Importance of Keros Classification in Surgery

Objective:The relationship between the cribriform plate and the uncinate process may be elaborated with the help of the Keros classification.The observations were analysed using high-resolution computed tomography (HRCT).Additionally, the relationship between the superior attachment of the uncinate process, the existence of concha bullosa, and the different types of ethmoid roofs were examined.Methods: Five-hundred and sixteen subjects complaining of sinonasal disorders between 2015 and 2016 were enrolled retrospectively at the Okmeydani Training and Research Hospital, Department of Otolaryngology.HRCT scans of 1-mm sections were obtained.Keros classification was used for the measurement of the depth of the olfactory fossa as follows: Keros I: 1-3 mm, Keros II: 3-7 mm, and Keros III: 7-16 mm.Results: Fifty-one point nine percentage of cases were of Keros type II, 27.7% of type III, and 20.3% of type I.In 82.4% of the reported cases, the uncinate process was attached to the lamina papyraceae, in 11% of the cases it was attached to the middle nasal turbinate, and in 6.4% cases to the skull base.A concha bullosa was observed in the right nasal cavity in 13.8% of the cases, in the left nasal cavity in 11% of the cases, and bilaterally in 16.3% of the cases.Variances observed in the Keros types were not statistically significant with respect to sex (p>0.05).Concha bullosa was significantly more frequently seen in females (53.1%) relative to males (p=0.001).Conclusion: Endoscopic sinus surgery (ESS) is the primary mode of treatment for chronic sinus diseases.In this procedure, a proper assessment of the vital structures is very important to avoid further complications.In the present study, it has been suggested that determining the depth of the ethmoid roof is necessary to avoid injuring the bony lamella, which can lead to cerebrospinal fluid rhinorrhea.