Radiographic Analysis of Ethmoid Roof Based on KEROS Classification among Egyptian People Using Multidector CT: A Cross-Sectional Study

Document Type : Original Article


The Department of Radiology* and ENT**, Faculty of Medicine, Al-Azhar University for Girls


Abstract Background: Endoscopic sinus surgery (ESS) is a com-monly prescribed intervention not only indicated for chronic rhinosinusitis, but also applies to many disorders, such as mucocele, optic nerve decompression, sellar and parasellar tumors, and nasal polyposis. Aim of Study: Evaluation of the height of ethmoid roof among the egyptian people using MDCT, classify the meas-urements according to Keros classification and determination of the incidence and degree of asymmetry in the height. Material and Method: This study enrolled 1200 patients who were referred to from the ENT department to the radiology department over a period of 10 months from August 2020 to September 2021 at Al-Zahraa Hospital. We excluded non-adult (<18 years old), non-Egyptian patients to overcome racial variations and ethnic problems. The results were clas-sified according to their Keros classification. Any asymmetries in the ethmoid roof depth and fovea ethmoidalis configuration were examined. Results: The study enrolled 1200 patients, 542 males with a mean age of 34.81±9.35 years, and 658 females with a mean age of 33.35±8.42 years. The average height of the ethmoid roof was 4.85±0.70mm for males and 4.70±0.62mm for females with a statistically significant difference (p<0.001). The number of patients with Class I was 68 (5.7%), and the Class II was 1132 (94.3%). The frequency of Class I in males was 21 (3.87%), and Class II was 521 (96.13%). While, in females, the frequency of Class I was 47 (7.14%), and the Class II was 611 (92.85%). The average age of the Class I patients was 20.64±1.11 years and 34.81±8.49 years for Class II, with a significant difference between both classes (p<0.001). Cases were having asymmetric ethmoid roof with different classifi-cation type on either side of crista galli. Conclusion: The majority of the studied population showed Keros Class II, followed by Class I. The frequency of Class II was higher in males and older population. Age and gender need to be assessed as predictors in future studies.