Total aplasia of the paranasal sinuses
Hakan Korkmaz, M.D. and Mukadder Korkmaz, M.D.
Although a variety of theories have been proposed about
functions of the paranasal sinuses, not one is clear
today.Nonetheless, paranasal sinusrelated diseases are associated
with a high rate of morbidities. Therefore, it is essential to
identifythe structure and pathophysiology of the paranasal sinuses.
Computed tomography (CT) is a valuable tool displaying
anatomicvariations and diseases. Because paranasal sinus
development is a complex and long-lasting process, there are great
structuralvariations between individuals. Several degrees and
combinations of aplasias and hypoplasias have been reported;
however, thereis only one case of total paranasal sinus aplasia in
the literature. Here, we present the second case of total paranasal
sinusaplasia. Paranasal sinus development, functions of the
paranasal sinuses, and the role of CT were evaluated.
(Allergy Rhinol 4:e105e109, 2013; doi:
Paranasal sinuses are empty spaces located withinthe skull bones
around the nasal cavity. Theirdevelopment and final shape show
great variations,and even identical twins may have different
configu-rations.1 Fractures, tumors, mucoceles, primary
ciliarydyskinesia, infections, and some syndromes such asDown
syndrome may have adverse effects on parana-sal sinus
development.25 Paranasal sinus structure incystic fibrosis and
primary ciliary dysplasia patients isassociated with decreased
pneumatization and devel-opment, either because of repeated
infections or ge-netic variations.68 It is crucial to clarify the
anatomicdetails of the paranasal sinuses with respect to
correctdiagnosis of diseases and appropriate surgical plan-ning
before surgical procedures such as functional en-doscopic sinus
surgery and transsphenoidal hypophy-sectomy. Computed tomography
(CT) scan is anexcellent tool that is used to document the
detailedanatomy of the paranasal sinuses.
A variety of paranasal sinus anomalies have beendescribed in the
literature but, to our knowledge, onlyone case of total paranasal
sinus aplasia has been re-ported.9 This article presents the second
case of totalparanasal sinus aplasia.
CASE REPORTThe patient, a 57-year-old woman, presented to
clinic with the complaints of occasional nasal stuffinessand
chronic frequent bilateral headache attacks con-centrating around
both ears and lasting a few days.
Headache accompanied nausea, fullness of the faceand ears, and
hearing loss during attacks. Addition-ally, she described tiredness
around upper jaw duringchewing. Physical examination of the
temporomandib-ular joint appeared normal. She said she had
nevercaught a cold before.
She had no previous history of recurrent sinusitisattacks,
previous nasal surgery, or facial trauma.Physical examination did
not reveal any pathologicalsign, and lateral nasal wall, septum,
and nasal cavi-ties were normal. Her facial appearance was
normal.CT scans were obtained with 3-mm-slice thicknessand 1-mm
increment. The CT scans showed normal-appearing nasal septum and
conchae. However,there was total lack of development of all
paranasalsinuses (Figs. 114).
From the Department of Otorhinolaryngology Head and Neck
Surgery, Ordu Uni-versity Medical School, Education and Research
Hospital, Ordu, TurkeyThe authors have no conflicts of interest to
declare pertaining to this articleAddress correspondence to Hakan
Korkmaz, M.D., Ordu Universitesi Tp FakultesiEgitim ve Arastrma
Hastanesi KBB AD, Bucak Mah, Nefsi Bucak Cad, 52200
Ordu,TurkeyE-mail address: firstname.lastname@example.org.Copyright 2013,
OceanSide Publications, Inc., U.S.A.
Figure 1. Coronal CT scan of the patient.
Allergy & Rhinology e105
chemical irritants, stress, and anxiety easily triggers
theheadache. Her second complaint, masseter tiredness onchewing,
points out another function of the paranasalsinuses, which is
dispersal of masticatory forces onchewing.
The other total paranasal sinus aplasia patient re-ported by
Celebi and friends had less specific com-plaints attributed to
aplasia.9 His major symptom wasfullness of the face, which was also
described by ourpatient. He did not have headache and
masticatoryproblems. Fortunately, both patients were free of
re-current sinus infections.
CONCLUSIONParanasal sinuses are subject to great structural
ations. CT scan is the main tool to reveal the detailedstructure
of the paranasal sinuses. They may showgreat aeration differences
ranging from normal to totalaplasia. We have to be aware of any of
these morpho-logical alternatives to reach correct diagnoses
andtreatment of diseases. Patients with aplasia and hypo-plasia may
be evaluated to make clear the roles of thesinuses.
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Figure 14. Sagittal CT scan of the patient.
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