scholarly journals A radiological study of anatomical variations in ostiomeatal complex in patients with chronic rhinosinusitis

2017 ◽  
Vol 3 (3) ◽  
pp. 528
Author(s):  
Rajneesh . ◽  
Rahul S.
Keyword(s):  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Intraoperative Complications ◽  
Preoperative Evaluation ◽  
Middle Turbinate ◽  
Uncinate Process ◽  
Leonardo Da Vinci ◽  
Type I ◽  
Anatomical Variants ◽  
Increased Risk

<p class="abstract"><strong>Background:</strong> In ancient times the paranasal sinuses, without any anatomical differentiation, were thought to be a system of hollow spaces through which mucus produced by the brain was drained. Leonardo da Vinci in Milano in 1489 was the first to prepare and draw anatomical specimens of the paranasal sinuses; the drawings, however, only became accessible to scientific evaluation as late as 1901.</p><p class="abstract"><strong>Methods:</strong> All adult patients (more than 20 years of age) attending the Outpatient department at ENT, diagnosed to have chronic rhinosinusitis, willing to undergoing Computed Tomographic evaluation were included in this study. Sample of 50 was selected using purposive sampling technique. All CT scans were obtained with GE Brightspeed scanner (16 slice MDCT scanner). Coronal sections were performed with the patients in prone position, with extended neck and the plane perpendicular to the infraorbitomeatal line.</p><p class="abstract"><strong>Results:</strong> Agger nasi was the most common variation seen in 72% cases followed by dwviated nasal septum in 66% patients. Other variations found were lateral attachment of uncinate process in 54%, uncinate attachment to skull base in 33%, concha bullosa in 32%, overpneumatized bulla ethmoidalis in 21%, medial attachment of unicinate process to middle turbinate in 13%, paradoxical bent middle turbinate in 11%, haller cell seen in 6%. 56% had type I frontoethmoidal cells, 29% had type II, and 15% had type III frontoethmoidal air cells.</p><p><strong>Conclusions:</strong> The presence of anatomical variants does not indicate a predisposition to sinus pathology but these variations may predispose patients to increased risk of intraoperative complications. The surgeon must pay close attention to anatomical variants in the preoperative evaluation avoid possible complications and improve success of management strategies. </p>

scholarly journals CT evaluation of anatomical variations of paranasal sinus region and their clinical importance

2019 ◽  
Vol 7 (6) ◽  
pp. 2260
Author(s):  
Tapendra Nath Tiwari ◽  
Narendra Kumar Kardam
Keyword(s):  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Anatomical Variation ◽  
Intraoperative Complications ◽  
Preoperative Evaluation ◽  
Anatomical Variations ◽  
Uncinate Process ◽  
Concha Bullosa ◽  
Increased Risk ◽  
Mucosal Changes

Background: Paranasal sinuses are air filled spaces present within the skull and facial bones. Paranasal sinuses region anatomy is highly variable. Knowledge of these variations is very important for radiologists as well as endoscopic surgeons for preoperative evaluation to avoid damage to adjacent vital structures. CT is the best modality to delineate the sinus anatomy as well as soft tissue structures. Thus, this study was undertaken to evaluate the anatomical variations of paranasal sinus region and ascertain their clinical importance.Methods: A total of 142 patients, those referred from various outdoor/indoor departments with the symptoms related to nose and paranasal sinuses were included. Detailed history, appropriate clinical examinations, biochemical investigations and X-ray PNS were recorded. Unenhanced CT scan of the PNS was performed for these patients in the axial planes and reformatted coronal planes. Observation was made and analysed using descriptive tools and scientific methods.Results: Deviated nasal septum was the most common variation followed by middle concha bullosa, Paradoxical middle turbinate, curved uncinate process, overpneumatized ethmoidal bulla, superior concha bullosa, prominent Agger Nasi cells, haller cells, onodi cells, maxillary sinus septae and pneumatization of uncinate process. Incidence of anatomical variation was 75% among the patients showing PNS mucosal changes while it was 94% among patients showing no mucosal changes. Chi square statics revealed that presence of anatomical variation does not mean a predisposition to mucosal changes.Conclusions: The presence of anatomical variants does not indicate predisposition to sinus pathology but may predispose to increased risk of intraoperative complications. It is important to pay close attention to anatomical variations in the preoperative evaluation to avoid possible complications.

scholarly journals Diagnosis of chronic rhinosinusitis: can nasal endoscopy be the new gold standard in developing countries?

2016 ◽  
Vol 2 (1) ◽  
pp. 30
Author(s):  
Sushant Tyagi ◽  
Mohit Srivastava ◽  
Vandana Singh
Keyword(s):  
Developing Countries ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Middle Turbinate ◽  
Anatomical Variations ◽  
Diagnostic Value ◽  
Uncinate Process ◽  
Nasal Endoscopy ◽  
Deviated Nasal Septum ◽  
Diagnostic Modality

<p class="abstract"><strong>Background:</strong> Objective of the study was to study the role of diagnostic value of nasal endoscopy in diseases involving nasal cavity and paranasal sinuses particularly chronic rhinosinusitis in developing countries.</p><p class="abstract"><strong>Methods:</strong> A total of 200 Patients with clinical evidence of sinonasal diseases were evaluated. All patients were subjected to thorough ENT examination with special emphasis on anterior and posterior rhinoscopy. Nasal Endoscopy was done using Hopkins rod endoscopes ( 0º, 30º, 45º, 70º and 90º) - diameter 2.7 mm/ 4 mm, length 18 cm after administering a spray puff of Xylocaine with adrenaline (10 drops of adrenaline to 2 ml of Xylocaine). Computed tomography of paranasal sinuses was done in 100 patients whose symptoms, examination and clinical picture were sufficient to warrant the procedure.  </p><p><strong>Results: </strong>The most common anatomical variations detected on nasal endoscopy were deviated nasal septum (83.5%) followed by paradoxical middle turbinate (42.5), and concha bullosa (26.5%). Accessory middle turbinate was seen in 7 out of 200 cases (3.5%). The most common pathological abnormality detected on nasal endoscopy was mucopus in middle meatus (69%) and next were hypertrophied (45 and 35% inferior and middle turbinate respectively) and congested turbinates (44.5%), followed by polypoidal changes (28%) and oedematous/congested uncinate process (27.5%).</p><strong>Conclusion: </strong>Diagnostic nasal endoscopy can prove to be a better diagnostic modality compared to CT scan when conditions like middle meatal secretions, condition of mucosa, polyps are looked for. It can detect early polypoidal and other pathological changes missed on CT which can aid in early diagnosis and medical management of sinonasal diseases thereby preventing patient from unnecessary surgical exposure. Also being easily available and cost effective, patients can be spared from unnecessary cost and radiation exposure by performing diagnostic nasal endoscopy prior to CT.

scholarly journals Computer Tomographic study of Anatomic Variations of Paranasal Sinuses in Libyan Population and their Clinical Correlation

2020 ◽  
pp. 1-8
Author(s):  
Hawa M R Hawla ◽  
Keyword(s):  
Paranasal Sinus ◽  
Endoscopic Surgery ◽  
Paranasal Sinuses ◽  
Nasal Septum ◽  
Intraoperative Complications ◽  
Middle Turbinate ◽  
Sinus Surgery ◽  
Anatomical Variants ◽  
Precise Knowledge ◽  
Anatomic Variants

Introduction: In the era of Functional Endoscopic Sinus Surgery, precise knowledge of paranasal sinus anatomy and variations are essential for the surgeon. The multi-slice computed tomography is the imaging modality of choice provides accurate evictions of the anatomy, the anatomical variants and the extent of the disease in paranasal sinuses, such a method allowing their accurate identification with high anatomical details. Some of these variants may predispose to sinus diseases or become of high risk for injuries and complication during surgical procedure, therefore, the study of anatomic variants of paranasal sinuses is important in the preoperative endoscopic surgery. Objectives: The purpose of this study is to assess the frequency of anatomic variants and their clinical importance. Materials and methods: This retrospective study was conducted at the Department of Radiology, Benghazi Medical Center, Benghazi, Libya. Data comprised the paranasal sinus computed images of 112 patients (46 males and 66 females) analyzed for the presence of anatomic variants and associated sinus pathology. Results: Our results showed that the most common anatomical variants was deviated nasal septum (60.7%) with slight higher incidence on left side, followed by concha bullosa (22.3%), other variants found were absent frontal sinus (18.8%), Nasal spur (14.3%) , Agger nasi cell (16.1%), Haller cell (5.4%), Onodi cell (2.7%), accessory ostia of maxillary sinuses (10.7%), accessory middle nasal concha (1.8%), paradoxical middle turbinate (1.8%), nasal septum pneumatization (5.4%), Crista galli pneumatization (2.7%), pneumatization of hard palate (1.8%) and pneumatization of clinoid process (6.3%). (53.6%) patients suffered from sinusitis, the results showed that the most common sinus involved was maxillary sinus. Conclusion: Anatomical variations of PNS are quite common. Analysis of every paranasal CT scan obtained for sinusitis for the presence of different anatomic variants is of questionable value unless endoscopic surgery is planned to reduce the risk of intraoperative complications.

scholarly journals A Radiological Study of Anatomical Variations of Uncinate Process

2016 ◽  
Vol 9 (2) ◽  
pp. 59-61
Author(s):  
Shrinath D Kamath Patla ◽  
Pretty Rathnakar ◽  
Vadisha S Bhat ◽  
Jayaramesh LNU
Keyword(s):  
Clinical Significance ◽  
Paranasal Sinuses ◽  
Intraoperative Complications ◽  
Anatomical Variations ◽  
Uncinate Process ◽  
Ct Scans ◽  
Radiological Study ◽  
Lamina Papyracea ◽  
Endoscopic Surgeon ◽  
Coronal Section

ABSTRACT Aim (a) To study the variations in the superior attachment of uncinate process. (b) Incidence of pneumatization of uncinate process was also studied. Materials and methods A total 200 sides of 100 CT scans of paranasal sinuses coronal section were studied for variations in the superior insertion of uncinate process using Landsberg and Friedman classification. Incidence of pneumatization of uncinate process was also studied. Results In our study out of 200 sides, type 6 attachment was commonest (41%) followed by types 1 and 2. Pneumatization of the uncinate was seen in very small percentage of cases. Conclusion Lateral insertion of uncinate (lamina papyracea + aggar nassi) is the commonest variant followed by the insertion into the skulbase. Pneumatization of uncinate is rare. Clinical significance Though the inferior attachment of the uncinate is almost constant the superior attachment has several variations, the knowledge of which is very important for the endoscopic surgeon to avoid intraoperative complications. How to cite this article Patla SDK, Rathnakar P, Bhat VS, Jayaramesh. A Radiological Study of Anatomical Variations of Uncinate Process. Clin Rhinol An Int J 2016;9(2):59-61.

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

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.

scholarly journals Role of anatomical variations in chronic rhinosinusitis on diagnostic nasal endoscopy and computed tomography scan of paranasal sinuses

2019 ◽  
Vol 6 (1) ◽  
pp. 101
Author(s):  
Falguni J. Parmar ◽  
Avani D. Patel
Keyword(s):  
Computed Tomography ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Care Center ◽  
Tertiary Care ◽  
Middle Turbinate ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Nasal Endoscopy ◽  
Advantages And Disadvantages

<p class="abstract"><strong>Background:</strong> Diagnostic nasal endoscopy (DNE) and computed tomography (CT) of para nasal sinuses play an important role in the diagnosis and treatment of chronic rhinosinusitis (CRS). The aim and objective of the study is to see the anatomical variations of the sinonasal region in CRS on DNE and CT paranasal sinuses (PNS).</p><p class="abstract"><strong>Methods:</strong> A descriptive type retrospective study of 30 patients attending the ENT outpatient department of our tertiary care center clinically diagnosed as CRS with symptoms persisting for 12 weeks or more, along with previously failed medical management, including topical nasal steroids, systemic decongestant and extended courses of antibiotics and who were willing to undergo endoscopic sinus surgery are included.  </p><p class="abstract"><strong>Results:</strong> Majority of the patients had septal deviation either an anterior or posterior deviation but majority of the cases are asymptomatic for the deviation. Anatomical variations of uncinate process, middle turbinate, inferior turbinate, frontal recess, agger nasi cells, haller cells were studied as well.</p><p class="abstract"><strong>Conclusions:</strong> Prolonged duration of  rhinosinusitis symptoms (more than 8-12 weeks) is the primary reason to evaluate a patient for CRS and making the choice between CT PNS or DNE is patient and disease dependent. Understanding the advantages and disadvantages of each helps us realize that they are of synergistic in nature and not competitive.</p>

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

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

<p class="abstract"><strong>Background:</strong> To study the contribution of anatomical variations at osteomeatal complex area in development of chronic maxillary sinusitis.</p><p class="abstract"><strong>Methods:</strong> 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.  </p><p class="abstract"><strong>Results:</strong> 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.</p><p><strong>Conclusions:</strong> 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. </p>

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