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ORIGINAL ARTICLE
Year : 2015  |  Volume : 18  |  Issue : 4  |  Page : 166-171

Cephalometric assessment of the maxillary sinus using computed tomography, from Sokoto, North Western Nigeria


1 Department of Anatomy, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
2 Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Web Publication16-Feb-2016

Correspondence Address:
A Abdul-Hameed
Department of Anatomy, College of Health Sciences, Usmanu Danfodiyo University, PMB. 2346, Sokoto
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1118-8561.176583

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  Abstract 

Background: The maxillary sinus is characterized by a significant inter-individual variation. Computed tomography (CT) measurement of sinus dimensions using provides a satisfactory assessment of the maxillary sinus and its conditions. Aim of the Study: To determine the size of the maxillary antrum and compare the depth, width, and height of the maxillary sinus between sexes and to establish a baseline for values in our environment using CT. Materials and Methods: One hundred and thirty subjects (79 males, 51 females), between 20 and 80 years, with normal maxillary sinus CT anatomy, from head CT scans done at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital Sokoto, were studied. Measurements were taken between the widest points of the sinuses, antero-posterior (AP) and transverse diameters from axial images, craniocaudal diameter from coronal and sagittal images, and volumes were determined by the product of these three-dimensional and slice thickness. Results: In males, the mean craniocaudal, transverse, AP diameters and volume on the right were: 32.21 ± 5.56 mm, 24.18 ± 5.80 mm, 36.94 ± 4.73 mm, and 14.98 ± 6.53 cm 3. On the left, it was 32.38 ± 5.33 mm, 24.12 ± 5.81 mm, 36.84 ± 5.31 mm, and 15.08 ± 6.66 cm 3 respectively. Similarly in females, values on the right were: 30.93 ± 6.09 mm, 23.14 ± 4.70 mm, 36.29 ± 4.71 mm and 13.26 ± 5.04 cm 3, and left was, 31.14 ± 6.00 mm, 23.69 ± 5.50 mm, 36.43 ± 4.64 mm and 16.06 ± 17.96 cm 3 respectively. Conclusions: CT measurements of the maxillary sinus dimensions are larger in males; however, females had higher left sinus volume.

Keywords: Cephalometry, computed tomography, maxillary sinus, Nigeria, Sokoto


How to cite this article:
Abdul-Hameed A, Zagga A D, Ma'aji S M, Bello A, Bello S S, Usman J D, Musa M A, Tadros A A. Cephalometric assessment of the maxillary sinus using computed tomography, from Sokoto, North Western Nigeria. Sahel Med J 2015;18:166-71

How to cite this URL:
Abdul-Hameed A, Zagga A D, Ma'aji S M, Bello A, Bello S S, Usman J D, Musa M A, Tadros A A. Cephalometric assessment of the maxillary sinus using computed tomography, from Sokoto, North Western Nigeria. Sahel Med J [serial online] 2015 [cited 2024 Feb 23];18:166-71. Available from: https://www.smjonline.org/text.asp?2015/18/4/166/176583


  Introduction Top


Cephalometry is a branch of anthropometry that describes the measurement of head and face in cadaveric, living, or radiologic specimen.[1] Computed tomography (CT) of the maxillary sinus has improved the quality and quantity of available information of the maxillary sinus not directly visible using other procedures and this is increasingly becoming important, especially among anthropologists and paleopathologists.[2] CT has proved to be a very precise technique used in detecting simulated lesions of all surfaces of the maxillary sinus, allowing access to all walls of the sinus and should be used when there is a definite evidence of maxillary sinus pathology.[3] It is a fast and painless scanning method, permitting improved contrast enhancement and decreased motion artifacts as such, enables the radiologist to visualize lesions quickly and maneuver volumetric data in three-dimensional reconstructed images (3D-CT).[4] The use of CT followed by 3D reconstructions provides valuable measurements like craniocaudal, transverse, and antero-posterior (AP) diameters,[5] this has demonstrated consistency with manual measurements of the maxillary sinus obtained from dry human skulls.[6] This consistency in measurements of the maxillofacial region using CT images has been evaluated in the last decade.[7],[8]

The maxillary sinus is pyramidal in shape, occupying the cavity of the maxilla; it is the largest among the paranasal sinuses, initially referred to as the antrum of highmore.[9],[10],[11] It represents a complex anatomical structure with a significant inter and intra-individual variation.[5],[9],[10],[12] The wide range of maxillary sinus dimensions in different studies is a reflection of the influential effects of human variability and the different degrees of pneumatisation.[6],[13] According to Williams et al.,[11] the craniocaudal, transverse and AP diameters were 35 mm, 25 mm, and 32 mm respectively, while Uchida et al.,[14] reported 34.6 mm, 25.4 mm, and 30.1 mm respectively in that order of diameters from Saga Medical School, Nabeshima, Japan. Kim et al.,[15] from Yonsei University, Seoul, Korea, reported higher values in the craniocaudal (37.1 mm), transverse (32.6 mm) and AP (39.3 mm) diameters, while from the Radiology Department, Minia Faculty of Medicine, El-Minia, Egypt, Amin and Hassan,[16] found craniocaudal, transverse and AP diameters of 32.2 mm, 18.7 mm and 33.5 mm respectively. These works were done on Caucasian subjects, and may be quite different from those obtainable from Africans (Nigerians). The present study was therefore meant to determine the size and dimensions of the maxillary antrum, to establish baseline data for maxillary sinus in our environment, and to compliment results from previous works.


  Materials and Methods Top


One hundred and thirty, subjects (79 males and 51 females), between 20 and 80 years, with normal maxillary sinus CT anatomy, from head CT scans carried out at the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital Sokoto, over a 5 years period were studied. Head CT scans were obtained from the local data base of the CT machine and back up compact disc from the CT library. Images were viewed on the computer monitor. Good positioning of images was observed to ensure symmetry or asymmetry of the maxillary sinus. Image acquisition and measurements were made with Neusoft Dual Slide Helical CT machine (2005 model, 15 cm FOV, 200 mA, 120 kV, scanning at high resolution bone algorithm at 1 s and slice thickness of 5 mm), with software that provides a meter rule, with which measurements were taken. The axial images were reformatted to coronal and sagittal images and the reformatted cross-sectional images were used for the radiographic evaluation of the inferior wall and to observe the anterior and posterior limit of the sinus. The AP and transverse diameters were measured from axial images, and the craniocaudal diameter was measured from coronal and sagittal reformatted images. All measurements were taken in millimeters between the widest points on the sinuses and the volume of each sinus was determined by the product of the previous 3D and the slice thickness as described by Amin and Hassan,[16] and Sahlstrand et al.[17] These measurements were performed on 3D reconstructed images using V-works 3.0 program (Linux USA). Data was manually sorted out, tabulated, entered into computer using Microsoft word and Microsoft Excel and analyzed using Minitab 16.0 statistical package (Minitab Inc. USA). The mean ± standard deviation craniocaudal, transverse, AP diameters and volume were determined. Comparisons of mean values were done using Student's t-test [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5].
Figure 1: Annotated diagram (axial slide) of the maxillary sinus showing landmarks of measurements. AP = Antero-posterior, TS = Transverse diameter, NS = Nasal septum, MS = Maxillary sinus, NP = Nasopharynx, AX = Axis vertebra, PT = Pterygoid process, HD = Head of mandible, CP = Coronoid process, MP = Mastoid process, A = Area behind the posterior wall of the maxillary sinus

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,
Figure 2: Annotated diagram (coronal slide) of the maxillary sinus showing landmarks of measurements. CC = Craniocaudal, TS = Transverse diameters, ACF = Anterior cranial fossa, Or = orbit, ES = Ethmoidal sinus, MT = Middle turbinate, IT = Inferior turbinate, S = Nasal septum, MS = Maxillary sinus, OC = Oral cavity, TE = Teeth below sinus floor, Rt = Right side, Lt = Left side

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,
Figure 3: Coronal computed tomography of a 30-year-old female showing measurements of the craniocaudal diameter CC (height). The right CC was 32.20 mm while the left CC was 36.15 mm. R = Right side, L = Left side, CN = Cranial end, CD = Caudal end, CC = Craniocaudal

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,
Figure 4: Axial computed tomography of a 27-year-old female showing measurements of the transverse diameter (TR). The right TR is 13.40 mm, while TR on the left is 14.72 mm. R = Right side, L = Left side, A = Anterior, P = Posterior

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,
Figure 5: Axial computed tomography of a 45 year of male showing measurement of the AP diameter AP (depth). The right and left AP diameters were 39.81 mm and 39.74 mm respectively. The arrows point towards septa on the anterolateral sinus wall. R = Right side, L = Left side, AP = Anteroposterior

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  Results Top


The mean right craniocaudal, transverse and AP diameters of the maxillary sinus were 31.71 ± 5.78 mm, 23.77 ± 5.40 mm, and 36.69 ± 4.71 mm respectively. The mean values on the left were 31.90 ± 5.61 mm, 23.95 ± 5.68 mm, and 36.68 ± 5.04 mm respectively [Table 1].
Table 1: Mean and (±SD) of maxillary sinus dimensions of subjects used in the study

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With respect to sex distribution [Table 2], on the right maxilla, the mean craniocaudal diameter for males was 32.21 ± 5.56 mm, and 30.93 ± 6.09 mm for females, indicating no statistically significant difference in the craniocaudal diameter between males and females (t = 1.21; df = 100; P = 0.24). The right transverse diameter for males was 24.18 ± 5.80 mm and 23.14 ± 4.70 mm for females subjects (t = 1.12; df = 121; P = 0.27). The average AP diameter of the right maxillary sinus for males and females was 36.94 ± 4.73 mm, and 36.29 ± 4.71 mm respectively (t = 0.76; df = 107; P = 0.45). The mean volume for the right sinus in males was 14.98 ± 6.53 cm 3 while in females it was 13.26 ± 5.04 cm 3, indicating that no statistically significant difference existed in the right maxillary sinus volume between males and females (t = 1.68; df = 124; P = 0.09).
Table 2: Mean and (±SD) of measurements of the maxillary sinus in relation to sex distribution of subjects used in the study

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On the left side, the mean sinus craniocaudal diameter was 32.38 ± 5.33 mm for males, and 31.14 ± 6.00 mm for females (t = 1.20; df = 98; P = 0.23), showing no statistically significant differences between both sexes. The mean left transverse diameter for males and females was 24.12 ± 5.81 mm, and 23.69 ± 5.50 mm respectively (t = 0.43; df = 111; P = 0.67). Similarly the mean AP diameter in males and females were 36.84 ± 5.31 mm and 36.43 ± 4.64 mm respectively, indicating no statistically significant difference on the left side between both sexes, (t = 0.46; df = 117; P = 0.65). The average left sinus volume for males was 15.08 ± 6.66 cm 3, while that for females was 16.06 ± 17.96 cm 3. This showed no statistically significant difference between both sexes (t = −0.38; df = 59; P = 0.71).

The different variables of the maxillary sinus that were measured showed attainment of peak at different age groups [Figure 6] and [Figure 7]. However, there was an observed marked decrease in the right and left craniocaudal, and left transverse diameters between 20–29 and 79–80 years. This appears reversed in the other variables within the same groups of compared age.
Figure 6: Bar chart showing the relationship between the mean of the left maxillary sinus dimensions in relation to age groups of subjects used in the study. LCC= Left craniocaudal diameter, LTR= Left transverse diameter, LAP= Left anteroposterior diameter

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Figure 7: Bar chart showing the relationship between the mean of the right maxillary sinus dimensions in relation to age groups of subjects used in the study. RCC=Right craniocaudal diameter, RTR= Right transverse diameter, RAP= Right anteroposterior diameter

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  Discussion Top


The complex structural anatomy of the maxillary sinus, the influential effects of human variability and the different degrees of pneumatisation accounts for the wide range of sinus dimensions in different studies.[6],[13]

This study found that in most variables for both sides of the maxillary sinus, females had statistically insignificant lower values (P < 0.001.) compared to males as supported by previous authors.[15],[18],[19]

The results of our study agrees favourably with Amin and Hassan,[16] who reported from the Radiology Department, Minia Faculty of Medicine, El-Minia, Egypt, a mean craniocaudal diameter of 33.73 ± 0.54 mm in males and 31.30 ± 0.55 mm in female Egyptians. Higher values were reported among Koreans in Seoul,[15] where males had 39.40 mm and females; 34.00 mm, and from Mansoura, among Egyptian population,[18] reported a higher right craniocaudal diameter in males of 40.03 ± 6.84 mm, and 35.65 ± 4.86 mm in females, while according to Uchida et al.,[14] an overall of 34.6 ± 7.71 mm for craniocaudal diameter was reported from Saga Medical School, Nabeshima, Japan.

The mean transverse diameter for both sexes over the right maxillary sinus were lower than 25.40 ± 5.71 mm,[14] but essentially the same with values reported from Mansoura University, among Egyptian population, (24.68 ± 5.67 mm for males and 23.27 ± 3.47 mm) for females).[18] However, our values were higher than values for similar variables; 18.90 ± 0.37 mm in males and 18.80 ± 0.31 mm in females among Egyptian population from El-Minia.[16]

The average right sinus AP diameter among North Western Nigerians was higher than the overall average of 30.10 ± 5.65 mm among the Japanese,[14] and Egyptians (males 33.6 ± 0.31 mm and females 33.9 ± 0.36 mm),[16] therefore, racial reasons could be advanced for this outcome. Our results were slightly lower compared to values among Koreans from Yonsei University, Seoul, (male: 40.70 mm, female: 37.40 mm),[15] but agrees favourably with the findings from Mansoura where males had 37.86 ± 5.18 mm, and females 36.40 ± 4.19 mm.[18]

The results obtained from this study for all variables (craniocaudal, transverse, AP diameters and volumes) were higher than those obtained among Indian population from JSS University, Mysore,[19] where the mean craniocaudal, transverse, AP diameters and volume, were 30.22 ± 0.545 mm, 21.84 ± 0.556 mm, 31.00 ± 0.499 mm, and 13.606 ± 5.247 cm 3 on the right and 31.06 ± 0.560 mm, 23.72 ± 0.510 mm, 32.78 ± 0.444 mm and 13.50 ± 6.513 cm 3 on the left side respectively in males, while in females, it was 28.25 ± 0.367 mm, 18.83 ± 0.307 mm, 28.58 ± 0.345 mm, and 9.733 ± 3.389 cm 3 on the right and 30.25 ± 0.407 mm, 19.75 ± 0.331 mm, 31.58 ± 0.375 mm, and 10.908 ± 3.31 cm 3 respectively, on the left maxillary sinus.

On the left maxillar, values obtained from this study were higher than those reported from El-Minia,[16] except over the craniocaudal diameter in males. However, the results of this study were low when compared with a previous study from Mansoura,[18] though, both studies had essentially similar outcomes in the transverse diameter (males: 24.62 ± 6.09 mm, females: 23.05 ± 4.42 mm).[18]

The mean sinus volume from this study concurs with the findings from the University of Texas, United States by Colhoun et al.,[20] who reported mean volume of 14.75 cm 3. Our result also falls within the range of values established among Japanese in Ariji et al.,[21] (4.56–35.21 cm 3, mean: 14.71 ± 6.33 cm 3), and that of Pirner et al.,[8] 11.1 ± 4.5 cm 3–23.0 ± 6.7 cm 3 from the University of Bonn, Germany, although, higher on the right and similar on the left in comparison with values among South Western Nigerians using dry crania by Amusa et al.[22] (11.59 ± 5.36 cm 3 on the right and 14.98 ± 10.77 cm 3 on the left).

Sinus volumes were generally larger on the left than on the right maxillary sinus in both sexes, this is in tandem with the reports from East Germany,[23] and South Western Nigeria.[24] However, from Okayama University School of Dentisty, Japan, Koppe,[13] maintained that, the volume of the right maxillary sinus was larger than that of the left side.

This study also revealed that, no statistically significant differences existed between the right and left maxillary sinus volume in both sexes (P < 0.001). Sinus volumes among North Western Nigerians were less, more so in males, when compared with volumes of 24.04 cm 3 (males) and 15.86 cm 3 (females) among Koreans in Seoul, at the Catholic University of Korea.[24] Our results were also lower but compared favourably with the conclusions from Lund, Sweden,[17] that for males, the right was 18.0 ± 6.00 cm 3, and left, 18.0 ± 7.00 cm 3, while for females, right: 14.0 ± 3.00 cm 3, and left: 15.0 ± 4.00 cm 3. Sinus volumes of Nigerians in the North West were found to be larger than among Indian males (right: 13.606 ± 5.247 cm 3, left: 13.50 ± 6.513 cm 3); and females (right: 9.733 ± 3.389 cm 3, right and left: 10.908 ± 3.39 cm 3) respectively.[19]


  Conclusions Top


In this study, females had statistically insignificant lower values compared to males while sinus volumes were generally larger on the left maxillary sinus in both sexes.

 
  References Top

1.
Umar MBT, Singh SP, Shugaba AI. Orbital measurements among the ethnic groups of Plateau State, Nigeria. Highland Med Res. 2005;3:26-8.  Back to cited text no. 1
    
2.
Cesarani F, Martina MC, Ferraris A, Grilletto R, Boano R, Marochetti EF, et al. Whole-body three-dimensional multidetector CT of 13 Egyptian human mummies. AJR Am J Roentgenol 2003;180:597-606.  Back to cited text no. 2
    
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Perez CA, Farman AG. Diagnostic radiology of maxillary sinus defects. Oral Surg Oral Med Oral Pathol 1988;66:507-12.  Back to cited text no. 3
    
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Cavalcanti MG, Vannier MW. The role of three-dimensional spiral computed tomography in oral metastases. Dentomaxillofac Radiol 1998;27:203-8.  Back to cited text no. 4
    
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Uthman AT, Al-Rawi NH, Al-Naaimi AS, Al-Timimi JF. Evaluation of maxillary sinus dimensions in gender determination using helical CT scanning. J Forensic Sci 2011;56:403-8.  Back to cited text no. 5
    
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Ariji Y, Ariji E, Yoshiura K, Kanda S. Computed tomographic indices for maxillary sinus size in comparison with the sinus volume. Dentomaxillofac Radiol 1996;25:19-24.  Back to cited text no. 6
    
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Kawarai Y, Fukushima K, Ogawa T, Nishizaki K, Gunduz M, Fujimoto M, et al. Volume quantification of healthy paranasal cavity by three-dimensional CT imaging. Acta Otolaryngol Suppl 1999;540:45-9.  Back to cited text no. 7
    
8.
Pirner S, Tingelhoff K, Wagner I, Westphal R, Rilk M, Wahl FM, et al. CT-based manual segmentation and evaluation of paranasal sinuses. Eur Arch Otorhinolaryngol 2009;266:507-18.  Back to cited text no. 8
    
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Helmy ID, Tadros AA, Micheal M.A. The Anatomical Basis of Medical Practice. The Human Skeleton. 1st ed. Alexandria University Press, Alexandria. 1969. p. 197.  Back to cited text no. 9
    
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Sinnatamby CS, editor. Last's Anatomy. Regional and Applied. 11th ed. Edinburgh: Churchill Livingstone; 2005. p. 386-90.  Back to cited text no. 10
    
11.
Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE. Gray's Anatomy. 38th ed. Edinburgh: Churchill Livingstone; 1995. p. 295-302.  Back to cited text no. 11
    
12.
Kojima K, Endo T, Shimooka S. Effects of maxillary second molar extraction on dentofacial morphology before and after anterior open-bite treatment: A cephalometric study. Odontology 2009;97:43-50.  Back to cited text no. 12
    
13.
Koppe T, Weigel C, Bärenklau M, Kaduk W, Bayerlein T, Gedrange T. Maxillary sinus pneumatization of an adult skull with an untreated bilateral cleft palate. J Craniomaxillofac Surg 2006;34 Suppl 2:91-5.  Back to cited text no. 13
    
14.
Uchida Y, Goto M, Katsuki T, Akiyoshi T. A cadaveric study of maxillary sinus size as an aid in bone grafting of the maxillary sinus floor. J Oral Maxillofac Surg 1998;56:1158-63.  Back to cited text no. 14
    
15.
Kim HJ, Yoon HR, Kim KD, Kang MK, Kwak HH, Park HD, et al. Personal-computer-based three-dimensional reconstruction and simulation of maxillary sinus. Surg Radiol Anat 2003;24:393-9.  Back to cited text no. 15
    
16.
Amin MF, Hassan EI. Sex identification in Egyptian population using multidetector computed tomography of the maxillary sinus. J Forensic Leg Med 2012;19:65-9.  Back to cited text no. 16
    
17.
Sahlstrand-Johnson P, Jannert M, Strömbeck A, Abul-Kasim K. Computed tomography measurements of different dimensions of maxillary and frontal sinuses. BMC Med Imaging 2011;11:8.  Back to cited text no. 17
    
18.
Attia AM, El-Badrawy AM, Haytham MS. Gender identification from maxillary sinus using multidetector computed tomography. Mansoura J Forensic Med Clin Toxicol 2012;20:17-27.  Back to cited text no. 18
    
19.
Vidya CS, Shamasundar NM, Manjunatha B, Keshav B. Evaluation of the size and volume of the maxillary sinuse to determine gender by 3D computerized tomography scan method using dry skulls of south Indian origin. Int J Curr Res Rev 2013;5:97-100.  Back to cited text no. 19
    
20.
Colhoun EN, O'Neill G, Francis KR, Hayward C. A comparison between area and volume measurements of the mastoid air spaces in normal temporal bones. Clin Otolaryngol Allied Sci 1988;13:59-63.  Back to cited text no. 20
    
21.
Ariji Y, Kuroki T, Moriguchi S, Ariji E, Kanda S. Age changes in the volume of the human maxillary sinus: A study using computed tomography. Dentomaxillofac Radiol 1994;23:163-8.  Back to cited text no. 21
    
22.
Amusa YB, Eziyi JA, Akinlade O, Famurewa OC, Adewole SA, Nwoha PU, et al. Volumetric measurements and anatomical variants of paranasal sinuses of Africans (Nigerians) using dry Crania. Int J Med Med Sci 2011;3:299-303.  Back to cited text no. 22
    
23.
Nowak R, Mehls G. X-rayfilm analysis of the sinus paranasales from cleft patients (in comparison with a healthy group) (author's transl). Anat Anz 1977;142:451-70.  Back to cited text no. 23
    
24.
Jun BC, Song SW, Park CS, Lee DH, Cho KJ, Cho JH. The analysis of maxillary sinus aeration according to aging process; volume assessment by 3-dimensional reconstruction by high-resolutional CT scanning. Otolaryngol Head Neck Surg 2005;132:429-34.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

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