Brazilian Journal of OTORHINOLARYNGOLOGY.

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www.bjorl.org

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

SPECIAL

ARTICLE

Anatomical

terminology

of

the

internal

nose

and

paranasal

sinuses:

cross-cultural

adaptation

to

Portuguese

夽

Thiago

Freire

Pinto

Bezerra

a_,b_,_∗

_,

_Aldo

_Stamm

c

_,

_Wilma

_Teresinha

_Anselmo-Lima

d

_,

Marco

Aurélio

Fornazieri

e_,f

_,

_Nelson

_D’Ávila

_Melo

g

_,

_Leonardo

_Balsalobre

c

_,

Geraldo

Pereira

Jotz

h

_,

_Henrique

_Zaquia

_Leão

h

_,

_André

_Alencar

_Araripe

_Nunes

i

_,

Alexandre

Felippu

j

_,

_Antonio

_Carlos

_Cedin

k

_,

_Carlos

_D.

_{Pinheiro-Neto}

l

_,

Diego

Lima

Oliveira

m

_,

_Eulalia

_Sakano

n

_,

_Eduardo

_Macoto

_Kosugi

o

_,

Elizabeth

Araújo

h

_,

_Fabiana

_Cardoso

_Pereira

_Valera

d

_,

_Fábio

_de

_Rezende

_Pinna

b

_,

Fabrizio

Ricci

Romano

b

_,

_Francine

_Grecco

_de

_Melo

_Pádua

p

_,

_Henrique

_Faria

_Ramos

q

_,

João

Telles

Jr.

r

_,

_Leonardo

_Conrado

_Barbosa

_de

_Sá

r

_,

Leopoldo

Marques

D’Assunc

¸ão

Filho

a

_,

_Luiz

_Ubirajara

_Sennes

b

_,

Luis

Carlos

Gregório

o

_,

_Marcelo

_H.

_Sampaio

n

_,

Marco

César

Jorge

dos

Santos

s

_,

_Marco

_Franca

t

_,

_Marcos

_Mocellin

u,s

_,

Marcus

Miranda

Lessa

v

_,

_Melissa

_Ameloti

_G.

_Avelino

w

_,

_Miguel

_Tepedino

r_,x

_,

Nilvano

Alves

de

Andrade

y

_,

_Otavio

_B.

_Piltcher

h

_,

_Renato

_Roithmann

z

_,

Renata

Mendonc

¸a

Pilan

b

_,

_Roberto

_Campos

_Meireles

aa

_,

Roberto

Eustáquio

Guimarães

bb

_,

_Rodrigo

_de

_Paula

_Santos

o

_,

_Rogério

_Pezato

b_,o

_,

Shirley

Pignatari

o

_,

_Tatiana

_Telles

_Abdo

b

_,

_Victor

_Nakajima

cc

_,

_Washington

_Almeida

dd

_,

Richard

L. Voegels

b

a_Universidade_Federal_de_Pernambuco_(UFPE),_Recife,_PE,_Brazil

b_Universidade_de_São_Paulo_(USP),_Faculdade_de_Medicina_(FM),_São_Paulo,_SP,_Brazil

c_Complexo_Hospitalar_Edmundo_Vasconcelos,_Centro_de_{Otorrinolaringologia}_e_{Fonoaudiologia}_(COF),_São_Paulo,_SP,_Brazil d_Universidade_de_São_Paulo_(USP-RP),_Faculdade_de_Medicina_(FM),_Ribeirão_Preto,_SP,_Brazil

e_Universidade_Estadual_de_Londrina_(UEL),_Londrina,_PR,_Brazil

f_Pontifícia_Universidade_Católica_do_Paraná_(PUC-PR),_Londrina,_PR,_Brazil g_Universidade_Tiradentes_(UNIT),_Aracaju,_SE,_Brazil

h_Universidade_Federal_do_Rio_Grande_do_Sul_(UFRGS),_Porto_Alegre,_RS,_Brazil i_Universidade_Federal_do_Ceará_(UFC),_Fortaleza,_CE,_Brazil

j_Instituto_Felippu_de_{Otorrinolaringologia}_e_Base_do_Crânio,_São_Paulo,_SP,_Brazil k_{Beneﬁcência}_Portuguesa_de_São_Paulo,_São_Paulo,_SP,_Brazil

夽 _Please_cite_this_article_as:_Bezerra_TF,_Stamm_A,_Anselmo-Lima_WT,_Fornazieri_MA,_Melo_ND,_Balsalobre_L,_et_al._Anatomical_terminology

oftheinternalnoseandparanasalsinuses:cross-culturaladaptationtoPortuguese.BrazJOtorhinolaryngol.2018;84:677---86.

∗_{Corresponding}_author.

E-mail:oto@thiagobezerra.com(T.F.Bezerra).

PeerReviewundertheresponsibilityofAssociac¸ãoBrasileiradeOtorrinolaringologiaeCirurgiaCérvico-Facial. https://doi.org/10.1016/j.bjorl.2018.08.003

1808-8694/©2018AssociaçãoBrasileiradeOtorrinolaringologiaeCirurgiaCérvico-Facial.PublishedbyElsevierEditoraLtda.Thisisanopen accessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).

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l_Albany_Medical_Center,_Albany,_NY,_United_States

m_Hospital_Memorial_Arthur_Ramos_(HMAR),_Maceió,_AL,_Brazil n_Universidade_Estadual_de_Campinas_(UNICAMP),_Campinas,_SP,_Brazil

o_Universidade_Federal_de_São_Paulo_(UNIFESP),_Escola_Paulista_de_Medicina_(EPM),_São_Paulo,_SP,_Brazil p_Hospital_Israelita_Albert_Einstein,_São_Paulo,_SP,_Brazil

q_Universidade_Federal_do_Espírito_Santo_(UFES),_Vitória,_ES,_Brazil

r_Universidade_do_Estado_do_Rio_de_Janeiro_(UERJ),_Faculdade_de_Ciências_Médicas,_Rio_de_Janeiro,_RJ,_Brazil s_Instituto_Paranaense_de_{Otorrinolaringologia,}_Curitiba,_PR,_Brazil

t_Faculdade_de_Enfermagem_e_Medicina_Nova_Esperanc_¸a_(FAMENE),_João_Pessoa,_PB,_Brazil u_Universidade_Federal_do_Paraná_(UFPR),_Curitiba,_PR,_Brazil

v_Universidade_Federal_da_Bahia_(UFBA),_Faculdade_de_Medicina,_Salvador,_BA,_Brazil w_Universidade_Federal_de_Goiás_(UFG),_Goiânia,_GO,_Brazil

x_Policlínica_Botafogo,_Rio_de_Janeiro,_RJ,_Brazil

y_Fundac_¸ão_Bahiana_para_{Desenvolvimento}_das_Ciências,_Salvador,_BA,_Brazil z_Universidade_Luterana_do_Brasil,_Faculdade_de_Medicina,_Porto_Alegre,_RS,_Brazil aa_Universidade_Federal_do_Rio_de_Janeiro_(UFRJ),_Rio_de_Janeiro,_RJ,_Brazil bb_Universidade_Federal_de_Minas_Gerais_(UFMG),_Belo_Horizonte,_MG,_Brazil cc_Universidade_Estadual_Paulista_(UNESP),_Botucatu,_SP,_Brazil

dd_Hospital_Otorrinos_de_Feira_de_Santana,_Feira_de_Santana,_BA,_Brazil

Received23July2018;accepted8August2018 Availableonline18September2018

KEYWORDS

Cross-cultural adaptation; Anatomy; Nose; Paranasalsinus; Consensus Abstract

Introduction:Functionalendonasalendoscopicsurgeryisafrequentsurgicalprocedureamong otorhinolaryngologists.In 2014,theEuropeanSocietyofRhinologypublishedthe‘‘European Position Paperonthe AnatomicalTerminologyoftheInternalNose andParanasalSinuses’’, aimingtounifythetermsintheEnglishlanguage.Wedonotyethaveauniﬁedterminologyin thePortugueselanguage.

Objective:Transculturaladaptationoftheanatomicaltermsofthenoseandparanasal cavi-tiesofthe‘‘EuropeanAnatomicalTerminologyoftheInternalNoseandParanasalSinuses’’to Portuguese.

Methods:A groupofrhinologists fromdiversepartsofBrazil,allexperiencedinendoscopic endonasal surgery,was invited toparticipate inthe creation of thisposition paper onthe anatomicaltermsofthenoseandparanasalsinusesinthePortugueselanguageaccordingto themethodologyadaptedfromthatpreviouslydescribedbyRudmikandSmith.

Results:Theresultsofthisdocumentweregeneratedbasedontheagreementofthemajority oftheparticipantsaccordingtothemostpopularsuggestionsamongtherhinologists.A cross-culturaladaptationofthesinonasalanatomicalterminologywasconsolidated.Wesuggestthe terms‘‘inferiorturbinate’’,‘‘nasalseptum’’,‘‘(bone/cartilaginous)partofthenasalseptum’’, ‘‘(middle/inferior)nasalmeatus’’, ‘‘frontalsinusdrainagepathway’’,‘‘frontal recess’’and ‘‘uncinateprocess’’bestandardized.

Conclusion:WehaveconsolidatedaPortugueseversionoftheEuropeanAnatomicalTerminology ofthe InternalNose andParanasal Sinuses, which willhelp inthe publicationof technical announcements,scientiﬁcpublicationsandtheteachingoftheinternalanatomicaltermsof thenoseandparanasalsinusesinBrazil.

© 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

PALAVRAS-CHAVE

Adaptac¸ão transcultural; Anatomia; Nariz;

Terminologiaanatômicanasossinusal:adaptac¸ãotransculturalparaoportuguês Resumo

Introduc¸ão:A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico fre-quenteentreosotorrinolaringologistas.Em2014,aSociedadeEuropeiadeRinologiapublicou o‘‘DocumentoEuropeuparaPosicionamentosobreaTerminologiaAnatômicaInternadoNariz

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Cavidadesparanasais; Consenso

edasCavidadesParanasais’’comoobjetivodeuniﬁcarostermosnalínguainglesa.Aindanão dispomosdeumaterminologiauniﬁcadanalínguaportuguesa.

Objetivo: Adaptac¸ãotransculturaldostermosanatômicosdonarizedascavidadesparanasais para oportuguês da‘‘EuropeanAnatomicalTerminologyoftheInternalNoseandParanasal Sinuses’’.

Método: UmgrupoderinologistasdetodooBrasil,comexperiênciaemcirurgiaendoscópica endonasal, foiconvidado aparticiparda elaborac¸ão desse posicionamento sobreos termos anatômicosdonarizedascavidadesparanasaisparaoportuguêsconformemetodologia adap-tadadapreviamentedescritaporRudmikeSmith.

Resultados: Osresultadosdessedocumentoforamgeradosapartirdaconcordânciadamaioria dosparticipantesconformeassugestõesmaispopularesentreosrinologistas.Umaadaptac¸ão transculturaldaterminologiaanatômicanasossinusalfoiconsolidada.Sugerimosquesebusque uniformizartermoscomo‘‘conchainferior’’,‘‘septonasal’’,‘‘porc¸ão(óssea/cartilagionasa)do septonasal’’,‘‘meato(médio/inferior)nasal’’,‘‘viadadrenagemdoseiofrontal’’,‘‘recesso frontal’’e‘‘processouncinado’’.

Conclusão:Consolidamosumaversãoadaptadaemportuguêsda‘‘EuropeanAnatomical Termi-nologyoftheInternalNoseandParanasalSinuses’’queauxiliaráapublicaçãodecomunicados técnicos, publicações científicas eo ensino dos termos anatômicosinternos do nariz edas cavidadesparanasaisnoBrasil.

© 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Este é um artigo Open Access sob uma licença CC BY (http:// creativecommons.org/licenses/by/4.0/).

Introduction

Endoscopic surgery and sinonasal computed tomography stimulatedrhinologyin theearly1980sintothe revivalof researchintheﬁeldsofanatomyandphysiologyofthenose andparanasal sinuses.1 _In _1994,_the _{International} Confer-ence on Sinus Disease took place aiming to describe the newlyidentiﬁedstructuresindetail,sinceAnatomical Ter-minologyhadfewdescriptorsofthesinonasalanatomy.2,3

In 2014, the European Society of Rhinology published the‘‘EuropeanPositionPaperontheAnatomical Terminol-ogy of the Internal Noseand Paranasal Sinuses’’ tounify thesinonasalanatomicalterminologythroughthereviewof anatomicalterms andanalysisof theofﬁcial‘‘Anatomical Terminology’’.1 _They _sought _to _respect _the embryologi-caldevelopmentofstructures,avoidterminologyinLatin, removeeponyms,andsimplifytheanatomicalterms.

Lund et al. summarized in the English language all structures that couldbe found during a routine sinonasal endoscopicsurgery.At thattime,therewereseveral pub-lications on clinical anatomy and much discussion about the exactnames anddeﬁnitions for structuresof surgical relevance.2

Itisclearlynecessarytounifythisterminologyinallother languagesand, thatin theprocess ofcross-cultural adap-tation, the defined terms find correspondence in English. This publication in other languages would facilitate tech-nicalinformation, scientific publications andthe teaching oftheinternalanatomicaltermsofthenoseandparanasal cavities.

Thepurposeofthisstudyisthecross-culturaladaptation oftheanatomicaltermsofthenoseandparanasalcavities tothePortugueselanguageoftheEuropeanAnatomical Ter-minologyoftheInternalNoseandParanasalSinusesandthe propositionof a Sinonasal AnatomicalTerminologyin Por-tuguese.

Methods

This is a prospective study of cross-cultural adaptation, carriedoutinBrazil,from2015to2016.Forty-four acknowl-edged rhinologists from all over Brazil were invited to participate (Fig. 1). We followed an adapted version of themethodusedby Rudmik andSmith.4 _The _entire _study processwascarriedoutatdistancewiththeaid ofa plat-form, which allowed the uniﬁcation and analysis of the results.

Inclusion

criteria

for

the

group

of

rhinologists

- Voluntaryinterestinparticipatinginthestudy;

- Otorhinolaryngologists with proven experience in sinonasalendoscopicsurgerythroughpublicationsonthe subjectand/orworkinginreferralcentersinrhinology.

Exclusion

criteria

for

the

group

of

rhinologists

- Nointerestinparticipatingaftertheinvitation;

- No experience in sinonasal endoscopic surgery through publicationsonthesubjectand/ornotworkinginreferral centersinrhinology.

Phase

1. Term

suggestion

phase

The ﬁnal list of the 126 terms of Supplement 24 (1) was dividedinto8blocks(Table1)andeachblockwasrandomly assignedtoagroupof4---5authors.Allauthorsreceiveda copyoftheoriginalsupplementbye-mail1_and_were_invited tosuggest three or more known terms in Portuguese for eachEnglishtermoftheblockassignedtothem.Allauthors were also encouraged to suggest more terms for other blocks.

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1- Term suggestion

2- Interactive Review

3- Voting

4- Final writing

Each author can suggest up to three names for each term in the list that

is assigned to them. But all authors can contribute to all terms, if they are available

The most voted names will be submitted to a review process, so the three most relevant ones can be chosen.

The three most relevant names for each term will be put to

a vote by all authors.

The final version of the text will be sent to the authors and, after approval, will be sent for publication.

Figure1 Studydesign.

Phase

2. Iterative

assessment

The most often suggested terms were reviewed by the authors underthe supervision of authors with experience inanatomy(G.J.andH.Z.L.).Aﬁnallistwascreatedwith uptothreemostrelevanttermsforeachterm.

Phase

3. Final

voting

Anelectronic surveywassent to each rhinologistthrough an online platform. The survey included multiple-choice optionsfor each ofthe 126 terms, divided into thesame eightpreviously deﬁned blocks. All the rhinologists could chooseonly one termoption in Portuguese for each term inEnglish.ThemostvotedterminPortuguesewaschosen foreachterminEnglish.Incasesoftievotesorwhenthere

wasdivergenceofnamesforsimilarstructures,thesewere discussedanddecidedbyconsensus.

Phase

4. Writing

of

this

article

A summarized list of terms in Portuguese was created togetherwiththisarticleforﬁnalapprovalbytheauthors.

Results

Alloftherhinologistsacceptedtheinvitationtoparticipate. The ﬁnallistofterms thatweresuggested andthevoting frequency ofthe threetermsvoted onlaterareshown in

Table1.Theproposedtermsareunderlined.

Discussion

Thisstudyproposesauniﬁedsinonasalanatomical terminol-ogythroughtheprocessofcross-culturaladaptationofthe anatomicalterms deﬁnedfortheEnglishlanguagerelated to the nose and the paranasal cavities. The presence of researcherswithexperienceinanatomicalterms(G.J.and H.Z.L.)wasimportantfortheprojectadequacy.

Thehistoryofcontroversyregardingsinonasalanatomical terminologyhasexisted for manyyearsandcanbe exem-pliﬁedbytheuseof theterminfundibulumandsemilunar hiatus to designate several lateral wall structures to the point that theabandonment of thisterminology hasbeen suggestedin thepast.Inthisterminology,wepropose the useoftermsthathelptodifferentiatetheanatomical struc-tures so that eponyms are not utilized.5 _We _believe _this favorsthelearningandthecorrectnamingofthestructures. Thevastmajorityoftheresults,aschosenbythe rhinol-ogistsinvitedtoparticipateinthestudy,weremaintained. However,theresultsforsomeofthetermshadtobebetter discussed toresultinauniformterminologyforstructures withsimilarnamesandanomenclatureadequacywithfocus onsurgicalpractice.

The nasal septum is a structure commonly divided into two parts, called bony and membranous parts. The uniformization of the term proposed by most authors for the membranous portion (of the nasal septum) was ‘‘Membranouspartofthenasalseptum’’,by53.7%[22/41]. Ontheotherhand,despitethemostoftensuggestedterm for‘‘bonyseptum’’[Anatomicterminology(AT):‘‘parsosses septinasi’’] was‘‘BonyNasalSeptum’’,by48.8%[20/41], we suggested the term ‘‘Bonypart of the nasal septum’’ (34.1% [14/41]) to maintain uniformity in relation to the ‘‘membranouspartofthenasalseptum’’.

Wealsosuggestedthatfortheterm‘‘inferiorturbinate’’ (AT: concha nasalisinferior), theterm ‘‘concha inferior’’

should bechosen (concha inferior39% [16/41] vs.concha nasal inferior,61% [25/41]).This termis most frequently used and will maintain the standardization in relation to therelatedstructures:‘‘Middleturbinate’’[51.2%(21/41)], ‘‘Basal Lamella of Middle Turbinate’’ [53.7% (22/41)] ‘‘Superiorturbinate’’[48.8%(20/41)]and‘‘Supremenasal turbinate’’[48.8%(20/41)].

‘‘Nasal meatus’’ was also chosen instead of the term ‘‘meatus’’, since there are other anatomical structures

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Table1 Finalresultsofthesuggestedtermsandvotingfrequencyofthethreevotedterms. Suggestedterm(EPOS) Terminologia

Anatômica

3Termosmaissugeridosporordemdefrequênciasetermoproposto (sublinhado)

‘‘Nasalcavity’’ Cavitasnasi Cavidadenasal82,9%

(34/41)a

Fossanasal14,6% (6/41)

Cavidadedonariz2,4% (1/41)

‘‘Lateralnasalwall’’ Nãoexiste(n.e.) Paredenasallateral 41,5%(17/41)a

Paredelateralda cavidadenasal 39%(16/41)

Paredelateraldonariz 19,5%(8/41)

‘‘Nasalﬂoor’’ n.e. AssoalhodaCavidade nasal48,8%(20/41)a

Assoalhonasal29,3% (12/41)

Assoalhodafossanasal 22%(9/41)

’’Nasalseptum’’ Septumnasi Septonasal97,6% (40/41)a

Septodonariz 2,4%(1/41) ‘‘Septalcartilage’’ Parscartilaginea(septi

nasi)Cartilagosepti nasi Cartilagemseptal 61%(25/41)a Septonasal cartilaginoso24,4% (10/41)

Cartilagemnasalseptal 14,6%(6/41)

‘‘Bonyseptum’’ Parsosseaseptinasi Septonasalósseo 48,8%(20/41)

Porc¸ãoósseado Septonasal34,1% (14/41)a Septoósseo17,1 (7/41)% ‘‘Perpendicularplateof ethmoid’’ Laminaperpendicularis ossisethmoidalis Laminaperpendicular doetmóide73,2% (30/41)a Lâminaperpendicular doossoetmóide24,4% (10/41)

LâminaÓsseaSeptal 2,4%(1/41)

‘‘Vomer’’ Parsosseaseptinasi; Vomer

Vômer87,8%(36/41)a _Vômer_nasal_12,2%

(5/41)

OssoInferiordoSepto Nasal0,0%

‘‘Membranousportion (ofnasalseptum)’’

Parsmembranacea septinasi

Porc¸ãomembranosa doseptonasal53,7% (22/41)a Septonasal membranoso36,6% (15/41) Septomembranoso 9,8%(4/41) ‘‘Vomero-nasalorgan’’ Organumvomeronasale Órgãovômero-nasal

51,2%(21/41)a

Órgãovomeronasal 48,8%(20/41) ‘‘Septaltubercle’’ nãoexiste Tuberculoseptal

70,7%(29/41)a

Tuberculonasal19,5% (8/41)

Corpocavernosodo septonasal9,8%(4/41) ‘‘Inferiorturbinate’’ Conchanasiinferior ConchanasalInferior

61%(25/41)

Conchainferior39% (16/41)a

Turbinanasalinferior 0,0%

‘‘Inferiormeatus’’ Meatusnasiinferior Meatoinferior53,7% (22/41)

Meatonasalinferior 43,9%(18/41)a

Meatoinferiornasal 2,4%(1/41) ‘‘Naso-lacrimalduct opening’’ Apertura/ostium ductusnasolacrimalis AberturadoDucto nasolacrimal51,2% (21/41)a Óstiododucto nasolacrimal48,8% (20/41) Aberturanasolacrimal 0,0%(0/41)

‘‘Middleturbinate’’ Conchanasimedia Conchamédia51,2% (21/41)a

Conchanasalmédia 48,8%(20/41)

Turbinanasalmédia 0,0%(0/41) ‘‘Basallamellaofmiddle

turbinate’’

n.e Lamelabasaldaconcha media53,7%(22/41)a

Lamelabasaldaconcha media31,7%(13/41)

Lamelabasal14,6% (6/41)

‘‘Paradoxicalmiddle turbinate’’

n.e. Conchamédia

paradoxal61%(25/41)a

Conchanasalmédia paradoxal36,6% (15/41)

Conchanasalmédia comcurvatura paradoxal2,4%(1/41) ‘‘Conchabullosa(of

middleturbinate)’’

n.e. Conchamédiabolhosa 82,9%(34/41)a

Conchabolhosa17,1% (7/41)

Conchamédiaglobose 0,0%(0/41)

‘‘Interlamellarcell’’ n.e. Célulainterlamellar 78%(32/41)a

t.b.a22%(9/41) ‘‘Middlemeatus’’ Meatusnasimedius Meatomédio48,8%

(20/41)

Meatomédionasal 34,1%(14/41)

Meatonasalmédio 17,1%(7/41)a

‘‘Ostiomeatalcomplex’’ n.e. Complexoóstio-meatal 85,4%(35/41)a

Unidadeóstiomeatal 14,6%(6/41) ‘‘Superiorturbinate’’ Conchanasisuperior Conchanasalsuperior

51,2%(21/41)

Conchasuperior 48,8%(20/41)a

‘‘Conchabullosa(of superiorturbinate)’’

n.e. Conchasuperior bolhosa53,7%(22/41)a

Conchanasalsuperior bolhosa39%(16/41)

Conchasuperior pneumatizada 7,3%(3/41) ‘‘Superiormeatus’’ Meatusnasisuperior Meatosuperior48,8%

(20/41)

Meatonasalsuperior 41,5%(17/41)a

Meatosuperiornasal 9,8%(4/41)

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Table1 (Continued)

Suggestedterm(EPOS) Terminologia Anatômica

‘‘Supremeturbinate’’ Conchanasisuprema Conchanasalsuprema 51,2%(21/41)

Conchasuprema48,8% (20/41)a

‘‘Paradoxicalmiddle turbinate’’

n.e. Meatosupremonasal 48,8%(20/41)

Meatosupremo48,8% (20/41)

Meatonasalsupremo 2,4%(1/41)a ‘‘Spheno-ethmoidal recess’’ Recessus sphenoethmoidalis Recessoesfenoetmoidal 73,2%(30/41)a Recesso esfeno-etmoidal26,8% (11/41) ‘‘Sphenopalatine foramen’’ Foramen sphenopalatinum Forameesfenopalatino 82,9%(34/41)a ForamedaArtéria esfenopalatina17,1% (7/41)

‘‘Olfactorycleft’’ Sulcusolfactorius Fendaolfatória 70,7%(29/41)a

Sulcoolfatório17,1% (7/41)

Áreaolfatóriaou olfativa12,2%(5/41) ‘‘Olfactoryrbre(s)’’ Filaolfactoria(Sing.:

rlumolfactorium) Fibra(s)olfatória(s) 48,8%(20/41) Fibrasdonervo olfatório46,3%(19/41)a Nervosolfatórios4,9% (2/41)

‘‘Choana’’ Choana(Plur.: choanae);Apertura nasalisposterior Coana(coanas)97,6% (20/41)a Aberturanasal posterior2,4%(1/41) ‘‘Maxillarysinus’’ Sinusmaxillaris Seiomaxilar95,1%

(19/41)a

CavidadeParanasal Maxilar4,9%(2/41) ‘‘Maxillarysinusostium’’ n.e. ÓstiodoSeiomaxilar

70,7%(29/41)a

Óstionaturaldoseio maxilar29,3%(12/41)

ÓstiodaCavidade ParanasalMaxilar0,0% ‘‘Accessoryostium’’ n.e Óstioacessóriodo

seiomaxilar87,8% (36/41)a,b Óstiosupranumerário doseiomaxilar7,3% (3/41) Óstioacessórioda CavidadeParanasal Maxilar4,9%(2/41) ‘‘Maxillaryhiatus’’ Hiatusmaxillaris Hiatomaxilar97,6%

(40/41)a

Tba2,4%(1/41) ‘‘Infraorbitalcanal’’ Canalisinfraorbitalis Canaldonervo

infraorbitário61% (25/41)a

Canalinfraorbitário 39%(16/41)

Canaldonervoinfra orbital0,0%(0/41) ‘‘Zygomaticrecess’’ n.e. Recessozigomático

87,8%(36/41)a

Recessodoosso zigomático12,2% (5/41)

‘‘Alveolarrecess’’ n.e. Recessoalveolar 68,3%(28/41)a

Processoalveolar31,7% (13/41)

‘‘Prelacrimalrecess’’ n.e. Recessopré-lacrimal 100%(41/41)a

‘‘Lacrimaleminence’’ n.e. Eminêncialacrimal 58,5%(24/41)a

Proeminênciadoosso lacrimal41,5%(17/41) ‘‘Caninefossa’’ Fossacanina Fossacanina100%

(41/41)a

‘‘Anteriorfontanelle’’ n.e. Fontanelaanterior 100%(41/41)a

‘‘Posteriorfontanelle’’ n.e Fontanelaposterior 100%(41/41)a

‘‘Maxillaryartery’’ Arteriamaxillaris Artériamaxilar78% (32/41)a

Artériamaxilarinterna 22%(9/41)

‘‘Ethmoidalcomplex’’ Cellulaeethmoidales Célulasetmoidais 70,7%(29/41)

Complexoetmoidal 26,8%(11/41)a

Labirintoetmoidal2,5% (1/41)

‘‘t.b.a.’’ Cellulaeethmoidales mediae Célulasetmoidais medias53,7%(22/41) t.b.a.-aser abandonado43,9% (18/41)a Lamelabasalda Conchasuperior2,4% (1/41) ‘‘Posteriorethmoidal cells’’ Cellulaeethmoidales posteriores Célulasetmoidais posteriors95,1% (39/41),substituído porComplexo EtmoidalPosteriorb,a

Etmóideposterior4,9% (2/41)

Célulasdoetmóide posterior0,0%(0/41)

(7)

3Termosmaissugeridosporordemdefrequênciasetermoproposto (sublinhado) ‘‘Anteriorethmoidal artery’’ Arteriaethmoidalis anterior Artériaetmoidal anterior100%(41/41)a ‘‘Accessoryethmoidal artery’’

n.e. Artériaetmoidal acessória58,5% (24/41)a

Artériaetmoidalmédia 39%(16/41) Artériaetmoidal intermedia2,5%(1/41) ‘‘Posteriorethmoidal artery’’ Arteriaethmoidalis posterior Artériaetmoidal posterior100%(41/41)a ‘‘Anteriorethmoidal complex’’ Cellulaeethmoidales anteriores Célulasetmoidais anteriores82,9% (34/41) Complexoetmoidal anterior12,2%(5/41)a

Seioetmoidalanterior 4,9%(2/41)

‘‘Aggernasi’’ Aggernasi AggerNasi100% (41/41)a

‘‘Aggernasicell’’ n.e.(cellula

ethmoidalisanterior)

CélulaAggerNasi 92,7%(38/41)a

CéluladoAggernasi 2,43%(1/41)

Aggernasi2,43%(1/41) ‘‘Uncinateprocess’’ Processusuncinatus Processouncinado

78%(32/41)a Processounciforme 19,5%(8/41) Uncinado2,5%(1/41) ‘‘Everteduncinate process’’

n.e. Processouncinado evertido78%(32/41)a

Processounciforme evertido22%(9/41) ‘‘Aerateduncinate

process’’

n.e. Processouncinado pneumatizado80,5% (33/41)a Processounciforme pneumatizado 19,5%(8/41) ‘‘Basallamellaof uncinateprocess’’

n.e. Lamelabasaldo processouncinado 80,5%(33/41)a Lamelabasaldo processounciforme 19,5%(8/41) ‘‘Inferiorsemilunar hiatus’’

Hiatussemilunaris Hiatosemilunar inferior90,2%(37/41)a

Hiatosemilunar anterior9,8%(4/41) ‘‘Superiorsemilunar

hiatus’’

n.e. Hiatosemilunar superior85,4%(35/41)a

Recessoretrobular 14,6%(6/41) ‘‘Ethmoidalbulla’’ Bullaethmoidalis Bulaetmoidal92,7%

(38/41)a

Bolhaetmoidal7,3% (3/41)

‘‘Basallamellaof ethmoidalbulla’’

n.e. LamelabasaldaBula etmoidal87,8%(36/41)a

LamelabasaldaBolha etmóidal7,3%(3/41)

TA2,4%(1/41) ‘‘Suprabullarrecess’’ n.e. Recessosuprabular

95,1%(39/41)a

Recessosupra-bolhoso 4,9%(2/41)

‘‘Retrobullarrecess’’ n.e. Recessoretrobular 95,1%(39/41)a

Recessoretro-bolhoso 4,9%(2/41)

‘‘Supraorbitalrecess’’ n.e. Recessosupra-orbitário 95,1%(39/41)a

Recessosupra-orbital 2,45%(1/41)

Incisurasupra-orbitaria 2,45%(1/41)

‘‘Infraorbitalcell’’ n.e. Célulainfra-orbital 90,2%(37/41)a

Célulainfraorbitaria 2,4%(1/41) célulainfraorbitária 2,4%(1/41) ‘‘Ethmoidal infundibulum’’ Infundibulum ethmoidale Infundíbuloetmoidal 78%(32/41)a Infundíbulo22%(9/41) ‘‘Terminalrecess’’ n.e Recessoterminal

100%(41/41)a

‘‘Frontalrecess’’ n.e Recessofrontal 97,6%(40/41)a

RecessodoSeiofrontal 2,4%(1/41)

‘‘t.b.a.’’ Ductusnasofrontalis Ductonasofrontal 68,3%(28/41)

t.b.a.29,3%(12/41) Cristamaxilar2,4% (1/41)

‘‘Lacrimalbulge’’ n.e. Aserabandonado 41,5%(17/41)

Cristamaxilar39% (16/41)

Ductonasofrontal 19,5%(8/41) ‘‘Ethmoidalcrest’’ Cristaethmoidalis Cristaetmoidal

73,2%(30/41)

Cristaetmoidaldoosso palatino26,8%(11/41) ‘‘Frontalsinusdrainage

pathway’’

n.e Recessofrontal63,4% (26/41) Viadadrenagemdo Seiofrontal26,8% (11/41)a DrenagemdoSeio frontal9,8%(4/41)

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‘‘Frontalsinus’’ Sinusfrontalis Seiofrontal95,1%

(39/41) Cavidadeparanasal Frontal2,45%(1/41) Cavidadefrontal2,45% (1/41) ‘‘Frontalintersinus septum’’ Septumsinuum frontalium Septointersinusal doseiofrontal92,7% (38/41) Septointerfrontal7,3% (3/41) ‘‘Frontalsinus infundibulum’’

n.e. Infundíbulodoseio

frontal63,4%(26/41)

aserabandonado 29,3%(12/41)

Infundíbulofrontal 7,3%(3/41) ‘‘Frontoethmoidalcells’’ Bullaefrontales(sing.:

bullafrontalis)

Célulasfrontoetmoidais 97,6%(40/41)

Célulasintrafrontais 2,4%(1/41)

‘‘Intersinusseptalcell’’ n.e. Celulaseptal

intersinusal63,4% (26/41)

Célulainterfrontal 34,1%(14/41)

Céluladoseptosinusal 2,5%(1/41)

‘‘aserabandonado’’ n.e.(cellula

ethmoidalisanterior)

aserabandonado 85,4%(35/41)

Bulafrontal14,6% (6/41)

‘‘Frontalsinusopening’’ Aperturasinus frontalis

ÓstiodoSeioFrontal 48,8%(20/41)

AberturadoSeio frontal34,1%(14/41)

Recessofrontal17,1% (7/41)

‘‘Frontalbeak’’ Spinafrontalis(ossis frontalis

EspinhaFrontal 41,5%(17/41)

Bicofrontal34,1% (14/41)

Espinhanasalsuperior 24,4%(10/41) ‘‘Posteriorethmoidal complex’’ Cellulaeethmoidales posteriores Célulasetmoidais posteriors80,5% (33/41)

Seioetmoidalposterior 9,8%(4/41)

ComplexoEtmoidal Posterior9,8%(4/41) ‘‘Sphenoethmoidalcell’’ n.e.(cellula

ethmoidalisposterior) Célulaesfeno-etmoidal 48,8%(20/41) CéluladeOnodi43,9% (18/41) Célulaetmoidal posterior7,3%(3/41) ‘‘Basallamellaof superiorturbinate’’

n.e Lamelabasalda

conchanasalsuperior 100%(41/41) ‘‘Laminapapyracea’’ Laminaorbitalisossis

ethmoidalis Lâminapapirácea daparedemedialda órbita87,8%(36/41) Paredemedialda órbita12,2%(5/41)

‘‘Orbitalapex’’ n.e Ápiceorbitário100%

(41/41)

‘‘AnnulusofZinn’’ Annulustendineus

communis

Aneltendinosocomum 58,5%(24/41)

Ânuloorbital41,5% (17/41)

‘‘Ophthalmicartery’’ Arteriaophthalmica ArtériaOftálmica 100%(41/41)

‘‘Sphenoidsinus’’ Sinussphenoidalis SeioEsfenoidal

97,6%(40/41) CavidadeEsfenoidal 2,4%(1/41) ‘‘Sphenoidintersinus septum’’ Septumsinuum sphenoidalium SeptoInteresfenoidal 56,1%(23/41) Septointersinusaldo seioesfenóidal43,9% (18/41)

‘‘Sphenoidseptations’’ n.e. SeptosIntraesfenoidais

75,6%(31/41)

Septointersinusaldo seioesfenóidal24,4% (10/41)

‘‘Sphenoidsinusostium’’ Ostium(apertura) sinussphenoidalis

Óstiodoseioesfenoidal 100%(41/41)

Óstiodacavidade esfenoidal0,0% ‘‘Planumsphenoidale’’ Jugumsphenoidale Planoesfenoidal

100%(41/41)

‘‘Sellarloor’’ n.e. Assoalhodaselatúrcia

73,2%(30/41)

Assoalhoselar26,8% (11/41)

‘‘Pterygoid(Vidian) canal’’

Canalispterygoideus Canalpterigóideo 43,9%(18/41)

Canaldonervovidiano 41,5%(17/41)

Canaldovidiano14,6% (6/41)

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‘‘Foramenrotundum’’ Foramenrotundum Forameredondo

100%(41/41) ‘‘Lateralrecessof

sphenoidsinus’’

n.e. Recessolateraldo

seioesfenoidal100% (41/41)

‘‘Opticnervetubercle’’ Tuberculumnervi optici Tubérculodonervo óptico97,6%(40/41) Proeminênciaósseado nervoóptico2,4% (1/41)

‘‘Opticnervecanal’’ Canalisopticus Canaldonervoóptico

100%(41/41) ‘‘Carotidarterybulge’’ n.e.Proeminênciada

artéricacarótida

Proeminênciada artériacarótida 92,7%(38/41)

Proeminênciaósseada artériacarótidainterna 2,4%(1/41)

Proeminênciada artériacarótida2,4% (1/41)

‘‘Optico-carotidrecess’’ n.e. Recesso

óptico-carotídeo100%(41/41) ‘‘Lateral

craniopharyngeal (Sternberg ´s)canal’’

n.e. Canallateral

crânio-faríngeo56,1%(23/41)

CanaldeSternberg 41,5%(17/41)

Canalcrânio-faríngeo lateral2,4%(1/41) ‘‘Sphenoidrostrum’’ Rostrumsphenoidale Rostrodoseio

esfenoidal100%(41/41)

Rostrodacavidade esfenoidal0,0% ‘‘Vomerovaginalcanal’’ Canalis

vomerovaginalis

Canalvomero-vaginal 97,6%(40/41)

Canalvomerovaginal 2,4%(1/41)

‘‘Palatovaginalcanal’’ Canalispalatovaginalis Canalpalato-vaginal 95,1%(39/41)

canalpalatoesfenoidal 2,45%(1/41)

Canalpalatovaginal 2,45%(1/41) ‘‘Anteriorcranialfossa’’ Fossacraniianterior Fossacranianaanterior

75,6%(31/41)

Fossaanteriordo crânio24,4%(10/41)

Superfícieanteriorda basedocrânio0,0%

‘‘Olfactoryfossa’’ n.e Fossaolfatória70,7%

(29/41)

ÁreaOlfatória19,5% (8/41)

Goteiraolfatória9,8% (4/41)

‘‘Cribriformplate’’ Laminacribrosa(ossis ethmoidalis) Lâminacribriforme 53,7%(22/41) Placacribriforme29,3% (12/41) Lâminacrivosa17,1% (7/41)

‘‘Cribriformforamina’’ Foraminacribrosa Foramescribriformes 58,5%(24/41) Foramescrivosos 22%(9/41) Lâminacribriforme 9,8%(4/41) ‘‘Laterallamellaof cribriformplate’’

n.e. Lamelalateralda

lâminacribriforme 58,5%(24/41)

LamelalateraldaPlaca Cribiforme24,4% (10/41)

Lamelalateralda lâminacrivosa 17,1%(7/41)

‘‘Ethmoidalroof’’ n.e. Tetodoetmóide61%

(25/41)

Fóveaetmoidal34,1% (14/41)

Fóveaetmoidaldoosso frontal4,9%(2/41)

‘‘Cristagalli’’ Cristagalli Cristagalli95,1%

(39/41)

Processoetmoidal4,9% (2/41)

‘‘Pneumatizedcrista galli’’

n.e. Cristagalli

pneumatizada95,1% (39/41)

Processoetmoidal pneumatizada4,9% (2/41)

‘‘Foramencaecum’’ Foramencaecum Foramencego75,6%

(31/41)

Foramencecum24,4% (10/41)

‘‘Middlecranialfossa’’ Fossacraniimedia Fossacranianamedia 80,5%(33/41)

Fossamediadocrânio 14,6%(6/41)

Fossamedia4,9% (2/41)

‘‘Sella(turcica)’’ Sellaturcica Selatúrcica92,7%

(38/41)

Selaturca4,9%(2/41) Fossapituitária2,4% (1/41)

‘‘Tuberculumsellae’’ Tuberculumsellae Tubérculoselar

65,9%(27/41)

Tubérculodasela 34,1%(14/41)

‘‘Dorsumsellae’’ Dorsumsellae Dorsoselar58,5%

(24/41) Dorsodasela41,5% (17/41) Dorsumsellae0,0% ‘‘Anteriorclinoid process’’ Processusclinoideus anterior(plur.: processusclinoidei anteriores) Processoclinóide anterior92,7%(38/41) Clinóideanterior7,3% (3/41)

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3Termosmaissugeridosporordemdefrequênciasetermoproposto (sublinhado) ‘‘Posteriorclinoid process’’ Processusclinoideus posterior(plur.: processusclinoidei posteriores) Processoclinóide posterior92,7%(38/41) Clinóideposterior7,3% (3/41)

‘‘Posteriorcranialfossa’’ Fossacraniiposterior Fossacraniana

posterior95,1%(39/41)

‘‘Clivus’’ Clivus Clivus95,1%(39/41) Clivo2,45%(1/41) Clivo2,45%(1/41)

n.e.,notexist.

a_Chosen_term.

b _Adapted_after_discussion_with_the_authors_for_better_anatomical_description.

called‘‘meatus’’inotherpartsofthehumanbody.Although thisoptionreceivedfewervotes,itwouldbethemost appro-priateone:‘‘Inferiormeatus’’53.7%(22/41)vs.‘‘Inferior nasal meatus’’ 43.9% (18/41); ‘‘Middle meatus’’ 48.8% (20/41)vs.‘‘Middlenasalmeatus’’17.1%(7/41);‘‘Superior meatus’’48.8%(20/41)vs.‘‘Superiornasalmeatus’’41.5% (17/41).Anotherrecommendedterm thatdid notreceive themost votesonewas‘‘supreme nasalmeatus’’instead of‘‘nasalsuprememeatus’’.Themostvotedterm,‘‘nasal suprememeatus’’,suggeststhatmeatusisabovethenose. Theterm ‘‘olfactoryﬁber(s)’’,48.8%(20/41),although receivingthemostvotes,wasalsopassedoverforanother term,becauseitisimportanttoindicatethatitisa‘‘nerve’’ andtoaddtheterm‘‘nerve’’.Wechosetouse‘‘olfactory nerveﬁbers’’,46.3%(19/41).

It wassuggested that the siteshould be added tothe term‘‘accessory ostium’’,87.8% (36/41), sincethere are otheraccessoryostiainthebody,andtheterm‘‘accessory ostiumofmaxillarysinus’’wassuggested.

Despitethediversevoting,itwasproposedthattheterm ‘‘ethmoidalcells’’ be replaced by ‘‘complexo etmoidal’’

following the English term ‘‘ethmoidal complex’’. The ‘‘ethmoidalcomplex’’ wouldbesubdividedinto‘‘anterior ethmoidalcomplex’’ and‘‘posteriorethmoidalcomplex’’; alsodiverging fromthe mostvoted terms: ‘‘anterior eth-moidalcells’’and‘‘posteriorethmoidalcells’’forthesame reason.

Theterm‘‘frontalsinusdrainagepathway’’wasalso re-discussedconsensuallyandwechose‘‘Viadadrenagemdo Seio frontal’’ (26.8%; 11/41). Although it has been sug-gestedthatweusetheterm‘‘frontalrecess’’(63.4%,26/41) to designate this structure, the chosen term emphasizes that it is a different entity from the ‘‘frontal recess’’, theproposed termof which is ‘‘Recesso frontal’’ (97.6%; 40/41).Althoughcontroversial,theterms‘‘frontalrecess’’ and‘‘frontalsinusdrainagepathway’’aregenerallydistinct entities.Thefrontalrecessisgenerallydeﬁnedasthemost anterosuperior part of the ethmoid, inferior tothe sinus opening.1 _Its_use _as_a_synonym _of _{‘‘frontal}_sinus _drainage pathway’’is notappropriate, sincethe drainagepathway ofthefrontalsinusthroughthefrontalrecessisacomplex one,alteredbytheconﬁguration oftheair cellswithinit andbythedifferentconnectionsoftheuncinateprocess.1_It

commonlyincludesthefrontalrecess,butisnotconstituted exclusively byit. Usually, the frontal recess is posteriorly delimited by the anterior wall of the ethmoidal bulla (if thatis ﬁxedat thebaseof theskull),antero-inferiorly by theaggernasi,laterallybythelaminapapyraceaand inferi-orlybytheterminalrecessoftheethmoidalinfundibulum,if present.Theterm‘‘ductonasofrontal’’(fromthe anatom-ical terminology, ‘‘Ductus nasofrontalis’’) was abandoned because the frontal sinus drainage pathway is not a true duct.Theterm‘‘maxillarycrest’’(fromtheterm‘‘Lacrimal buldge’’inEnglish)wasdeﬁnedforthisimportantstructure asa point of referencefor endoscopic dacryocystorhinos-tomyandisformedbythefrontalprocessofthemaxilla.

Final

consideration

We propose an adapted version in Portuguese of the ‘‘EuropeanAnatomicalTerminologyoftheInternalNoseand Paranasal Sinuses’’,that willhelp withthe publicationof technical announcements, scientiﬁc publications and the teachingoftheinternalanatomicaltermsof thenoseand paranasalsinusesinBrazil.

Conﬂicts

of

interest

Theauthorsdeclarenoconﬂictsofinterest.

References

1.LundVJ,StammbergerH,FokkensWJ,BealeT,Bernal-Sprekelsen M,EloyP,etal.Europeanpositionpaperontheanatomical ter-minologyoftheinternalnoseandparanasalsinuses.Rhinology. 2014;24:1---34.

2.VoegelsRL,MeloNAD,BezerraT.Uniﬁcationofsinonasal anatom-icalterminology.IntArchOtorhinolaryngol.2016;20:1.

3.StammbergerHR,KennedyDW.Paranasalsinuses:anatomic ter-minology and nomenclature. Ann Otol Rhinol Laryngol Suppl. 1995;167:7---16.

4.RudmikL,SmithTL.Developmentofanevidence-basedreview with recommendations using an online iterative process. Int ForumAllergyRhinol.2011;1:431---7.

5.LaytonTB.PrefacetoCatalogueoftheOnodiCollection.Royal CollegeofSurgeonsofEngland;1934.p.i---xx.