SIGNIFICANCE OF ANATOMICAL VARIATIONS OF MAXILLARY SINUS AND OSTIOMEATAL COMPONENTS COMPLEX IN SURGICAL TREATMENT OF SINUSITIS
Objective. Determining the anatomical variability of the upper maxillary sinus and ostiomeatal complex components as well as on the basis of the obtained data the selection of the optimal access to the zones of the maxillary sinus to choose sinusitis treatment method, which allows minimizing intra- and postoperative complications. Methods. The results of studies of the paranasal sinuses of 30 patients conducted on the spiral computed tomography were studied: 10 with the subtotal reduction of pneumatization of the maxillary sinus and 10 patients with hyperplasia of the mucous membrane. The control group included 10 SCTs of healthy individuals. The average volume, bone density of the maxillary sinus, the average size of the inferior nasal turbinate, the size, density of processus uncinatus under physiological and pathological conditions, the correlation between these parameters were determined. Results. A significant correlation (r=0.96, 0.96, 0.95, and 0.9 in the physiological state and r=0.95, 0.94, 0.97, and 0.91 in sinusitis) was noted between the volume, thickness and the density of the walls of the maxillary sinus. A moderate correlation was between the volume of the sinus, the thickness and density of the processus uncinatus, the volume of the sinus and the longitudinal size of the inferior turbinate in the unchanged sinus (r=0.65, 0.68 and 0.66). A very strong correlation was between the thickness of the upper wall and the volume of the sinus (r=0.96). A strong positive linear relationship (r=0.72) is noted between the volume and thickness of the medial wall (p<0.05). The reliable (p<0.01) strong (r=0.75) interconnection was between the thickness of the processus uncinatus and the average sinus volume. Very strong linear correlation was between the density of the middle and upper walls of the maxillary sinus in physiological and pathological conditions (r=0.9 and 0.84) Conclusions. Spiral computed tomography is a diagnostically significant method for the study of the maxillary sinuses. Parameters of the paranasal sinuses necessary for successful endoscopic rhinosurgery were determined.The obtained data helps to choose access during endoscopic operations, to prevent intra-, postoperative complications, to predict the likelihood of intracranial or intraocular spread of the pathological process. What this paper adds For the first time the ostiomeatal complex bone density has been studied in case of different severity of pathological changes that is important for endoscopic invasions in the given area. This sign has been never studied before with CT investigation. Correlation between maxillary sinus volume, its density, thickness, sizes of the inferior and middle turbinate, processus uncinatus has been established.