대 한 방 사 선 의 학 회 지 1993 ; 29 (6) : 1313"-' 1319 Journal of Korean Radiological Society. November. 1993 N ormal Development of the Paranasal Sinuses in Children: A CT Study* Hyung-Jin Kim, M.D., Eui Dong Park, M.D., Pil Youb Choi, M.D., Hae Gyeong Chung, M.D.**, Jae Hyoung Kim, M.D., Sung Hoon Chung, M.D. D epartm e η t 01 Diα， 'gno s itc Radiology, College 01 Medicine, Gy e ongsαη~g Natioη a l University - Abstract- To evaluate the normal development of the paranasal sinuses in children with CT, authors prospectively studied with brain CT scans of 260 children without known sinus diseases, ranging in age from 7 days to 16 2 years. M값imal anteroposterior and transverse diameters(mm) and maximal cross-sectional area(mm ) of both sides of the maxillaπ sinus were measured with the aid of computer device. As to the ethmoidal and sphenoi­ dal sinuses, we simply documented the presence of the aplastic ethmoidal sinus and calculated the age-inci­ dence of the sphenoidal sinus pneumatization, respectively. There noted three phases in the development of the maxillaη sinus. The anteroposterior and transverse di­ ameters of the m값illay sinus increased nearly in par외 le l. The former was always greater than the latter. In no cases was the ethmoidal sinus aplastic and almost all sinuses were pneumatized even in infants 'as early as 7 days old. CT identified the conchal pattern of sphenoidal sinus pneumatization in infants as early as 11 days old. Sphenoidal sinus pueumatization was seen in 38% of the children under the age of 1 year, 82% of the children between the age of 1 and 2 years, and almost all children older than 2 years. The anteroposterior and transverse diameters of the maxillary sinus seem to reach the adult size by 8 years of age, and the conchal pattern of sphenoidal sinus pneumatization can be recognized earlier with CT than on the plain radiographs. Index Words: Paranasal sinuses, anatomy 23.1 Paranasal sinuses. CT 23.1211 thology, but they are frequently badly INTRODUCTION influeured by patient’s motion and position. Its qu띠 ity could be degraded by the small size of Knowledge of the embryology and the de­ the sinuses and overlying soft tissue densites. velopmental anatomy of the paransal sinuses in The younger is the child, the more troublesome infants and children allows better understand­ is the case. In this regard, the cross-sectional ing of normal and abnormal sinuses. Plain radi­ imaging techniques such as computed tomogra­ ographs have played a role as an essential phy(CT) or magnetic resonance imaging(MRI) screening method in the detection of sinus pa- are superior to plain radiographs in the assess- * 이 논문은 1991 년 도 한 국 방사선연구재단의 연구비 로 이루어 졌 음. **마산 성모병원 진단방사선과 ** Deþartmeη t 01 Diα， gnos tic Radiology, Masan Suη~gmo Hospital 이 논문은 1993 년 4 월 1 일 접 수하여 199 3 년 6월 21 일 에 채택 되 었음. Received April 1, Accepted June 21. 1993 - 1313 - Journal of Korean Radiological Soci ety 1993; 29 (6) 13 13 ~ 13 19 ment of the sinus development as well as other sinus diseases. Although there are abundant reports on the embryology and development of the paranasal sinuses(l -4), few studies were done in respect to the development of the normal paranasal si­ nuses with CT. The purpose of this study is to evaluate the normal development of the para­ nasal sinuses in children with CT, especially em­ phasizing the development of the maxillaη and sphenoidal sinuses. Fig. 1. Measurement of the maxillary sinus. MATERIALS AND METHODS The maximal cross-sectional area is obtained with computer device by drawing the line conforming to the inner margin of the m값illaη sinus. A : m었imal Between August 1990 and February 1993, anteroposterior diameter of the right maxillaη slnus. T:maximal transvere diameter of the left maxillary we prospectively evaluated the brain CT scans smus of 260 children, ranging in age from 7 days to 16 years(164 boys, 96 girls). Additional axial scans parallel to the orbitomeatal line were ob­ tained with a 4-10mm collimation through the region of the paranasal sinuses. All patients un­ derwent CT examination for indications other than sinus disease, such as seizures, headache, meningitis, hydrocephalus, head trauma, brain tumors, mental retardation, or ocular problems. All the CT scans were performed with a 9800 scanner (GE Medical System, Milwaukee, WI), and all the images were photographed with a bone-window setting. We excluded the CT scans which showed the significant changes Fig. 2. Conchal pattern of pneumatization of the of chronic sinusitis, e.g., sclerosis and thicken­ sphenoidal sinus. CT scan in this 5-month-old boy ing of the bony walls of the maxillary sinuses shows bilateral well pneumatized air-containing spac­ andj or atrophy, but induded ones showing the es(arrows) between the posterior nasal cavity anteri­ orly and sphenoid bone posteriorly. mucosal reactions unaccompanied by bony or atrophic changes. Subjects with craniofacial anomaly were also exduded from the study. Pa­ documented the presence of aplastic sinus, if tients aged less than 4 years were routinely se­ any, rather than size measurement of the eth­ dated. moidal sinus owing to its complex shape. As to M<o‘imal anteroposterior and transverse di­ the sphenoidal sinus, which is normally delayed ameters(mm) and maximal cross-sectional area in pneumatization compared with the maxillaη 2 (mm ) of both sides of the maxillarγ sinus were and ethmoidal sinuses, we simply documented measured with the aid of computer device(Fig. the presence of pneumatization and calculated 1). Lack of a discernible cavity of the maxillary the incidence of the pneumatized sinuses in sinus was considered to be aplastic. We simply each age group. We considered it to be the - 1314 - Hyung Jin Kim , et al : Normal Development of the Paranasal Sinuses in Children Table 1. Meaurements of Each Side of the Maxillary Sinus According to Age Mean Value ::1: SD NO. of Age Right maxillary sinus Left Maxillary Sinus children 2 2 AP-D*(mm) TR- D**(mm) Area(mm ) AP-D*(mm) TR-D**(mm) Area(mm ) -3mo 20 9.6 ::1: 3.4 4.3 ::1: 1.0 3.3:1:1 .9 9.8 ::1: 3.2 4.5 :t0.2 3.2 :t1.7 -6mo 16 14.2:t3.4 7.6:t2.3 8.7:t3.7 14.4:t3.2 7.4:t2.1 7.3 :t3.1 -9mo 20 15 .3:t3.7 8.8:t2.5 10.6:t5.0 14.7:t3.9 8.4:t2.5 9.5 :t3.9 -12mo 12 17.0:t3.9 9.7:t3.0 12.6:t5.7 16.7:t4.0 10.7:t2.8 12.6:t5.3 -lyr6mo 21 19.8:t3.4 11. 7:t2.8 17.0:t5.7 19.9:t3.0 11. 5 :t2.3 16.3:t5.3 -2 yr 12 23 .9:t2.6 13.7:t2.8 23 .3:t5.8 23.3:t3.2 14.0 :t3.1 23.5:t6.5 -3 15 26.1 :t2.3 16.3:t4.9 29.3 :t6.7 26.4 :t2.6 17.5 :t2.4 30.0 :t5.4 4 16 27 .9:t3.5 18.5:t3.4 33.1 :t8.3 27.7:t3.3 18.6:t3.0 33.7:t8.0 -5 15 29.6 :t3.5 21. 4 :t3.3 43.3 :t l0.0 29.7 :t3.0 20.6 :t3.0 39.5:t9.1 -6 16 29 .9 :t3.0 21. 4 :t3.6 44.1 :t9.3 29.8 :t3.1 21. 0 :t3.0 4 1.4 :t7.9 -7 16 30.5:t2.4 21. 0:t3.3 44.0 :t7.9 29.5 :t3.0 21. 8 :t3.9 42.2:t7.8 -8 14 33.8:t2.5 24.3 :t2.9 53.1 :t9.0 34.0 :t2.6 24.9 :t3.2 53.6:t 10 .5 -9 11 34.3:t2.5 23.9 :t3.2 53.0 :t 10.3 33.9:t2.9 25.0 :t3.0 53.7:t 10 .4 -10 10 33.0:t2.1 22.7:t3.1 49.6 :t9.2 33.1 :t2.2 25.1 :t4.6 50.8:t9.9 -11 14 33.0:t4.4 22.3:t4.1 50.0 :t12.7 33.7:t4.0 23:5 :t3.8 51. 7:t 10.9 -12 16 35.2:t2.3 24.9 :t3.8 57.3 :t l 1. 9 33.9 :t3.4 24.8 :t3.5 55.1:t 13 .0 >12 16 34.9:t3.7 24.9:t5.3 58.1 :t 15.4 34.5:t3.4 26.3 :t5.9 58.7:t 15.8 * anteroposterior diameter ** transverse diameter concha1 pattern of pneumatization of the sphe­ (mm) 40 noida1 sinus if there was a discrete air-contain­ A p.D ing space between the posterior nasa1 cavity and sphenoid bone on CT(Fig. 2)(5). We did 30 not include the ana1ysis of frontal sinus devel­ opment in this study because of the great varia­ 20 tions in size and shape and the reported high rate of aplasia. RESULT Development of the maxillary sinus 05""yl y6m 2y ‘ 12< Maxillany sinus appeared as a discernible Fig. 3. Chronological changes of the anteroposterior (AP-D) and transverse diameters(TR-D) of the right cavity in a11 260 children.