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. 111
ACKNOWLEDGMENT The authors would like to thank Drs. Sesan Castro and Archangel de Leon of the Department of Anatomy, UP College of Medicine, for the use of their facilities in this study. 112
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