sphenoid

They are two large, irregular cavities hollowed out inside the body of the bone and separated by a septum of bone tissue, usually curved to one side or the other.

Body of the sphenoid bone

The body of the sphenoid bone, which is roughly cubic in shape, consists of two large cavities, the sphenoid sinuses, which are separated from each other by a septum.

The upper side of the body [Fig. 1] has a forward-projecting ostium, the lattice ostium, which serves to connect with the lattice plate of the sphenoid bone; behind it is a smooth surface, slightly raised along the midline, with grooves on either side for the olfactory lobes of the brain.

This surface is bounded posteriorly by a ridge which forms the anterior edge of a narrow transverse furrow, above and behind which lies the orbit; the furrow ends on both sides with the optic foramen, through which the optic nerve and the optic artery flow into the orbit.

Behind the chiasmal canal. There is a bulge in the sulcus, the tuberculum sellae; and behind it a deep depression, the sella turcica (Turk's saddle), in the deepest part of which, the pituitary fossa, lies the pituitary gland.

The anterior edge of the sella turcica terminates in two small projections on each side, called the medial cuneiform processes, and the posterior margin is formed by a square plate of bone, the dorsum sellae, which is divided at its upper corners into two tubercles, the posterior cuneiform processes, ends, the size and shape of which varies greatly from person to person.

The posterior wedge processes deepen the turian saddle and serve as an attachment for the tentorium cerebelli.

On either side of the posterior saddle are indentations for the passage of the inversion nerve, and below the indentation is a sharp process, the stony process, which articulates with the tip of the stony part of the temporal bone and forms the medial border of the foramen lacerum.

Behind the saddle crest is a shallow notch, the clivus, which slopes backwards and continues in a groove on the basal part of the occipital bone; it supports the upper part of the bridge.

Lateral surfaces

Above the base of each large wing is a broad furrow, curved like a curved letter f; it surrounds the internal carotid artery and the cavernous sinus and is called the cervical groove.

Wedge-shaped body

On the Top of the sphenoid boneIn the spleen bone there is a depression, the sella turcica (Latin sella turcica), at the bottom of which is the hypophysial fossa (pituitary fossa).Hypophysial fossa), in which the pituitary gland is located. The front boundary of the saddle is the saddle tuber, the rear boundary is the saddle dorsum (Dorsum sellae). On the sides of the Turkish saddle there is the cervical sulcus (sulcus caroticus).Carotid sulcus) with erectile tissue cavities that line the carotid arteries (Interior carotid artery) and the associated nerve plexuses.

Before of the tuberculum saddleum there is a prehiasmatic sulcus (Prehiasmatic sulcus), on which the optic nerves (which arise from the optic nerve canals (Optic canal)). The saddle ridge in the lateral parts projects forward and forms the posterior oblique processes (Posterior clinoid process). The posterior surface of the back of the turbinate saddle gently extends to the upper surface of the basal part of the occipital bone, forming a slope (Clivus). Anteriorly, the shaft of the sphenoid bone passes into the vertical plate of the neck bone (Lamina perpendicularis ossis ethmoidale) and the auditory ossicle (Vomer) by a vertically arranged wedge-shaped ridge (Crista sphenoidalis).

From behind The shaft of the sphenoid bone connects to the basal part of the occipital bone.

Most of the shaft of the sphenoid bone is formed by the cuneiform sinus (Sphenoid sinus), which is divided into two halves by a partition. Anteriorly, the sinus is bounded by the sphenoid conchae (Spheroidal shells), which are located on the sides of the sphenoid crest. These shells form the openings (apertura sinus ossis sphenoidalis), through which the visceral cavity is connected to the nasal cavity. The walls of the cuneiform sinus are lined with mucous membranes.

Little wings

The little wings (ala minor) extend laterally from the anteromedial corners of the body in the form of two horizontal plates. At its base there are rounded openings that are the origin of the visual channels (Optic canal), in which the optic nerves and the ocular arteries run. The upper sides of the small wings are directed into the cranial cavity (skull) and the lower ones in the orbital cavity (eye socket) and form the upper walls of the upper eye cleft (Supraorbital fissure). The front edges of the wings are articulated with the orbital parts of the frontal bone. The posterior edges lie freely within the cranial cavity and form the boundary between the anterior and middle cranial fossa (Fossa cranium anterior and posterior).

The small wings are connected to each other by a wedge-shaped process, which is located in the front part of the cranial fossa (Fossa cranium anterior et posterior).

causes

Wedge vertebrae can occur in Scheuermann-Mau disease, a hereditary anomaly that is inherited in both the male and female lines. Other factors that can negatively affect the development of the vertebrae during the fetal period include endocrine disorders, infectious diseases and poor maternal nutrition, stress during pregnancy, unhealthy working conditions and a poor environment. Acquired vertebral deformities can arise from trauma, granulomatous, infectious and inflammatory diseases, dystrophic processes, primary tumors and metastatic lesions of the spine.

A normal vertebra is a complex bone consisting of a rectangular vertebral body, an epiphysis and appendages. The massive vertebral body carries most of the load, the posterior vertebral body and arch form the spinal cord reservoir, and the processes serve to connect the vertebrae to each other. The intervertebral discs lie between the vertebral bodies. As with other bones, the vertebrae grow at the expense of the marginal zone, the epiphyseal growth plate.

If the blood vessels do not grow in properly during the fetal period, half of the vertebral body remains undeveloped, resulting in the vertebra being wedge-shaped rather than rectangular. Wedge vertebrae can be lateral (underdevelopment of the left or right half), less often anterior or posterior (underdevelopment of the anterior or posterior, respectively). Anterior and posterior wedge deformities are caused by underdevelopment of the anterior or posterior ossifying nucleus.

classification

Wedge vertebrae can occur in any area of the spine, but are more commonly found in the lower thoracic and upper lumbar regions. The deformed vertebrae can be single, double or multiple. Two wedge-shaped vertebrae that lie between 2-3 normal vertebrae and are mirror images of each other (one has an underdeveloped right side and the other has an underdeveloped left side) are called alternating vertebrae. This is a favorable variant of the pathology, since the vertebral deformities 'neutralize' each other and the curvature is localized. Multiple underdeveloped wedge vertebrae on the same side are rare and represent a more serious spinal abnormality.

In traumatology and orthopedics, a distinction is made between active and inactive wedge vertebrae, depending on their ability to grow. In active vortices, the growth zone is preserved. This is unfortunate because as the child grows older, the vertebrae grow and the spinal deformity worsens. Inactive vertebrae cannot grow due to the underdeveloped epiphyseal zone and are often fused to a normal vertebra above or below. The fusion of a wedge with a normal vertebra is called a vertebral embolism.

Material and methods.

We reviewed 51 medical records of patients who underwent transnasal wedge sinus dissection between January 2014 and December 2016. The age of the patients ranged from 21 to 68 years. The study was based on the ENT departments of the Rostov Regional Clinical Hospital and NA Semashko City Hospital No. 1. Semashko in Rostov-on-Don. The data examined included clinical symptoms of the disease, type and location of headache, radiological findings, surgical findings, rate of resolution of clinical symptoms after surgery, and histopathological findings of the surgical material.

In 32 cases, suspicion of sphenoid sinus involvement was expressed during the examination of patients who initially consulted a neurologist because of chronic headaches and/or oculomotor disorders. Magnetic resonance imaging (MRI) was performed in these patients, and cuneiform sinus pathology was confirmed by spiral computed tomography (SCT). At the time of referral to an otolaryngologist, the duration of the disease was between three months and four years.

During the same period (2014-2016), 12 patients with suspected sphenoid sinus involvement were consulted using MRI, in whom SCT revealed no pathology.

Endoscopic examination showed no pathological changes in the nasal cavity and nasopharynx in 70 % patients with isolated involvement of the sieve space, 13 patients had polyps or mucosal edema in the sieve space on the side of the lesion, 17 patients had a curvature of the nasal septum, which did not allow to examine the area of the junction of the affected sieve sinus, and nine patients had purulent exudate oozing from the junction, which was narrowed by mucosal edema.

In all patients, transnasal opening of the affected cuneiform sinus through the common nasal meatus was performed, with the natural rectum dilated under the guidance of a rigid endoscope. In 17 cases, limited resection of the nasal septum was required to create surgical access; in the remaining patients, the anus was identified after regression of the middle and upper nasal cavities, thorough anesthesia, and removal of the mucous membrane altered by polyposis.

Conclusions.

1. Headache is the most common and, in 56% cases, the only clinical sign of isolated sphenoid sinus involvement.

(2) The absence of pathological changes on endoscopic examination of the nasal cavity cannot exclude the presence of an isolated lesion of the clinical maxillary sinus.

(3) All patients with persistent subacute and chronic headaches should be examined with modern sinus imaging techniques.

4. The most informative method for diagnosing isolated sinusitis is computed tomography.

5. Transnasal opening of the wedge sinus through the common nasal meatus by dilation of the natural rectum under the guidance of a rigid endoscope is the method of choice for surgical intervention for isolated wedge sinusitis.

Conflict of interest: The authors declare that there are no potential conflicts of interest to disclose in this article.

diagnosis

Instrumental examination methods are used to make the diagnosis:

• Scintigraphy (X-ray of the spine in 2 projections)
• Multi-slice computed tomography
• Ultrasound of the chest and abdominal cavities
• Osteoscintigraphy (examination of the bones of the spine)
• and MRI

The safest and most informative method that allows a comprehensive assessment of all perivertebral and spinal structures is the MRI examination. It is considered a decisive factor in the decision about surgical correction.

causes of injury

Only very strong mechanical stress on the base of the skull can cause a skull fracture. This injury can be both closed and open. A person is capable of sustaining such an injury:

Fractures of the skull base with linear fractures in which there is no displacement of the bones are considered the least dangerous. Splinter injuries are life-threatening. These injuries cause a tear to the dura mater. This leads to uninterrupted communication with the environment and increases the risk of infection.

In fractures of the skull base, the dura can also be damaged. As a result, the patient may develop large bruises that compress internal structures. Such a condition can be fatal.

Crack fractures at the base of the skull are considered the most serious and life-threatening fractures. They occur as a result of a gunshot wound. The bullet typically penetrates deep into the brain, causing severe structural damage that is almost always fatal.

Which doctor should be consulted?

If a skull base fracture is suspected, an ambulance should be called immediately. The following doctors can quickly diagnose the injury and provide the patient with expert help:

Our specialists

surgical treatment

Cysts of the sphenoid sinus are removed surgically. Indications for surgery are the following diseases:

Endonasal (transnasal) surgery is a minimally invasive procedure for removing sinus cysts. Access to the cyst is created through natural openings using microsurgical instruments. This approach allows the tumor to be removed with minimal damage to healthy tissue. Endoscopic equipment allows the surgeon to visually check his procedure and completely remove the affected mucous membrane areas. The removal of polyps and the placement of sutures are also possible during the procedure.

prevention

There is no specific method for preventing a wedge sinus cyst. It is important to avoid factors that can cause chronic inflammation of the nasal and paranasal sinus mucosa. Proper treatment of respiratory infections under medical supervision, staying in a favorable environment, maintaining a healthy lifestyle and avoiding bad habits contribute to the overall health of the body. It is important to wear personal protective equipment when working in hazardous environments.

A sphenoid sinus cyst usually has no symptoms of rhinitis. Headaches of unclear localization often occur. The lack of a specific clinical picture complicates the initial diagnosis and is the reason for late referral to a doctor. A comprehensive approach to diagnosis and treatment is required to determine the nature of the problem. A highly qualified otolaryngologist tries to determine the cause of the problem based on the history, physical examination and instrumental examination. Based on this information, the doctor makes an objective diagnosis and develops an individual treatment plan to ensure the patient's full recovery.

Cranio-sacral mobility of the hyoid bone.

The role of the sphenoid bone in realizing the basic respiratory mechanism is immeasurable. The movement of the anterior quadrants of the skull depends on the sphenoid bone.

Axis of movement of the sphenoid bone.
The axis of movement of the craniosacral hyoid bone runs transversely through the lower edge of the anterior wall of the Turkish saddle. It can also be said that this axis lies at the intersection of two planes: the horizontal plane at the level of the bottom of the Turk's saddle and the frontal plane at the level of the front wall of the Turk's saddle.

Fig. Movement of the hyoid bone during the flexion phase of the primary respiratory mechanism.

The transverse axis of the sphenoid bone appears on the surface of the cranial vault and crosses the punctum sphenosquamous pivot (PSS).
During forward movement, the axis of movement of the hyoid bone crosses the midline of the zygomatic arch.

Fig. The intersection point corresponds to the projection of the axis of movement of the parietal bone. The arrow indicates the direction of movement of the large wings during the flexion phase of the primary respiratory mechanism.

In the flexion phase of the primary respiratory mechanism:
The shaft of the sphenoid bone rises upwards;
The large wings point ventro-caudo-laterally – towards the mouth.
The wings spread and descend;

During the expansion phase of the primary respiratory mechanism:
The shaft of the hyoid bone descends;
The large wings point upwards, backwards and inwards;
The wings converge and rise.

Practical aspects of craniosacral work in osteopathy

For those who palpate the diaphragms and work with the craniosacral system in osteopathy, we discuss practical questions on our Telegram channel.
Curious Osteopathy Telegram Channel .

• Discuss how and when to finish techniques and hands. Question and answer.
• Which body model and which system is most correct in osteopathy.
• The basics of osteopathic technique.

prevention

There are no specific preventative measures to prevent osteos. Doctors recommend annual X-rays to detect tumors and, if necessary, remove them.

The specialists of the surgical department of the SM-Clinic Medical Center successfully perform operations to remove various types of osteomas. If you notice a nodule on a bone, you should see a specialist who will make a diagnosis and recommend treatment immediately.

There is no specific prevention for this disease. Genetic predisposition is believed to be the main cause of osteomas.

• avoid trauma;
• Treat musculoskeletal diseases in a timely manner;
• Get checked if you notice a tumor of unknown origin.

Popular questions.

Can osteoma lead to cancer?

No. Osteoma is a benign tumor. It can cause health problems if it grows into the cranial cavity. However, the chance of it developing into cancer is almost zero.

What are the causes of osteosarcoma?

The causes of this cancer are not known. The role of hereditary predisposition has been proven. If your relatives have been diagnosed with osteomas, you have a higher risk of developing them than the general population. The trigger for osteoma growth can be bone trauma or an acute inflammatory process. There is also a theory about intrauterine malformations. It is based on the fact that osteomas most often develop at the junction between the frontal and sacrum, where membranous and cartilaginous tissue forms during embryogenesis.

Does an osteoma need to be removed?

The tumor grows very slowly. In most cases it is not dangerous. Only clinically relevant osteomas that could grow into the eye socket or skull bone are removed. The operation can also be performed for aesthetic reasons.

1. Kudaibergenova SF Osteoma of nasal cavity / SF Kudaibergenova [et al.] // Bulletin of KAZNMU. – 2012. – № 2. – С. 92-93.
2. Toropova IA Features of the clinical course of nasal and paranasal sinus osteomas / IA Toropova // Vestnik PFUR. – Medicine series. – 2005. – № 1(29). – C. 95-97.

Aleksey Gennadyevich Mikhaylov surgical oncologist, doctor of the highest qualification category, candidate of medical sciences Experience: 22 years

The information contained in this article is indicative and is not a substitute for consultation with a qualified medical professional. Do not try to do the treatment on your own! At the first signs of illness, you should see a doctor.

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