Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

A comparative analysis of the CP and CG using 2D and 3D visualisation approaches

A comparative analysis of the CP and CG using 2D and 3D visualisation approaches Investigations on the structural variations in the cribriform plate (CP), olfactory foramina and the Crista Galli showcase the benefits of using 3D imaging on smaller structures. These techniques reveal accurate details about bone morphology and density. Comparing different techniques, this project aims to examine the correlation between the CP, olfactory foramina, and Crista Galli. Computed tomography was used to translate and apply the findings acquired from the samples in radiographic studies on CPs for potential clinical significance. The findings show that the surface area measurements were significantly larger when using 3D imaging techniques in comparison with the 2D counterpart. Using 2D imaging, the maximum surface 2 2 area of the CPs was 239.54  mm , however, paired 3D samples showed the maximum surface area was 355.51  mm . The findings show that Crista Galli’s dimensions varied greatly, with length ranging from 15 to 26 mm, height ranging from 5 to 18 mm, and width ranging from 2 to 7 mm. The 3D imaging allowed for surface area measurements on the Crista Galli, and the surface area ranged from 130 to 390  mm . When 3D imaging was used, significant correlations were found between the surface area of the CP and the length of the Crista Galli (p = 0.001). The findings show that measurements on the Crista Galli using 2D and 3D reconstructed radiographic imaging reflect similar ranges of dimensions to 3D imaging measure- ments. The findings also suggest that the Crista Galli may increase in length with the CP to support the latter and olfactory bulb during trauma which may be used by clinicians alongside 2D CT scans for optimal diagnosis. Keywords Cribriform plate · Crista Galli · Computed tomography · 2D imaging · 3D imaging Introduction measurements are performed on the lateral lamella using various views, such as the Coronal CT scan to measure the The cribriform plate (CP) is a very thin bony plate that is superior-inferior length of the lateral lamella (Keros 1962), situated in the anterior skull base and forms the roof of the and the Axial CT scan to measure the anterior–posterior nasal cavity (Gomez and Pickup 2022). The CP is lined with length of the lateral lamella (Yenigun et al. 2016). Lastly, many foramina, called olfactory foramina, which allow the the Thailand, Malaysia, and Singapore classification known olfactory nerve fibres to travel from the nasal cavity to the as TMS classifications where distances from the orbital floor olfactory bulb which rests upon the CP, and allows for the to the CP and the ethmoid roof was used (Abdullah et al. sensation of smell (Snell 2009). A large bulb-like structure 2020). The various classifications of CP morphology are called the Crista Galli separates the right and left sides of assessed using a CT scan-Coronal view; however, this may the CP, and some studies suggest that the Crista Galli may overlook many features of the CP, and increase the risk of support the CP and the olfactory bulb from trauma, reducing fracture misdiagnosis. its risk of fracture (Murray et al. 2017). Fractures of the CP may sever the olfactory epithelium The risk of fracture is currently determined by focusing or puncture the olfactory bulb, resulting in limited or total on the thinnest portion of the CP (Keast et al. 2008). These anosmia. Cerebrospinal Fluid (CSF) leaks may also occur due to meningeal damage or following the olfactory epi- thelium being severed (Kühnel and Reichert 2015), causing * Ali Al-Rubaie headaches, stroke (Shah et al. 2017) and meningitis, which aalrubaie@swin.edu.au can have high morbidity rates (Oh et al. 2017). Lastly, CP School of Health Sciences, Swinburne University fractures may result in traumatic brain injuries, especially of Technology, PO Box 218, Hawthorn, VIC 3122, Australia Vol.:(0123456789) 1 3 M. Boulton et al. when a transnasal-penetrating injury has occurred (Gray and laws concerning the use of human cadaveric donors in et al. 2019; Teng et al. 2019; Yoneoka et al. 2020). These anatomical research. A total of 42 samples from human tis- types of fractures are most commonly diagnosed using sue donors were received with approval from the Swinburne 2D CT scans (Gray et al. 2019; Douglas and White 2021; Human Ethics Committee (Human Ethics Approval Number Knížek et al. 2021), however, in recent years 3D Recon- #2026045-9453). To include matched sample pairs to com- structed CT scans have been used to diagnose CP fractures pare the 2D and 3D imaging methods, images were excluded (Teng et al. 2019). if the 3D imaging calibration failed, or if the CP surface area As technology advances, 3D imaging techniques have was impaired preventing accurate measurements. Further increased in use amongst clinicians as it allows for precise analysis was then conducted using five donor CT scans of diagnosis of fractures to be performed in the facial region CPs which were acquired from Digital Imaging and Com- (Wei et  al. 2015; Teng et  al. 2019, Wubulihasimu et  al. munications in Medicine (DICOM). This number of samples (2021). Recent examples include a recent study that catego- was used as they were the only CT scans available that cap- rized anterior skull base fractures using virtual reality 3D tured the CP and Crista Galli. hologram technology (Umana et al. 2022). In clinical case The 2D images of the samples were captured from the studies, 3D reconstructed CT scans have been used to diag- superior view using a Canon Digital Camera DSLR EOS nose CP fractures and the resulting CSF leaks have damag- 1100D, with a ruler at the same level as the CP to allow for ing consequences (Teng et al. 2019). Many studies suggest accurate calibration and scaling of length measurements. that the preciseness of 3D imaging techniques may allow for For the duration of this study, the images were stored in a more accurate measurements to be performed on anatomi- secure Swinburne drive which is only accessible by author- cal structures compared to measurements determined by 2D ised researchers. imaging or 2D CT scans (Wei et al. 2015; Teng et al. 2019; These images were then uploaded to ImageJ (Wayne Ras- Belgin et al. 2021, Wubulihasimu et al. 2021). band, NIH, Bethesda, MD, USA) to allow measurements With many of the current classification systems measur - to be performed and for images to be calibrated so those ing the lateral lamella (Keros 1962; Yenigun et al. 2016) accurate length measurements can be made. Each image was and the nasal cavity (Abdullah et al. 2020), limited atten- then individually calibrated by measuring 10 mm on the tion has been given to other features of the CP, such as its ruler at the same level of the CP, with the number of pixels surface area, olfactory foramina and bone percentages, or representing 10 mm calibrated into the image. the Crista Galli’s dimensions. While advanced 3D imaging All measurements were performed by two blinded has been used on the CP to diagnose fractures (Teng et al. researchers, with the resulting measurements being averaged 2019), limited studies have utilised this technology to per- for the final data. Measurements were then carried out on form measurements on the CP. the surface area of the CP. This was measured by tracing the This project aims to use multiple imaging techniques borders of the CP (see Fig. 1A), and then ImageJ was used on human samples to investigate the variation and correla- to automatically calculate the surface area of the encircled tion between the CP, olfactory foramina, and Crista Galli. region in mm . This was conducted on both the left and right It also used computed tomography (CT) scans to translate sides of the CP and was summed for the total area. and apply the findings acquired from 2 and 3D imaging into The total olfactory foramina area of the CP was measured radiographic studies of CPs to determine the potential clini- by tracing the borders of the foramina of the CP, which was cal significance of the measurements. then automatically calculated in mm using ImageJ. The 2D It is hypothesised that measuring the surface area of the foramina percentage was then calculated by dividing the 2D CP by using 3D imaging will result in a larger calculated foramina area by the total 2D surface area, multiplied by surface area than when 2D imaging is used also, the mor- 100%. The remainder of the area of the CP which was not phology of the CP will positively correlate with the dimen- represented by foramina was then recorded as the 2D bone sions of the Crista Galli. Lastly, the measurements using 3D percentage. imaging will result in similar dimensions to radiographic Three-dimensional images for the same samples were studies on the CP and Crista Galli. also captured using the Artec Space Spider and were auto- matically calibrated to allow for accurate measurements to be performed on the scans. These images were analysed Materials and methods using ArtecStudio (Luxembourg) for measurements to be performed, as shown in Fig. 1B. Experimental design Measurements were made on the surface area of the left and right sides of the CP, which was then summed for the The authors hereby confirm that every effort was made to total surface area. The surface area was measured by high- comply with all local and international ethical guidelines lighting the CP region. Using ArtecStudio (Luxembourg), 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches Fig. 1 A Superior view image of Cribriform Plate showing right surface area traced using ImageJ (WayneRasband, NIH, Bethesda, MD, USA). B 3D Image of Cribriform Plate looking from Superior View using ArtecStudio (Luxem- bourg) the surface area of the highlighted region was automatically calculated in mm . Further measurements were conducted on the Crista Galli’s total length, width, and height in mm, alongside the total surface area in mm . These measurements on the Crista Galli were performed firstly by highlighting the Crista Galli region, then excluding all structures from the 3D model except the Crista Galli. The surface area of the Crista Galli was automatically calculated, and then direct measurements were performed to measure its length, width, and height. The 3D foramina percentage was calculated by dividing the 2D foramina area by the total 3D surface area of the CP multiplied by 100%. The remainder of the area of the CP not represented by foramina was then recorded as the 3D Fig. 2 Coronal view CT scan of Crista Galli and Cribriform Plate bone percentage. in Bone Window mode using SECTRA (Linköping, Sweden) IDS7 Software Radiological analysis For the radiological samples, the above-mentioned five mul- tiplanar CT scans were used to conduct further measure- ments. The CT scans images were received using Digital Imaging and Communications in Medicine (DICOM) data with a slice thickness of 0.8  mm. These CT scans were measured using SECTRA (Linköping, Sweden) IDS7 soft- ware using Coronal View CT scans as shown in Fig. 2 and 3D reconstructed CT scans as shown in Fig. 3. Measurements were conducted on the Crista Galli dimen- sions. The Crista Galli’s height was measured using Coronal CT scan sections as seen in Fig. 2, with five separate cuts of the Crista Galli being measured, the greatest height was recorded. Similarly, the width of the Crista Galli was meas- ured using Coronal CT scan sections, with five separate cuts of the Crista Galli being measured, and the greatest width Fig. 3 3D Reconstructed CT scan of Cribriform Plate and Crista was recorded. The length of the Crista Galli was measured Galli using SECTRA (Linköping, Sweden) IDS7 Software using 3D reconstructed CT scans as seen in Fig. 3. 1 3 M. Boulton et al. Statistical analysis Statistical analysis was then conducted on the collected measurements using SPSS (ver. 28.0.1.1; SPSS Inc., Chi- cago, IL, USA) and GraphPad Prism 7 software (San Diego, CA, USA). To compare the 2D CP surface area to the 3D CP surface area, paired samples t tests were performed with p < 0.05 being considered a statistically significant differ - ence. To compare the CP’s 2D bone percentage with the 3D bone percentage, paired samples t-tests were performed with p < 0.05 being considered a statistically significant differ - ence. Lastly, to analyse any correlations between the Crista Galli and the CP’s surface area or olfactory foramina area, bivariate correlations were performed with p < 0.05 being considered a statistically significant correlation. Results Fig. 4 Box plot comparing 2D cribriform plate surface area with 3D 2D image analysis was performed on the surface area of the cribriform plate surface area, n=23 (*p < 0.05). The data shown here are represented in Table 2 CP. The results showed the samples ranged between 100.11 and 239.54 mm , with an average surface area of 152.60 mm (SD 33.72) as shown in Table 1. Using the same paired was also found between the 2D and 3D surface area meas- samples, 3D image analysis was conducted on the CP’s sur- urements (r = 0.811, p < 0.001). face area. The results showed the samples ranged between Using the same 23 human tissue samples, 2D image 2 2 205.82 and 355.51 mm , with an average of 288  mm (SD analysis was performed on the foramen area of the CP. The 46.10) as shown in Table 1. results showed the foramen area ranged between 10.23 and The results showed that for the 23 paired CP samples, the 2 2 30.92 mm , with an average foramen area of 17.19 mm (SD 2D surface area ranged from 100.11 to 239.54 mm , while 5) as shown in Table 1. the 3D surface area ranged from 205.82 to 355.51 mm , To calculate the bone percentage of the CPs, the area with the comparison being shown in Fig. 4. The difference of the olfactory foramina was divided by the total surface in surface area measurements between 2D and 3D imag- area of the CP measured using 2D imaging and 3D imag- ing was compared using a paired samples t test, which was ing, multiplied by 100%. This gave the percentage of the CP determined to be statistically significant (p < 0.001). This represented by foramen for both the 2D surface area and the test determined that the 3D imaging surface area measure- 3D surface area. The remaining surface area in the CP was ments were significantly higher than the 2D imaging surface then presumed to be bone, resulting in a 2D bone percentage area measurements. A strong significant positive correlation (using 2D surface area) and a 3D bone percentage (using 3D surface area). In general, the 2D bone percentages ranged between 81.62 and 93.01% bone, with an average bone per- centage of 88.41% (SD 3.63%), while the 3D bone percent- ages ranged between 90.84 and 96.63%, with an average Table 1 CP surface area measurements using 2D imaging and 3D bone percentage of 93.96% (SD 1.67%) as shown in Table 1. imaging, foramen area measurements using 2D imaging, and the The results showed that in the 23 paired CP samples, the resulting bone percentages for 2D and 3D surface area (N = 23) 2D bone percentages ranged from 81.62 to 93.01%, while the Dimension measured Mean and SD Minimum Maximum 3D bone percentages ranged from 90.84 to 96.63%, which can be seen in Fig.  5. The difference in bone percentage 2D surface area (mm ) 152.60 ± 33.72 100.11 239.54 measurements using 2D and 3D surface area was compared 3D surface area (mm ) 288.00 ± 46.10 205.82 355.51 using a paired samples t test, which was determined to be 2D foramen area (mm ) 17.19 ± 5.00 10.23 30.92 statistically significant (p < 0.001). This test determined that 2D bone percentage 88.41% ± 3.63% 81.62% 93.01% the resulting bone percentages calculated using 3D surface 3D bone percentage 93.96% ± 1.67% 90.84% 96.63% area were significantly higher than the bone percentages cal- SD standard deviation, Min. minimum value, Max. maximum value, culated using 2D surface area. A strong significant positive N number of samples 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches measurements, to determine whether the Crista Galli’s dimensions increased in size alongside the CP’s surface area. There were no significant correlations found between the surface area of the Crista Galli and the surface area of the CP when measured using 2D (p = 0.968) or 3D imag- ing (p = 0.498). Furthermore, there were also no significant correlations between the length of the Crista Galli and the CP’s total surface area using 2D (p = 0.119) or 3D imaging (p = 0.067). When the surface area of the CP was divided between the left and right sides, a significant moderate positive correla- tion was found between the surface area of the left side of the CP and the length of the Crista Galli, when the surface area was measured using both 2D (r = 0.549, p = 0.007) and 3D imaging (r = 0.634, p = 0.001). There were significant negative correlations between Crista Galli’s width and the surface area of the CP. This correlation was significant when the surface area was meas- ured using 2D (r = − 0.532, p = 0.009) and 3D imaging Fig. 5 Box plot comparing 2D cribriform plate surface area with 3D cribriform plate surface area, n = 23 (*p < 0.05). The data shown here (r = − 0.429, p = 0.041). are represented in Table 2. There were no significant correlations found between the height of the Crista Galli and the CP surface area when measured using 2D (p = 0.588) or 3D imaging (p = 0.228). correlation was also found between the 2D and 3D bone percentage measurements (r = 0.918, p < 0.001). CT scan Using a total of 35 human tissue samples, 3D imaging (ArtecStudio) was used to measure the Crista Galli’s length, Five CT scans from human donors were used, with measure- height, width, and surface area. The results show that Crista ments being performed on the Crista Galli’s length, width, Galli’s length ranged from 15.8 to 25.8 mm, with an aver- and height in Hounsfield units in the bone window. The age length of 20 mm (SD 2.45), Crista Galli’s height ranged results show that Crista Galli’s length ranged between 17.5 from 5.3 to 17.7 mm, with an average height of 11 mm (SD and 21.1 mm, with an average length of 19.04 mm (SD 1.40). 2.70), the Crista Galli’s width ranged from 2 to 6.6 mm, with The Crista Galli’s width ranged between 3.8 and 5.8 mm, an average width of 4.4 mm (SD 1.03) and the Crista Galli’s with an average width of 4.48 mm (SD 0.79). Lastly, Crista surface area ranged from 130 to 390 mm , with an average Galli’s height ranged between 8.5 and 13.6 mm, with an surface area of 217 mm (SD 56.56). The measurements of average height of 11.12 mm (SD 2.22). The measurements Crista Galli’s dimensions using 3D imaging can be seen in of Crista Galli’s dimensions measured using CT scans can Table 2. be seen in Table 3. The range of the Crista Galli’s dimen- Using the 23 paired CP samples, bivariate correlations sions which were measured using CT scans (SECTRA ISD7) were run between the Crista Galli’s dimensions meas- was consistent with the range of Crista Galli’s dimensions ured using 3D imaging and the CP’s total surface area measured using 3D imaging (ArtecStudio). This was true for Table 2 Measurements on the Crista Galli’s length, height, width and Table 3 Crista Galli’s length, height, and width were measured using surface area measured using 3D imaging (ArtecStudio) (N = 35) CT scan technology (N = 5) Crista Galli dimension Mean and SD Minimum Maximum Crista Galli dimension Mean and SD Minimum Maximum Length (mm) 19.96 ± 2.45 15.84 25.79 Length (mm) 19.04 ± 1.40 17.50 21.10 Height (mm) 10.75 ± 2.70 5.34 17.68 Width (mm) 4.48 ± 0.79 3.80 5.80 Width (mm) 4.41 ± 1.03 2.04 6.61 Height (mm) 11.12 ± 2.22 8.50 13.60 Surface area (mm ) 217.36 ± 56.56 135.62 384.85 SD standard deviation, Min. minimum value, Max. maximum value, SD standard deviation, Min. minimum value, Max. maximum value, N number of samples N number of samples 1 3 M. Boulton et al. Fig. 6 Box plot comparing the distributions of the Crista Galli’s Fig. 8 Box plot comparing distributions of Crista Galli’s height when length using ArtecStudio 3D imaging (n=35) and 3D reconstructed measured using ArtecStudio 3D imaging technology (n=35) and Cor- CT scans (n = 5). The data shown here is represented in Tables 2 and onal view CT scan technology (n = 5). The data shown here are repre- sented in Tables 2 and 3 have also used this technology to conduct virtual surgery on the scaphoid bone (Faudot et al. 2021) while other studies have used it to scan the peri-orbital region for a very high clinical accuracy (Hollander et al. 2021). This project used human tissue samples and advanced imaging technology in the form of two-dimensional (2D) and three-dimensional (3D) imaging to investigate the vari- ation and correlations between the CP and the olfactory foramina, alongside examining the dimensions of the Crista Galli in correlation with the CP. This study also used CT scan technology to translate and apply the findings from the above aims into radiographic studies of CPs to determine the potential clinical significance of the measurements. To establish a complete set of measurements, the fol- Fig. 7  Figure 7. Box plot comparing distributions of the Crista Gal- lowing techniques were used to measure and correlate the li’s width when measured using ArtecStudio 3D imaging technol- dimensions of the CP, olfactory foramina, and Crista Galli. ogy (n = 35) and Coronal view CT scan technology (n = 5). The data The 2D imaging technique was chosen as it is used in much shown here are represented in Tables 2 and 3 of the current literature when direct anatomical measure- ments are being performed on dry skull samples (Coelho et al. 2018; Ganjaei et al. 2018). This imaging technique Crista Galli’s length shown in Fig. 6, Crista Galli’s width used calibrated digital images of CPs. This was compared shown in Fig. 7, and Crista Galli’s height shown in Fig. 8. with the 3D imaging technique, an advanced imaging tech- nique that was chosen as a comparative measure to deter- mine the potential benefits this technology may have on Discussion diagnosis and measurements on smaller structures such as the CP (Teng et al. 2019). This technique used an advanced Recent medical literature shows a significant increase in 3D scanner (ArtecStudio) to measure the dimensions of the the use of 3D imaging as a diagnostic tool in many clini- CP and the Crista Galli. The CT scan data was measured cal cases, including facial fractures (de Carvalho et  al. using Coronal CT scans, as this is the most common method 2021, Wickwire et  al. 2022), naso-orbital-ethmoid frac- of radiographic measurement on the CP (Keros 1962; tures (Onisor 2022), cervical fractures (Ren et al. 2021) and Skorek et al. 2017; Inal et al. 2018, Abdullah et al. 2020) orbital blowout fractures (Jansen et al. 2018). Researchers 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches and the Crista Galli (Şahan et al. 2019; Keşkek and Aytuğar of the CP, as it does not account for the additional surface 2021). Lastly, the CT scan data were then measured using area from the curvature of the CP which is obtained when 3D reconstructed CT scans to measure the greatest length of 3D imaging is used. the Crista Galli. This was chosen to accurately measure the The additional surface area measured using 3D imaging entire length of the Crista Galli, as opposed to the axial view techniques resulted in the majority of 3D imaging samples used in other studies (Akiyama and Kondo 2020) which may recording 60–140% additional surface area when using 3D not accurately represent the full length of the Crista Galli. imaging compared to their 2D imaging counterparts. This The morphology of the CP is concave in shape to house the shows a large variation in the additional surface area result- olfactory bulb and the numerous olfactory foramina that pass ing from the curvature of the CP, and this curvature has through the CP, from the nasal cavity to the olfactory bulb not been well studied in the current literature due to lim- (Snell 2009). This curvature in the morphology cannot be ited access to 3D imaging technology. This difference in detected using 2D imaging, however, the 3D scanners used the surface area suggests that the 2D imaging technique is in this study enabled a more specific and accurate measure- insufficient to accurately measure the full surface area of the ment method that traces the curvature of these samples. CP, and results in much lower bone percentages than would This study measured the CP’s total surface area using otherwise be reported. This finding also impacts our current superior view 2D images and 3D imaging technology, to knowledge of the CP’s olfactory foramina, as there may be compare the differences in surface area measurements of vastly fewer foramina reported by 2D imaging methods. these two imaging techniques. The measurements performed Prior research by Ganjaei et  al. (2018) compared the on the surface area of the CP using 3D imaging were sig- recorded bone percentage of the CP using 2D imaging on nificantly higher than the measurements performed using anatomical samples with the bone percentage measured 2D imaging. This difference in measurements supports the using CT scans, with the recorded bone percentage using a hypothesis that the surface area of the CP would be greater CT scan ranging from 92 to 98% with an average of 95.3% when measured using 3D imaging compared to 2D imaging. bone. These results are quite similar to the bone percentages The resulting greater surface area of the CP measured by 3D calculated in this study when accounting for the curvature imaging may indicate that prior studies which have investi- of the CP by measuring surface area using 3D imaging, gated the surface area and foramina area of the CP using 2D which ranged from 90 to 97% with an average of 94% bone. images (Ganjaei et al. 2018) did not accurately depict the Initially, their study concluded that the bone percentages surface area of the CP. This is due to the 2D imaging method recorded using CT scans, which averaged 95.3% were inac- not accurately measuring the additional surface area that the curate due to the differences in bone calculations of roughly curvature of the CP may provide, thus resulting in a lower 11% when compared with the paired 2D bone percentage overall surface area, and a lower calculated bone percentage which averaged 84.5% (Ganjaei et al. 2018). However, due to than would otherwise be found. the similarities with the range found in this study, the results Using 2D imaging to measure total surface area, the pro- may suggest that measuring bone percentage using CT scans portion of the CP which was represented by olfactory foram- may include the curvature of the CP in its measurements. ina ranged from 7 to 19% of the CP, resulting in roughly This suggests that CT scans may provide a more accurate 81–93% of the CP area consisting of bone. This is a similar depiction of the bone percentages than when measurements range to previous research which suggests found foramen are conducted using 2D imaging. areas ranging from 9 to 26%, resulting in roughly 74–91% Researchers who may face difficulties in accessing 3D of the CP consisting of bone (Ganjaei et al. 2018). However, imaging ArtecStudios may be able to use CT scans to meas- due to the increased surface area measurements from using ure the bone percentage of the CP. This data could be com- 3D imaging which accounts for the curvature of the CP, the pared to 2D imaging findings to determine the additional proportion of foramina to the bone area of the CP ranged surface area for which the curvature is included. from 3 to 10%, which resulted in 90–97% of the CP consist- For clinical cases, 3D reconstructed CT scans would be ing of bone. This value is considerably less than previous beneficial to use, however, this view would require a high research using anatomical specimens (Ganjaei et al. 2018), level of radiographic exposure to study the CP, Crista Galli, which may demonstrate that additional measurements need and olfactory foramina in detail. When a facial fracture has to be taken to accurately determine the foramina to bone occurred, due to the susceptibility of the CP to fracture ratio when measuring using 2D imaging. (Kühnel and Reichert 2015), clinicians could conduct addi- The measurements of the bone percentage of the CP using tional checks to determine whether an individual’s CP is the 3D surface area resulted in significantly higher bone at a higher risk of fracture. This could be useful to prevent percentages than when the bone percentage was calculated potential spontaneous CSF leaks (Murray et al. 2017) and using the 2D surface area. This suggests that the 2D imaging the infections which may occur as a result (Oh et al. 2017; technique may not accurately represent the bone percentage Stopa et al. 2022). 1 3 M. Boulton et al. The length of the Crista Galli measured using 3D imag- This study found a strong significant positive correlation ing ranged from 15.8 to 25.8 mm, these results are similar between the surface area of the CP when measured using to previous research showing large variability of Crista Galli 2D imaging and 3D imaging (r = 0.811, p < 0.001), along- length (Akiyama and Kondo 2020). However, the minimum side a strong significant positive correlation between the 2D length of this study was considerably less than that of previ- and 3D bone percentages (r = 0.918, p < 0.001). These cor- ous reports (33). This difference may be due to the different relations show the similarities between the measurements measuring methods used, as the studies which measure the of 2D and 3D imaging, which may provide support for the length of the Crista Galli commonly use Axial CT scans accuracy of the 3D imaging method, while also displaying (Akiyama and Kondo 2020), which may be unable to meas- significantly higher surface area measurements and bone ure the entire length as accurately as 3D imaging. Due to the percentage calculations. variations in the height of the Crista Galli, one section of There was no significant correlation between the total the axial view may only be able to measure a portion of the surface area of the CP and Crista Galli length. When data length, resulting in a much smaller length measurement than were used to contrast the difference between the left and would otherwise be reported for that sample if 3D imaging right sides, this resulted in the left surface area of the CP was used. This shows the benefits of using 3D imaging for having a moderate positive correlation with the length of measurement, as this enabled much more accurate length the Crista Galli for both 2D imaging (r = 0.549, p = 0.007) measurements to be made. and 3D imaging (r = 0.634, p = 0.001). This correlation sug- The height of the Crista Galli measured using 3D imaging gests that as the Crista Galli increases in length, so does ranged from 5.3 to 17.7 mm, similarly supporting previous the surface area of the left side of the CP. These results research indicating a large range of height measurements may suggest that as the surface area of the CP increases, so from the Crista Galli (Akiyama and Kondo 2020). How- does the Crista Galli’s length, to support the CP (Murray ever, the recorded maximum range of 17.7 mm was less et al. 2017) and protect the olfactory bulb from trauma. The than the maximum of 26 mm found by Akiyama and Kondo ability to measure accurately and efficiently the length of (Akiyama and Kondo 2020). This difference is likely due to the Crista Galli to determine the size of the CP may assist sampling size, as the previous study by Akiyama and Kondo clinicians when conducting pre-operative assessments. This (Akiyama and Kondo 2020) had a much larger sample size could allow them to determine the size of the CP, to avoid of 300, allowing for a larger range of Crista Galli’s height surgical complications which may occur if surgery is being to be recorded. conducted close to the CP, such as during endoscopic sinus The Crista Galli’s width measured using 3D imaging surgery (Abdullah et al. 2020) and ethmoidectomy (Goanţǎ ranged from 2 to 6.6 mm, which is quite similar to previous et al. 2017). research which has found this width to range from 0 to 4 mm A moderately significant negative correlation was also (Coelho et al. 2018), 2–10 mm (Akiyama and Kondo 2020) found between the total surface area of the CP and Crista and 2.5–7 mm (Şahan et al. 2019). The width of the Crista Galli’s width. This correlation was found when the surface Galli may impact the risk of trauma-related fracture, as it has area was measured with both 2D imaging (r = − 0.532, been suggested to provide support to the CP (Murray et al. p = 0.003) and 3D imaging (r = − 0.429, p = 0.041). This 2017). From this, it can be postulated that an increased width likely resulted from the Crista Galli blocking the anterior of the Crista Galli may result in a decreased risk of trauma- portion of the CP’s surface area (Kalmey et al. 1998; Patron related fracture, due to the buttressing ee ff ct that it may have et al. 2015; Ganjaei et al. 2018), lowering the total measured (Murray et al. 2017). The increased width of the Crista Galli surface area of the CP. The Crista Galli’s width could be would also likely protect the olfactory bulbs which rest upon explored in more detail in a dissection study, whereby the the anterior portion of the CP from trauma. dimensions of the Crista Galli could be recorded, then sub- The surface area of the Crista Galli using 3D imaging sequently removed, and the CP’s surface area then measured ranged from 135.6 to 384.9  mm . An increase in the surface to more accurately assess whether the Crista Galli’s width area of the Crista Galli and the resulting volume may help correlates with the total surface area of the CP. insulate the CP from fractures that may occur and limit the There were no significant correlations between the CP’s resulting damage which may be inflicted on the olfactory total surface area and the Crista Galli’s height, or surface bulb. Due to the wide range of Crista Galli’s surface area, area. The length, height, and width of the Crista Galli also this implies vastly differing levels of insulation to fracture did not significantly correlate with each other, suggesting that the Crista Galli may be providing between individuals. that these dimensions develop separately and do not impact This variation may be able to be classified to determine the each other. risk of fracture, with a larger surface area or volume of the The Crista Galli’s length measured using a 3D Recon- Crista Galli resulting in a decreased risk of fracture and a structed CT scan ranged from 17.5 to 21.1 mm, which is lowered risk of trauma to the olfactory bulb. 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches consistent with the range of length measurements recorded tool for researchers, which could be used to assess future risk using 3D Imaging of 15.8–25.8 mm. This suggests a high of trauma in further studies. For clinicians, 3D reconstructed accuracy of measurements for both 3D CT scans alongside CT scans could be used alongside 2D CT scan technology the 3D imaging used in this study. The length measurements to perform accurate diagnoses, as this may allow for a more recorded using the 3D Reconstructed CT scan were simi- precise and holistic assessment to be performed on patients larly much greater than the minimum recorded using Axial when head injuries have occurred. CT sections by Akiyama and Kondo (Akiyama and Kondo The demographic data and patient information of the CP 2020). This again supports the use of 3D imaging, with 3D samples could not be accessed, and detailed data analysis Reconstructed CT scans giving a similar range of length (e.g., how features such as age, sex and race may impact the measurements to the 3D imaging, and accurately represent- morphology of the CP and the Crista Galli) on these features ing the length of the Crista Galli compared to the Axial was unable to be conducted. However, studies measuring view. Crista Galli’s dimensions with regard to age would be of Crista Galli’s height measured using Coronal CT scans interest for future studies due to the implications on the risk ranged from 8.5 to 13.6 mm, which is consistent with the of fracture. Future research may investigate these findings range of height measurements recorded using 3D imaging with a larger samples size to confirm the correlations which of 5.3–17.7 mm. This was also consistent with the range may occur between the Crista Galli and Cribriform Plate. recorded in previous studies of 5–21 mm (Şahan et al. 2019; The implementation of simulated fracture technology Akiyama and Kondo 2020), which further supports the accu- to directly investigate the risk of trauma-related fracture of racy of the 3D imaging technique and the use of Coronal CT the CP and its structures could benefit the literature, with scans to accurately measure the height of the Crista Galli. this technology already being used on the femur, humerus, The Crista Galli’s width measured using Coronal CT fibula, and ulna (Ota et al. 1999; Parra-Cabrera et al. 2022). scans ranged from 3.8 to 5.8 mm, which is consistent with Researchers could also measure the bone composition of the range of width measurements recorded using 3D imag- the CP and investigate whether features such as the Crista ing of 2–6.6 mm. This was also consistent with the range Galli’s dimensions, or increased foramina area impact the recorded in previous studies of 2–10 mm (Akiyama and bone composition of the CP. Kondo 2020), 2.5–7 mm (Şahan et al. 2019), and 0–4 mm Where medical facilities have limited access to 3D imag- (Coelho et al. 2018). While studies have measured the width ing software, future researchers may be able to generate a of the Crista Galli using a variety of methods such as Coro- formula to apply the 3D imaging findings to 2D images to nal CT scans (Şahan et al. 2019), Axial CT scans (Akiyama enhance the accuracy of these imaging methods. 2D imag- and Kondo 2020), and 2D imaging (Coelho et al. 2018), ing measurements could be compared with 3D imaging to the similarities between these results suggest that the width explore the rate of the additional surface area measured of the Crista Galli can be accurately determined through a with 3D imaging to generate this formula. The percentage variety of imaging techniques. of additional surface area could also be investigated with how it may correlate with other classifications such as the Keros (Keros 1962), Yenigun (Yenigun et al. 2016) or TMS Conclusion (Abdullah et al. 2020) classifications. Lastly, if a strong link could be determined between The results of this study support the use of 3D imaging these CP structures and increased risk of fracture, individu- techniques, alongside the 3D reconstructed CT scan as an als with a higher risk of facial fractures such as athletes in accurate method for measurement, which allows for compre- competitive sports (Povolotskiy et al. 2019) could receive an hensive analysis of complex surfaces such as the CP mor- examination to determine whether their CP is at risk before phology and variations, olfactory foramina, and Crista Galli. engagement in the physical activity. This could result in at- This study shows the potential correlations between the risk individuals wearing appropriate headgear to prevent Crista Galli and the CP, with a positive correlation between complications regarding the CP, and if assessed by insur- the length of the Crista Galli and the surface area of the left ance companies, policy premium could be more accurately side of the CP. This correlation should be further investi- moderated based on the risk of fractures of the individual. gated, as this may suggest that the Crista Galli increases in Acknowledgements The authors thank the school of Health Sciences length alongside the CP to support the bone and olfactory at Swinburne University of Technology for the academic the profes- bulb. The similarities between the results using 3D imaging, sional support. The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. CT scans, and 3D reconstructed CT scans also support the use of these imaging techniques as a precise measurement 1 3 M. Boulton et al. Results from such research can potentially increase mankind's overall comparison of two surgical constructs for wrist four-corner arthro- knowledge that can then improve patient care. Therefore, these donors desis via dorsal and radial approaches. Clin Biomech 82:105274 and their families deserve our highest gratitude. Ganjaei KG, Soler ZM, Mappus ED, Taylor RJ, Worley ML, Mulligan JK, Mattos JL, Rowan NR, Garcia GJM, Dubno JR, Eckert MA, Author contributions MB conducted the experiment, interpreted Matthews LJ, Schlosser RJ (2018) Novel radiographic assessment data, and wrote the manuscript. FK acted as a supervisor in this study of the cribriform plate. Am J Rhinol Allergy 32(3):175–180 and revised the manuscript. AA acted as a supervisor for this study, Goanţǎ CM, Cîrpaciu D, Soricǎ A, Tuşaliu M, Budu VA (2017) Ethmoid- designed the project, scanned all samples, assisted in data collection ectomy—procedures and complications. Arch Balkan Med Union and revised the manuscript. All authors reviewed the results and manu- 52(3):333–337 script and approved the final version of the manuscript. Gomez J, Pickup S (2022) Cribiform plate fractures. StatPearls. StatPearls Publishing, Treasure Island Funding Open Access funding enabled and organized by CAUL and Gray ML, Kappauf C, Govindaraj S (2019) Management of an unu- its Member Institutions. sual intranasal foreign body abutting the cribriform plate: a case report and review of literature. Clin Med Insights Ear Nose Throat Data availability The data that support the findings of this study are not 12:1179550619858606–1179550619858606 openly available due to reasons of sensitivity and are available from the Hollander MHJ, Kraeima J, Meesters AML, Delli K, Vissink A, Jansma corresponding author upon reasonable request. J, Schepers RH (2021) Reproducibility of 3D scanning in the peri- orbital region. Sci Rep 11(1):3671 Inal M, Muluk NB, Arikan OK, Sahin S (2018) Is there a relationship Declarations between Keros classification of olfactory fossae depth, septal devia- tion angle and the distance between infraorbital foramens? Curr Med Conflict of interest The authors declare that they have no conflict of Imaging Rev 14(5):788–797 interest. Jansen J, Schreurs R, Dubois L, Maal TJJ, Gooris PJJ, Becking AG (2018) The advantages of advanced computer-assisted diagnostics Open Access This article is licensed under a Creative Commons Attri- and three-dimensional preoperative planning on implant position bution 4.0 International License, which permits use, sharing, adapta- in orbital reconstruction. J Craniomaxillofac Surg 46(4):715–721 tion, distribution and reproduction in any medium or format, as long Kalmey JK, Thewissen JGM, Dluzen DE (1998) Age-related size reduc- as you give appropriate credit to the original author(s) and the source, tion of foramina in the cribriform plate. Anat Rec 251(3):326–329 provide a link to the Creative Commons licence, and indicate if changes Keast A, Yelavich S, Dawes P, Lyons B (2008) Anatomical variations were made. The images or other third party material in this article are of the paranasal sinuses in Polynesian and New Zealand European included in the article's Creative Commons licence, unless indicated computerized tomography scans. Otolaryngol Head Neck Surg otherwise in a credit line to the material. If material is not included in 139(2):216–221 the article's Creative Commons licence and your intended use is not Keros P (1962) On the practical value of differences in the level of the permitted by statutory regulation or exceeds the permitted use, you will lamina cribrosa of the ethmoid. Z Für Laryngol Rhinol Otol Ihre need to obtain permission directly from the copyright holder. To view a Grenzgeb 41:809–813 copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . Keşkek C, Aytuğar E (2021) Clinical significance and radiological evalu- ation of Crista Galli: a CBCT study. Eur J Anat off J Span Soc Anat 25(6):705–711 References Knížek Z, Michálek R, Vodička J, Zdobinská P (2021) Cribriform plate injury after nasal swab testing for COVID-19. JAMA Otolaryngol Head Neck Surg 147(10):915–917 Abdullah B, Chew SC, Aziz ME, Shukri NM, Husain S, Joshua Kühnel TS, Reichert TE (2015) Trauma of the midface. Laryngorhi- SW, Wang DY, Snidvongs K (2020) A new radiological clas- nootologie 94:S206–S247 sification for the risk assessment of anterior skull base injury Murray RD, Friedlander R, Hanz S, Singh H, Anand VK, Schwartz TH in endoscopic sinus surgery. Sci Rep. https:// doi. org/ 10. 1038/ (2017) Nonrandom spatial clustering of spontaneous anterior fossa s41598- 020- 61610-1 cerebrospinal fluid fistulas and predilection for the posterior cribri- Akiyama O, Kondo A (2020) Classification of crista Galli pneumatiza- form plate. J Neurosurg 126(5):1720–1724 tion and clinical considerations for anterior skull base surgery. J Oh J-W, Kim S-H, Whang K (2017) Traumatic cerebrospinal fluid leak: Clin Neurosci 82:225–230 diagnosis and management. Korean J Neurotrauma 13(2):63–67 Belgin CA, Bayrak S, Orhan K, AktunaBelgİN C (2021) Evaluation Onisor FG (2022) Global avulsion of the globe associated with fron- of the ethmoid bone using by cone beam computed tomography tal sinus and naso-orbital-ethmoid (FSNOE) complex fracture. in Turkish subpopulation. Clin Exp Health Sci 11(4):679–682 A rare case report and short literature review. Ann Ital Chir 11: Coelho DH, Pence TS, Abdel-Hamid M, Costanzo RM (2018) Cribriform S2239253X22036878. https://eur opepmc. or g/ar ticle/ med/ 35670 024 plate width is highly variable within and between subjects. Auris Ota T, Yamamoto I, Morita R (1999) Fracture simulation of the femoral Nasus Larynx 45(5):1000–1005 bone using the finite-element method: how a fracture initiates and de Carvalho MF, Vieira JNM, Figueiredo R, Reher P, Chrcanovic BR, proceeds. J Bone Miner Metab JBMM 17(2):108–112 Chaves M (2021) Validity of computed tomography in diagnosing Parra-Cabrera G, Pérez-Cano FD, Jiménez-Delgado JJ (2022) Fracture midfacial fractures. Int J Oral Maxillofac Surg 50(4):471–476 pattern projection on 3D bone models as support for bone fracture Douglas CF, White BD (2021) Traumatic cribriform plate defect fol- simulations. Comput Methods Prog Biomed 224:106980 lowing self-administered COVID-19 nasal swab test. Appl Radiol Patron V, Berkaoui J, Jankowski R, Lechapt-Zalcman E, Moreau S, Hitier 50(4):44–46 M (2015) The forgotten foramina: a study of the anterior cribriform Faudot B, Ballerini J, Ross M, Bellemère P, Goislard de Monsabert plate. Surg Radiol Anat 37(7):835–840 B, Vigouroux L, Milan J-L (2021) Mechanical performance 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches Povolotskiy R, Youssef P, Kaye R, Paskhover B (2019) Facial fractures Wei J-J, Tang Z-L, Liu L, Liao X-J, Yu Y-B, Jing W (2015) The manage- in young adults: a national retrospective study. Ann Otol Rhinol ment of naso-orbital-ethmoid (NOE) fractures. Chin J Traumatol Laryngol 128(6):516–523 18(5):296–301 Ren C, Zhu Q, Yuan H (2021) Imaging features of spinal fractures in Wickwire P, Kahlon S, Kazemi S, Tollefson T, Steele T, Chang J, Strong ankylosing spondylitis and the diagnostic value of different imaging B (2022) Improving patient education of facial fractures using methods. Quant Imaging Med Surg 11(6):2499–2508 3-dimensional computed tomography. Otolaryngol Head Neck Surg Şahan MH, Inal M, Muluk NB, Şimşek G (2019) Cribriform plate, Crista 166(4):657–661 Galli, olfactory fossa and septal deviation. Curr Med Imaging For- Wubulihasimu Z, Tuerhong M, Zhang Z, Li H, Kadir N, Xie M, Abulaiti mer Curr Med Imaging Rev 15(3):319–325 M, Abulaiti A, Tulamaiti N, Maimaitiming B, Aili W, Ni Y (2021) Shah N, Deopujari CE, Chhapola Shukla S (2017) Spontaneous recur- Clinical analysis and CT 3D-mediated precise internal fixation in rent CSF rhinorrhoea: a rare case and review of literature. Indian J maxillofacial fracture. Ear Nose Throat J 100(5_suppl):420S-426S Otolaryngol Head Neck Surg 69(3):420–424 Yenigun A, Goktas SS, Dogan R, Eren SB, Ozturan O (2016) A study Skorek A, Tretiakow D, Szmuda T, Przewozny T (2017) Is the Keros of the anterior ethmoidal artery and a new classification of the classification alone enough to identify patients with the “dangerous ethmoid roof (Yenigun classification). Eur Arch Otorhinolaryngol ethmoid”? An anatomical study. Acta Otolaryngol 137(2):196–201 273(11):3759–3764 Snell R (2009) Clinical neuroanatomy, 7th edn. Ringgold, Inc, Portland, Yoneoka Y, Aizawa N, Nonomura Y, Ogi M, Seki Y, Akiyama K (2020) p 33 Traumatic nonmissile penetrating transnasal anterior skull base Stopa BM, Leyva OA, Harper CN, Truman KA, Corrales CE, Smith TR, fracture and brain injury with cerebrospinal fluid leak: intraopera- Gormley WB (2022) Decreased incidence of CSF leaks after skull tive leak detection and an effective reconstruction procedure for a base fractures in the 21st century: an institutional report. J Neurol localized skull base defect especially after coronavirus disease 2019 Surg 83(1):059–065 outbreak. World Neurosurg 140:166–172 Teng TS, Ishak NL, Subha ST, Bakar SA (2019) Traumatic transna- sal penetrating injury with cerebral spinal fluid leak. EXCLI J Publisher's Note Springer Nature remains neutral with regard to 18:223–228 jurisdictional claims in published maps and institutional affiliations. Umana GE, Pucci R, Palmisciano P, Cassoni A, Ricciardi L, Tomasi SO, Strigari L, Scalia G, Valentini V (2022) Cerebrospinal fluid leaks after anterior skull base trauma: a systematic review of the literature. World Neurosurg 157:193-206.e192 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anatomical Science International Springer Journals

A comparative analysis of the CP and CG using 2D and 3D visualisation approaches

Loading next page...
 
/lp/springer-journals/a-comparative-analysis-of-the-cp-and-cg-using-2d-and-3d-visualisation-YLlnGhO7FE

References (45)

Publisher
Springer Journals
Copyright
Copyright © The Author(s) 2023
ISSN
1447-6959
eISSN
1447-073X
DOI
10.1007/s12565-023-00729-3
Publisher site
See Article on Publisher Site

Abstract

Investigations on the structural variations in the cribriform plate (CP), olfactory foramina and the Crista Galli showcase the benefits of using 3D imaging on smaller structures. These techniques reveal accurate details about bone morphology and density. Comparing different techniques, this project aims to examine the correlation between the CP, olfactory foramina, and Crista Galli. Computed tomography was used to translate and apply the findings acquired from the samples in radiographic studies on CPs for potential clinical significance. The findings show that the surface area measurements were significantly larger when using 3D imaging techniques in comparison with the 2D counterpart. Using 2D imaging, the maximum surface 2 2 area of the CPs was 239.54  mm , however, paired 3D samples showed the maximum surface area was 355.51  mm . The findings show that Crista Galli’s dimensions varied greatly, with length ranging from 15 to 26 mm, height ranging from 5 to 18 mm, and width ranging from 2 to 7 mm. The 3D imaging allowed for surface area measurements on the Crista Galli, and the surface area ranged from 130 to 390  mm . When 3D imaging was used, significant correlations were found between the surface area of the CP and the length of the Crista Galli (p = 0.001). The findings show that measurements on the Crista Galli using 2D and 3D reconstructed radiographic imaging reflect similar ranges of dimensions to 3D imaging measure- ments. The findings also suggest that the Crista Galli may increase in length with the CP to support the latter and olfactory bulb during trauma which may be used by clinicians alongside 2D CT scans for optimal diagnosis. Keywords Cribriform plate · Crista Galli · Computed tomography · 2D imaging · 3D imaging Introduction measurements are performed on the lateral lamella using various views, such as the Coronal CT scan to measure the The cribriform plate (CP) is a very thin bony plate that is superior-inferior length of the lateral lamella (Keros 1962), situated in the anterior skull base and forms the roof of the and the Axial CT scan to measure the anterior–posterior nasal cavity (Gomez and Pickup 2022). The CP is lined with length of the lateral lamella (Yenigun et al. 2016). Lastly, many foramina, called olfactory foramina, which allow the the Thailand, Malaysia, and Singapore classification known olfactory nerve fibres to travel from the nasal cavity to the as TMS classifications where distances from the orbital floor olfactory bulb which rests upon the CP, and allows for the to the CP and the ethmoid roof was used (Abdullah et al. sensation of smell (Snell 2009). A large bulb-like structure 2020). The various classifications of CP morphology are called the Crista Galli separates the right and left sides of assessed using a CT scan-Coronal view; however, this may the CP, and some studies suggest that the Crista Galli may overlook many features of the CP, and increase the risk of support the CP and the olfactory bulb from trauma, reducing fracture misdiagnosis. its risk of fracture (Murray et al. 2017). Fractures of the CP may sever the olfactory epithelium The risk of fracture is currently determined by focusing or puncture the olfactory bulb, resulting in limited or total on the thinnest portion of the CP (Keast et al. 2008). These anosmia. Cerebrospinal Fluid (CSF) leaks may also occur due to meningeal damage or following the olfactory epi- thelium being severed (Kühnel and Reichert 2015), causing * Ali Al-Rubaie headaches, stroke (Shah et al. 2017) and meningitis, which aalrubaie@swin.edu.au can have high morbidity rates (Oh et al. 2017). Lastly, CP School of Health Sciences, Swinburne University fractures may result in traumatic brain injuries, especially of Technology, PO Box 218, Hawthorn, VIC 3122, Australia Vol.:(0123456789) 1 3 M. Boulton et al. when a transnasal-penetrating injury has occurred (Gray and laws concerning the use of human cadaveric donors in et al. 2019; Teng et al. 2019; Yoneoka et al. 2020). These anatomical research. A total of 42 samples from human tis- types of fractures are most commonly diagnosed using sue donors were received with approval from the Swinburne 2D CT scans (Gray et al. 2019; Douglas and White 2021; Human Ethics Committee (Human Ethics Approval Number Knížek et al. 2021), however, in recent years 3D Recon- #2026045-9453). To include matched sample pairs to com- structed CT scans have been used to diagnose CP fractures pare the 2D and 3D imaging methods, images were excluded (Teng et al. 2019). if the 3D imaging calibration failed, or if the CP surface area As technology advances, 3D imaging techniques have was impaired preventing accurate measurements. Further increased in use amongst clinicians as it allows for precise analysis was then conducted using five donor CT scans of diagnosis of fractures to be performed in the facial region CPs which were acquired from Digital Imaging and Com- (Wei et  al. 2015; Teng et  al. 2019, Wubulihasimu et  al. munications in Medicine (DICOM). This number of samples (2021). Recent examples include a recent study that catego- was used as they were the only CT scans available that cap- rized anterior skull base fractures using virtual reality 3D tured the CP and Crista Galli. hologram technology (Umana et al. 2022). In clinical case The 2D images of the samples were captured from the studies, 3D reconstructed CT scans have been used to diag- superior view using a Canon Digital Camera DSLR EOS nose CP fractures and the resulting CSF leaks have damag- 1100D, with a ruler at the same level as the CP to allow for ing consequences (Teng et al. 2019). Many studies suggest accurate calibration and scaling of length measurements. that the preciseness of 3D imaging techniques may allow for For the duration of this study, the images were stored in a more accurate measurements to be performed on anatomi- secure Swinburne drive which is only accessible by author- cal structures compared to measurements determined by 2D ised researchers. imaging or 2D CT scans (Wei et al. 2015; Teng et al. 2019; These images were then uploaded to ImageJ (Wayne Ras- Belgin et al. 2021, Wubulihasimu et al. 2021). band, NIH, Bethesda, MD, USA) to allow measurements With many of the current classification systems measur - to be performed and for images to be calibrated so those ing the lateral lamella (Keros 1962; Yenigun et al. 2016) accurate length measurements can be made. Each image was and the nasal cavity (Abdullah et al. 2020), limited atten- then individually calibrated by measuring 10 mm on the tion has been given to other features of the CP, such as its ruler at the same level of the CP, with the number of pixels surface area, olfactory foramina and bone percentages, or representing 10 mm calibrated into the image. the Crista Galli’s dimensions. While advanced 3D imaging All measurements were performed by two blinded has been used on the CP to diagnose fractures (Teng et al. researchers, with the resulting measurements being averaged 2019), limited studies have utilised this technology to per- for the final data. Measurements were then carried out on form measurements on the CP. the surface area of the CP. This was measured by tracing the This project aims to use multiple imaging techniques borders of the CP (see Fig. 1A), and then ImageJ was used on human samples to investigate the variation and correla- to automatically calculate the surface area of the encircled tion between the CP, olfactory foramina, and Crista Galli. region in mm . This was conducted on both the left and right It also used computed tomography (CT) scans to translate sides of the CP and was summed for the total area. and apply the findings acquired from 2 and 3D imaging into The total olfactory foramina area of the CP was measured radiographic studies of CPs to determine the potential clini- by tracing the borders of the foramina of the CP, which was cal significance of the measurements. then automatically calculated in mm using ImageJ. The 2D It is hypothesised that measuring the surface area of the foramina percentage was then calculated by dividing the 2D CP by using 3D imaging will result in a larger calculated foramina area by the total 2D surface area, multiplied by surface area than when 2D imaging is used also, the mor- 100%. The remainder of the area of the CP which was not phology of the CP will positively correlate with the dimen- represented by foramina was then recorded as the 2D bone sions of the Crista Galli. Lastly, the measurements using 3D percentage. imaging will result in similar dimensions to radiographic Three-dimensional images for the same samples were studies on the CP and Crista Galli. also captured using the Artec Space Spider and were auto- matically calibrated to allow for accurate measurements to be performed on the scans. These images were analysed Materials and methods using ArtecStudio (Luxembourg) for measurements to be performed, as shown in Fig. 1B. Experimental design Measurements were made on the surface area of the left and right sides of the CP, which was then summed for the The authors hereby confirm that every effort was made to total surface area. The surface area was measured by high- comply with all local and international ethical guidelines lighting the CP region. Using ArtecStudio (Luxembourg), 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches Fig. 1 A Superior view image of Cribriform Plate showing right surface area traced using ImageJ (WayneRasband, NIH, Bethesda, MD, USA). B 3D Image of Cribriform Plate looking from Superior View using ArtecStudio (Luxem- bourg) the surface area of the highlighted region was automatically calculated in mm . Further measurements were conducted on the Crista Galli’s total length, width, and height in mm, alongside the total surface area in mm . These measurements on the Crista Galli were performed firstly by highlighting the Crista Galli region, then excluding all structures from the 3D model except the Crista Galli. The surface area of the Crista Galli was automatically calculated, and then direct measurements were performed to measure its length, width, and height. The 3D foramina percentage was calculated by dividing the 2D foramina area by the total 3D surface area of the CP multiplied by 100%. The remainder of the area of the CP not represented by foramina was then recorded as the 3D Fig. 2 Coronal view CT scan of Crista Galli and Cribriform Plate bone percentage. in Bone Window mode using SECTRA (Linköping, Sweden) IDS7 Software Radiological analysis For the radiological samples, the above-mentioned five mul- tiplanar CT scans were used to conduct further measure- ments. The CT scans images were received using Digital Imaging and Communications in Medicine (DICOM) data with a slice thickness of 0.8  mm. These CT scans were measured using SECTRA (Linköping, Sweden) IDS7 soft- ware using Coronal View CT scans as shown in Fig. 2 and 3D reconstructed CT scans as shown in Fig. 3. Measurements were conducted on the Crista Galli dimen- sions. The Crista Galli’s height was measured using Coronal CT scan sections as seen in Fig. 2, with five separate cuts of the Crista Galli being measured, the greatest height was recorded. Similarly, the width of the Crista Galli was meas- ured using Coronal CT scan sections, with five separate cuts of the Crista Galli being measured, and the greatest width Fig. 3 3D Reconstructed CT scan of Cribriform Plate and Crista was recorded. The length of the Crista Galli was measured Galli using SECTRA (Linköping, Sweden) IDS7 Software using 3D reconstructed CT scans as seen in Fig. 3. 1 3 M. Boulton et al. Statistical analysis Statistical analysis was then conducted on the collected measurements using SPSS (ver. 28.0.1.1; SPSS Inc., Chi- cago, IL, USA) and GraphPad Prism 7 software (San Diego, CA, USA). To compare the 2D CP surface area to the 3D CP surface area, paired samples t tests were performed with p < 0.05 being considered a statistically significant differ - ence. To compare the CP’s 2D bone percentage with the 3D bone percentage, paired samples t-tests were performed with p < 0.05 being considered a statistically significant differ - ence. Lastly, to analyse any correlations between the Crista Galli and the CP’s surface area or olfactory foramina area, bivariate correlations were performed with p < 0.05 being considered a statistically significant correlation. Results Fig. 4 Box plot comparing 2D cribriform plate surface area with 3D 2D image analysis was performed on the surface area of the cribriform plate surface area, n=23 (*p < 0.05). The data shown here are represented in Table 2 CP. The results showed the samples ranged between 100.11 and 239.54 mm , with an average surface area of 152.60 mm (SD 33.72) as shown in Table 1. Using the same paired was also found between the 2D and 3D surface area meas- samples, 3D image analysis was conducted on the CP’s sur- urements (r = 0.811, p < 0.001). face area. The results showed the samples ranged between Using the same 23 human tissue samples, 2D image 2 2 205.82 and 355.51 mm , with an average of 288  mm (SD analysis was performed on the foramen area of the CP. The 46.10) as shown in Table 1. results showed the foramen area ranged between 10.23 and The results showed that for the 23 paired CP samples, the 2 2 30.92 mm , with an average foramen area of 17.19 mm (SD 2D surface area ranged from 100.11 to 239.54 mm , while 5) as shown in Table 1. the 3D surface area ranged from 205.82 to 355.51 mm , To calculate the bone percentage of the CPs, the area with the comparison being shown in Fig. 4. The difference of the olfactory foramina was divided by the total surface in surface area measurements between 2D and 3D imag- area of the CP measured using 2D imaging and 3D imag- ing was compared using a paired samples t test, which was ing, multiplied by 100%. This gave the percentage of the CP determined to be statistically significant (p < 0.001). This represented by foramen for both the 2D surface area and the test determined that the 3D imaging surface area measure- 3D surface area. The remaining surface area in the CP was ments were significantly higher than the 2D imaging surface then presumed to be bone, resulting in a 2D bone percentage area measurements. A strong significant positive correlation (using 2D surface area) and a 3D bone percentage (using 3D surface area). In general, the 2D bone percentages ranged between 81.62 and 93.01% bone, with an average bone per- centage of 88.41% (SD 3.63%), while the 3D bone percent- ages ranged between 90.84 and 96.63%, with an average Table 1 CP surface area measurements using 2D imaging and 3D bone percentage of 93.96% (SD 1.67%) as shown in Table 1. imaging, foramen area measurements using 2D imaging, and the The results showed that in the 23 paired CP samples, the resulting bone percentages for 2D and 3D surface area (N = 23) 2D bone percentages ranged from 81.62 to 93.01%, while the Dimension measured Mean and SD Minimum Maximum 3D bone percentages ranged from 90.84 to 96.63%, which can be seen in Fig.  5. The difference in bone percentage 2D surface area (mm ) 152.60 ± 33.72 100.11 239.54 measurements using 2D and 3D surface area was compared 3D surface area (mm ) 288.00 ± 46.10 205.82 355.51 using a paired samples t test, which was determined to be 2D foramen area (mm ) 17.19 ± 5.00 10.23 30.92 statistically significant (p < 0.001). This test determined that 2D bone percentage 88.41% ± 3.63% 81.62% 93.01% the resulting bone percentages calculated using 3D surface 3D bone percentage 93.96% ± 1.67% 90.84% 96.63% area were significantly higher than the bone percentages cal- SD standard deviation, Min. minimum value, Max. maximum value, culated using 2D surface area. A strong significant positive N number of samples 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches measurements, to determine whether the Crista Galli’s dimensions increased in size alongside the CP’s surface area. There were no significant correlations found between the surface area of the Crista Galli and the surface area of the CP when measured using 2D (p = 0.968) or 3D imag- ing (p = 0.498). Furthermore, there were also no significant correlations between the length of the Crista Galli and the CP’s total surface area using 2D (p = 0.119) or 3D imaging (p = 0.067). When the surface area of the CP was divided between the left and right sides, a significant moderate positive correla- tion was found between the surface area of the left side of the CP and the length of the Crista Galli, when the surface area was measured using both 2D (r = 0.549, p = 0.007) and 3D imaging (r = 0.634, p = 0.001). There were significant negative correlations between Crista Galli’s width and the surface area of the CP. This correlation was significant when the surface area was meas- ured using 2D (r = − 0.532, p = 0.009) and 3D imaging Fig. 5 Box plot comparing 2D cribriform plate surface area with 3D cribriform plate surface area, n = 23 (*p < 0.05). The data shown here (r = − 0.429, p = 0.041). are represented in Table 2. There were no significant correlations found between the height of the Crista Galli and the CP surface area when measured using 2D (p = 0.588) or 3D imaging (p = 0.228). correlation was also found between the 2D and 3D bone percentage measurements (r = 0.918, p < 0.001). CT scan Using a total of 35 human tissue samples, 3D imaging (ArtecStudio) was used to measure the Crista Galli’s length, Five CT scans from human donors were used, with measure- height, width, and surface area. The results show that Crista ments being performed on the Crista Galli’s length, width, Galli’s length ranged from 15.8 to 25.8 mm, with an aver- and height in Hounsfield units in the bone window. The age length of 20 mm (SD 2.45), Crista Galli’s height ranged results show that Crista Galli’s length ranged between 17.5 from 5.3 to 17.7 mm, with an average height of 11 mm (SD and 21.1 mm, with an average length of 19.04 mm (SD 1.40). 2.70), the Crista Galli’s width ranged from 2 to 6.6 mm, with The Crista Galli’s width ranged between 3.8 and 5.8 mm, an average width of 4.4 mm (SD 1.03) and the Crista Galli’s with an average width of 4.48 mm (SD 0.79). Lastly, Crista surface area ranged from 130 to 390 mm , with an average Galli’s height ranged between 8.5 and 13.6 mm, with an surface area of 217 mm (SD 56.56). The measurements of average height of 11.12 mm (SD 2.22). The measurements Crista Galli’s dimensions using 3D imaging can be seen in of Crista Galli’s dimensions measured using CT scans can Table 2. be seen in Table 3. The range of the Crista Galli’s dimen- Using the 23 paired CP samples, bivariate correlations sions which were measured using CT scans (SECTRA ISD7) were run between the Crista Galli’s dimensions meas- was consistent with the range of Crista Galli’s dimensions ured using 3D imaging and the CP’s total surface area measured using 3D imaging (ArtecStudio). This was true for Table 2 Measurements on the Crista Galli’s length, height, width and Table 3 Crista Galli’s length, height, and width were measured using surface area measured using 3D imaging (ArtecStudio) (N = 35) CT scan technology (N = 5) Crista Galli dimension Mean and SD Minimum Maximum Crista Galli dimension Mean and SD Minimum Maximum Length (mm) 19.96 ± 2.45 15.84 25.79 Length (mm) 19.04 ± 1.40 17.50 21.10 Height (mm) 10.75 ± 2.70 5.34 17.68 Width (mm) 4.48 ± 0.79 3.80 5.80 Width (mm) 4.41 ± 1.03 2.04 6.61 Height (mm) 11.12 ± 2.22 8.50 13.60 Surface area (mm ) 217.36 ± 56.56 135.62 384.85 SD standard deviation, Min. minimum value, Max. maximum value, SD standard deviation, Min. minimum value, Max. maximum value, N number of samples N number of samples 1 3 M. Boulton et al. Fig. 6 Box plot comparing the distributions of the Crista Galli’s Fig. 8 Box plot comparing distributions of Crista Galli’s height when length using ArtecStudio 3D imaging (n=35) and 3D reconstructed measured using ArtecStudio 3D imaging technology (n=35) and Cor- CT scans (n = 5). The data shown here is represented in Tables 2 and onal view CT scan technology (n = 5). The data shown here are repre- sented in Tables 2 and 3 have also used this technology to conduct virtual surgery on the scaphoid bone (Faudot et al. 2021) while other studies have used it to scan the peri-orbital region for a very high clinical accuracy (Hollander et al. 2021). This project used human tissue samples and advanced imaging technology in the form of two-dimensional (2D) and three-dimensional (3D) imaging to investigate the vari- ation and correlations between the CP and the olfactory foramina, alongside examining the dimensions of the Crista Galli in correlation with the CP. This study also used CT scan technology to translate and apply the findings from the above aims into radiographic studies of CPs to determine the potential clinical significance of the measurements. To establish a complete set of measurements, the fol- Fig. 7  Figure 7. Box plot comparing distributions of the Crista Gal- lowing techniques were used to measure and correlate the li’s width when measured using ArtecStudio 3D imaging technol- dimensions of the CP, olfactory foramina, and Crista Galli. ogy (n = 35) and Coronal view CT scan technology (n = 5). The data The 2D imaging technique was chosen as it is used in much shown here are represented in Tables 2 and 3 of the current literature when direct anatomical measure- ments are being performed on dry skull samples (Coelho et al. 2018; Ganjaei et al. 2018). This imaging technique Crista Galli’s length shown in Fig. 6, Crista Galli’s width used calibrated digital images of CPs. This was compared shown in Fig. 7, and Crista Galli’s height shown in Fig. 8. with the 3D imaging technique, an advanced imaging tech- nique that was chosen as a comparative measure to deter- mine the potential benefits this technology may have on Discussion diagnosis and measurements on smaller structures such as the CP (Teng et al. 2019). This technique used an advanced Recent medical literature shows a significant increase in 3D scanner (ArtecStudio) to measure the dimensions of the the use of 3D imaging as a diagnostic tool in many clini- CP and the Crista Galli. The CT scan data was measured cal cases, including facial fractures (de Carvalho et  al. using Coronal CT scans, as this is the most common method 2021, Wickwire et  al. 2022), naso-orbital-ethmoid frac- of radiographic measurement on the CP (Keros 1962; tures (Onisor 2022), cervical fractures (Ren et al. 2021) and Skorek et al. 2017; Inal et al. 2018, Abdullah et al. 2020) orbital blowout fractures (Jansen et al. 2018). Researchers 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches and the Crista Galli (Şahan et al. 2019; Keşkek and Aytuğar of the CP, as it does not account for the additional surface 2021). Lastly, the CT scan data were then measured using area from the curvature of the CP which is obtained when 3D reconstructed CT scans to measure the greatest length of 3D imaging is used. the Crista Galli. This was chosen to accurately measure the The additional surface area measured using 3D imaging entire length of the Crista Galli, as opposed to the axial view techniques resulted in the majority of 3D imaging samples used in other studies (Akiyama and Kondo 2020) which may recording 60–140% additional surface area when using 3D not accurately represent the full length of the Crista Galli. imaging compared to their 2D imaging counterparts. This The morphology of the CP is concave in shape to house the shows a large variation in the additional surface area result- olfactory bulb and the numerous olfactory foramina that pass ing from the curvature of the CP, and this curvature has through the CP, from the nasal cavity to the olfactory bulb not been well studied in the current literature due to lim- (Snell 2009). This curvature in the morphology cannot be ited access to 3D imaging technology. This difference in detected using 2D imaging, however, the 3D scanners used the surface area suggests that the 2D imaging technique is in this study enabled a more specific and accurate measure- insufficient to accurately measure the full surface area of the ment method that traces the curvature of these samples. CP, and results in much lower bone percentages than would This study measured the CP’s total surface area using otherwise be reported. This finding also impacts our current superior view 2D images and 3D imaging technology, to knowledge of the CP’s olfactory foramina, as there may be compare the differences in surface area measurements of vastly fewer foramina reported by 2D imaging methods. these two imaging techniques. The measurements performed Prior research by Ganjaei et  al. (2018) compared the on the surface area of the CP using 3D imaging were sig- recorded bone percentage of the CP using 2D imaging on nificantly higher than the measurements performed using anatomical samples with the bone percentage measured 2D imaging. This difference in measurements supports the using CT scans, with the recorded bone percentage using a hypothesis that the surface area of the CP would be greater CT scan ranging from 92 to 98% with an average of 95.3% when measured using 3D imaging compared to 2D imaging. bone. These results are quite similar to the bone percentages The resulting greater surface area of the CP measured by 3D calculated in this study when accounting for the curvature imaging may indicate that prior studies which have investi- of the CP by measuring surface area using 3D imaging, gated the surface area and foramina area of the CP using 2D which ranged from 90 to 97% with an average of 94% bone. images (Ganjaei et al. 2018) did not accurately depict the Initially, their study concluded that the bone percentages surface area of the CP. This is due to the 2D imaging method recorded using CT scans, which averaged 95.3% were inac- not accurately measuring the additional surface area that the curate due to the differences in bone calculations of roughly curvature of the CP may provide, thus resulting in a lower 11% when compared with the paired 2D bone percentage overall surface area, and a lower calculated bone percentage which averaged 84.5% (Ganjaei et al. 2018). However, due to than would otherwise be found. the similarities with the range found in this study, the results Using 2D imaging to measure total surface area, the pro- may suggest that measuring bone percentage using CT scans portion of the CP which was represented by olfactory foram- may include the curvature of the CP in its measurements. ina ranged from 7 to 19% of the CP, resulting in roughly This suggests that CT scans may provide a more accurate 81–93% of the CP area consisting of bone. This is a similar depiction of the bone percentages than when measurements range to previous research which suggests found foramen are conducted using 2D imaging. areas ranging from 9 to 26%, resulting in roughly 74–91% Researchers who may face difficulties in accessing 3D of the CP consisting of bone (Ganjaei et al. 2018). However, imaging ArtecStudios may be able to use CT scans to meas- due to the increased surface area measurements from using ure the bone percentage of the CP. This data could be com- 3D imaging which accounts for the curvature of the CP, the pared to 2D imaging findings to determine the additional proportion of foramina to the bone area of the CP ranged surface area for which the curvature is included. from 3 to 10%, which resulted in 90–97% of the CP consist- For clinical cases, 3D reconstructed CT scans would be ing of bone. This value is considerably less than previous beneficial to use, however, this view would require a high research using anatomical specimens (Ganjaei et al. 2018), level of radiographic exposure to study the CP, Crista Galli, which may demonstrate that additional measurements need and olfactory foramina in detail. When a facial fracture has to be taken to accurately determine the foramina to bone occurred, due to the susceptibility of the CP to fracture ratio when measuring using 2D imaging. (Kühnel and Reichert 2015), clinicians could conduct addi- The measurements of the bone percentage of the CP using tional checks to determine whether an individual’s CP is the 3D surface area resulted in significantly higher bone at a higher risk of fracture. This could be useful to prevent percentages than when the bone percentage was calculated potential spontaneous CSF leaks (Murray et al. 2017) and using the 2D surface area. This suggests that the 2D imaging the infections which may occur as a result (Oh et al. 2017; technique may not accurately represent the bone percentage Stopa et al. 2022). 1 3 M. Boulton et al. The length of the Crista Galli measured using 3D imag- This study found a strong significant positive correlation ing ranged from 15.8 to 25.8 mm, these results are similar between the surface area of the CP when measured using to previous research showing large variability of Crista Galli 2D imaging and 3D imaging (r = 0.811, p < 0.001), along- length (Akiyama and Kondo 2020). However, the minimum side a strong significant positive correlation between the 2D length of this study was considerably less than that of previ- and 3D bone percentages (r = 0.918, p < 0.001). These cor- ous reports (33). This difference may be due to the different relations show the similarities between the measurements measuring methods used, as the studies which measure the of 2D and 3D imaging, which may provide support for the length of the Crista Galli commonly use Axial CT scans accuracy of the 3D imaging method, while also displaying (Akiyama and Kondo 2020), which may be unable to meas- significantly higher surface area measurements and bone ure the entire length as accurately as 3D imaging. Due to the percentage calculations. variations in the height of the Crista Galli, one section of There was no significant correlation between the total the axial view may only be able to measure a portion of the surface area of the CP and Crista Galli length. When data length, resulting in a much smaller length measurement than were used to contrast the difference between the left and would otherwise be reported for that sample if 3D imaging right sides, this resulted in the left surface area of the CP was used. This shows the benefits of using 3D imaging for having a moderate positive correlation with the length of measurement, as this enabled much more accurate length the Crista Galli for both 2D imaging (r = 0.549, p = 0.007) measurements to be made. and 3D imaging (r = 0.634, p = 0.001). This correlation sug- The height of the Crista Galli measured using 3D imaging gests that as the Crista Galli increases in length, so does ranged from 5.3 to 17.7 mm, similarly supporting previous the surface area of the left side of the CP. These results research indicating a large range of height measurements may suggest that as the surface area of the CP increases, so from the Crista Galli (Akiyama and Kondo 2020). How- does the Crista Galli’s length, to support the CP (Murray ever, the recorded maximum range of 17.7 mm was less et al. 2017) and protect the olfactory bulb from trauma. The than the maximum of 26 mm found by Akiyama and Kondo ability to measure accurately and efficiently the length of (Akiyama and Kondo 2020). This difference is likely due to the Crista Galli to determine the size of the CP may assist sampling size, as the previous study by Akiyama and Kondo clinicians when conducting pre-operative assessments. This (Akiyama and Kondo 2020) had a much larger sample size could allow them to determine the size of the CP, to avoid of 300, allowing for a larger range of Crista Galli’s height surgical complications which may occur if surgery is being to be recorded. conducted close to the CP, such as during endoscopic sinus The Crista Galli’s width measured using 3D imaging surgery (Abdullah et al. 2020) and ethmoidectomy (Goanţǎ ranged from 2 to 6.6 mm, which is quite similar to previous et al. 2017). research which has found this width to range from 0 to 4 mm A moderately significant negative correlation was also (Coelho et al. 2018), 2–10 mm (Akiyama and Kondo 2020) found between the total surface area of the CP and Crista and 2.5–7 mm (Şahan et al. 2019). The width of the Crista Galli’s width. This correlation was found when the surface Galli may impact the risk of trauma-related fracture, as it has area was measured with both 2D imaging (r = − 0.532, been suggested to provide support to the CP (Murray et al. p = 0.003) and 3D imaging (r = − 0.429, p = 0.041). This 2017). From this, it can be postulated that an increased width likely resulted from the Crista Galli blocking the anterior of the Crista Galli may result in a decreased risk of trauma- portion of the CP’s surface area (Kalmey et al. 1998; Patron related fracture, due to the buttressing ee ff ct that it may have et al. 2015; Ganjaei et al. 2018), lowering the total measured (Murray et al. 2017). The increased width of the Crista Galli surface area of the CP. The Crista Galli’s width could be would also likely protect the olfactory bulbs which rest upon explored in more detail in a dissection study, whereby the the anterior portion of the CP from trauma. dimensions of the Crista Galli could be recorded, then sub- The surface area of the Crista Galli using 3D imaging sequently removed, and the CP’s surface area then measured ranged from 135.6 to 384.9  mm . An increase in the surface to more accurately assess whether the Crista Galli’s width area of the Crista Galli and the resulting volume may help correlates with the total surface area of the CP. insulate the CP from fractures that may occur and limit the There were no significant correlations between the CP’s resulting damage which may be inflicted on the olfactory total surface area and the Crista Galli’s height, or surface bulb. Due to the wide range of Crista Galli’s surface area, area. The length, height, and width of the Crista Galli also this implies vastly differing levels of insulation to fracture did not significantly correlate with each other, suggesting that the Crista Galli may be providing between individuals. that these dimensions develop separately and do not impact This variation may be able to be classified to determine the each other. risk of fracture, with a larger surface area or volume of the The Crista Galli’s length measured using a 3D Recon- Crista Galli resulting in a decreased risk of fracture and a structed CT scan ranged from 17.5 to 21.1 mm, which is lowered risk of trauma to the olfactory bulb. 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches consistent with the range of length measurements recorded tool for researchers, which could be used to assess future risk using 3D Imaging of 15.8–25.8 mm. This suggests a high of trauma in further studies. For clinicians, 3D reconstructed accuracy of measurements for both 3D CT scans alongside CT scans could be used alongside 2D CT scan technology the 3D imaging used in this study. The length measurements to perform accurate diagnoses, as this may allow for a more recorded using the 3D Reconstructed CT scan were simi- precise and holistic assessment to be performed on patients larly much greater than the minimum recorded using Axial when head injuries have occurred. CT sections by Akiyama and Kondo (Akiyama and Kondo The demographic data and patient information of the CP 2020). This again supports the use of 3D imaging, with 3D samples could not be accessed, and detailed data analysis Reconstructed CT scans giving a similar range of length (e.g., how features such as age, sex and race may impact the measurements to the 3D imaging, and accurately represent- morphology of the CP and the Crista Galli) on these features ing the length of the Crista Galli compared to the Axial was unable to be conducted. However, studies measuring view. Crista Galli’s dimensions with regard to age would be of Crista Galli’s height measured using Coronal CT scans interest for future studies due to the implications on the risk ranged from 8.5 to 13.6 mm, which is consistent with the of fracture. Future research may investigate these findings range of height measurements recorded using 3D imaging with a larger samples size to confirm the correlations which of 5.3–17.7 mm. This was also consistent with the range may occur between the Crista Galli and Cribriform Plate. recorded in previous studies of 5–21 mm (Şahan et al. 2019; The implementation of simulated fracture technology Akiyama and Kondo 2020), which further supports the accu- to directly investigate the risk of trauma-related fracture of racy of the 3D imaging technique and the use of Coronal CT the CP and its structures could benefit the literature, with scans to accurately measure the height of the Crista Galli. this technology already being used on the femur, humerus, The Crista Galli’s width measured using Coronal CT fibula, and ulna (Ota et al. 1999; Parra-Cabrera et al. 2022). scans ranged from 3.8 to 5.8 mm, which is consistent with Researchers could also measure the bone composition of the range of width measurements recorded using 3D imag- the CP and investigate whether features such as the Crista ing of 2–6.6 mm. This was also consistent with the range Galli’s dimensions, or increased foramina area impact the recorded in previous studies of 2–10 mm (Akiyama and bone composition of the CP. Kondo 2020), 2.5–7 mm (Şahan et al. 2019), and 0–4 mm Where medical facilities have limited access to 3D imag- (Coelho et al. 2018). While studies have measured the width ing software, future researchers may be able to generate a of the Crista Galli using a variety of methods such as Coro- formula to apply the 3D imaging findings to 2D images to nal CT scans (Şahan et al. 2019), Axial CT scans (Akiyama enhance the accuracy of these imaging methods. 2D imag- and Kondo 2020), and 2D imaging (Coelho et al. 2018), ing measurements could be compared with 3D imaging to the similarities between these results suggest that the width explore the rate of the additional surface area measured of the Crista Galli can be accurately determined through a with 3D imaging to generate this formula. The percentage variety of imaging techniques. of additional surface area could also be investigated with how it may correlate with other classifications such as the Keros (Keros 1962), Yenigun (Yenigun et al. 2016) or TMS Conclusion (Abdullah et al. 2020) classifications. Lastly, if a strong link could be determined between The results of this study support the use of 3D imaging these CP structures and increased risk of fracture, individu- techniques, alongside the 3D reconstructed CT scan as an als with a higher risk of facial fractures such as athletes in accurate method for measurement, which allows for compre- competitive sports (Povolotskiy et al. 2019) could receive an hensive analysis of complex surfaces such as the CP mor- examination to determine whether their CP is at risk before phology and variations, olfactory foramina, and Crista Galli. engagement in the physical activity. This could result in at- This study shows the potential correlations between the risk individuals wearing appropriate headgear to prevent Crista Galli and the CP, with a positive correlation between complications regarding the CP, and if assessed by insur- the length of the Crista Galli and the surface area of the left ance companies, policy premium could be more accurately side of the CP. This correlation should be further investi- moderated based on the risk of fractures of the individual. gated, as this may suggest that the Crista Galli increases in Acknowledgements The authors thank the school of Health Sciences length alongside the CP to support the bone and olfactory at Swinburne University of Technology for the academic the profes- bulb. The similarities between the results using 3D imaging, sional support. The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. CT scans, and 3D reconstructed CT scans also support the use of these imaging techniques as a precise measurement 1 3 M. Boulton et al. Results from such research can potentially increase mankind's overall comparison of two surgical constructs for wrist four-corner arthro- knowledge that can then improve patient care. Therefore, these donors desis via dorsal and radial approaches. Clin Biomech 82:105274 and their families deserve our highest gratitude. Ganjaei KG, Soler ZM, Mappus ED, Taylor RJ, Worley ML, Mulligan JK, Mattos JL, Rowan NR, Garcia GJM, Dubno JR, Eckert MA, Author contributions MB conducted the experiment, interpreted Matthews LJ, Schlosser RJ (2018) Novel radiographic assessment data, and wrote the manuscript. FK acted as a supervisor in this study of the cribriform plate. Am J Rhinol Allergy 32(3):175–180 and revised the manuscript. AA acted as a supervisor for this study, Goanţǎ CM, Cîrpaciu D, Soricǎ A, Tuşaliu M, Budu VA (2017) Ethmoid- designed the project, scanned all samples, assisted in data collection ectomy—procedures and complications. Arch Balkan Med Union and revised the manuscript. All authors reviewed the results and manu- 52(3):333–337 script and approved the final version of the manuscript. Gomez J, Pickup S (2022) Cribiform plate fractures. StatPearls. StatPearls Publishing, Treasure Island Funding Open Access funding enabled and organized by CAUL and Gray ML, Kappauf C, Govindaraj S (2019) Management of an unu- its Member Institutions. sual intranasal foreign body abutting the cribriform plate: a case report and review of literature. Clin Med Insights Ear Nose Throat Data availability The data that support the findings of this study are not 12:1179550619858606–1179550619858606 openly available due to reasons of sensitivity and are available from the Hollander MHJ, Kraeima J, Meesters AML, Delli K, Vissink A, Jansma corresponding author upon reasonable request. J, Schepers RH (2021) Reproducibility of 3D scanning in the peri- orbital region. Sci Rep 11(1):3671 Inal M, Muluk NB, Arikan OK, Sahin S (2018) Is there a relationship Declarations between Keros classification of olfactory fossae depth, septal devia- tion angle and the distance between infraorbital foramens? Curr Med Conflict of interest The authors declare that they have no conflict of Imaging Rev 14(5):788–797 interest. Jansen J, Schreurs R, Dubois L, Maal TJJ, Gooris PJJ, Becking AG (2018) The advantages of advanced computer-assisted diagnostics Open Access This article is licensed under a Creative Commons Attri- and three-dimensional preoperative planning on implant position bution 4.0 International License, which permits use, sharing, adapta- in orbital reconstruction. J Craniomaxillofac Surg 46(4):715–721 tion, distribution and reproduction in any medium or format, as long Kalmey JK, Thewissen JGM, Dluzen DE (1998) Age-related size reduc- as you give appropriate credit to the original author(s) and the source, tion of foramina in the cribriform plate. Anat Rec 251(3):326–329 provide a link to the Creative Commons licence, and indicate if changes Keast A, Yelavich S, Dawes P, Lyons B (2008) Anatomical variations were made. The images or other third party material in this article are of the paranasal sinuses in Polynesian and New Zealand European included in the article's Creative Commons licence, unless indicated computerized tomography scans. Otolaryngol Head Neck Surg otherwise in a credit line to the material. If material is not included in 139(2):216–221 the article's Creative Commons licence and your intended use is not Keros P (1962) On the practical value of differences in the level of the permitted by statutory regulation or exceeds the permitted use, you will lamina cribrosa of the ethmoid. Z Für Laryngol Rhinol Otol Ihre need to obtain permission directly from the copyright holder. To view a Grenzgeb 41:809–813 copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . Keşkek C, Aytuğar E (2021) Clinical significance and radiological evalu- ation of Crista Galli: a CBCT study. Eur J Anat off J Span Soc Anat 25(6):705–711 References Knížek Z, Michálek R, Vodička J, Zdobinská P (2021) Cribriform plate injury after nasal swab testing for COVID-19. JAMA Otolaryngol Head Neck Surg 147(10):915–917 Abdullah B, Chew SC, Aziz ME, Shukri NM, Husain S, Joshua Kühnel TS, Reichert TE (2015) Trauma of the midface. Laryngorhi- SW, Wang DY, Snidvongs K (2020) A new radiological clas- nootologie 94:S206–S247 sification for the risk assessment of anterior skull base injury Murray RD, Friedlander R, Hanz S, Singh H, Anand VK, Schwartz TH in endoscopic sinus surgery. Sci Rep. https:// doi. org/ 10. 1038/ (2017) Nonrandom spatial clustering of spontaneous anterior fossa s41598- 020- 61610-1 cerebrospinal fluid fistulas and predilection for the posterior cribri- Akiyama O, Kondo A (2020) Classification of crista Galli pneumatiza- form plate. J Neurosurg 126(5):1720–1724 tion and clinical considerations for anterior skull base surgery. J Oh J-W, Kim S-H, Whang K (2017) Traumatic cerebrospinal fluid leak: Clin Neurosci 82:225–230 diagnosis and management. Korean J Neurotrauma 13(2):63–67 Belgin CA, Bayrak S, Orhan K, AktunaBelgİN C (2021) Evaluation Onisor FG (2022) Global avulsion of the globe associated with fron- of the ethmoid bone using by cone beam computed tomography tal sinus and naso-orbital-ethmoid (FSNOE) complex fracture. in Turkish subpopulation. Clin Exp Health Sci 11(4):679–682 A rare case report and short literature review. Ann Ital Chir 11: Coelho DH, Pence TS, Abdel-Hamid M, Costanzo RM (2018) Cribriform S2239253X22036878. https://eur opepmc. or g/ar ticle/ med/ 35670 024 plate width is highly variable within and between subjects. Auris Ota T, Yamamoto I, Morita R (1999) Fracture simulation of the femoral Nasus Larynx 45(5):1000–1005 bone using the finite-element method: how a fracture initiates and de Carvalho MF, Vieira JNM, Figueiredo R, Reher P, Chrcanovic BR, proceeds. J Bone Miner Metab JBMM 17(2):108–112 Chaves M (2021) Validity of computed tomography in diagnosing Parra-Cabrera G, Pérez-Cano FD, Jiménez-Delgado JJ (2022) Fracture midfacial fractures. Int J Oral Maxillofac Surg 50(4):471–476 pattern projection on 3D bone models as support for bone fracture Douglas CF, White BD (2021) Traumatic cribriform plate defect fol- simulations. Comput Methods Prog Biomed 224:106980 lowing self-administered COVID-19 nasal swab test. Appl Radiol Patron V, Berkaoui J, Jankowski R, Lechapt-Zalcman E, Moreau S, Hitier 50(4):44–46 M (2015) The forgotten foramina: a study of the anterior cribriform Faudot B, Ballerini J, Ross M, Bellemère P, Goislard de Monsabert plate. Surg Radiol Anat 37(7):835–840 B, Vigouroux L, Milan J-L (2021) Mechanical performance 1 3 A comparative analysis of the CP and CG using 2D and 3D visualisation approaches Povolotskiy R, Youssef P, Kaye R, Paskhover B (2019) Facial fractures Wei J-J, Tang Z-L, Liu L, Liao X-J, Yu Y-B, Jing W (2015) The manage- in young adults: a national retrospective study. Ann Otol Rhinol ment of naso-orbital-ethmoid (NOE) fractures. Chin J Traumatol Laryngol 128(6):516–523 18(5):296–301 Ren C, Zhu Q, Yuan H (2021) Imaging features of spinal fractures in Wickwire P, Kahlon S, Kazemi S, Tollefson T, Steele T, Chang J, Strong ankylosing spondylitis and the diagnostic value of different imaging B (2022) Improving patient education of facial fractures using methods. Quant Imaging Med Surg 11(6):2499–2508 3-dimensional computed tomography. Otolaryngol Head Neck Surg Şahan MH, Inal M, Muluk NB, Şimşek G (2019) Cribriform plate, Crista 166(4):657–661 Galli, olfactory fossa and septal deviation. Curr Med Imaging For- Wubulihasimu Z, Tuerhong M, Zhang Z, Li H, Kadir N, Xie M, Abulaiti mer Curr Med Imaging Rev 15(3):319–325 M, Abulaiti A, Tulamaiti N, Maimaitiming B, Aili W, Ni Y (2021) Shah N, Deopujari CE, Chhapola Shukla S (2017) Spontaneous recur- Clinical analysis and CT 3D-mediated precise internal fixation in rent CSF rhinorrhoea: a rare case and review of literature. Indian J maxillofacial fracture. Ear Nose Throat J 100(5_suppl):420S-426S Otolaryngol Head Neck Surg 69(3):420–424 Yenigun A, Goktas SS, Dogan R, Eren SB, Ozturan O (2016) A study Skorek A, Tretiakow D, Szmuda T, Przewozny T (2017) Is the Keros of the anterior ethmoidal artery and a new classification of the classification alone enough to identify patients with the “dangerous ethmoid roof (Yenigun classification). Eur Arch Otorhinolaryngol ethmoid”? An anatomical study. Acta Otolaryngol 137(2):196–201 273(11):3759–3764 Snell R (2009) Clinical neuroanatomy, 7th edn. Ringgold, Inc, Portland, Yoneoka Y, Aizawa N, Nonomura Y, Ogi M, Seki Y, Akiyama K (2020) p 33 Traumatic nonmissile penetrating transnasal anterior skull base Stopa BM, Leyva OA, Harper CN, Truman KA, Corrales CE, Smith TR, fracture and brain injury with cerebrospinal fluid leak: intraopera- Gormley WB (2022) Decreased incidence of CSF leaks after skull tive leak detection and an effective reconstruction procedure for a base fractures in the 21st century: an institutional report. J Neurol localized skull base defect especially after coronavirus disease 2019 Surg 83(1):059–065 outbreak. World Neurosurg 140:166–172 Teng TS, Ishak NL, Subha ST, Bakar SA (2019) Traumatic transna- sal penetrating injury with cerebral spinal fluid leak. EXCLI J Publisher's Note Springer Nature remains neutral with regard to 18:223–228 jurisdictional claims in published maps and institutional affiliations. Umana GE, Pucci R, Palmisciano P, Cassoni A, Ricciardi L, Tomasi SO, Strigari L, Scalia G, Valentini V (2022) Cerebrospinal fluid leaks after anterior skull base trauma: a systematic review of the literature. World Neurosurg 157:193-206.e192 1 3

Journal

Anatomical Science InternationalSpringer Journals

Published: Sep 1, 2023

Keywords: Cribriform plate; Crista Galli; Computed tomography; 2D imaging; 3D imaging

There are no references for this article.