A STUDY OF MORPHOLOGY OF AIR CELLS IN THE MIDDLE TURBINATE AND IT’S RELATIONSHIP WITH SINUSITIS AND DEVIATED NASAL SEPTUM

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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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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Is Septoplasty Necessary When Using the Endoscopic Endonasal Transsphenoidal Approach for a Deviated Nasal Septum?

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1641602 ◽

2018 ◽

Vol 79 (06) ◽

pp. 569-573

Author(s):

Do Hyun Kim ◽

Yong-Kil Hong ◽

Sin-Soo Jeun ◽

Jae-Sung Park ◽

Soo Whan Kim ◽

...

Keyword(s):

Nasal Cavity ◽

Nasal Septum ◽

Middle Turbinate ◽

Case Series ◽

Septal Cartilage ◽

Transsphenoidal Approach ◽

Deviated Nasal Septum ◽

Endoscopic Endonasal ◽

Significant Difference ◽

Group B

Objective This article describes the role played by endoscopic endonasal transsphenoidal approach (EETSA) to the sphenoidal process of the septal cartilage of a deviated nasal septum. Design Case series with chart review. Setting Tertiary referral center. Participants Between 2009 and 2016, 177 patients with skull base tumors who underwent EETSA were included. Main Outcome Measures In 8 cases, the conventional two nostrils–four hands technique was employed (group A). In 16 cases, we placed a right-side conventional nasoseptal flap and a left-side modified nasoseptal rescue flap (group B), and in 153 cases, bilateral modified nasoseptal rescue flaps (group C). The number of septoplasty-required cases and the change of nasal cavity area differences reflecting septal deviation were measured. Results Septoplasty during EETSA was performed in two cases: one from group B and one from group C. There was no significant difference in the ratio of septoplasty-required cases among the three groups (p = 0.127). Between pre- and postoperative nasal cavity, the cross-sectional area difference at the anterior end of the middle turbinate level significantly decreased (p = 0.045). Also, the angle of deviation at the level of ostiomeatal unit significantly decreased after EETSA (p < 0.001). Conclusion Separation of a deviated complex surrounding the sphenoidal process of the septal cartilage is the key to relieving a deviated nasal septum. EETSA combined with the two nostrils–four hands technique allows posterior septectomy (including removal of this deviated complex) to be performed. Thus, EETSA may commence without preceding septoplasty even in cases with severe nasal septum deviations.

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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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Nasal endoscopic evaluation of patients presenting with frontal headache

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195704 ◽

2019 ◽

Vol 6 (1) ◽

pp. 137

Author(s):

Lakshmi Menon Ravunniarth ◽

G. K. Narayana

Keyword(s):

Nasal Septum ◽

Mucociliary Clearance ◽

Chronic Sinusitis ◽

Middle Turbinate ◽

Anatomic Variations ◽

Concha Bullosa ◽

Endoscopic Evaluation ◽

Deviated Nasal Septum ◽

Common Cause ◽

Ethmoidal Bulla

Background: Headache is a universal symptom affecting most people at some point in their lifetime. The most common cause of headache in ENT is acute sinusitis or an acute exacerbation of chronic sinusitis. Anatomic variations like a massive concha bullosa, enlarged ethmoidal bulla, laterally rotated uncinate can interfere with mucociliary clearance. Thus, a thorough nasal endoscopic evaluation will help us to detect any anatomic abnormality which may predispose to sinogenic headache.Methods: 100 patients with frontal headache underwent diagnostic nasal endoscopy and all anatomic variations and pathological abnormalities were notedResults: 83% cases had a diagnosis of deviated nasal septum or rhinosinusitis, and the rest 17% had non sinonasal cause for headacheConclusions: Anatomic abnormalities like middle turbinate anomaly, spur, enlarged bulla, hyperplastic uncinate and pathological abnormality like mucopurulent discharge, polypi can be diagnostic of sinogenic cause for frontal headache.

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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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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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