A Radiological Study of Anatomical Variations of Uncinate Process

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.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192509 ◽

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.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20172102 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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Correlation : Anatomical Variations of Nasal Cavity and Paranasal Sinuses and the Quality of Life Based on SNOTT-22 Score

Saintika Medika ◽

10.22219/sm.vol17.smumm1.13763 ◽

2021 ◽

Vol 17 (1) ◽

pp. 49-60

Author(s):

Rani Rahmawati

Keyword(s):

Quality Of Life ◽

Ct Scan ◽

Nasal Cavity ◽

Paranasal Sinuses ◽

Anatomical Variation ◽

Anatomical Variations ◽

Uncinate Process ◽

Paranasal Sinuses Ct ◽

Snot 22

This study aims to determine the correlation between the anatomical variations of nasal cavity and paranasal sinuses and the quality of life based on SNOT-22 score in the patients who underwent paranasal sinuses CT scan. The samples are 36 patients with age ≥ 18 years. The method is Chi Square test / Fisher's test and Spearman’s rho test. The results showed that anatomical variations of the nasal cavity and paranasal sinuses from most of the patients who underwent paranasal sinuses CT scan had septal deviation n = 29, p = 0.007 (p <0.05) and concha bullosa n = 15, p = 0.029 (p <0.05). There was a significant correlation between total anatomical variation and quality of life based on SNOT-22 score in the patients who underwent paranasal sinuses CT scan p = 0.025 (p <0.05). There was no correlation between the anatomical variations of frontal cells, agger nasi cells, ethmoid bulla, uncinate process and haller cells and the quality of life based on SNOT-22 score in the patients who underwent paranasal sinuses CT scan.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20160066 ◽

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

Background: 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.Methods: 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. Results: 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%).Conclusion: 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.

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Anatomical Variations of Uncinate Process in a Tertiary Care Hospital of a Coastal city in Karnataka

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2021/v19i1130394 ◽

2021 ◽

pp. 17-21

Author(s):

Carol Jacob ◽

Anita Aramani ◽

Basavaraj N. Biradar ◽

Shaista Naaz

Keyword(s):

Tertiary Care ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

Ciliary Activity ◽

Care Hospital ◽

Lamina Papyracea ◽

Osteomeatal Complex ◽

The Right ◽

Observational Descriptive Study

Introduction: Superior attachment of uncinate process is the most important anatomical landmark in frontal recess surgery. The uncinate process is an integral structure of osteomeatal complex and prevents the direct contact of the inspired air with the maxillary sinus. It acts as a shield and also plays a role in muco-ciliary activity. Anatomic variations of the uncinate process have surgical implications. Aim: This study was done to know the different variations of superior attachment of uncinate process. Materials and Methods: In this retrospective observational descriptive study, Computed Tomography (CT) scans of Para Nasal Sinuses (PNS) of 256 patients from Sept 2018 to May 2020 were studied. The results were expressed in percentages and proportions. Results: Among 256 CT images, 139 belonged to males and 117 females. In the CT films examined, on the right side, the most common attachment of uncinate was to lamina papyracea which was (64.8%) followed by skull base (19.5%) and to the middle turbinate(15.6%). Similar findings were seen on left side. Conclusion: Uncinate process shows different variations in its superior attachment. Superior attachment to lamina papyracea was the most common attachment of uncinate in our study.

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Role of Sinonasal Anatomic Variations in the Development of Maxillary Sinusitis: A Cone Beam CT Analysis

The Open Dentistry Journal ◽

10.2174/1874210601711010367 ◽

2017 ◽

Vol 11 (1) ◽

pp. 367-374 ◽

Cited By ~ 5

Author(s):

Leila Khojastepour ◽

Abdolaziz Haghnegahdar ◽

Negar Khosravifard

Keyword(s):

Maxillary Sinus ◽

Paranasal Sinuses ◽

Maxillary Sinusitis ◽

Cone Beam Ct ◽

Anatomical Variations ◽

Uncinate Process ◽

Inflammatory Status ◽

The Status ◽

Ct Analysis ◽

Sinus Ostium

Background:Several anatomical variations can lead to the inflammation of the paranasal sinuses; therefore, surgeons should be familiar with these variations and their impacts on the status of the paranasal sinuses.Objectives:The present study aimed to determine the prevalence of Haller cells and its association with patients’ sex and age. Furthermore, the relationships between the presence and size of Haller cells, deviation of the uncinate process and size of the maxillary sinus ostium with the occurrence of maxillary sinusitis were investigated.Materials/ Patients and Methods:120 coronal CBCT images were retrieved and analyzed. Statistical analysis of the data was performed by means of Mann - Whitney, χ2and T tests.Results:There were statistically significant associations between the presence and surface area of Haller cells and the occurrence of ipsilateral maxillary sinusitis. Neither the angulation of the uncinate process nor the size of the maxillary sinus ostium significantly correlates with the formation of maxillary sinusitis.Conclusion:Haller cells can interfere with the normal drainage of the maxillary sinus and result in sinusitis. In contrast, diameter of the sinus ostium and deviation of the uncinate process do not influence the inflammatory status of the maxillary sinus significantly.

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Pneumatization of the uncinate process

The Journal of Laryngology & Otology ◽

10.1017/s0022215100123060 ◽

1993 ◽

Vol 107 (4) ◽

pp. 361-362 ◽

Cited By ~ 7

Author(s):

V. L. Cumberworth ◽

J. Russell ◽

I. Colquhoun ◽

I. S. Mackay

Keyword(s):

Paranasal Sinuses ◽

Uncinate Process ◽

Ct Scans ◽

Consecutive Series ◽

Ct Findings

We report one case of extensive and two of partial pneumatization of the uncinate process from a consecutive series of 250 CT scans of the paranasal sinuses. The CT findings are illustrated and the literature reviewed.

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Radiological study of the myriad variations in frontal sinus anatomy: an institutional study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190762 ◽

2019 ◽

Vol 5 (2) ◽

pp. 369

Author(s):

Sreenivas Vepamininti ◽

Soumya M. Seetharam ◽

Jomy George ◽

Hemanth Vamanshankar ◽

Poonam K. Saidha

Keyword(s):

Paranasal Sinuses ◽

Frontal Sinus ◽

Chronic Sinusitis ◽

Signs And Symptoms ◽

Anatomical Variations ◽

Sinus Disease ◽

Radiological Study ◽

Medical College ◽

Sinus Drainage ◽

Axial Ct

Background: The frontal sinus is a challenging area for endoscopic surgeons. The variations in the frontal sinus differs so much among individuals that there are forensic applications. A detailed radiological study of the sinus is important for understanding the pathophysiology of sinusitis and as a prerequisite for frontal sinus drainage procedures. Aims and objectives were to document the anatomical variations of the frontal sinus (radiological) and to correlate the variations with the signs and symptoms of sinusitis.Methods: Coronal and axial CT paranasal sinuses scans of 30 consecutive patients who attended the Otolaryngology clinic OPD in St. John’s medical college and hospital, Bangalore, India with signs/symptoms of chronic sinusitis were evaluated between January to July 2018. Results: The average frontal sinus diameter in patients with sinusitis was 6.65 mm. The prevalence of frontal cells in our study was 48%. Agger nasi cells were the most common cells seen. Frontal sinus disease was found in 72% of the studied sides in the scans.Conclusions: Frontal sinus anatomy varies with different ethnicities. It is very important to study the frontal sinus anatomy before exploring the sinus for disease clearance and avoid surgical complications.

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Clinical significance of paranasal sinuses and its anatomical variations using 3D cone beam computed tomography: a retrospective study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191730 ◽

2019 ◽

Vol 5 (3) ◽

pp. 683 ◽

Cited By ~ 1

Author(s):

Saraswathi Gopal ◽

Madhu Preetha

Keyword(s):

Retrospective Study ◽

Maxillary Sinus ◽

Clinical Significance ◽

Paranasal Sinuses ◽

Developmental Process ◽

Anatomical Variations ◽

Sinus Surgery ◽

P Value ◽

Chronic Infections ◽

Study Population

Background: Paranasal sinuses are a group of four paired air filled spaces surrounding the nasal cavity. During the developmental process, anatomical variations can occur in consequence of intra and extramural migration of the ethmoidal air cells, over pneumatization or hypoplasia of the sinuses and bulging of the neurovascular structures to the sinuses, thereby affecting the drainage pathways, causing chronic infections and complications during functional endoscopic sinus surgery (FESS). The aim of the study was to study the clinical significance of paranasal sinuses and it’s anatomical variations using CBCT.Methods: A retrospective study was carried out at Meenakshi Ammal Dental College, Chennai, from June 2018 to November 2018 using 100 CBCT images of 50 males and 50 females, with their age group ranging from18-60 years. Radiographic assessment of paranasal sinuses and it’s variations were accurately characterized using customized Planmeca Romexis software and the data was analysed statistically. Results: It is found that agar nasi cells were found to be higher 79% followed by Kuhn cells 45%, onodi cells 23% and haller cells 12%. Concha bullosa was found in 39%. Nasal septum was deviated to right in 31% and to the left in 36%. Maxillary sinus septa in 21%, sphenoid sinus pneumatization in 23%,maxillary sinus pneumatization in 2%, and crista galli pneumatization in 7% of the study population. And the results based on gender, the p value is found to be highly significant.Conclusions: CBCT is the best tool for imaging the paranasal sinuses including osteo meatal complex, due to its high quality bone definition, thin slicing, multi planar cross-sectioning and low patient dosage.

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