Uncinate Preserving Procedures: A Leading Step toward Conservation in Functional Endoscopic Sinus Surgery

ABSTRACT Uncinate process is thought to be having role in controlling airflow dynamics at the osteo meatal complex. Excision of uncinate process during traditional functional endoscopic sinus surgery (FESS) affects these airflow patterns increasing the flow in the sinuses in inspiration and decreasing it during expiration. Conventional way of performing a FESS always includes uncinectomy. However, preservation of uncinate process during surgery leads to the protection of the opened sinuses and avoid the attack of direct airflow to the sinus along with maintaining the normal nasal drainage from the sinus cavities. There is no clear evidence or consensus in the issue and regarding the feasibility of successful access in the ethmoids and sphenoids and beyond by preserving this immensely important land mark. In this study, we have tried to see that whether it is feasible to conserve uncinate as a future eland mark and preserve more normal nasal physiology compared with the resection of uncinate process. How to cite this article Gupta AK, Patro SK. Uncinate Preserving Procedures: A Leading Step toward Conservation in Functional Endoscopic Sinus Surgery. Clin Rhinol An Int J 2015;8(1):12-14.

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Partial Endoscopic Middle Turbinectomy Augmenting Functional Endoscopic Sinus Surgery

Otolaryngology ◽

10.1177/019459989210700307 ◽

1992 ◽

Vol 107 (3) ◽

pp. 382-389 ◽

Cited By ~ 49

Author(s):

William R. Lamear ◽

William E. Davis ◽

Jerry W. Templer ◽

Joel P. Mckinsey ◽

Herbierto Del Porto

Keyword(s):

Endoscopic Sinus Surgery ◽

Underlying Disease ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Atrophic Rhinitis ◽

Standard Component ◽

Patients At Risk ◽

Nasal Physiology ◽

Middle Meatus Antrostomy ◽

The Impact

Endoscopic sinus surgery has gained acceptance in the otolaryngologic community as an effective and safe method of treating inflammatory disease of the paranasal sinuses. At our institution, partial endoscopic middle turbinectomy has become a standard component of the procedure and our experience is reported. Middle turbinectomy enhances surgical exposure, specific anatomic anomalies are more completely corrected, and subpopulations of patients at risk for failure because of their underlying disease enjoy decreased rates of synechiae formation and closure of the middle meatus antrostomy when followed over time. Photodocumentation of the surgical technique and a discussion regarding the impact of middle turbinectomy on normal nasal physiology are presented. It is reported that the procedure is safe, and no complications directly attributable to middle turbinectomy (including atrophic rhinitis) are reported in a series of 298 patients.

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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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Retroverted Uncinate Process: An Anatomic Variation

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v24i2.691 ◽

2009 ◽

Vol 24 (2) ◽

pp. 40 ◽

Cited By ~ 1

Author(s):

Armando T. Isla ◽

Josefino G. Hernandez

Keyword(s):

Endoscopic Sinus Surgery ◽

Anatomic Variation ◽

Middle Turbinate ◽

Uncinate Process ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Anatomic Variations ◽

Intelligent Decision Making ◽

Intelligent Decision ◽

Ct Analysis

Considerable attention has been directed toward analysis of paranasal sinus anatomy through coronal plane computerized tomographic (CT) imaging in this age of functional endoscopic sinus surgery. Recently, it has become apparent that anatomic variations are also evident on CT analysis of patients. Subtle anatomic features can now be imaged through CT, with a level of clarity previously not afforded by standard sinus radiographs.1 The key to a successful endoscopic sinus surgery is the proper identification of landmarks, and intelligent decision-making should there be any doubts as to what structure lies ahead. The middle turbinate is the main landmark in the region and should be preserved if possible. Attention to the limits of the middle turbinate landmark is one of the keys to uncomplicated surgery.2 The presence of a retroverted uncinate process, wherein the uncinate process ( rather than the middle turbinate) is the first bone to encountered, can be misleading to the rhinologic surgeon and lead to inadequate surgery. Familiarity with anatomic variations such as the retroverted uncinate process should increase the safety and effectiveness of functional endoscopic sinus surgery.

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Use of computational fluid dynamics to study the influence of the uncinate process on nasal airflow

The Journal of Laryngology & Otology ◽

10.1017/s002221511000191x ◽

2010 ◽

Vol 125 (1) ◽

pp. 30-37 ◽

Cited By ~ 9

Author(s):

G-X Xiong ◽

J-M Zhan ◽

K-J Zuo ◽

L-W Rong ◽

J-F Li ◽

...

Keyword(s):

Fluid Dynamics ◽

Computational Fluid Dynamics ◽

Nasal Cavity ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Uncinate Process ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Nasal Airflow ◽

Before And After

AbstractBackground:Chronic rhinosinusitis is commonly treated by functional endoscopic sinus surgery involving excision of the uncinate process and opening of the osteomeatal complex.Methods:Computational fluid dynamics were used to compare nasal airflow after two different surgical interventions which involved opening the paranasal sinuses, excising the ethmoid sinus, and excising or preserving the uncinate process, in a cadaveric head model. Cross-sectional computed tomography images were obtained before and after the interventions. Imaging data were used to prepare computer simulations, which were used to assess the airflow characteristics of the nasal cavities and paranasal sinuses during inspiration and expiration, before and after intervention.Results:Significantly larger nasal cavity airflow velocity changes were apparent following the uncinate process excising procedure. Nasal cavity airflow distribution remained relatively unchanged following the uncinate process preserving procedure. There was a significantly greater increase in airflow volume following the uncinate process excising procedure, compared with the uncinate process preserving procedure.Conclusion:Preservation of the uncinate process may significantly reduce the alteration of nasal cavity airflow dynamics occurring after functional endoscopic sinus surgery for chronic rhinosinusitis.

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Uncommon anatomic variations in patients with chronic paranasal sinusitis

Otolaryngology ◽

10.1016/j.otohns.2004.09.132 ◽

2005 ◽

Vol 132 (2) ◽

pp. 221-225 ◽

Cited By ~ 9

Author(s):

Ting-Kuang Chao

Keyword(s):

Endoscopic Sinus Surgery ◽

Middle Turbinate ◽

Uncinate Process ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Correct Identification ◽

Anatomic Variations ◽

Paranasal Sinusitis ◽

Number Of Patients ◽

Tomography Scan

OBJECTIVE: Some uncommon anatomic variations would be encountered with the increasing number of patients with chronic paranasal sinusitis who have undergone functional endoscopic sinus surgery. The correct identification and proper treatment for these variations are important. STUDY DESIGN AND SETTING: A retrospective study of serial computed tomography scan images was conducted in 100 patients collected randomly. Uncommon anatomic variations were recorded and clinical features were analyzed. RESULTS: Five (5%) cases with uncommon anatomic variations were found. These variations included bilateral pneumatization of uncinate process (1%), large uncinate process mimics the middle turbinate (1%), nontraumatic protrusion of orbital contents through dehiscence of lamina papyracea (1%), and nasal septal pneumatization (2%). Two of these 5 cases caused some modifications of routine functional endoscopic sinus surgery procedures and another 2 variants commanded further caution during routine uncinectomy. CONCLUSION AND SIGNIFICANCE: Uncommon anatomic variations, though unusual, are not rare in chronic paranasal sinusitis patients. Procedures should be tailored for most of these special conditions.

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Evaluation of ostiomeatal complex pathology related to endoscopic sinus surgery – a retrospective analysis

Romanian Journal of Rhinology ◽

10.1515/rjr-2015-0011 ◽

2015 ◽

Vol 5 (18) ◽

pp. 95-100

Author(s):

Vlad Budu ◽

Alexandra Schnaider ◽

Maria Sabina Tache ◽

Ioan Bulescu

Keyword(s):

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Uncinate Process ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Common Finding ◽

Nasal Discharge ◽

Lateral Nasal Wall ◽

Concha Bullosa ◽

Ostiomeatal Complex

Abstract BACKGROUND. The ostiomeatal complex (OMC) is the anatomical region situated between the middle turbinate and the lateral nasal wall, at the level of the middle meatus. Common anatomical variations of OMC are concha bullosa, hypertrophy of the uncinate process and of the bulla ethmoidalis and Haller’s cell. Our study was aimed to investigate the prevalence of these conditions and their relations to different symptoms. MATERIAL AND METHODS. The study is a retrospective descriptive study based on 256 files of patients who were hospitalized and treated for OMC pathology in our clinic between January 2009 and January 2014. The data acquired were included into Excel Worksheets and statistically analyzed using GraphPad Software. RESULTS. The most common finding was concha bullosa (63.67%), followed by hypertrophy of the bulla ethmoidalis (10.93%) and of the uncinate process (10.15%). Haller’s cell was found in only 3% of cases. The most common symptom for all patients was nasal obstruction, followed by nasal discharge. The majority of symptoms improved after functional endoscopic sinus surgery for OMC drainage. CONCLUSION. OMC pathology is a frequent indication for functional endoscopic sinus surgery. The most common condition that determines blockage of OMC and need for surgical treatment is concha bullosa. The most common complaint of patients with OMC pathology is nasal obstruction.

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