Evaluation of ostiomeatal complex pathology related to endoscopic sinus surgery – a retrospective analysis

Abstract BACKGROUND. The ostiomeatal complex (OMC) is the anatomical region situated between the middle turbinate and the lateral nasal wall, at the level of the middle meatus. Common anatomical variations of OMC are concha bullosa, hypertrophy of the uncinate process and of the bulla ethmoidalis and Haller’s cell. Our study was aimed to investigate the prevalence of these conditions and their relations to different symptoms. MATERIAL AND METHODS. The study is a retrospective descriptive study based on 256 files of patients who were hospitalized and treated for OMC pathology in our clinic between January 2009 and January 2014. The data acquired were included into Excel Worksheets and statistically analyzed using GraphPad Software. RESULTS. The most common finding was concha bullosa (63.67%), followed by hypertrophy of the bulla ethmoidalis (10.93%) and of the uncinate process (10.15%). Haller’s cell was found in only 3% of cases. The most common symptom for all patients was nasal obstruction, followed by nasal discharge. The majority of symptoms improved after functional endoscopic sinus surgery for OMC drainage. CONCLUSION. OMC pathology is a frequent indication for functional endoscopic sinus surgery. The most common condition that determines blockage of OMC and need for surgical treatment is concha bullosa. The most common complaint of patients with OMC pathology is nasal obstruction.

Download Full-text

Effect of functional endoscopic sinus surgery on the symptom profile in chronic rhinosinusitis cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200154 ◽

2020 ◽

Vol 6 (2) ◽

pp. 375

Author(s):

G. Syam Manohar ◽

Khan Majid Jabbar

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Facial Pain ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Nasal Discharge ◽

Symptom Profile

Background: Chronic rhinosinusitis (CRS) is a common chronic disease, that have considerable impact on quality of life, functional and emotional impairments of affected beings. Post-surgical improvement of quality of life indicates the surgical success. Functional endoscopic sinus surgery (FESS) is the dominating surgical procedure for CRS. This study was designed to assess the symptom profile of patient before and after surgery and the complications after FESS in the post-operative period.Methods: A total of 50 cases attending ENT outpatient department with clinical features and investigations suggestive of chronic sinusitis with infective pathology were randomly considered for this study. Cases were assessed for CRS symptoms pre and post operatively using grading symptoms. Results: Common major symptom was nasal obstruction (93.3%, N=28) followed by post nasal drip (83.33%, N=25), purulent nasal discharge (76.66%, N=23), facial pain/pressure (66.66%, N=20) and hyposmia (60%, N=18). None of the patients reported fever and facial congestion or fullness. Post operatively, cases with nasal obstruction (92.8%), purulent nasal discharge (86.9%), facial pain or pressure (85%), headache (81.8%), post nasal drip (84%), ear pain or fullness or pressure (92.8%) and hyposmia (61.1%) showed improvement after FESS at the end of three follow-up.Conclusions: The most common symptom pre operatively was nasal obstruction which also responded best to FESS, along with all the other minor symptoms including headache. The results of this study confirm that FESS is an excellent method of treatment in patients with CRS refractory to medical treatment.

Download Full-text

TO EVALUATE THE RESULTS OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY TO PATIENTS SUFFERING FROM CHRONIC SINUSITIS WITH SPHENOID SINUSITIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.6.16 ◽

2017 ◽

pp. 114-121

Author(s):

Xuan Trung Ho ◽

Van Dung Phan ◽

Tu The Nguyen ◽

Thanh Thai Le

Keyword(s):

Ct Scan ◽

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

University Hospital ◽

Sinus Surgery ◽

Nasal Discharge ◽

Sphenoid Sinusitis ◽

Grade Iii

Objective: To evaluate the features and CT scan of chronic sinusitis with sphenoid sinusitis. To evaluate the results in patients undergoing Functional Endoscopic Sinus Surgery. Subjects and Method: a prospective descriptive study with intervention was designed for 34 patients at Hue Pharmacy and Medicine University hospital and Da nang hospital. Results: almost all patients presented nasal discharge, headache and nasal obstruction. Endoscopic assessment: grade III-IV 82,3%, grade I-II 17,7%. CT scan assessment: grade III-IV 85,2%, grade I-II 14,8%. 34 patients were followed up after 6 months. Conclusions: almost common presenting complaints were nasal discharge, headache and nasal obstruction. Majority of patients were better in symptoms, endoscopic and CT scan features. Key words: sphenoid sinusitis, chronic sinusitis, endoscopic sinus surgery

Download Full-text

Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181853 ◽

2018 ◽

Vol 4 (3) ◽

pp. 694 ◽

Cited By ~ 1

Author(s):

Neeraj Suri ◽

Bhavya B. M.

Keyword(s):

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Histological Evaluation ◽

Nasal Discharge ◽

Fungal Sinusitis ◽

Surgical Specimen ◽

Specimen Handling ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis

Background: The objective of the study was to evaluate the criteria for diagnosing allergic fungal rhinosinusitis and to maintain permanent drainage and ventilation, while preserving the integrity of the mucosa.Methods: This is a prospective study of 50 patients with allergic fungal sinusitis with or without polyposis all of whom were treated with endoscopic debridement. Mucous sample collection, nasal secretion culture, surgical specimen handling, and histological evaluation of surgical specimens are described. All patients treated with endoscopic sinus surgery, debridement, post-operative use of steroids and antifungal therapy. Results: Fungal mucin was found in all 50 cases, histology and fungal cultures confirmed the diagnosis. Out of 50 patients, 29 were females and 21 were males, with a mean age of 32 years. The most common symptom was nasal discharge 41 (82%) cases, nasal obstruction in 38 (76%) cases, headache and facial pain in 32 (72%) cases, 7 (14%) patients had bronchial asthma. Symptoms of nasal obstruction and nasal discharge were improved in 46 (92%) cases. All preoperative versus postoperative changes in AFRS associated complaints reached statistical significance of p value <0.001 except in patients with asthma.Conclusions: Comprehensive management with endoscopic sinus surgery, oral steroids and antifungals reduces the recurrence or need for revision surgery. Long term follow up is very important.

Download Full-text

Does surgical treatment of nasal airway obstruction improve sexual functions?

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001798 ◽

2019 ◽

Vol 133 (09) ◽

pp. 805-809 ◽

Cited By ~ 2

Author(s):

S Cayir ◽

O Hizli ◽

M Gul

Keyword(s):

Surgical Treatment ◽

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Erectile Function ◽

Sinus Surgery ◽

Concha Bullosa ◽

Sexual Performance ◽

Symptom Evaluation ◽

Operative Evaluation ◽

Operative Assessment

AbstractObjectiveTo investigate the effects of surgical treatment for nasal obstruction on sexual functions, regardless of the condition causing the nasal obstruction.MethodsOf 238 patients identified with nasal obstruction, 57 complained of erectile dysfunction and were included in the analysis. Patients underwent septoplasty, functional endoscopic sinus surgery, concha bullosa excision or radiofrequency ablation of the inferior turbinates, depending on their obstruction-causing disease. Pre- and post-operative evaluation of perceived nasal obstruction was performed using the Nasal Obstruction Symptom Evaluation questionnaire. Pre- and post-operative assessment of sexual functions was performed using the International Index of Erectile Function.ResultsMean post-operative scores for erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall sexual satisfaction were significantly higher compared to the pre-operative scores (p = 0.022, p = 0.036, p = 0.033, p = 0.016 and p = 0.029, respectively).ConclusionSurgical treatment of nasal obstruction by septoplasty, endoscopic sinus surgery, concha bullosa excision or radiofrequency can significantly improve sexual performance.

Download Full-text

Paranasal Sinus Mucoceles in Cystic Fibrosis

American Journal of Rhinology ◽

10.2500/105065893781976609 ◽

1993 ◽

Vol 7 (1) ◽

pp. 31-35 ◽

Cited By ~ 12

Author(s):

William E. Davis ◽

Giulio J. Barbero ◽

William R. LaMear ◽

Jerry W. Templer ◽

Peter Konig

Keyword(s):

Cystic Fibrosis ◽

Paranasal Sinus ◽

Computerized Tomography ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

The Other ◽

Sinus Surgery ◽

Lateral Nasal Wall ◽

Osteomeatal Complex

Six patients between the ages of 6 and 22 years old with cystic fibrosis were found to have mucoceles of the paranasal sinuses. Four were male and two were female. They experienced nasal obstruction, purulent rhinorrhea, and anosmia, but none had fever or pain. Nasal endoscopy and coronal computerized tomography scans revealed the lateral nasal wall to be displaced medially against the septum. Functional endoscopic sinus surgery revealed large cystic spaces filled with thick yellow-green mucus. Postoperatively most patients are able to smell and breathe through their noses. The mucocele probably begins as an obstructed anterior ethmoid cell, which then enlarges and obstructs the osteomeatal complex, which further impairs drainage of the other sinuses into this area.

Download Full-text

Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1259 ◽

2016 ◽

Vol 9 (1) ◽

pp. 28-32 ◽

Cited By ~ 2

Author(s):

V Narendrakumar ◽

V Subramanian

Keyword(s):

Endoscopic Sinus Surgery ◽

Middle Turbinate ◽

Preoperative Assessment ◽

Ct Scanning ◽

Anatomical Variations ◽

Uncinate Process ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Frequency Of Occurrence ◽

Osteomeatal Complex

ABSTRACT Aims To study the anatomical variations of osteomeatal complex and the importance of preoperative computed tomography (CT) in patients with chronic sinusitis undergoing functional endoscopic sinus surgery. We studied the different variations and their frequency of occurrence. Materials and methods A total of 100 patients undergoing endoscopic sinus surgery were studied by nasal endoscopy, CT scanning, and at the time of definitive surgery, variations were recorded. Results The frequency of occurrence of sinonasal anatomical variations was septal deviation in 76%, agger nasi cells in 71%, concha bullosa in 61%, medialized uncinate process in 48%, prominent bulla ethmoidalis in 41%, paradoxical middle turbinate in 33%, accessory maxillary ostium in 28%, frontal cell in 22%, intumescentia septi nasi anterior in 21%, lateralized uncinate in 15%, pneumatized uncinate process in 4%, Haller cells in 12%, and Onodi cells in 8%. Conclusion The high incidence of variations emphasizes the need for proper preoperative assessment for safe and effective endoscopic sinus surgery. How to cite this article Narendrakumar V, Subramanian V. Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery. Clin Rhinol An Int J 2016;9(1):28-32.

Download Full-text

TREATMENT OF CHRONIC SINUSITIS BY SEPTOPLASTY WITH TURBINOPLASTY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.6.8 ◽

2018 ◽

Vol 8 (6) ◽

pp. 59-67

Author(s):

Thanh Dang ◽

Hien Le Xuan ◽

Quang Nguyen Ngoc Minh

Keyword(s):

Nasal Obstruction ◽

Chronic Sinusitis ◽

High Rate ◽

Nasal Discharge ◽

Concha Bullosa ◽

Cross Sectional ◽

Ostiomeatal Complex ◽

Medium Level ◽

Key Words Chronic Sinusitis ◽

Smell Disorders

Objective: To study the clinical, paraclinical features and evaluate the treatment results of patients who have chronic sinusitis with abnormal nasal septal and nasal tubinate by septoplasty and turbinoplasty. Material and method: 40 patients were diagnosed chronic sinusitis, operated by septoplasty and turbinoplasty. Methods are cross sectional and propective studies. Results: Percentage of male (57.5%), female (42.5%). The most common age group is 16-30 years old (72.5%). Main reason for being hospitalized is nasal obstruction (65%). Funtional symtoms: headache (77.5%), nasal obstruction (97.5%), nasal discharge (60%), smell disorders (20%). Physical symtoms: mucosal oedema (87.5%), fluid in nasal cavity (90%), partial obstructed ostiomeatal complex (47.5%), 100% patients without nasal polyps. The most prevalent morphologies of nasal septal is deviation (50%). Medium level of nasal septal deviation is most common (67.5%). Nasal septal deformities (NSD) in area 4.5 has a higher rate (70%) than area 1,2,3 (30%). 37 patients have hypertrophy inferior tubinate: soft (57.8%), both side (67.6%). 7 patients (100%) have concha bullosa, left and right side at the same rate (42.85%). After 3 months, results through funtional symtoms: very good (80%), good (20%). Results through nasal endoscopy: very good (70%), good (20%). 100% of patients have straight nasal septal, 95% have thin tubinate. Conclusions: Treatment of chronic sinusitis with abnormal nasal septal and turbinate by septoplasty and turbinoplasty have high rate in very good result. Key words: Chronic sinusitis, nasal septal deformities, hypertrophy inferior tubinate, concha bullosa

Download Full-text

Retroverted Uncinate Process: An Anatomic Variation

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v24i2.691 ◽

2009 ◽

Vol 24 (2) ◽

pp. 40 ◽

Cited By ~ 1

Author(s):

Armando T. Isla ◽

Josefino G. Hernandez

Keyword(s):

Endoscopic Sinus Surgery ◽

Anatomic Variation ◽

Middle Turbinate ◽

Uncinate Process ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Anatomic Variations ◽

Intelligent Decision Making ◽

Intelligent Decision ◽

Ct Analysis

Considerable attention has been directed toward analysis of paranasal sinus anatomy through coronal plane computerized tomographic (CT) imaging in this age of functional endoscopic sinus surgery. Recently, it has become apparent that anatomic variations are also evident on CT analysis of patients. Subtle anatomic features can now be imaged through CT, with a level of clarity previously not afforded by standard sinus radiographs.1 The key to a successful endoscopic sinus surgery is the proper identification of landmarks, and intelligent decision-making should there be any doubts as to what structure lies ahead. The middle turbinate is the main landmark in the region and should be preserved if possible. Attention to the limits of the middle turbinate landmark is one of the keys to uncomplicated surgery.2 The presence of a retroverted uncinate process, wherein the uncinate process ( rather than the middle turbinate) is the first bone to encountered, can be misleading to the rhinologic surgeon and lead to inadequate surgery. Familiarity with anatomic variations such as the retroverted uncinate process should increase the safety and effectiveness of functional endoscopic sinus surgery.

Download Full-text

Mucocele of a giant inferior turbinate concha bullosa mimics a nasal mass: case report

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00128-3 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Kamal Ebeid ◽

Mohamed H. Askar

Keyword(s):

Nasal Cavity ◽

Endoscopic Sinus Surgery ◽

Nasal Septum ◽

Inferior Turbinate ◽

Sinus Surgery ◽

Lateral Nasal Wall ◽

Complete Disappearance ◽

Concha Bullosa ◽

Left Nasal Cavity ◽

Nasal Tumors

Abstract Background The concha bullosa is a pneumatized nasal turbinate commonly middle turbinate but that of the inferior turbinate is an uncommon entity. A giant inferior conchal pneumatization with mucocele formation is not reported in the literature till now. Case presentation A 17-year-old female patient presented with bilateral severe nasal obstruction. Anterior rhinoscopy and endoscopic examination revealed a giant mass which filled the left nasal cavity completely, pushing the septum to the contralateral side. The paranasal sinus CT showed a mass in the left nasal cavity ballooning the whole nasal cavity with compression of the nasal septum to the right side. MRI was done and the lesion was hyperintense in T2 MRI sequences and hypointense in T1 sequences consistent with a cystic lesion. The patient was consented and prepared for endoscopic resection under general anesthesia. The lesion was completely separated from the nasal septum and the orbit but attached to the lateral nasal wall at the site of origin of the inferior turbinate. Conchoplasty was done and patient follow-up for 9 years is excellent with complete disappearance of all patient symptoms. Conclusions Concha bullosa of the inferior turbinate should be considered in the differential diagnosis of nasal tumors, nasal cystic lesions, and preoperative evaluation of endoscopic sinus surgery. Also, a systematic approach for dealing with nasal lesions with thorough examination and radiological review will be of great value in decision-making. The anatomy of the paranasal should be thoroughly examined prior to endoscopic sinus surgery to develop treatment strategies and to prevent possible complications.

Download Full-text

Two Case Reports of Antrorhinoliths

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1171 ◽

2014 ◽

Vol 6 (3) ◽

pp. 118-120 ◽

Cited By ~ 1

Author(s):

Santosh Kumar Swain ◽

Ranjan Kumar Sahoo ◽

Mahesh Chandra Sahu

Keyword(s):

Nasal Cavity ◽

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Histopathological Examination ◽

Case Reports ◽

Radiological Examination ◽

Sinus Surgery ◽

Nasal Discharge ◽

Ostiomeatal Complex ◽

Bony Mass

ABSTRACT Antrorhinolith is an uncommon nasal mineralized mass of nasal cavity invading into maxillary sinus. Most antrorhinoliths are small and asymptomatic, caused by calcification of a nidus and are detected incidentally on radiological examination. Sometimes they present symptoms like pain and foul smelling nasal discharge. Here, we are presenting two cases of antrorhinoliths. One was found after endoscopic sinus surgery and second one was seen in patient with prolonged use of topiramate medication. In all these two cases, radiological examination revealed a discrete bony density in the nasal cavity and maxillary sinus which was blocking the ostiomeatal complex. The bony mass was removed endoscopically from the nasal cavity and maxillary sinus with drainage of discharge and debris from the sinuses. Histopathological examination revealed an antrolith with bony nidus and calcium deposited around it. How to cite this article Swain SK, Sahoo RK, Sahu MC. Two Case Reports of Antrorhinoliths. Int J Otorhinolaryngol Clin 2014;6(3):118120.

Download Full-text