups taken by standard technique.
Measurements
187
2. Maxillary sinus—in both the views. 3. Frontal sinus in both views. 4. Orbital area only in occipitomental position. 5. Sphenoid sinuses only in lateral view. 6. The nasal angle was measured with the help of a protector. As it is difficult to observe any group of ethmoidal sinus in any of the above two views, these could not be measured. Observations and Discussion
variation of sphenoid sinus anatomy. Sindoni (1935) made a study of sphenoid sinus of persons at all ages and found large sinuses to be present in 60% of the entire group. Maresh (1940) among others agree that there is no constant or so called normal type in the anatomy of the paranasal sinuses. It is, therefore, obvious that adherence to a single fixed standard and arbitrary normal is fraught with danger as this variation can alter the anatomical relationship of sinus.
Size variation of paranasal sinus (Table I). Frontal Sinus There are extreme variations of the frontal sinuses at different age groups in both the sexes and the frontal sinuses are invariable developed after the age of 15 years. Shima and Tsuji (1939) reported that both frontal sinuses were present 88% of the cases. Right sinus was per cent in only 2% and left in 4% of the cases. A median sinus was present in 3% of the cases.
Asymmetry of Paranasal Sinus
Maxillary Sinus
The conclusion derived is that the size variations in both these sexes increases with age and it is uncommon to see the complete absence of the maxillary sinus after the age of 15-16 years. Since no data on the subject are available, it is impossible to compare the figures. Sphenoid Sinus The size variation of the sphenoid sinus increases with the advancement in age and complete absence of sphenoid sinus is uncommon after the age of 7-8 years in both sexes. According to Neivert (1925) there is great
(Table I) FRONTAL SINUS — The maximum asymmetry is present at 11-12 years in both the sexes. MAXILLARY SINUS—The asymmetry between two sides in maximum at 3-4 years of age decreases as the age advances till the age of 24-25 years when there is no difference between right and left sides of the maxillary sinuses in both sides. The frontal sinuses as compared to the maxillary sinus are less symmetrical. Soldatini (1935) has also found that the greatest number of abnormalities are in frontal sinuses and least in the maxillary sinuses. Rate of Growth (Table No. 1) FRONTAL SINUS—The frontal sinus is present at 3.4 years of age but the rate of growth is maximum at 15-16 years and continue to grow rapidly up to 24.25 years of age in both the sexes. According to Turner (1901) the development of frontal sinus starts at 3-4 years of age. In the present study the development of frontal sinuses has already started at 3-4 years in 80% of the cases whereas according to Schaeffer(1936) the
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development starts at the age of 6-12 skull in anteroposterior view and it months and the rate of growth is at has been shown that there is signifithe peak at 15-16 years of age and cant statistical correlation between the goes up to 24-25 years of age which development of frontal and maxillary correlates with present study. sinuses individually with the developMAXILLARY SINUS — The ment of skull in both the sexes. growth rate is different in both sexes. Paranasal Sinuses and Nasal Angle The sinus is present in 70 -90% of the (Table II) cases at 3 4 years of age. The rate is There is hardly any change in at the peak at 11-12 years of age in nasal angle from 3-4 years to 24-25 both the sexes. The rate of growth years in both sexes whereas the sinus is very slow after the age of 15-16 grows rapidly. There is no correlayears in females whereas it is rapid tion present between them. till 24-25 years of age in males. Paranasal Sinus and Orbital Area According to Turner (1901) the (Table II) growth is rapid at the age of 7-8 years The total area of orbit has been but the maximum size is reached in compared with total frontal and orbi20-25 years of age. According to tal maxillary area and for comparison Schaeffer (1936) the maximum size area has been kept constant. is at 15-16 years after which the There is statistical correlations growth is very slow. present between the development of SPHENOID—Tbe shadow of the maxillary and frontal sinus with areas sphenoid sinus is already seen in 3 -4 of orbit in occipitomental areas in years of age in 40-70% of the cases both the sexes. and its rate of growth is maximum at Paranasal Sinus and Dentition 11-12 years and continues up to 25 (Table II) years of age in both the sexes. AcThe total number of teeth in a cording to Turner (1901)the sphenoid specific age group is compared with sinus is seen as early as 6 years and the sum of both frontal and maxillary according to Schoeffer (1936) it is sinus. From the above table one can present as early as 1 year and develops conclude that there is definite relationfrom birth to puberty. ship between the development of Development of frontal and Maxillary paranasal sinuses and the eruption Sinuses (Table II) of molar teeth as the growth of the Both the frontal sinuses are com- sinus is very rapid at 3-4 years, 11-12 pared with both the maxillary sinuses. years, 15-16 years and 24-25 years, In male and female there is statis- when the molars are erupting. This tically significant correlation present has been established by Turner (1901) between the development of frontal and proved experimentally by Grahe and maxillary sinuses in occippito- (1931) on rabits. mental position. Summary and Conclusion Paranasal Sinuses and Skull (Table /1) This study of planimetric measureIn this relationship both maxillary ments of roentgenograms of onesinuses and both frontal sinuses are hundred subjects at different age compared with the whole shadow of groups taken by standard techniques
190 Ind. J. Otol. Vol. XXI, No. 4, December, 1969
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has been conducted to review the development of paranasal sinuses. The information regarding the size variations, the sex variations and the asymmetry of sinuses and its important correlations with the skull shadow, orbits, nasal angle and dentition has been evaluated.
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REFERENCES
1.
Grahe, K. K. (1931). Acta Otolaryng., 15:141. 2. Maresh, Maron, M. (1940). Amer. Jour. Disc Child, 50: 55. 3. Murai, Y. Sei-1-Kai. Med. Jour. (Abstr. Sec.), 56:8, Feb-1937. Cited by Sammuel Salinger (1940). Arch. Otolaryng., 32: 344. 4. Naatanen, E. and Paatero, Y. Duodeoim, 54:1032, 1938. Cited by Sammuel Salinger (1940). Arch. Otolaryng., 32;344
8.
Neivert, H. (1925). Arch. Otolaryng., 1: 366. Schaeffer, J.P. (1936). Pennsylvania Med. Jour.: 39: 395. Shima, F. and Tsuji, T. Orient Med. (Abstr. Sec.), 30:162, Mar, 1939. Cited by Sammuel Salinger (1940). Arch. Otolaryng., 32:394 Stren, L. Nasen-u. Ohrenarzt (pt.), 30 : 169, May, 1939. Cited by Samuel Salinger (1940). Arch Otolaryng., 32: 344.
9.
Sindoni. Arch. Ital. do. Otol., 40:864, Dec., 1935. Cited by (1937), Sammuel Salinger. Arch. Otolaryng., 26:206.
10.
Turner, A.L. Accessory sinuses of Nose, Edinburgh, 1961. Cited in Gray's Anatomy. Ed. Davis, 1904, ed. 33, p. 1253.
192 Ind. J. Otol. Vol. XXI, No. 4, December, 1969
