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DENTAL RADIOLOGY
VOLUME, ASYMMETRY AND RECIPROCAL
Original Articles
RELATIONSHIPS BETWEEN PARANASAL SINUSES:
A 3D SEGMENTATION STUDY ON HEAD CT-SCANS
Giulia Andrea Guidugli1,2a , Daniele Maria Gibelli1b , Michaela Cellina3c , Antonio Giancarlo Oliva3d,
Luisa Barni1e , Patrizia Sartori1f , Chiarella Sforza1g*
1
Department of Biomedical Sciences for Health, University of Milan, I-20133 Milan, Italy
2
Department of Orthopedics and Traumatology, Lugano Regional Hospital, CH-6900 Lugano, Switzerland
3
Department of Radiology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, I- 20157 Milan, Italy
a
MD; e-mail: giulia.a.guidugli@hotmail.it; ORCIDiD: https://orcid.org/0000-0002-3473-9888
b
MD, PhD; e-mail: daniele.gibelli@unimi.it; ORCIDiD: https://orcid.org/0000-0002-9591-1047
c
MD; e-mail: michaela.cellina@asst-fbf-sacco.it; ORCIDiD: https://orcid.org/0000-0002-7401-1971
d
MD; e-mail: linforisonanza@gmail.com;
e
BSc, PhD; e-mail: luisa.barni@unimi.it; ORCIDiD: https://orcid.org/0000-0002-2414-408X
f
BSc, PhD; e-mail: patrizia.sartori@unimi.it; ORCIDiD: https://orcid.org/0000-0002-4806-2337
g
MD, Professor; e-mail: chiarella.sforza@unimi.it; ORCIDiD: https://orcid.org/0000-0001-6532-6464
ABSTRACT https://doi.org/10.25241/stomaeduj.2020.7(1).art.3
Introduction Very little is known about the morphology of paranasal sinuses, especially with respect to
symmetry.
Methodology The head CT-scans of 100 patients (50 male, 50 female) were retrospectively analyzed. The
volume segmentation of frontal, sphenoid and maxillary sinuses was performed through semi-automatic
segmentation. An asymmetry index was extracted, and differences according to sex and side were assessed
through ANOVA test (p<0.05). Pearson test was applied to verify possible correlation between age and
volume and asymmetry index in different paranasal sinuses and sexes (p<0.05).
Results On average, male sinuses were larger in volume than female ones (p<0.01). Generally, volumes
of the three sinuses were significantly related each other in both sexes (correlation coefficients ranging
between 0.34 and 0.58). In both sexes, the maxillary sinus was less asymmetric than the other two types,
without significant sex-related differences (p>0.05). Significant inverse correlations between sinus volume
and asymmetry index were found for the sphenoid and maxillary sinuses in males, and for the maxillary sinus
in females. No correlation of sinus volume or asymmetry index with age was found, with the exception of
maxillary volume/age in females.
Conclusion The present results may find practical applications in planning surgical procedures involving
paranasal sinuses.
KEYWORDS
Anatomy; CT-Scan; Segmentation; Paranasal Sinuses; Surgery.
1. INTRODUCTION the most variable of all the anatomical structures of
the entire body [3,4]. Genetic diseases, infectious
The paranasal sinuses are air-filled anatomical and environmental conditions may influence these
structures inside the skull and facial bones forming variations [5]. A detailed knowledge of anatomy
a complex interconnected system communicating and anatomic variations of paranasal sinuses has
with the nasal cavities through an ostium [1,2]. There become mandatory in the recent years due to
are four paired paranasal sinuses: the maxillary, advances in imaging technology and in functional
frontal and sphenoid sinuses, and the ethmoid cells, endoscopic sinus surgery (FESS) which represents
with great inter- and intra-individual variations. the current standard treatment for chronic paranasal
Shape and size of the paranasal sinuses are probably sinus pathology [6]. To detect sinus pathologies,
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Guidugli GA, Gibelli DM, Cellina M, Oliva AG, Barni L, Sartori P, Sforza C. Volume, asymmetry and reciprocal relationships between paranasal
sinuses: a 3D segmentation study on head CT-scans. Stoma Edu J. 2020;7(1):20-27.
Received: January 13, 2020; Revised: February 07, 2020; Accepted: February 10, 2020; Published: February 11, 2020
*Corresponding author: Prof. Chiarella Sforza, MD, Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli, 31, I-20133
Milano, MI, Italy
Tel/Fax: +39 02 5031 5384,
e-mail: chiarella.sforza@unimi.it
Copyright: © 2020 the Editorial Council for the Stomatology Edu Journal.
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Metrical characteristics of paranasal sinuses
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Original Articles
Figure 1. Example of 3D segmentation on CT-scan: in the lower left box, the 3D models of frontal, sphenoid and maxillary sinuses.
determine therapy, plan endonasal surgeries and height and width of frontal sinuses continue to
avoid careless manipulation, detailed knowledge of increase until the age of 20 related to the growth
their morphology has a crucial clinical value [7]. pattern and grade of craniofacial structures [11,12].
Despite the great importance of this topic, the During the sinus development, struts, structural com-
morphological characteristics of paranasal sinuses ponents and bony deposition are crucial to protect
are incompletely known. Most of the studies per- against external physical forces. Several inter-
formed on adults analyzed the maxillary sinuses, individual differences in shape and behavior
and very few investigations considered the patterns can be noticed. According to Kim et al.
maxillary, frontal and sphenoid sinuses together, [8], three different explanations can be considered.
and especially their symmetry [8]. The development The first one is that the incessant conflict between
of the paranasal sinuses starts in the late embryonic epithelial expansion (formation of cavities) and
period and continues into young adulthood [8]. bony deposition (protection from the external
The maxillary sinus is the first sinus to appear and environment) can undergo different patterns, and
starts from ectodermal cells between the 7th and produces a great variability. The second and third
10th week of development and grows until 17 years hypotheses try to explain differences between
of life. It develops from a shallow groove expanding individuals through heredity: for the second one
from the primitive infundibulum to the maxilla. pneumatization is genetically determined and for
After birth, the growth of the maxillary sinus is the latter hypothesis the degree of pneumatization
biphasic: the first spurt occurs during the first also depends on the pathological involvement
three years then again between the ages of 7–12. during childhood [8]. In recent years, the three-
After the age of 12, the growth slowly continues dimensional segmentation of medical image data
until adulthood. The sphenoid sinus develops as has been largely applied to the morphological
evagination of the spheno-ethmoidal recess about evaluation of the upper airways, included the para-
the 3rd intrauterine month and reaches full size at nasal sinuses. The volume of air cavities is the simplest
the age of 7. In extreme cases of pneumatization and most significant parameter for the evaluation
the optic nerve and internal carotid artery may lie of the paranasal sinuses [13]. Several investi-
naked within the sinus cavity [9]. The frontal sinus gations analyzed the volume of paranasal sinuses
is the most variable; its development begins during [8,10,14-17], but little is known about their
the 16th prenatal week as a direct continuation of symmetry, and the calculation of asymmetry indices
the embryonic infundibulum and frontal recess has been performed only in forensic contexts
superiorly, or by upward migration of anterior eth- [17,18]. In the present study, we segmented CT-
moidal air cells to penetrate the inferior aspect of scan images to create three-dimensional models
the frontal bone between its outer and inner tables. of the maxillary, frontal and sphenoid sinuses, and
The right and left sides of the frontal sinuses develop calculated their volume. The aim of the study was
independently as a result of bone resorption and to investigate inter and intra-individual variations
septations [10]. It remains as a cul de sac within the and possible correlations of the sinuses’ volume
frontal bone till 2 years of age. The pneumatization and pneumatization in a large sample of adults.
process continues till the age of 9, but the volume, The results will improve knowledge concerning the
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Guidugli GA. et al.
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Original Articles Table 1. Volume of paranasal sinuses in 100 healthy subjects (mean±SD).
Frontal sinuses Sphenoid sinuses Maxillary sinuses
Right Left Total Right Left Total Right Left Total
Males 4.2 ± 2.2 5.4 ± 3.6 9.6 ± w5.04 5.4 ± 3.6 5.6 ± 3.4 10.9 ± 5.3 16.4 ± 5.1 15.9 ± 5.6 32.3 ± 10.4
Females 2.2 ± 1.4 2.7 ± 1.8 4.9 ± 2.8 4.4 ± 2.6 3.9 ± 2.2 8.3 ± 2.9 13.2 ± 3.8 13.1 ± 3.6 26.3 ± 6.9
M+F 3.2 ± 2.1 4.0 ± 3.1 7.2 ± 4.7 4.9 ± 3.2 4.7 ± 2.9 9.6 ± 4.4 14.8 ± 4.8 14.9 ± 4.9 29.3 ± 9.3
All values are expressed in cm3
Table 2. Correlation coefficients among Table 3. Correlation coefficients among age, sinus volumes and a
sinus volumes. symmetry indices.
Frontal Sphenoid Maxillary Volume Asymmetry
Frontal 0.34* 0.36** Sex Frontal Sphenoid Maxillary Frontal Sphenoid Maxillary
Sphenoid 0.58** 0.36** Age Females -0.02 -0.04 -0.07 -0.14 -0.06 0.29*
Maxillary 0.23 0.47** Age Males -0.13 -0.21 -0.24 0.14 -0.14 0.16
Female values are in italics; *p<0.05; **p<0.01 Female values are in italics; *p<0.05
morphological characteristics of paranasal sinuses. (Fig. 1) [19]. Volume was automatically calculated
through VAM® (Vectra Analysis Module, version
2. METHODS AND MATERIALS 2.8.3, Canfield Scientific Inc., USA) [20].
Intra-operator repeatability of segmentation through
2.1. Sample ITK-SNAP had already been tested: no significant
For this study, 100 head CT-scans were selected differences between repeated segmentations and
from the database of a hospital in Northern Italy and volume measurements were found, with a random
analyzed retrospectively. The CT-scans were anony- error explaining less than 1% of sample variance [21].
mized according to local and international ethic The sinus side prevalence was assessed for every pair
rules. The study followed the guidelines of the of sinuses, and an asymmetry index was calculated
Helsinki Declaration and was approved by the local as follows:
ethical committee (7331/2019). The mean age of the |(volumer - volumel) / (volumer + volumel) x 100 |
male patients was 49.32 ± 18.9 years (range, 21-91
years), while the mean age of the female patients was Where volumer is the volume of the right sinus,
57.1 ± 22.8 years (range, 20-91 years). No differences volumel the volume of the left sinus. The index
were found in the age distribution between males ranges from 0 (perfect symmetry) to 100 (totally
and females (Student’s t test, p>0.05). The most asymmetrical).
frequent clinical requests for CT-scan were screening
for fractures in case of trauma (57.3%), suspected 2.4. Statistical analysis
sinusitis (20.0%), neurological symptoms (12.7%). The normal distribution and homoscedasticity
Subjects with paranasal sinuses aplasia, chronic for volumes and asymmetry index were assessed
paranasal sinus pathology, edentulism, maxillofacial respectively through Jarque-Bera test and Bartlett
fractures or congenital craniofacial abnormalities, tests. Tests were run through the MATLAB statistic
or any pathological conditions involving paranasal toolbox. Possible statistically significant differences
sinuses were excluded from the study. in volume and asymmetry index according to sex
and type of sinus were assessed through the two-
2.2. CT-scan acquisition way ANOVA test. In case of statistically significant
All CT-scans were acquired through the same differences according to type of sinus, post-hoc
instrument, a second generation dual-source sca- tests were performed through the Tukey’s Honestly
nner, Somatom Definition Flash (Siemens, Forchheim, Significant Difference (HSD), separately for males
Germany). The acquisition parameters were: kV: 120; and females. Pearson correlation coefficients
mAs: 320; collimation: 40 x 0.6 mm; tube rotation: 1 were calculated between age, sinus volume and
sec; reconstruction thickness: 3 mm; reconstruction asymmetry index.
filters: H21s smooth for soft tissues and H60 sharp A p value of 0.05 or less was considered significant.
for bone.
3. RESULTS
2.3. Data collection
Volume segmentation from the DICOM files was The volume measurements are listed in Table 1. On
performed by a single operator using a semi-auto- average, male sinuses were larger in volume than
matic segmentation with the freeware ITK-SNAP female ones (F=38.87, p<0.0001), with the maxillary
22 Stoma Edu J. 2020;7(1):20-27 pISSN 2360-2406; eISSN 2502-0285
Metrical characteristics of paranasal sinuses
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Original Articles
Figure 2. Distribution of side prevalence in
the analyzed patients (M, males; F, females).
Table 4. Asymmetry indices in the analyzed paranasal
sinuses (mean±SD).
Frontal Sphenoid Maxillary
Males 22.28 ± 18.36 36.96 ± 26.00 7.47 ± 8.40
Females 28.69 ± 18.59 37.89 ± 27.89 8.11 ± 8.51
M+F 25.48 ± 18.66 37.43 ± 26.83 7.79 ± 8.42
All values are %.
sinus being about three (sphenoid sinus) and four
(frontal sinus) times larger than the other ones
(F=387.75; p<0.0001). Post-hoc HSD tests found
that both the frontal and sphenoid sinuses were
significantly smaller than the maxillary one in both
males and females (p<0.01); in addition, in females
also the difference between frontal and sphenoid
sinuses was significant (p<0.01). No significant sex
x sinus interaction was found (F=1.96, p=0.1427). Figure 3. Correlation between maxillary sinus volume (X axis) and
The volumes of the three sinuses were significantly asymmetry index (Y axis) in males (open circles, continuous line) and in
females (closed circles, interrupted line). Both regressions are significant
related to each other in both sexes, except for the (p = 0.01).
maxillary and frontal sinuses volumes in males (Table
2). However, in all cases the correlation coefficients more asymmetric than the maxillary one (p<0.01
were generally low, ranging between 0.34 and 0.58. for both comparisons in both sexes), while the
No correlation of sinus volume with age was found difference between the frontal and sphenoid
(Table 3).The side prevalence was assessed for every sinuses was significant only in males (p<0.01). No
pair of sinuses (Fig. 2). In both males and females the significant sex differences (F=1.4, p=0.2377) and sex
left frontal sinus was prevailing in about two-thirds x sinus interactions were found (F=0.7, p=0.4974).
of patients (68% males and 66% females). For the No correlations of sinus asymmetry with age were
sphenoid sinus, the larger volume was in the right found, except for the maxillary sinus in females:
side in 52% of patients (both males and females). The older women had more asymmetric sinuses (Table
right maxillary sinus was prevalent in 60% of males 3).Significant inverse correlations between the sinus
and in 48% of females. Only 26% of subjects had the volume and asymmetry index were found for the
same side prevailing for all sinuses (17% left side and sphenoid (r= -0.28, p<0.05) and maxillary (r= -0.39,
9% right side). The asymmetry indices calculated p<0.01) sinuses in males, and for the maxillary sinus
for the three pairs of sinuses and according to sex in females (r= -0.37, p<0.01): in all occasions, larger
are reported in Table 4. In both sexes, the maxillary sinuses were less asymmetric (Fig. 3).
sinus was the less asymmetric of the other two, its
asymmetry index being approximately one third of 4. DISCUSSION
the frontal sinus and one fifth of the sphenoid sinus
(F=58.53, p<0.0001). Post hoc tests found that both The morphology of paranasal sinuses represents
the frontal and sphenoid sinuses were significantly a long-time debated issue. In the last decades,
Stoma Edu J. 2020;7(1): 20-27 pISSN 2360-2406; eISSN 2502-0285 23
Guidugli GA. et al.
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[17]. In addition, very few studies used an asymmetry
Original Articles Table 4. Paranasal sinuses volume in literature (mean±SD).
All values are cm3. index in order to evaluate the side prevalence for
every pair of sinuses [8,22,23]. Only Kim et al. [8]
and Yoshino et al. [24] provided some calculations
29.3±9.3
18.0±6.0
of the frontal sinus asymmetry but within forensic
Total
41.6
contexts. They proposed a “bilateral asymmetry
index” (BAI) calculated dividing the smaller sinus
by the larger one multiplied by 100 and used it for
26.3±6.9
16.0±5.0
21.8±7.8
22.7±9.8
Females
classification purposes. This index maximizes the
34.6
Maxillary sinuses
asymmetry values, and it was considered useful for
individual identification, but it has not been applied
32.3±10.4
31.0±11.4
to surgery. As far as sinus volumes are concerned,
19.8±6.3
32.0±9.0
the comparison with existing literature highlights
Males
43.7
differences in values according to authors: these
discordances may be explained by ethnic variations
and by discrepancies in defining cranial structure.
9.6±4.5
Total
As far as the Italian population is concerned, values
13.7
for sphenoid volume are well in line with those
already published in a previous publication [25].
6.09±3.63
7.07±3.72
7.88±3.0
Interestingly, different authors reporting data from
Females
8.3±2.9
6.1±3.2
8.7±2.4
the same population show discordances in volume
10.6
Sphenoid sinuses
measurements [10,14,15]; this detail may confirm
the importance of ethnic variability which may be
extended also to geographical location of different
10.9±5.3
6.1±3.4
7.4±3.5
7.7±4.0
9.7±2.6
8.5±4.2
Males
population groups. Another possible variant which
14.7
may explain discordances in literature is the variety
of techniques for volume extraction: however,
3.4±2.7
4.1±2.7
7.2±4.7
5.8±4.1
Karakas and Kavakli found results similar to those
Total
of the present study for all three pairs of sinuses,
6.8
although they used the Cavalieri principle to extract
volume, and not a segmentation software (Table
Females
5). On the other side, the Cavalieri principle was
4.9±2.8
4.1±2.9
3.5±3.1
3.5±2.4
also used by Emirzeoglu et al. [15] to estimate the
4.4
Frontal sinuses
sinus volume, obtaining slightly different results
from those currently calculated with semi-automatic
segmentation for frontal and sphenoidal sinuses,
9.6±5.0
8.8±4.5
8.4±4.0
7.5±4.3
Males
and smaller values for the maxillary sinus. The use of
7.6
the Cavalieri principle for the paranasal sinuses has
been criticized because of the complex morphology
Age/side
21-25 y
of these organs. The method estimates the organ
>25 y
Right
Right
Total
Total
Total
Left
Left
volume starting from a sample of cross sections, but
they may not be sufficiently representative for the
Population
organ shape, thus producing unreliable results.
Brazilian
Turkish
Turkish
Turkish
Korean
Nonetheless, even if Kim et al. [18] used a segmen-
Italian
tation software similar to that applied in the
current study, their results are pretty different,
Oliveira et al., 2017
Kim et al., 2010 (8)
Yuksel et al., 2016
with somewhat smaller values for the frontal sinus,
Emirzeoglu et al.,
Present Study
and larger for the sphenoidal and maxillary ones.
Karakas et al.,
Moreover, also the segmentation protocol used by
2007 (14)
2005 (1)
Oliveira et al. [16] in their analysis of the sphenoid
(15)
sinus morphology was similar to the present one, but
(9)
they obtained 1.2-1.6 larger volumes in both sexes.
the technological improvements and widening Therefore, possible differences due to the segmen-
of applications of paranasal sinuses surgery have tation method cannot be excluded, although its
required further investigations to clarify some aspects influence cannot be clearly separated from the
still unexplored, such as the asymmetry of these ethnic variability. Anyway, but for the differences in
structures. To the best of our knowledge, several volumetric measurements, all studies are concordant
studies have assessed the volume of the paranasal on the sexual dimorphism of paranasal sinuses, with
sinuses but very few studies have considered the male structures always larger than the female ones
frontal, maxillary and sphenoid sinuses together [10,14,15]. An interesting result from the present
24 Stoma Edu J. 2020;7(1):20-27 pISSN 2360-2406; eISSN 2502-0285
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study concerns the correlation between the volumes tigations measuring the volume of paranasal
Original Articles
of different paranasal sinuses: Emirzeoglu et al. [15] sinuses, the systematic study of their asymmetry has
found a high correlation between the volumes been neglected so far. The asymmetry index applied
of the maxillary-frontal and maxillary-ethmoidal in the current study is of easy calculation, and can
sinuses for female subjects, while in the male group complement the analysis of sinus volumes.
the volumes of all sinuses correlated well with each
other except for the frontal-sphenoid sinuses. These 5. CONCLUSIONS
data confirm that paranasal sinuses are somehow
linked one type to another: generally, the similarities The current results show that paranasal sinuses
in size of different types of paranasal sinuses may in the single individual share some similarities
be explained by genetic variables involved in their in size possibly explained by underling genetic
development [8]. However, although statistically characteristics modulated by local modification
significant, the correlation coefficient is low (under due to environmental and acquired factors. Aging
0.70) in all cases; this additional information does not seem to be a key factor in explaining sinus
seems to demonstrate that other factors (probably dimensions and asymmetry, at least in healthy
acquired and/or environmental) may be involved adults, but the two aspects are significantly related,
in sinuses development. Finally, the present study with a larger asymmetry in small sinuses.
provided novel data concerning the morphological The present data may provide a contribution
characteristics of paranasal sinuses: first, both their for improving our knowledge concerning the
volume and asymmetry seem not to be related to development of paranasal sinuses and possible
age, with the exception of maxillary sinus volume factors involved in this process. Also, surgical
in females. Cohen et al. explored the same topic treatments involving paranasal sinuses should
and found that both maxillary and sphenoid consider these characteristics to better plan complex
sinuses volumes are related with age (they decrease interventions.
with age) in both sexes [17]. These discordances
may be explained in different ways: with respect CONFLICT OF INTEREST
to the maxillary sinuses, possible alterations of
the upper dental profile may represent a bias in The authors declare no conflict of interest.
assessing volumetric differences. On the other
side, differences in sphenoid volume need to be AUTHORS CONTRIBUTIONS
explained, although the ethnic variable may have
a role. Another innovative information concerns GG: conception and design of the study, data acquisition, data
the significant correlation between the asymmetry analysis, drafting the article, final approval. DG: conception
index and volume (the smallest the sinuses, the most and design of the study, data analysis, data interpretation,
asymmetric). This has not been reported in literature drafting the article, revising the article, final approval. MC: data
yet, and proves that asymmetry and volume are acquisition, data analysis, drafting the article, final approval.
somehow linked. However, again the coefficients AO: data interpretation, revising the article, final approval. LB:
are too small to exclude other possible variables in data acquisition, revising the article, final approval. PS: data
determing paranasal sinuses morphology. In the interpretation, revising the article, final approval. CS: conception
present study the volume segmentation of frontal, and design of the study, data interpretation, revising the article,
sphenoid and maxillary sinuses was performed using final approval.
semi-automatic segmentation with the freeware
ITK-SNAP. Although literature reports several inves- Drs. Guidugli and Gibelli equally contributed to this work.
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Giulia Andrea GUIDUGLI
MD
Department of Orthopedics and Traumatology
Lugano Regional Hospital
CH-6900 Lugano, Switzerland
CV
Dr. Giulia Andrea Guidugli is a medical doctor currently attending a Residency program in Orthopedics and Traumatology
(Lugano Regional Hospital, Switzerland). Her fields of research are the morphological and metrical assessment of anatomical
characteristics of bones, paranasal sinus and upper airways, including the analysis of facial anatomy in both healthy and
pathological conditions through the study of CT and 3D reconstruction of the upper airways.
Daniele Maria GIBELLI
MD, PhD
LAFAS-Laboratory of Functional Anatomy of the Stomatognathic System
Department of Biomedical Sciences for Health
University of Milan
I-20133 Milan, Italy
CV
Dr. Daniele Maria Gibelli is a senior researcher in Human Anatomy in Department of Biomedical Sciences for Health, University
of Milan, Italy. His fields of research are the morphological and metrical assessment of anatomical characteristics of bones
and teeth, including anatomical dimorphism, their modification with age, ethnic variability and the analysis of individualizing
characteristics. He also deals with the analysis of facial anatomy both in healthy and pathological conditions, for studies
concerning the assessment of facial symmetry, modifications with mimicry and anatomical uniqueness of facial structures.
26 Stoma Edu J. 2020;7(1):20-27 pISSN 2360-2406; eISSN 2502-0285
Metrical characteristics of paranasal sinuses
www.stomaeduj.com
Questions
Original Articles
1. When does the development of paranasal sinuses start?
qa. Childhood;
qb. Fetal period;
qc. Puberty;
qd. Adult age
2. On average, the volume of paranasal sinuses:
qa. Is higher in females than in males;
qb. Is equal in males and females;
qc. Is higher in males than in females;
qd. Cannot be analysed through 3D segmentation
3. Which paranasal sinus is the least asymmetric?
qa. Frontal sinus;
qb. Sphenoid sinus;
qc. Maxillary sinus;
qd. Ethmoid cells.
4. For which paranasal sinus a positive correlation was found between volume and age?
qa. Frontal sinus;
qb. Sphenoid sinus;
qc. Maxillary sinus;
qd. None.
www.ohi-s.com/eng/london/
Stoma Edu J. 2020;7(1): 20-27 pISSN 2360-2406; eISSN 2502-0285 27