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Facial sinus endoscopic evaluation, radiologic assessment, and classification.

Matteo Alicandri-Ciufelli1,2, Matteo Fermi1, Marco Bonali1

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PubMed
Summary

This study classifies facial sinus anatomy using endoscopy and CT scans, revealing three types (A, B, C) based on facial nerve proximity. Understanding these facial sinus variations is crucial for surgical planning.

Keywords:
Facial sinuschordiculuslateral tympanic sinusmiddle earradiologic classificationretrotympanumtranscanal endoscopic approach

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Area of Science:

  • Otolaryngology
  • Surgical Anatomy
  • Medical Imaging

Background:

  • The facial sinus is an anatomical structure within the temporal bone.
  • Detailed understanding of its relationship with the facial nerve is important for surgical procedures.
  • Endoscopic and CT imaging offer distinct perspectives on this anatomy.

Purpose of the Study:

  • To describe facial sinus anatomy from an endoscopic viewpoint.
  • To introduce a radiologic classification system for the facial sinus.
  • To correlate endoscopic findings with high-resolution computed tomography (HRCT) classifications.

Main Methods:

  • Endoscopic examination and HRCT scans were performed on 39 temporal bones.
  • A radiomorphologic classification (Types A, B, C) was developed based on facial sinus pneumatization relative to the mastoid facial nerve.
  • Anatomical variants of the chordiculus were also assessed endoscopically.

Main Results:

  • Facial sinus was identifiable in all 31 HRCT scans.
  • Type A facial sinuses were most common (58%), followed by Type B (29%) and Type C (13%).
  • Endoscopic assessment of 39 temporal bones revealed anatomical variants of the chordiculus: ridge (39%), bridge (18%), incomplete (15%), and absent (28%).

Conclusions:

  • Endoscopic exploration provides excellent visualization of the facial sinus and its surrounding structures.
  • Enhanced knowledge of facial sinus anatomy can aid in reducing residual disease during cholesteatoma surgery.
  • Angled endoscopes improve visualization of the facial sinus.