Ct Evaluation of Anatomical Variations In Osteomeatal Complex in Patients with Deviated Nasal Septum

Background:The presence of septal deviation has been positively associated with sinus disease, especially osteomeatal complex disease and anterior and posterior ethmoid disease.Computerized tomographic imaging (CT) of the paranasal sinuses has become a widely accepted tool for assessing the paranasal sinuses (PNS) and providing a detailed anatomy of the lateral nasal wall.Objective:The objective of the study was to identify the anatomical variations of lateral nasal wall and paranasal sinuses in patients with Deviated nasal septum.Methods:Computerized tomographic (CT) examination was carried out using the bone algorithm in the coronal plane in 40 patients who met the inclusion criteriain the Postgraduate Department of Otorhinolaryngology and Head and Neck Surgery, SMHS Hospital an associated Hospital of Government Medical College, Srinagar from March 2011 to May 2012.Results:In our study, CT Nose and PNS revealed Deviated nasal septum in 40 (100%) patients, Hypertrophied Inferior turbinate in 11 (27.50%) patients, Concha bullosa in 5 (12.50%) patients, Paradoxical Middle turbinate in 8 (20%) patients, Everted Hypertrophied Uncinate in 2 (5%) patients, Aggernasi cells in 4 (10%) patients, Haller cells in 3 (7.50%) patients and Onodi cells in 2 (5%) patients.Conclusion:The most common anatomical variation associated with deviated nasal septum was Hypertrophied Inferior turbinate and the least encountered variation was Everted Hypertrophied Uncinate and Onodi cells. The CT scan provides supplementary clinical data to the history and endoscopic examination and assists in directing surgical treatment to the affected areas.Bangladesh J Otorhinolaryngol; October 2015; 21(2): 90-93

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Radiological significance of the sinonasal anatomical variants in recurrent acute rhinosinusitis patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172121 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2379

Author(s):

Niranjan Sahu ◽

Satya Sundar G. Mohapatra ◽

Siba N. Rath ◽

Rabindra N. Padhy

Keyword(s):

Nasal Septum ◽

Middle Turbinate ◽

Uncinate Process ◽

Sinus Surgery ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Anatomical Variants ◽

Acute Rhinosinusitis ◽

Computed Tomography Images ◽

Osteomeatal Complex

Background: Recurrent acute rhinosinusitis (RARS), a low form chronic rhinosinusitis is frequently under evaluated. The significance of sinonasal anatomical variants of osteomeatal complex (OMC) and spheno-ethmoidal (SE) recess regions in patients of RARS is assessed.Methods: Retrospective analysis of coronal sinonasal computed tomography images of 120 RARS patients presented with sinonasal anatomical variants during November 2013 to October 2016 was carried out. Patients with acute and expansile sinonasal lesions are excluded.Results: Sinonasal anatomical variants in the regions of OMC and SE recess are responsible for obstruction of normal mucociliary drainage of corresponding paranasal sinuses in presence of inflammation predisposing to RARS. Anatomical variants of nasal septum were, deviated nasal septum (DNS) in 86 (72%) and septal spur in 58 (48%) patients. Anatomical variants in OMC region were, pneumatized middle turbinate (concha bullosa) in 50 (48%), paradoxical middle turbinate in 38 (28%), giant ethmoid bulla in 35 (32%), agger nasi cell in 29 (38%), Haller cell in 23 (15%), pneumatised uncinate process in 20 (18%), medialized uncinate process in 18 (22%) and septated maxillary sinus in 5 (4%) patients. Anatomical variants in SE recess were superior concha bullosa in 14 (12%) and septal bullosa in 11 (9%) patients.Conclusions: OMC pattern of recurrent rhinosinusitis is often prevalent in patients of RARS due to abundance of anatomical variants in the OMC region. DNS or ethmoid bulla when gets associated with concha bullosa increased the incidence of RARS. Present analysis would help surgeons to evaluate RARS patients for selective endoscopic sinus surgery.

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Anatomical variations in patients with chronic sinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180702 ◽

2018 ◽

Vol 4 (2) ◽

pp. 428 ◽

Cited By ~ 1

Author(s):

Pragadeeswaran Kumarasekaran ◽

Rajprakash Dharmapuri Yadhava krishnan ◽

Gurumani Sriraman

Keyword(s):

Nasal Septum ◽

Chronic Sinusitis ◽

Anatomical Variation ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

Sinus Surgery ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Anatomical Variant

Background: Chronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. Methods: Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed. Results: In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. Conclusions: In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process. Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.

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Computed tomography of paranasal sinuses for early and proper diagnosis of nasal and sinus pathology

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20160957 ◽

2016 ◽

Vol 2 (2) ◽

pp. 70 ◽

Cited By ~ 2

Author(s):

Jagram Verma ◽

Sushant Tyagi ◽

Mohit Srivastava ◽

Aman Agarwal

Keyword(s):

Nasal Obstruction ◽

Paranasal Sinuses ◽

Wide Spectrum ◽

Anatomical Variations ◽

Nasal Discharge ◽

Nasal Allergy ◽

Ct Scanner ◽

Deviated Nasal Septum ◽

Anatomical Variant ◽

Ct Evaluation

Background: Pathological lesions of the paranasal sinuses include a wide spectrum of conditions ranging from inflammation to neoplasms both benign and malignant. Most patient of common cold present with symptoms of nasal discharge, nasal obstruction, headache and nasal allergy etc. The patient of paranasal mass usually present with facial deformity, swelling or repeated episodes of epistaxis. The aim of the study was to establish the role of CT in evaluation of pathologies and their proper early diagnosis.Methods: It is a prospective study. A total of 100 patients who were referred to our department with clinical suspicion of PNS disease underwent CT evaluation of PNS using 64 multi slice CT scanner from December 2012 to October 2015. Results: Out of 100 cases 51 (51%) cases were males and rest 49 (49%) patients were females. The majority of the cases were of age group 16-30 which were 37case (37%) The most common symptoms were nasal obstruction (50%), followed by nasal discharge (49%), headache in 20% cases. Most common anatomical variations seen was deviated nasal septum (49%) more commonly on right side next common was agger nasi in 48% of cases. Maxillary sinuses are most commonly involved in the study (82 cases), followed by the ethmoid sinuses (ant. group 77 cases, post group 40 case) and frontal sinus 55 cases. The most common pathology seen was masses in 30% cases followed by DNS in 21% cases. The most common form of mucosal thickening noted is circumferential type seen in 7% cases. The most common pathology involving the sinuses was sinusitis (30%) followed by polyp (25%).Conclusions: Most of the patients with PNS pathology were from 2nd and 3rd decade. Slight male preponderance was noted. Majority of the patients presented with nasal obstruction. Most common anatomical variant seen was DNS. Most common sinus involved was maxillary. Sinonasal pathologies were the most common followed by pure nasal or pure sinosal. The most common pathology was inflammatory (74%). The most common benign pathologies were polyps with 92% accuracy. 15% of cases had malignancy with diagnostic accuracy of 90%.

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A clinico-radiological study of anatomical variations of nose and para-nasal sinuses in chronic rhinosinusitis patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182709 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1040

Author(s):

Daya Shankar ◽

Sunil Kumar ◽

H.P. Singh ◽

Veerendra Verma ◽

Anupam Mishra

Keyword(s):

Ct Scan ◽

Nasal Septum ◽

Anatomical Variations ◽

Uncinate Process ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Nasal Sinus ◽

Female Ratio

Background: There are a lot of anatomical variations in para-nasal sinuses that are responsible for various sinus pathologies. CT scan of paranasal sinuses prior to functional endoscopic sinus surgery has become extremely important to know the anatomy and its variations to avoid complications during surgery.Methods: This study was performed in 100 patients at King George’s Medical University, Lucknow UP, India to compare the anatomical variations between nasal endoscopy and CT scan findings. The outcome measures were deviated nasal septum, paradoxical middle turbinate, concha bullosa, medialized/lateralised uncinate process, pneumatized uncinate process, large ethmoid bulla, accessory ostium, Agger nasii cells, Haller’s cells and Onodi cells. Results: In this study the age of the patients were 30.00±9.56 yrs. with male to female ratio 1.9:1. Deviated nasal septum was the most common anatomical abnormality (70%) followed by large bulla ethmoidalis 17%. Occurrence of different types of special cells were studied which are better visualized on coronal CT scan images. Among these cells Agger nasi was the most common variety (15%) followed by Haller’s cells (11%) and Onodi cell (3%). Concha bullosa was present in 8%.Conclusions: The importance of CT and nasal endoscopy can be seen in patients with persistent symptoms to identify the anatomical variations that may responsible for the development of chronic sinus disease. In cases of sinusitis patients all the para-nasal sinus should be properly investigated to avoid complications.

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A rare case of nasal schwannoma of middle turbinate

Surgical Techniques Development ◽

10.4081/std.2016.6467 ◽

2016 ◽

Vol 6 (1) ◽

Author(s):

Nilam U. Sathe ◽

Sheetal Shelke ◽

Hetal Marfatia ◽

Shampa Mishra

Keyword(s):

Nasal Septum ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Nerve Sheath Tumor ◽

Deviated Nasal Septum ◽

Surgical Specimen ◽

Nasal Blockage ◽

Nasal Mass ◽

Osteomeatal Complex ◽

Slow Growing

Schwannoma is a benign, slow-growing nerve sheath tumor derived from the Schwann cells. Cases with nasal schwannoma arising from nasal septum and inferior turbinate have been reported, though being rare. A 32-yearold male patient presented to our hospital with left side progressive nasal blockage since 4 months and multiple episodes of epistaxis. Anterior rhinoscopy revealed left side smooth spherical nasal mass, which was bleeding on touch. Computed tomography was done, which was suggestive of right side deviated nasal septum. Left nasal cavity soft tissue lesion extended into anterior ethemoid cells, causing widening of the osteomeatal complex. The patient underwent endoscopic excision of nasal mass. Histopathology of nasal mass suggested nasal schwannoma. Though nasal schwannoma is rare, it should be considered as a differential diagnosis in case of unilateral nasal mass with epistaxis. Definitive diagnosis of schwannoma can be considered only after final histopathological reporting of the surgical specimen.

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Anatomical Variations Associated With Maxillary Sinus Fungal Ball

Ear Nose & Throat Journal ◽

10.1177/01455613211028470 ◽

2021 ◽

pp. 014556132110284

Author(s):

Mohammed Basurrah ◽

Il Hwan Lee ◽

Do Hyun Kim ◽

Sung Won Kim ◽

Soo Whan Kim

Keyword(s):

Maxillary Sinus ◽

Odds Ratio ◽

Nasal Septum ◽

Anatomical Variations ◽

Normal Group ◽

Deviated Nasal Septum ◽

Factors Associated ◽

Fungal Ball ◽

Computed Tomography Scans ◽

Sinus Ostium

Objective: We investigated the anatomical and dental factors associated with unilateral maxillary sinus fungal ball (MSFB). Also, we evaluated the effect of combinations of those factors on the incidence of MSFB. Methods: Three hundred patients were divided into MSFB, normal, and chronic rhinosinusitis (CRS) groups. We reviewed paranasal computed tomography scans for the presence of deviated nasal septum, concha bullosa (CB), Haller cells, and various dental factors. Also, we measured the ethmoid infundibulum, maxillary natural ostium, and CB. Results: Maxillary sinus fungal ball showed a more significant association with CB compared to the other 2 groups (37%, P < .05). The MSFB group had a lower rate of Haller cells than the normal group (10% vs 22%, respectively; P < .05). Also, the MSFB group had a wider maxillary sinus ostium than the normal group (7.07 ± 1.8 vs 5.48 ± 1.3 mm; P < .01). Moreover, the combination of CB and Haller cells was significantly associated with a decreased rate of the fungal ball ( P = .047, odds ratio = 0.694). The dental factors were more prevalent in the MSFB and CRS groups (73% and 75%, respectively) than in the normal group (32%, P < .001). Conclusions: Maxillary sinus fungal ball is significantly associated with CB, Haller cells, an increased maxillary sinus ostium size, and dental factors.

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A comparative study of synechiae formation in endoscopic septoplasty with and without intranasal splints

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212825 ◽

2021 ◽

Author(s):

M. Nagachaitanya ◽

M. Santosh Reddy ◽

Uzma Mohammadi ◽

G. Prathyusha

Keyword(s):

Computed Tomography ◽

Informed Consent ◽

Nasal Septum ◽

Chronic Sinusitis ◽

Nasal Endoscopy ◽

Deviated Nasal Septum ◽

Osteomeatal Complex ◽

Ethical Committee Approval ◽

Septal Spur ◽

Nose And Throat

Background: Septoplasty is the treatment of choice for deviated nasal septum. Deviated nasal septum can be C shaped or S shaped leading to unilateral or bilateral nasal obstruction. Septal spur may also require surgery. Sometimes deviated nasal septum may block osteomeatal complex leading to chronic sinusitis. For the evaluation of nasal cavities preoperatively computed tomography (CT) paranasal sinuses and diagnostic nasal endoscopy is done. Diagnostic nasal endoscopy done after two weeks of surgery. The objective of the study is to compare the efficacy of intranasal splints in the prevention of nasal synechiae following septoplasty.Methods: 100 patients undergoing septoplasty under general anesthesia from March 2018 to March 2019 were enrolled. Patients with nasal septal deviation and aged between 18-50 years were included in the study. All surgeries were performed by consultant ear, nose and throat (ENT) surgeons under general or local anesthesia. Institutional ethical committee approval was obtained for the study. Informed consent was obtained from all patients. Patients with age under 18 years or over 50 years were excluded for the study. Results: Septoplasty with intranasal splints reduce the formation of synechiae in 48 patients.Conclusions: Usage of intranasal splints indicates a decrease in the postoperative formation of synechiae after septoplasty.

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A CT and DNE study of osteomeatal complex variations and their correlation in chronic rhinosinusitis patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173032 ◽

2017 ◽

Vol 3 (3) ◽

pp. 606 ◽

Cited By ~ 1

Author(s):

Parul Sachdeva ◽

Kuldeep S. Sachdeva ◽

Baldev Singh ◽

Manjit Singh ◽

Manpreet Kaur ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Middle Turbinate ◽

Process Variations ◽

Anatomical Variations ◽

Uncinate Process ◽

Deviated Nasal Septum ◽

Chi Square ◽

Persistent Symptoms ◽

Osteomeatal Complex ◽

Chi Square Test

Background: CRS is a global burden reducing the productivity at work. This study was done to evaluate the occurrence of anatomical variations of osteomeatal complex (OMC) and to assess its relation in causation of chronic rhinosinusitis in the study population. Methods: A 100 patients diagnosed with CRS in the outdoor of Dept. Of ENT between November 2012 – November 2015 were subjected to CT Imaging and DNE and the frequency of anatomical variations and involvement of paranasal sinuses were evaluated. The correlation between them was established using chi-square test. Results: Agger nasi cells were the most common variant seen in 73 (73%) patients with 12% being unilateral and 61% bilateral. Other variants seen were: deviated nasal septum in 68%, uncinate process variations in 58%, concha bullosa in 30%, enlarged bulla ethmoidalis in 25%, paradoxical middle turbinate in 18%, haller’s cells in 6% and accessory maxillary ostia in 2%. We could establish a correlation between a few of these variants and the affected sinuses. Conclusions: The importance of CT and nasal endoscopy is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease.

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A Study of Anatomical Variations of Osteomeatal Complex in Correlation with Computed Tomography

Indian Journal Of Applied Research ◽

10.15373/2249555x/jan2014/130 ◽

2011 ◽

Vol 4 (1) ◽

pp. 428-429

Author(s):

Dr.M.Sasirekha Dr.M.Sasirekha ◽

◽

Dr.A.Ashokkumar Dr.A.Ashokkumar

Keyword(s):

Computed Tomography ◽

Anatomical Variations ◽

Osteomeatal Complex

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