Analyse der radiologischen Anatomie der unteren Nasenmuschel in Relation zum Nasenseptum und der Nasenhaupthöhle mittels digitaler Volumentomographie

In 1882 Emil Zuckerkandl reported about the anatomy of the nasal cavity very precisely. Since this time there were only few descriptions of the anatomical sizes of the inferior turbinate in the literature. And those are mostly based on cadaveric preparation studies. Especially the radiological dimensions with the thickness of the mucosal parts in vivo were not evaluated sufficiently. It would be useful to achieve standard values of the inferior turbinate, the nasal septum and the nasal cavity. In the last few years the digital volume tomography became more and more important for radiological imaging in the field of otorhinolaryngology. Permanent improvement of the technical capacity like higher resolution with lower radiation dose cause the rising of clinical interest. The digital volume tomography enables high quality 3D images of bony and mucosal structures. In addition to the endoscopic checkup it is also able to find out the reason for nasal obstruction. This can be caused by hypertrophy of the nasal turbinates, septal deviation or both. For this examination the 3D Accuitomo F17 (Morita, Japan) can be used in the Department of Otorhinolaryngology, Head and Neck surgery in Marburg. The data of 100 patients (50 men and 50 women) was measured retrospectively. The mean age is 38,6 years, range 19-83 years. The radiological sizes of the bone and the mucosa of the inferior turbinate, the nasal septum and the nasal cavity were collected. The statistical evaluation shows the differences both between men and women and between the left and the right inferior turbinate. Furthermore the size of the inferior turbinate was set in relation to an eventually existing septal deviation. The bony length of the inferior turbinate in sagittal direction was found to be 39,0 mm ± 4,0 mm the mucosal length 51,0 mm ± 5,1 mm. The bony height at the four measuring points is at M1 4,0 mm ± 2,0 mm, at M2 20,8 mm ± 5,2 mm, at M3 13,7 mm ± 3,2 mm and at M4 4,0 mm ± 2,0 mm. The bony thickness is 0,9 mm ± 0,4 mm at M1, 2,7 mm ± 1,1 mm at M2, 2,3 mm ± 1,0 mm at M3 and 1,1 mm ± 0,5 mm at M4. There are 36 patients (36 %) with septal deviation ≥ 3mm at the measuring points M1-M4. In 69 % of these cases the total thickness of the inferior turbinate shows a correlation to the direction of the deviation. With a deviation to the ipsilateral side the total thickness of the inferior turbinate is below the average value and with a deviation to the contralateral side the total thickness of the inferior turbinate is above the average value. The bony length of the nasal septum is 50,4 mm ± 4,4 mm. Its height is 37,7 mm ± 3,7 mm at measuring point S1, 45,5 mm ± 4,2 mm at S2, 44,2 mm ± 3,8 mm at S3 and 35,8 mm ± 10,5 mm at S4. Furthermore the thickness of the bony septum is 2,9 mm ± 0,5 mm at S1, 2,2 mm ± 1,0 mm at S2, 1,7 mm ± 0,8 mm at S3 and 1,1 mm ± 0,6 mm at S4. 46% of the Patients have a septal deviation ≥ 3mm. The bony height of the nasal cavity is 37,2 mm ± 3,5 mm at measuring point S1, 46,5 mm ± 4,1 mm at S2, 45,7 mm ± 4,6 mm at S3 and 38,6 mm ± 8,2 mm at S4. Its width on the level of the middle nasal meatus is 15,7 mm ± 2,9 mm at S1, 23,4 mm ± 5,0 mm at S2, 24,5 mm ± 4,5 mm at S3 and 28,2 mm ± 3,1 mm at S4. At its widest width the nasal cavity is 18,4 mm ± 2,5 mm at S1, 29,0 mm ± 4,2 mm at S2, 31,3 mm ± 3,3 mm at S3 and 29,6 mm ± 3,3 mm at S4. One female patient has an unilateral pneumatisation of the inferior turbinate. One male patient features a bilaterally pneumatised inferior turbinate. In one further patient the nasal septum is perforated. 48 patients (48%) have a septal spur. The results of this radiological study are able to point out the importance of preoperative anatomical evaluation of the radiological images. The more detailed this exposure is, the better a surgeon is prepared for his invasion. Today it is possible to credit the reason for the hypertrophy of a turbinate with an enlargement of the bone, the mucosa or both. This knowledge enables a systematic conservative or surgical treatment. Limited display of soft tissue may be one disadvantage of the digital volume tomography. For differentiation the magnetic resonance tomography can afford more advantages. The results of this study indeed cannot give an intersection through the whole population but it shows a representative impression of the anatomical mean data. They can help to find out, evaluate an classify pathological changes. They also can be the background for further multicenter studies.