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Antrum

An antrum is a chamber or cavity within the body, often located in bones or hollow organs, serving functions such as air retention, fluid storage, or glandular secretion.^[1] The term originates from the Latin antrum, borrowed from Ancient Greek ἄντρον (ántron), meaning "cave."^[2] In human anatomy, antra are specialized structures that vary by location, contributing to processes like digestion, respiration, hearing, and reproduction, and they can be affected by conditions such as inflammation or infection.^[3] One of the most prominent antra is the pyloric antrum, a 1-2 cm long segment forming the proximal portion of the stomach's pyloric region, situated between the distal stomach body and the pyloric canal.^[4] It features pyloric glands that secrete mucus for protection and enteroendocrine G cells that produce gastrin to stimulate gastric acid secretion, with fewer rugae (folds) compared to the rest of the stomach.^[4] Clinically, the pyloric antrum is prone to gastritis, characterized by nausea, vomiting, and abdominal cramps, or peptic ulcers, which cause burning pain and potential weight loss.^[3] The maxillary antrum, also known as the maxillary sinus, is the largest paranasal sinus, forming a pyramidal cavity of about 15 cm³ within the maxillary bone.^[5] Positioned above the upper teeth, below the orbit, and adjacent to the nasal cavity, it drains into the middle meatus of the nose via a small ostium and shares innervation with the posterior teeth via the trigeminal nerve.^[5] This proximity makes it relevant in dental procedures, where extractions can lead to oroantral fistulas, and it is commonly involved in maxillary sinusitis, treated with antibiotics or nasal decongestants.^[3]^[5] In the reproductive system, antral follicles (or follicular antra) are fluid-filled cavities within maturing ovarian follicles, typically measuring 2-9 mm in diameter and containing immature egg cells.^[6] These structures develop from primordial follicles during folliculogenesis, with the antrum providing a microenvironment of follicular fluid that regulates oocyte maturation.^[7] The antral follicle count, assessed via ultrasound, serves as a key indicator of ovarian reserve and fertility potential, with abnormalities linked to polycystic ovarian syndrome, which can impair follicle development and lead to infertility.^[3]^[8] Other notable antra include the mastoid antrum, an air-filled cavity in the temporal bone connecting to the middle ear and susceptible to mastoiditis from bacterial infections, and the cardiac antrum, a dilation at the gastroesophageal junction aiding food passage into the stomach.^[3] These diverse structures highlight the antrum's role as a fundamental anatomical feature across multiple bodily systems.

Definition and Etymology

Definition

An antrum is a general term in anatomy referring to a natural cavity, chamber, or sinus situated within a bone or organ, often containing air or fluid and fulfilling structural or physiological roles such as support, secretion, or drainage.^[1]^[9] This designation encompasses various bodily structures observed through dissection and imaging, emphasizing their innate formation rather than any induced or aberrant spaces.^[10] The recognition of antra in anatomical nomenclature dates to the late 17th century, originating from systematic observations in human and comparative anatomy that highlighted these as inherent features distinct from artificial constructs or pathological voids.^[1] Typically, antra are lined with mucosa or specialized epithelium adapted to their environment, and their morphology varies by site, ranging from approximately 1 cm in size to larger volumes, with shapes including pyramidal or funnel-like configurations.^[11]^[12]^[13] For example, the maxillary antrum adopts a pyramidal form within the maxilla, while the gastric antrum presents a funnel-shaped profile.^[12]^[13]

Etymology

The term antrum derives from the Latin antrum, meaning "cave," which itself was borrowed from the Ancient Greek ἄντρον (ántron), referring to a cavern, grotto, or hollow space.^[14]^[1]^[2] This root evokes the idea of a natural, enclosed depression, aligning with its later anatomical applications to body cavities resembling such formations. In classical antiquity, the term appeared in medical writings by Greek physicians, including Hippocrates (c. 460–370 BCE) and Galen (c. 129–c. 216 CE), who used ἄντρον to denote hollows or cavities within the body, such as those associated with paranasal structures.^[15]^[16] These early usages laid the groundwork for its adoption in Latin anatomical texts during the Roman period. The word entered English medical literature in the late 17th century, with the Oxford English Dictionary citing its first known appearance in 1684 within Samuel Pordage's translation of a German anatomical treatise.^[14] Distinctions from related terms highlight antrum's specificity: unlike sinus, which stems from Latin sinus (a curve, fold, or bay) and typically denotes air-filled cranial spaces, antrum emphasizes a deeper, cave-like hollow applicable beyond the skull. In contrast to the general cavity—a broad descriptor for any empty space in the body—antrum carries the historical connotation of a secluded, cavernous recess.

Major Anatomical Antra

Gastric Antrum

The gastric antrum, also known as the pyloric antrum, is the funnel-shaped distal portion of the stomach that connects the gastric body to the pylorus. It measures approximately 1-2 cm in length and features thick muscular walls that facilitate mixing and propulsion of gastric contents.^[4] The inner surface features fewer rugae folds compared to the body of the stomach, which are longitudinal mucosal ridges that increase surface area and allow for expansion during digestion.^[4] Positioned proximally to the pyloric sphincter and adjacent to the duodenum, the antrum forms the lower part of the J-shaped stomach curve.^[17] Its blood supply is derived primarily from the right gastric artery, which provides branches along the lesser curvature, and the right gastroepiploic artery, which supplies the greater curvature and pyloric region.^[18] These vessels ensure adequate perfusion for the antrum's role in the final stages of gastric digestion, where it receives partially processed food from the body of the stomach, further mixes it with enzymes, and regulates its release into the small intestine through coordinated peristaltic contractions.^[17] Histologically, the antral mucosa consists of simple columnar epithelium with deep gastric pits leading to branched pyloric glands, which are shorter and more tortuous than those in the proximal stomach.^[19] These glands are predominantly lined by mucous cells that secrete a protective alkaline mucus layer, along with scattered G cells that produce gastrin to stimulate acid secretion elsewhere in the stomach.^[20] Notably, the antral mucosa lacks parietal cells responsible for hydrochloric acid production, distinguishing it from the fundic and body regions.^[21]

Maxillary Antrum

The maxillary antrum, also known as the maxillary sinus, is the largest of the paranasal sinuses and occupies a pyramid-shaped cavity within the body of the maxilla bone. Its base forms the medial wall adjacent to the lateral nasal cavity, while the apex extends laterally toward the zygomatic bone. In adults, the average volume is approximately 15 mL, though it can range from 10 to 20 mL depending on individual variations such as sex and age. The sinus is divided into recesses, including the alveolar recess inferiorly, zygomatic recess laterally, and infraorbital recess superiorly, with walls comprising the orbital floor superiorly, anterior and posterior faces, and the alveolar process inferiorly. It is lined by a thin layer of pseudostratified ciliated columnar epithelium, known as the Schneiderian membrane, which is continuous with the nasal mucosa and facilitates mucociliary clearance.^[22]^[23]^[24] Development of the maxillary antrum begins during fetal life, with initial evagination from the middle meatus occurring around 17 weeks of gestation, making it the first paranasal sinus to form. At birth, the sinus is rudimentary with a volume of about 6-7 mL, and it undergoes progressive pneumatization postnatally, expanding inferiorly and laterally as the maxilla grows. Significant pneumatization reaches the level below the nasal floor by approximately age 9 years, with further expansion continuing into adolescence, achieving adult dimensions by around 12-18 years as permanent teeth erupt. The sinus drains through the maxillary ostium, a small opening (3-10 mm in diameter) located high on the medial wall, which connects to the middle meatus via the infundibulum and hiatus semilunaris, promoting airflow and secretion drainage but also predisposing to stasis due to its superior position.^[23]^[22]^[25] The maxillary antrum maintains close anatomical relations with surrounding craniofacial structures, influencing its clinical vulnerability. Inferiorly, its floor lies adjacent to the roots of the upper posterior teeth, particularly the molars and premolars, with root apices often abutting or protruding into the sinus in about 35% of cases. Superiorly, the roof corresponds to the orbital floor, separating the sinus from the orbit by a thin bony plate. Medially, it borders the nasal cavity, while posteriorly it adjoins the pterygopalatine fossa. These relations are supplied by branches of the maxillary artery, including the infraorbital and posterior superior alveolar arteries, and innervated by the maxillary division of the trigeminal nerve.^[23]^[22]^[12]

Other Anatomical Antra

Mastoid Antrum

The mastoid antrum is an irregular, air-filled cavity situated in the mastoid portion of the temporal bone, immediately posterior to the middle ear. It serves as the largest air cell in the mastoid air cell system and typically measures up to 1 cm in diameter, yielding a volume of approximately 1 cm³. The antrum communicates posteriorly with the network of mastoid air cells through a short passage known as the aditus ad antrum, which connects it to the epitympanum of the middle ear.^[26]^[27] Development of the mastoid antrum begins prenatally during embryonic weeks 22 to 24, with the antrum itself forming as an initial air space, but significant postnatal pneumatization occurs around age 2 years as epithelial tissue invades the surrounding bone to expand the air cell system. The cavity is lined by a thin mucous membrane that is continuous with the mucosa of the tympanic cavity, consisting of flattened, non-ciliated squamous epithelium.^[28]^[29]^[30] In terms of anatomical relations, the mastoid antrum lies adjacent to the sigmoid sinus plate posteriorly and the posterior cranial fossa, which houses the cerebellum, superiorly via the tegmen mastoideum. Medially, it borders structures such as the lateral semicircular canal and the vertical segment of the facial nerve, while anteriorly it is separated from the external auditory canal by the bony wall. Surgically, the antrum is accessible through a mastoidectomy procedure, where bone is removed to expose the cavity, often guided by landmarks like the spine of Henle.^[31]^[26]

Ovarian Antrum

The ovarian antrum is a fluid-filled cavity that develops within secondary and mature ovarian follicles, serving as a key structural component in folliculogenesis. It forms as a result of proliferation and fluid secretion by granulosa cells surrounding the oocyte, creating a central space that separates the oocyte from the follicular wall. This antrum is essential for the maturation of the follicle, providing a microenvironment that supports oocyte development through the accumulation of follicular fluid.^[32]^[33] The antrum emerges during the antral phase of folliculogenesis, which corresponds to days 5 through 14 of the menstrual cycle in the gonadotropin-dependent stage. Follicle-stimulating hormone (FSH) stimulates granulosa cell proliferation, leading to antrum formation in secondary follicles, with subsequent growth driven by both FSH and luteinizing hormone (LH). Among the cohort of antral follicles, a single dominant follicle is selected and enlarges rapidly, typically reaching a diameter of 20-25 mm by the preovulatory stage, while subordinate follicles undergo atresia. This selective growth process ensures that only the most responsive follicle proceeds toward ovulation.^[32]^[33] The antral fluid, or follicular fluid, is a complex transudate derived from plasma and enriched with secretions from the oocyte and granulosa cells, containing high concentrations of hormones such as estradiol and inhibin. Estradiol levels increase progressively in the antrum of the dominant follicle, peaking in the preovulatory phase to support endometrial preparation, while inhibin modulates FSH secretion to favor dominant follicle dominance. This fluid's composition facilitates nutrient exchange and paracrine signaling within the follicle. Additionally, the antrum's fluid-filled nature makes it visible on transvaginal ultrasound, allowing for non-invasive monitoring of follicular development and ovarian reserve assessment through antral follicle count.^[33]^[34]^[35]

Clinical Significance

Disorders and Conditions

Disorders affecting the gastric antrum primarily include peptic ulcers, antral gastritis, and gastric adenocarcinoma, often linked to Helicobacter pylori infection. Peptic ulcers in the antrum, frequently associated with H. pylori, manifest as abdominal pain, bloating, and potential complications like bleeding or perforation, with a lifetime prevalence of approximately 10% worldwide. H. pylori infection, a key risk factor, has a global prevalence of 43.9% in adults, though rates have declined to 10-20% in developed countries as of recent estimates. Antral gastritis, characterized by inflammation of the antral mucosa leading to symptoms such as epigastric discomfort and nausea, is present in nearly all H. pylori-infected individuals, with endoscopic studies showing nodular antral gastritis in up to 44% of affected cases. Gastric adenocarcinoma originating in the antrum accounts for about 30% of all stomach cancers, presenting with vague symptoms like early satiety and weight loss; its incidence is elevated in H. pylori-positive populations, contributing to roughly 76% of global gastric cancer cases. Conditions involving the maxillary antrum, the largest paranasal sinus, commonly encompass chronic rhinosinusitis and odontogenic infections. Chronic rhinosinusitis affects the maxillary antrum in many cases, causing facial pain, nasal congestion, and reduced sense of smell, with a global prevalence of 8.7% and up to 11.6% in the United States adult population. Odontogenic infections, arising from dental sources such as periapical abscesses or failed root canals, account for approximately 40-50% of maxillary sinusitis cases, leading to unilateral symptoms including toothache radiating to the sinus and purulent discharge; these are particularly prevalent in patients with untreated dental pathology, representing up to 50% of chronic maxillary sinus infections on imaging.^[36] Pathologies of other antra include mastoiditis in the mastoid antrum and antral follicle disturbances in the ovaries. Mastoiditis, an infection of the mastoid air cells often complicating acute otitis media, presents with postauricular swelling, ear pain, and fever; it occurs in less than 1% of otitis media cases post-antibiotic era, with surgical intervention rates around 0.004% in the United States. In the ovaries, polycystic ovary syndrome (PCOS) features multiple small antral follicles (typically 12 or more per ovary, 2-9 mm in diameter), leading to irregular menstruation, hirsutism, and infertility; PCOS affects 6-13% of reproductive-aged women globally, with up to 70% undiagnosed. Across antra, obstruction poses a general risk for secondary infection or malignancy, as seen in sinus blockages exacerbating sinusitis or antral narrowing promoting carcinogenesis in the stomach. Updated epidemiology as of 2025 indicates declining H. pylori rates in developed nations, potentially reducing associated antral disorders, while global burdens persist in regions with higher infection prevalence.

Diagnostic and Therapeutic Approaches

Diagnostic approaches to antrum-related conditions vary by anatomical site, with endoscopy serving as a primary method for evaluating the gastric antrum. Upper gastrointestinal endoscopy allows direct visualization of the gastric mucosa and facilitates biopsy sampling from the antrum to detect Helicobacter pylori infection, which is confirmed histologically through the identification of bacterial organisms on stained tissue sections.^[37] Biopsies are typically taken from both the antrum and corpus to improve diagnostic accuracy, as H. pylori distribution can be patchy.^[38] For the maxillary and mastoid antra, computed tomography (CT) and magnetic resonance imaging (MRI) are essential for assessing structural abnormalities such as opacification, which indicates mucosal thickening or fluid accumulation. CT scans provide detailed visualization of sinus opacification and bony erosion in the maxillary antrum, aiding in the diagnosis of inflammatory conditions like sinusitis.^[39] In the mastoid antrum, CT detects air cell opacification, which may signal infection or other pathologies without requiring contrast in routine cases.^[40] MRI complements CT by better delineating soft tissue involvement in complex cases.^[41] Ovarian antrum evaluation relies on transvaginal ultrasound to perform antral follicle counting, a non-invasive technique that measures the number of small follicles (typically 2-10 mm in diameter) in both ovaries to assess ovarian reserve. This method involves a standardized protocol where follicles are counted in real-time during the early follicular phase, providing prognostic information for fertility potential.^[42] The antral follicle count correlates with reproductive outcomes and is performed using high-frequency transducers for optimal resolution.^[43] Therapeutic interventions for antrum conditions are tailored to the underlying pathology, beginning with medical management for infections. For bacterial sinusitis affecting the maxillary antrum, amoxicillin-clavulanate is recommended as first-line antibiotic therapy, administered at 875 mg orally twice daily for 5-7 days in adults to cover common pathogens like Streptococcus pneumoniae.^[44] In cases of persistent obstruction, surgical options include maxillary antrostomy, which creates an opening in the sinus wall for drainage, often performed endoscopically. Functional endoscopic sinus surgery (FESS) extends this approach by addressing multiple sinuses, including the maxillary antrum, using a rigid endoscope to widen ostia and remove diseased tissue while preserving mucosa.^[45] For H. pylori-associated gastric antrum conditions, first-line eradication therapy is bismuth-based quadruple therapy, consisting of a proton pump inhibitor (PPI), bismuth subsalicylate, tetracycline, and metronidazole, administered for 14 days to achieve eradication rates exceeding 90% in many populations. Clarithromycin-based triple therapy (PPI, clarithromycin, amoxicillin) for 14 days may be considered in regions with confirmed low clarithromycin resistance or after susceptibility testing, though resistance testing is increasingly advised due to rising global resistance rates.^[46] As of 2025, advancements in diagnostic and therapeutic approaches include AI-assisted imaging for early detection of gastric antral neoplasms. Deep convolutional neural networks integrated with endoscopy achieve high sensitivity (over 90%) in identifying early gastric cancer lesions in the antrum by analyzing mucosal patterns in real-time during procedures.^[47] For mastoid antrum interventions, minimally invasive robotic systems enable precise drilling during mastoidectomy, reducing trauma to surrounding structures through cooperative control and virtual safety barriers, with studies demonstrating sub-millimeter accuracy in cadaveric models.^[48]

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