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

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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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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Significance of relationship between anatomical variants of middle turbinate and nasal septum in recurrent acute rhinosinusitis patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20172075 ◽

2017 ◽

Vol 3 (3) ◽

pp. 569

Author(s):

Satya Sundar G. Mohapatra ◽

Niranjan Sahu ◽

Siba N. Rath ◽

Mahesh C. Sahu ◽

Rabindra N. Padhy

Keyword(s):

Nasal Septum ◽

Tertiary Care ◽

Middle Turbinate ◽

Septal Deviation ◽

Transverse Diameter ◽

Deviated Nasal Septum ◽

Anatomical Variants ◽

Acute Rhinosinusitis ◽

Group I ◽

History Of

Background: Aim of the study was to evaluate the significance of relationship between anatomical variants of middle turbinate and nasal septum, and role for the causation of recurrent acute rhinosinusitis (RARS) in a tertiary care teaching hospital.Methods: Retrospective analysis of sinonasal computerized tomography (CT) images of 160 patients with history of RARS during August 2015 to December 2016 was done for evaluation of concha bullosa (CB) and paradoxical middle turbinate (PMT) associated with deviated nasal septum (DNS). Measurements of CB, PMT and septal deviation angles were recorded. Patients with acute and expansile paranasal sinus diseases were excluded.Results: Of the total 160 RARS cases with DNS, 120 cases had unilateral (contralateral and ipsilateral) and bilateral (dominant and similar sized) CB, and were distributed into group I (contralateral and dominant) and group II (ipsilateral and similar sized bilateral) basing on the direction of septal convexity. Maximum transverse diameter of CB (MTDCB) and septal deviation angle values were highly significant (p =0.0001) in group I CB cases. Direction of septal convexity had no significance (58 to right and 62 to left) in relation to CB pneumatization. Septal deviation severity in group I CB cases was highly significant (p =0.0001). The fraction of 40 unilateral and bilateral PMT cases revealed no significance (p =0.45) with severity of DNS.Conclusions: Anatomical variants of middle turbinate associated with DNS caused increased prevalence of OMC pattern RARS. Contralateral and dominant CBs had shown relationship in direct proportion to the severity of septal deviation contributing to recurrent rhinosinusitis.

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The Impact of Middle Turbinate Concha Bullosa on the Severity of Inferior Turbinate Hypertrophy in Patients with a Deviated Nasal Septum

American Journal of Neuroradiology ◽

10.3174/ajnr.a4705 ◽

2016 ◽

Vol 37 (7) ◽

pp. 1324-1330 ◽

Cited By ~ 8

Author(s):

C. M. Tomblinson ◽

M.- R. Cheng ◽

D. Lal ◽

J. M. Hoxworth

Keyword(s):

Nasal Septum ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Turbinate Hypertrophy ◽

Inferior Turbinate Hypertrophy ◽

The Impact

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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.

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

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v21i2.27646 ◽

2016 ◽

Vol 21 (2) ◽

pp. 90-93

Author(s):

Mirza Aneesa ◽

Sajad Majid Qazi ◽

Aijazul Haq

Keyword(s):

Paranasal Sinuses ◽

Nasal Septum ◽

Complex Disease ◽

Anatomical Variation ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Anatomical Variations ◽

Lateral Nasal Wall ◽

Deviated Nasal Septum ◽

Osteomeatal Complex

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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Study of anatomical variants at osteomeatal complex in cases of chronic maxillary sinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174661 ◽

2017 ◽

Vol 4 (1) ◽

pp. 100

Author(s):

Aditya Pathak ◽

Ramanand Yadav

Keyword(s):

Maxillary Sinus ◽

Maxillary Sinusitis ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

X Ray ◽

Anatomical Variants ◽

Osteomeatal Complex ◽

Causative Factors ◽

Chronic Maxillary Sinusitis

Background: To study the contribution of anatomical variations at osteomeatal complex area in development of chronic maxillary sinusitis.Methods: 60 patients with chronic maxillary sinusitis, clinically diagnosed on the criteria layed by Lanza and Kennedy and radiologically supported by X-ray PNS, were included in the study. Nasal endoscopy with different angled endoscopes done under local anaesthesia to recognize the anatomical variants at osteomeatal complex area. Results: In 41.09% of cases anatomical variants like concha bullosa, paradoxical middle turbinate, large bulla ethmoidalis or medially bent uncinate process were detected, but in rest 59.91% of cases of maxillary sinusitis there was no anatomical abnormality.Conclusions: Among the causative factors for development of chronic maxillary sinusitis different anatomical variants at osteomeatal area causes narrowing of the drainage pathway of maxillary sinus leading to development of chronic inflammation of the maxillary sinus.

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STUDY THE CLINICAL CHARACTERISTICS , COMPUTERIZED TOMOGRAPHY IMAGES AND SURGICAL OUTCOMES OF PATIENTS WITH CONCHA BULLOSA

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.1.12 ◽

2016 ◽

pp. 94-100

Author(s):

Nguyen Nguyen ◽

Van Dung Phan ◽

Thanh Thai Le

Keyword(s):

Computerized Tomography ◽

Nasal Septum ◽

Clinical Characteristics ◽

Nasal Congestion ◽

Postoperative Bleeding ◽

Middle Turbinate ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Before And After ◽

Grade 3

Background: This study aims to describe clinical characteristics, computerized tomography image of concha bullosa and evaluate the results of surgical patients with concha bullosa. Patients and method: 37 patients with 51 concha bullosa surgeried to partially outside, by the method described cross, from October 2012 to June 2014. Result: Main symptoms of patients with CB is headache (89.2 %) and nasal congestion (67.6 %). In patients with CB often changes the anatomy and pathology with particularly crooked nasal septum (75.7 %). Patients with bilateral CB accounted for 62.2 % of patients had unbiliteral CB is 37.8 %. Location CB: 88.2 % the previous section, the following 2 %, both before and after 9.8 %. Ventilation position of CB: 68.7 % lamellar type, type bulbous 7.8%, and type extensive 23.5 %. The size of CB as assigned Thomas: highest grade 3 (31.1 %) followed by grade 2 (27 %) and grade 4 (6.7 %) was the last grade 1 (4.1%). The size of CB according classified Nadas: highest level 1 (59.5 %), followed by the 0 (31.1 %) and grade 3 (8.1%), and finally grade 4 (1.3 %). Complications of surgery: tear the lining of the septum (18.9 %), multiple intraoperative bleeding (representing 8.1%), mucosal abrasions middle turbinate (accounting for 2.7 %). The incidence of post-operative Art: meche withdrawal bleeding after surgery (13.5 %), bleeding early before 6 hours (5.4 %); Roll stick after surgery (representing 2.7 %), postoperative bleeding before 24 hours. Functional impairment in patients after surgery: After 3 months of headaches decreased 84.8 %, stuffy nose fell 92 %, 90.9 % of reduction talks flow, Itchy nose, sneezing decreased 42.9 %. Middle turbinate endoscopic nasal after surgery: 100 % middle turbinate slim nose. Conclusion: The combined clinical and endoscopic sinus CT will improve the efficiency of diagnosis and treatment concha bullosa. Key words: concha bullosa, deviated nasal septum, rhinosinusal computerized tomographic scanner.

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A PROSPECTIVE STUDY ON ASSOCIATION BETWEEN DEVIATED NASAL SEPTUM AND SINUSITIS AT ENT DEPARTMENT OF SKMCH, MUZAFFARPUR, BIHAR

10.36106/ijsr/4031270 ◽

2020 ◽

pp. 21-22

Author(s):

Kameshwar Prasad Singh ◽

Debarshi Jana

Keyword(s):

Nasal Septum ◽

Chronic Sinusitis ◽

Anatomical Variation ◽

Middle Turbinate ◽

Sinus Surgery ◽

Nasal Discharge ◽

World Population ◽

Deviated Nasal Septum ◽

Turbinate Hypertrophy ◽

Group I

Background: Chronic sinusitis (CS) is an extremely prevalent disorder. It affects up to two percent of the world population. It has a significant impact on the quality of life of people. Basically, the word “sinusitis‟ refers to a group of disorders characterized by inflammation of mucosa of nose and paranasal sinuses. Deviated Nasal septum is one of the most common disorder that presents up to 62% of the population. Its role in the pathogenesis of chronic sinusitis remains uncertain. Methods: Two groups were included in this study.Each group had 30 cases with Midline nasal septum & Deviated nasal septum. This study conducted in the Department. of ENT, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. The duration of the study was over a period of six months from August 2019 to January 2020. Results: We were studied two groups, 30 cases involved in group I of Midline nasal septum and in group II 30 cases involved with Deviated nasal septum. In this study we showed symptom & sign of rhinoscopy. In the group I, 14 cases had congested nasal mucosa followed by 10 cases of nasal discharge, 4 cases of inferior turbinate hypertrophy & 2 cases of Middle turbinate hypertrophy. Conclusions: that management of chronic maxillary sinusitis should include simultaneous treatment of any anatomical variation. For treating chronic sinusitis along with deviated nasal septum, nowadays treatment of choice is Septoplasty along with Functional Endoscopic Sinus Surgery (FESS). FESS technique is used for managing sinus infection and ostial obstruction.

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Incidence of concha bullosa and its role in chronic rhinosinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212788 ◽

2021 ◽

Author(s):

Yalagandula Vijaya Lakshmi ◽

Thakur Dinesh Singh ◽

Razia Fathima ◽

Vaddi Hemanth Kumar

Keyword(s):

Chronic Rhinosinusitis ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Sinus Surgery ◽

Concha Bullosa ◽

Medical Sciences ◽

Osteomeatal Complex ◽

History Of ◽

Mucosal Edema ◽

Surgical Manipulation

Background: Pneumatization of nasal turbinates is called concha bullosa. Most often it involves the middle turbinate and is one of the commonest variants of sinonasal anatomy. Bulbous and extensive type of concha bullosa may lead to narrowing or even complete blockage of osteomeatal complex. This alters the normal airflow and drainage pathways of mucous, resulting in mucosal edema which obstructs the ethmoidal infundibulum and osteomeatal obstruction leading to sinusitis. The aim of the study was to determine the incidence of concha bullosa and assess its role in causation of chronic rhinosinusitis. The objective was to determine the incidence of concha bullosa and assess its role in chronic rhinosinusitis.Methods: A retrospective study of 120 patients suffering from chronic sinusitis of age group 18 years to 70 years old were taken between March 2018 to January 2021 at Malla Reddy institute of medical sciences (MRIMS) who had nasal symptoms significant enough to warrant a CT paranasal sinus (CT PNS) with positive findings. All PNSs involved were identified for sinus disease. Concha bullosa identified and graded into small, moderate and large. Patients with history of previous nasal surgeries were excluded.Results: Our study showed 54% cases of chronic sinusitis with concha bullosa.Conclusions: Concha bullosa may be one of the predisposing factors of chronic rhinosinusitis and hence surgical manipulation by functional endoscopic sinus surgery (FESS) is important to prevent recurrence of sinusitis.

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