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

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

<p class="abstract"><strong>Background:</strong> There are a lot of<strong> </strong>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.</p><p class="abstract"><strong>Methods:</strong> 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.  </p><p class="abstract"><strong>Results:</strong> In this<strong> </strong>study<strong> </strong>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%.</p><p><strong>Conclusions:</strong> 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. </p>

scholarly journals Anatomical variations in patients with chronic sinusitis

2018 ◽  
Vol 4 (2) ◽  
pp. 428 ◽  
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

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">C</span><span lang="EN-IN">hronic 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. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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.<strong> </strong>Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.</span></p>

scholarly journals Incidence of sinonasal anatomical variations associated with chronic sinusitis by CT scan in Karaikal, South India

2017 ◽  
Vol 3 (3) ◽  
pp. 576 ◽  
Author(s):  
Kranti Gouripur ◽  
Udaya Kumar M. ◽  
Anand B. Janagond ◽  
S. Elangovan ◽  
V. Srinivasa
Keyword(s):  
Ct Scan ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Chronic Sinusitis ◽  
Middle Turbinate ◽  
Anatomical Variations ◽  
Uncinate Process ◽  
Sinus Surgery ◽  
Nasal Endoscopy ◽  
Deviated Nasal Septum

<p class="abstract"><strong>Background:</strong> Variations in sinonasal anatomy of adults<strong> </strong>are common and vary among different populations. Their role in development of pathological conditions such as sinusitis, epistaxis, etc is debated. Having clear picture of sinonasal anatomy of a person is essential in avoidance of complications during surgery. This study was done<strong> </strong>to<strong> </strong>analyze<strong> </strong>sinonasal anatomy in adults from Karaikal region having chronic sinusitis by nasal endoscopy and CT scan imaging.</p><p class="abstract"><strong>Methods:</strong> A total of 50 patients undergoing endoscopic sinus surgery were studied by preoperative nasal endoscopy, CT scanning and endoscopy at the time of definitive surgery and variations recorded and analyzed.  </p><p class="abstract"><strong>Results:</strong> The incidence of the sinonasal anatomical variations in CT scan study were – discharge in the frontal sinus (100%), agger nasi cells (96%), deviated nasal septum (70%), anterior ethmoidal cells (86%), posterior ethmoidal cells (58%), sinus lateralis (52%), frontal cells (50%), discharge in sphenoid sinus (50%), pneumatised superior turbinate (46%), INSA (34%), prominent bulla ethmoidalis (30%), supra orbital cells (26%), pneumatised septum(16%), medialised uncinate process (16%), paradoxical middle turbinate (16%), Haller cells (14%), supreme turbinate (14%), pneumatised inferior turbinate (12%), frontal recess obliteration (12%), absent pneumatisation of frontal sinus (12%), pneumatised middle turbinate (10%), Onodi cells (6%), pneumatised uncinate process (2%), maxillary sinus septation (2%).</p><p><strong>Conclusions:</strong> The high incidence of variations emphasises the need for proper preoperative assessment for safe and effective endoscopic sinus surgery. </p>

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.

Study of Anatomical Variations of Nose and Para-nasal Sinuses in Computed Tomography Scan

2020 ◽  
Vol 2 (2) ◽  
pp. 20-25
Author(s):  
Sona Pokhrel ◽  
Bhuwan Raj Pandey
Keyword(s):  
Computed Tomography ◽  
Process Variation ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Uncinate Process ◽  
Concha Bullosa ◽  
Deviated Nasal Septum ◽  
College Hospital ◽  
Female Ratio ◽  
Onodi Cell

Introduction: Computed tomography (CT) has nowadays become the investigation of choice for diagnosis and evaluation of anatomical variations of the nose and paranasal sinuses. Methods: A cross sectional study was conducted in the Department of Radiology of Lumbini Medical College Hospital from June 2019 to May 2020. Total of 130 patients were enrolled for the study. All patients were subjected to Siemens Somatom scope 16 slice CT scan. Each scan was studied for the presence of agger nasi cell, concha bullosa, deviated nasal septum, haller cell, onodi cell, uncinate process variation and type of olfactory fossa. Results: The mean age of patients was 36. 86 ±12.06 years. There were 76 males (58.5%) and 54 females (41.5%) with male: female ratio of 1.4:1 with highest range in age group of 31 to 45 years (46.9%). Anatomical variation between male and female was statistically not significant (p>0.05). The most common anatomical variation noted was nasal septal deviation (73.1%), then agger nasi cell (59.3%), concha bullosa (24.6%), paradoxical medial turbinate (7.7%), onodi cell (6.9%), uncinate process variation (5.4%) and least was haller cell (4.6%). Most of the scans had more than one anatomical variation, which was statistically significant (p<0.05). The most common type of olfactory fossa depth was Keros type II (61.5%). Conclusion: Computed tomography of the paranasal sinus has improved the visualization of anatomical variation hence radiologist must pay close attention to variants.  

scholarly journals Evaluation of nose and paranasal sinus disease, anatomical variations by computerized tomography

2017 ◽  
Vol 3 (4) ◽  
pp. 898
Author(s):  
Prakash S. Handi ◽  
Mallikarjun N. Patil
Keyword(s):  
Ct Scan ◽  
Paranasal Sinuses ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Type I ◽  
Deviated Nasal Septum ◽  
Radiologic Evaluation ◽  
Road Map ◽  
Preoperative Information

<p class="abstract"><strong>Background:</strong> The anatomy of paranasal sinuses is very complicated. Evaluation of the location, extent of sino nasal diseases and anatomical variations by preoperative radiologic evaluation of the paranasal sinuses is essential in planning surgical intervention. Meticulous radiographic delineation of the small structures in this region, coupled with endoscopic evaluation, provides detailed preoperative information regarding morphology and pathology.</p><p class="abstract"><strong>Methods:</strong> Patients with sinonasal symptoms indicating requirement of CT scan evaluation and aged more than 10 years were included in the study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions.  </p><p class="abstract"><strong>Results:</strong> Sinusitis (single or multiple sinus involvement), nasal polyposis, frontal mucocele and ethmoidal carcinoma with destruction of medial wall of maxilla were the pathologies observed in these CT scans with sinusitis [22 (43.1%)] being the most common pathology observed. Deviated nasal septum [21 (41.2%)] was the most common anatomical variation observed. All patients who had concha bullosa [5 (9.8%)] were observed to have sinusitis involving multiple bilateral PNS. Based on Keros’ classification, olfactory fossa depth type I was most commonly observed followed by type II and type III.</p><p><strong>Conclusions:</strong> CT scan is important in patients undergoing endoscopic sinus surgery for sinonasal diseases where it acts as a road map in identifying the presence, extent of disease and any anatomical variations. This pre-operative CT scan evaluation improves planning and helps in significantly reducing morbidity and possible complications during surgery. </p>

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 Prospective evaluation of chronic rhinosinusitis with reference to anatomical variation

2020 ◽  
Vol 6 (2) ◽  
pp. 326
Author(s):  
Sindhura . ◽  
Mamatha Devi Kandipilli ◽  
Ali Shaik ◽  
Venkata Ramana
Keyword(s):  
Chronic Rhinosinusitis ◽  
Anatomical Variation ◽  
Medical Science ◽  
Middle Turbinate ◽  
Anatomical Variations ◽  
Final Diagnosis ◽  
Sinus Surgery ◽  
Nasal Endoscopy ◽  
Deviated Nasal Septum ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> Rhinosinusitis is one of the commonest sinonasal condition with chronic Rhinosinusitis affecting 10% of population worldwide. Although the diagnosis of chronic rhinosinusitis is clinical, the final diagnosis should be confirmed by objective measures like radiography and nasal endoscopy. Though anatomical variations in sinonasal region are rare, they have significant impact in the causation of sinonasal diseases and pose difficulties during surgery.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study conducted on 60 patients who attended to the Department of ENT and HNS, Konaseema Institute of Medical Science, Amalapuram between December 2017 to July 2019. By considering AAO-HNS criteria patients were selected and subjected to high resolution computerized tomography para nasal sinuses and diagnostic nasal endoscopy.  </p><p class="abstract"><strong>Results:</strong> As per study, 60% patients are having deviated nasal septum, followed by aggar nasi in 58.3%, concha bullosa in 26.8%, Haller cells in 11.7%, paradoxical middle turbinate in 11.7%, uncinate pneumatisation in 5%, and onodi cells in 5% of cases.</p><p class="abstract"><strong>Conclusions:</strong> Anatomical variations in sinonasal cavity predispose to chronic rhinosinusitis and hence require correction. Also, detecting these variations preoperatively by computed tomography of paranasal sinus helps in avoiding complications during functional endoscopic sinus surgery.</p>

scholarly journals A comparative analysis of CT scan versus diagnostic nasal endoscopy in chronic rhino sinusitis

2018 ◽  
Vol 4 (4) ◽  
pp. 930
Author(s):  
Ahamed Nauphal Pullarat ◽  
Shakeeber Kottayil ◽  
Girish Raj ◽  
Basheer N. K.
Keyword(s):  
Ct Scan ◽  
Chronic Rhinosinusitis ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Nasal Endoscopy ◽  
Common Symptom ◽  
Medical College ◽  
Sinus Cavity ◽  
Chronic Rhino Sinusitis ◽  
Extent Of Disease

<p class="abstract"><strong>Background:</strong> With the advent of nasal endoscopy (DNE) and computed tomography (CT) in the evaluation of patients with chronic rhinosinusitis, it has popularized the functional endoscopic sinus surgery. The objective of this study is to find out effectiveness and limitations of CT and DNE in chronic rhinosinusitis.</p><p class="abstract"><strong>Methods:</strong> Patients attending the Otorhinolaryngology outpatient department of MES medical college with chronic rhinosinusitis (CRS), who satisfy the inclusion criteria, were included in the study. They were given a course of antibiotics and antihistamines for a period of 10 days prior to CT Nose &amp; PNS followed by an interval of 5 days nasal endoscopy done and findings were compared.  </p><p class="abstract"><strong>Results:</strong> In this study, 58% cases were males and 42% females, most common symptom was a headache (76%). In DNE 82% cases had septal deviation and 86% in CT scan. Most common sinus cavity involved in CT scan was maxillary sinus.</p><p class="abstract"><strong>Conclusions:</strong> CT scan has got a better advantage compared to DNE in detecting the anatomical variations as well as to know the condition of the sinus cavity and the extent of disease in sinuses. In conditions like middle meatal secretions, mucosal change, polyp DNE gave a better picture of the condition. Both DNE and CT scan are complementary to each other in CRS.</p>

scholarly journals Role of CT Nose Paranasal Sinuses and Nasal Endoscopy for Decision Making in a Case of Deviated Nasal Septum

2019 ◽  
Vol 27 (3) ◽  
pp. 235-239
Author(s):  
Sayan Hazra ◽  
Ankit Choudhary ◽  
Swapan Kumar Ghosh ◽  
Subhradev Biswas ◽  
Kaustuv Das Biswas
Keyword(s):  
Ct Scan ◽  
Nasal Obstruction ◽  
Paranasal Sinuses ◽  
Nasal Septum ◽  
Pathological Condition ◽  
Middle Turbinate ◽  
Inferior Turbinate ◽  
Nasal Endoscopy ◽  
Deviated Nasal Septum ◽  
Pathological Conditions

Introduction Deviated nasal septum (DNS) can be asymptomatic in an individual or may cause nasal obstruction. The condition is generally diagnosed clinically and based on clinical diagnosis it is managed Surgically by large without much heed to diagnostic procedure. Thus, often underlying other causes of Obstruction is missed. Thus, it becomes essential to evaluate every patient presenting with history of Nasal obstruction and clinically Deviated septum, with aid of Nasal Endoscopy and CT scan Nose Paranasal Sinuses (PNS) to rule out/diagnose other coexisting conditions. Methods and Methodology 100 patients who presented with nasal obstruction and clinically diagnosed to have Deviated Nasal Septum were then subjected to Nasal Endoscopy and CT scan Nose and PNS and findings were noted for analysis. Results and Analysis Of these 100 patients, 48 patients were found to have coexisting pathological conditions/anatomical variants. Various anatomical and pathological Conditions were found to coexist together. Inferior turbinate hypertrophy in 34% is the most common pathological condition found to be associated with DNS followed by of sinusitis in 25% patients apart from polyp, concha bullosa and paradoxical middle turbinate. Discussion Studies done so far shows there is a definite link of deviated nasal septum to various anatomical and pathological conditions of the nose.  CT Scan Nose PNS and Nasal Endoscopy plays a vital role in diagnosing such anomalies. Conclusion Most of the patients, presenting with nasal obstruction and having Deviated Nasal Septum, undergo management without proper analysis and returns with recurrence of symptoms which could be analyzed properly if Nasal endoscopy and CT scan is employed during diagnosis of the condition, reducing risk of treatment failure.

scholarly journals Role of Nasal Endoscopy in Sinonasal Diseases

2015 ◽  
Vol 8 (1) ◽  
pp. 8-11
Author(s):  
Ritesh Shelkar ◽  
Jeevan Vedi ◽  
Seema Patel ◽  
KS Dasgupta ◽  
Kanchan Lanjewar
Keyword(s):  
Foreign Body ◽  
Anatomical Variation ◽  
Sinus Surgery ◽  
Nasal Endoscopy ◽  
Nasal Discharge ◽  
Deviated Nasal Septum ◽  
Female Ratio ◽  
Number Of Patients ◽  
Nasal Pathology

ABSTRACT Aims and objectives To evaluate sinunasal diseases with the help of nasal endoscopy. To study efficacy of nasal endoscopy in diagnosing nasal pathology over clinical examination. To define medical and surgical functional endoscopic sinus surgery (FESS), management according to type of nasal pathology. To define applications of nasal endoscopy (biopsy, swab, epistaxis control, foreign body removal, rhinolith removal, follow-up). Materials and methods Total 100 patients were studied. Patients came with complaints of nasal blocking, nasal discharge, mass in nasal cavity, bleeding etc, included in study. Pre-endoscopic assessment was carried out like history, examination, investigation. Endoscopic was done after consent under necessary anesthesia. Endoscopy was done using 0 and 30° endoscope with three standard passes. Result Total 100 patients were studied. Male to female ratio was 1.8:1. Out of 100 patients maximum number of patients had chronic sinusitis on nasal endoscopy examination (22); followed by nasal polyp (27) and deviated nasal septum and epistaxis (10). Nasal endoscopy was an excellent diagnostic aid in condition like epistaxis, nasal mass, nasal obstruction, foreign body, nasopharyngeal tumor. Conclusion Diagnostic nasal endoscopy offers high diagnostic accuracy in patient with sinonasal complaints. Diagnostic nasal endoscopy is gold standard tool in patient having sinonasal complaints. It has high accuracy due to vision control, has less bleeding, minimal complication, and early postoperative recovery. It is a good tool for diagnosing anatomical variation. How to cite this article Shelkar R, Vedi J, Patel S, Dasgupta KS, Lanjewar K. Role of Nasal Endoscopy in Sinonasal Diseases. Clin Rhinol An Int J 2015;8(1):8-11.

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