Secondary pneumatization patterns occur within the paranasal recess, in which the diverticula exit the boundaries of the nasal capsule to become extracapsular and is left occupying space in adjacent structures, causing the paranasal recess to become a paranasal sinus. These stages generate diverticular pouches that expand inside the boundaries of the capsule, which fabricate elaborate intracapsular airway spaces. Certain stages are necessary for the development of the paranasal sinus, which includes primary and secondary pneumatization patterns that call for differential growth of the cartilaginous olfactory capsule. Unlike all of the other sinuses, the ethmoid bone develops from the cartilaginous olfactory capsule or paleosinus while the other paranasal sinuses extend from the ethmoid into the membranous bone through epithelial diverticula extensions. The ethmoid bone starts to form at about 25 to 28 weeks of gestation. The ethmoid bones develop primarily through endochondral ossification. Thus, the ethmoid bone can become impaired through inflammation, infections, trauma, and complications during functional endoscopic surgery (FESS). It also influences drainage from the frontal and maxillary sinuses via the osteomeatal complex. The ethmoid bone is situated in the paranasal sinuses and hosts the ethmoid air cells, which are responsible for olfactory sensation, humidification, phonation, and ventilation. The ethmoid articulates with 13 bones: the frontal, sphenoid, nasals, maxillae, lacrimals, palatines, inferior nasal conchae, and vomer. Located between the ethmoid plate and nasal conchae are the ethmoid sinuses. The ethmoid bone also hosts the infundibulum of the frontal sinus and the ostium of the maxillary sinus inside the osteomeatal complex. The superior and middle turbinate arise from the ethmoidal lateral masses and become the superior and middle meatus. The ethmoid bone encloses ethmoidal cells and is separated from the orbits by the lamina papyracea. The ethmoid bone consists of the cribriform plate, two ethmoid labyrinths, and the perpendicular plate. It is relatively light and has a spongy texture. The ethmoid bone is a small bone with a cuboidal structure that forms the lateral boundaries of the orbit, the anterior cranial fossa superiorly, and the nasal cavities inferiorly.
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