Retrospective Study on the Prevalence of Haller Cells Using Cone Beam Computed Tomography

The paranasal sinuses are cavities filled with air located within specific bones, namely the frontal, ethmoidal, maxillary, and sphenoidal sinuses. The ethmoidal sinus is composed of three groups: anterior, middle, and posterior, which are found on both sides. Haller cells (HC), also known as infraorbital ethmoid cells, are projections of the anterior ethmoid sinus that extend into the floor of the orbit and the upper part of the maxillary sinus. Infraorbital ethmoid cells have been associated with several disease conditions and symptoms, such as sinusitis, headaches, orofacial pain, and mucoceles. Consequently, determining the frequency and form of HC is crucial. The objective of the study was to determine the frequency, form, and clinical significance of Haller cells (HC) using cone beam computed tomography (CBCT).

This retrospective study analyzed 100 cone beam computed tomographic (CBCT) images, with an equal distribution of 50 males and 50 females from the age range of 19 to 70 years. The images were randomly selected from the CBCT archives. The participants were chosen according to the specific criteria for inclusion and exclusion established for the study. The collected data were subjected to statistical analysis utilizing the Chi-square test, independent student t-test, one-way ANOVA test, Cohen's Kappa statistics, and intraclass correlation coefficients.

The occurrence of Haller cells (HC) was found to be 73%, with 32 cases observed in males and 41 in females. Among the 73 patients with HC, 52 (71%) had unilateral HC, while 21 (28.76%) had bilateral HC. Regarding the shape of the HCs, 31 (42.46%) were teardrop-shaped, 26 (35.61%) were oval-shaped, and 16 (21.91%) were round-shaped. Additionally, out of the 73 cases of HC, 69 (94.52%) were unilocular, and four (5.47%) were multilocular. Furthermore, the average dimensions of HC were greater in males than in females, regardless of whether the cells were distributed unilaterally or bilaterally. The interobserver agreement between observers one and two showed complete consistency, and our study found that the assessment of the dimension of HC had outstanding interrater reliability.

The findings of this study indicate that CBCT is highly effective in visualizing and accurately delineating Haller cells in a significant number of patients. It is essential for oral physicians and oral radiologists to be aware of these anatomical structures to accurately identify them. This awareness will enable them to provide a comprehensive differential diagnosis for individuals experiencing orofacial pain and discomfort that may be attributed to the presence of Haller cells.