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clinician but with the anatomy of the rgion as well. ostium as well as in designing instruments for access
Van Alyea had a •similar experience and reported that to this critical area of the osteomeatal complex in
based on his anatomical study, catheterization of the Filipinos.
ostium may be impossible if not at least very dificult
in nearby half of the cases.
Lastly, accessory ostia have been noted to be present REFERENCES
in the area of the middle meatus. Myerson reported
a 30.7% incidence while Van Alyea had _23% inci- Journals
dence in 163 specimens. Its presence was noted in
about 8 (16%) of cadavers dissected in this study. Kennedy, DW: Endoscopic Middle Meatal Anthros-
Multiple ostia were occasionally found. It is difficult tomy: Theory, Techniques and Pal_ncy. Lato
explain their origin embryologically. Ritter (1978) ryngoscope, 97 (8) Suppl 43 August 1987.
stated that the likely reason for their existence is that
•the bone of the middle meatus in the membranous area Myerson, MC: The Natural Orifice of the Maxillary
breaks down as a sequela of infection. Sinus I Anatomic Studies. Arch Otolaxyn
15: 80, 1932a.
LIMITATIONS OF THE STUDY
Myerson, MC: The Natural Orifice of the Maxillary
It would have been ideal to use fresh cadavers for Sinus II Clinical Studies, Arch Otolaryn 15:
dissections but there is a problem with acquisition of 716, 1932b.
such in the Philippine setting. As such a certain margin
of error with respect to them ucosal configuration of Schaeffer, JP: The Genesis, Development and Adult
the anatomic structures should be considered. Sagittal Anatomy of the Nasofrontal Region in Man.
sections of fresh cadavers in the morgue are impossible Am J Anat 20: 125, 1916.
since consent from relatives could •not be obtained.
Van Alyea, OE: The Ostium Maxillare: Anatomic Sutdy
SUMMARY of Its Surgical Accessibility. Arch Otolaryn
24: 553, 1936.
This study proves that there are notable variations
in the anatomy of the lateral, wall of Filipino adult Wilkerson, WW: Antral Window in the Middle Meatus.
cadavers, particularly the osteome_[tal complex. These Arch Otolaryn 49: 463, 1949.
variationsincluded the absence of the supreme turbinate.
The accessory ostium in this study is 16%
compared to that of Van Alyea (23%) and Myerson Books
(30.7%). The location of the nasolacrimal duct ostium
at the anterior end of the inferior turbinate was simi- Ballantyne, J and Groves, J. Disease of the Ear, Nose
laxly noted although the incidence of the different and Throat. Vol. 1, 4th ed. Butlerworth &
variations differ. Similar to published data based on Co. (Publishers) Ltd., 1979.
Caucasian cadavers, the maxillary ostium was noted
most frequently at the posterior third of the ethmoidal Clummings, CW. Otolaryngology-Head and Neck
infundibulum and had a vertical orientation. However, Surgery. Vol. 1 The C.V. Mosby
the greater incidence of cases wherein the ostium was Company, 1986.
located in the middle third and an oblique orientation Hollinshead, WH. Anatomy for Surgeons. Vol. 1:
were found in Filipino specimens. Such observations The Head and Neck. 3rd ed. Harper and
may prove clinically significant in attempts to can- Row, Publishers, 1982.
nulate the maxillary ostium. The data presented may
be ofpotential use not only to the rhinologist inpractice, Lee, KJ. Essential Otolaryngology-Head and Neck
in his pefformaee of different s_rgical procedures like Surgery. 3rd ed. Medical Examination
antrostomy, foreign body removal, or cannulation. It Publishings Co., Inc., 1983.
may also prove valuable in guiding functional sinus Schaeffer, JP. In Otolaryngology, Coates, GM and
endoscopy in Filipinos. Lastly, such data will be utilized Schenek, lip (eds). W.P. Prior Company,
in further studies on direct cannulation of the maxillary Inc. 1966.
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