Christopher C. Chang Gary A. Incaudo - Diseases of the Sinuses A Comprehensive Textbook of Diagnosis and Treatment

Springer Science+Business Media New York 2014

Samuel Mrquez 1 and Jeffrey T. Laitman 7

Abstract

The study of paranasal sinus diseases spans a 2000-year history from the earliest known investigators to the present. After an exhaustive historical review of the classification for each sinus, an operational definition of the anatomical status of the paranasal sinus system is presented from a developmental perspective. A comprehensive examination of nomenclature is undertaken to clarify discrepancies and vagaries in anatomical terminology, which have been a major source of confusion among those studying or operating upon the nasal complex nose and paranasal sinuses. Primary original sources of nomenclature were consulted to clarify persistent confusions encountered in the literature, which will permit better communication in addition to eliminating redundant terminology. Morphological entities such as the agger nasi versus agger nasi cells, frontal cell, frontal recess, lateral recess, ethmoid infundibulum, hiatus semilunaris, nasofrontal duct, and nasolacrimal duct are examined from an embryologic, comparative anatomical, and evolutionary frame of reference in order to identify their importance in sinus disease processes. Multiple approaches are used to describe the anatomy of the nasal complex utilizing the diverse backgrounds of the authors, who are comparative evolutionary anatomists, radiologist, and ENT surgeons from France and the USA with a combined clinical experience of 120 years of surgical practice. Methods used for this chapter include CT and endoscopic nasal imaging of living humans, examination of dry cranial material, fresh tissue anatomical dissections, and three-dimensional volume-rendering methods that allow for digitization of spaces within the nasal complex for graphical examination. Given the great complexity and extreme variability of the paranasal sinus system, otolaryngology is arguably among the most challenging of surgical fields. Indeed, when afflicted with a viral or bacterial infection, or presenting with one of many types of carcinomas, their formidable clinical manifestations challenge the depth of the ENT surgeons knowledge and experience. As such, a dizzying array of anatomical terms has been applied to these densely clustered, disease-prone spaces and their associated structures. It is thus the charge of the otolaryngologist to master the anatomy of the paranasal sinuses and greater nasal complex, which clinically may be considered the last frontier in craniofacial biology.