Incidence of Agger Nasi cells and Haller cells in Computed Tomography of Paranasal Sinuses

Introduction Agger nasi and haller cells are few of the common anatomical variants of Paranasal Sinuses (PNS) . They can cause obstruction of osteomeatal complex and frontal recess and can cause refractive sinusitis. Also these variants can lead to complications during procedures like Functional Endoscopic Sinus Surgery (FESS). Hence, complete knowledge about these variants and imaging features help in early diagnosis and also helps in avoiding complications during surgery. Materials and Method A retrospective study of 100 patients conducted during the period from January 2021- April 2021 in Saveetha Medical College and Hospital. All the patients included in the study were referred from the department of otorhinolaryngology for Computed Tomography of PNS. All the images were individually analysed and evaluated for occurrence of Agar Nasi cells and Haller cell variants. Results Out of the study population of 100 patients, 56% of the patients were observed for Agger Nasi cells and 19% of the patients were observed for Haller cells. Conclusion Our study concludes that agger nasi and haller cells are found in a significant proportion of the study population. Hence, Identifying these anatomical variants with great accuracy will help in diagnosing and appropriate management of refractive sinusitis and also be critical in supporting surgeons in tailoring surgery for patients when done preoperatively and thereby avoid fatal complications during procedures (1).

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Bilateral concha bullosa with right sided extensive rhinolith: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192744 ◽

2019 ◽

Vol 5 (4) ◽

pp. 1122

Author(s):

Sumit Prinja ◽

Jailal Davessar ◽

Gurbax Singh ◽

Simmi Jindal ◽

Alisha Bali

Keyword(s):

Computed Tomography ◽

Paranasal Sinus ◽

Nasal Obstruction ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Anatomical Variations ◽

Sinus Surgery ◽

Anatomic Variations ◽

Concha Bullosa ◽

Medical College

Anatomic variations of the paranasal sinuses can lead to various diseases per se. The paranasal sinus anatomy should be carefully examined prior to performing endoscopic sinus surgery in terms of both existent pathologies and anatomic variations. The anatomy of the paranasal sinuses and its variations have gained importance, along with advances in coronal paranasal sinus computed tomography and extensive use of endoscopic sinus surgery. Rhinolith is a mass resulting from calcification of an endogenous or exogenous nidus within the nasal cavity. It is an uncommon disease that may present asymptomatically or cause symptoms like headache and nasal obstruction. A 24 year old woman was admitted in ENT department of GGS Medical College and Hospital, Faridkot with complaints of nasal obstruction, anosmia and headache persisting for 5 years. Right sided rhinolith was detected on anterior rhinoscopy. Bilateral concha bullosa with right sided rhinolith was reported on preoperative paranasal computed tomography scan. It is known that the paranasal sinuses have a number of anatomical variations. Sometimes severe anatomic variations predispose to rhinosinusitis. Herein we report a rare case, along with a review of the literature, to emphasize that severe anatomical variations should not be ignored.

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Use of Computed Tomography (CT scan) for delineating anatomy and variation of frontal Sinus before Functional Endoscopic Sinus Surgery

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0903.13 ◽

2022 ◽

Vol 9 (3) ◽

pp. 54-57

Author(s):

Sajjad Ali Hashmi Syed ◽

Sadaf Tanveer Khan ◽

Jawwad Ali Hashmi Syed

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Anatomical Variations ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Medical College ◽

Orbital Roof

Abstract Introduction: For Functional Endoscopic Sinus Surgery (FESS), the surgeon needs an accurate depiction of the anatomy of paranasal sinuses and their variations. Computed tomography (CT Scan) fulfills this requirement by providing detailed anatomy, the anatomical variants, and the extent of the disease in and around the Para nasal sinuses. The aim of this study is to show the anatomy of the Frontal sinus as delineated by the computed tomography. Materials and Methods: STUDY DESIGN: Cross section Descriptive Study. Out of 337 patients above 12 years of age who were referred for computed tomography of paranasal sinuses in the Dept. of Radio- Diagnosis, Govt. Medical College and Hospital from December 2015 till October 2017, 200 adults(males and females) were randomly selected.Of the 200 subjects studied 37(18.5%) subjects had hypoplastic/ non or poorly pneumatised frontal sinuses of which 31 (15.5%) were bilateral and 6 (3%) were unilateral i.e. on right side. Observations and results: Intra frontal cell were seen in about 64 (32%) subjects of which 26 (13%) on right side, 24 (12%) were on left side and 14 (7%) were bilateral. Extension of pneumatisation into crista galli was seen in 16 (8%) subjects and into orbital roof was seen in 6 (3%) subjects. Conclusion: The findings in this study show that anatomical variations in the Para nasal sinuses and nasal cavity are common. Computed tomography is fundamental radiologic investigation for diagnosis of the Sino nasal lesions or pre and post-surgical assessment.

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The Prevalence of Protrusion of Infraorbital Nerve into Maxillary Sinus Identified on CT Scan of the Paranasal Sinuses at a Tertiary Hospital in Nepal

Nepalese Journal of Radiology ◽

10.3126/njr.v8i1.20440 ◽

2018 ◽

Vol 8 (1) ◽

pp. 7-12

Author(s):

Rupesh Gautam ◽

Deepak Adhikari ◽

Matrika Dhital ◽

Sudip Thakur ◽

Bhawana Adhikari

Keyword(s):

Ct Scan ◽

Maxillary Sinus ◽

Paranasal Sinuses ◽

Tertiary Hospital ◽

Sinus Surgery ◽

Infraorbital Nerve ◽

Median Length ◽

Accidental Injury ◽

Medical College ◽

Infraorbital Canal

Introduction: The variation in the course of infraorbital canal and protrusion of the infraorbital nerve through it to the maxillary sinus may lead to its accidental injury during reconstructive or endoscopic sinus surgery. Preoperative identification of this variant will prevent unintended injuries. Methods: A retrospective study of 307 patients who underwent CT scan study of the paranasal sinuses at Chitwan Medical College, Nepal was conducted. The protrusion of infraorbital nerve to the maxillary sinus was identified and the length of the bony septum along with the infraorbital nerve was measured. It was further classified as Class I to III according to the length of the septum.Results: The prevalence of protrusion of inferior orbital nerve in our study was 11.40 % and bilateral protrusion was 5.8 %. The median length of the protruding component along with the septum was 4.9 mm. Conclusion: Preoperative identification of the normal protrusion of infraorbital nerve to the maxillary sinus will prevent accidental injuries during sinus surgery. CT scan of the paranasal sinus would be the modality of choice for identification of this variant.

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Superior Turbinate Pneumatization in Patients with Chronic Rhinosinusitis: Prevalence on Paranasal Sinus CT

Ear Nose & Throat Journal ◽

10.1177/014556130808701012 ◽

2008 ◽

Vol 87 (10) ◽

pp. 578-586 ◽

Cited By ~ 5

Author(s):

Seth J. Kanowitz ◽

Annette O. Nusbaum ◽

Joseph B. Jacobs ◽

Richard A. Lebowitz

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Chronic Rhinosinusitis ◽

Paranasal Sinus ◽

Paranasal Sinuses ◽

Tertiary Referral ◽

High Resolution Computed Tomography ◽

Tertiary Referral Center ◽

Superior Turbinate ◽

Osteomeatal Complex

With the availability of high-resolution computed tomography (CT), a great deal of attention has been paid to the anatomy of the paranasal sinuses. But while investigators have focused on the osteomeatal complex and its relation to chronic rhinosinusitis, there has been little discussion of the superior turbinate. Although a few anatomic studies have tried to quantify pneumatization of the superior turbinate, the prevalence of this finding on radiography is not well addressed in the literature. We prospectively studied 100 consecutively presenting patients who underwent coronal CT of the paranasal sinuses (200 sides) for the evaluation of symptoms of chronic rhinosinusitis at an academic tertiary referral center to determine the prevalence of pneumatization of the superior turbinate. We found evidence of pneumatization in 44 of the 200 sides, for a prevalence of 22%. In all, pneumatized superior turbinates were found in 27 patients (27%)—bilaterally in 17 (17%) and unilaterally in 10 (10%).

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Paranasal Sinus Mucoceles in Cystic Fibrosis

American Journal of Rhinology ◽

10.2500/105065893781976609 ◽

1993 ◽

Vol 7 (1) ◽

pp. 31-35 ◽

Cited By ~ 12

Author(s):

William E. Davis ◽

Giulio J. Barbero ◽

William R. LaMear ◽

Jerry W. Templer ◽

Peter Konig

Keyword(s):

Cystic Fibrosis ◽

Paranasal Sinus ◽

Computerized Tomography ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

The Other ◽

Sinus Surgery ◽

Lateral Nasal Wall ◽

Osteomeatal Complex

Six patients between the ages of 6 and 22 years old with cystic fibrosis were found to have mucoceles of the paranasal sinuses. Four were male and two were female. They experienced nasal obstruction, purulent rhinorrhea, and anosmia, but none had fever or pain. Nasal endoscopy and coronal computerized tomography scans revealed the lateral nasal wall to be displaced medially against the septum. Functional endoscopic sinus surgery revealed large cystic spaces filled with thick yellow-green mucus. Postoperatively most patients are able to smell and breathe through their noses. The mucocele probably begins as an obstructed anterior ethmoid cell, which then enlarges and obstructs the osteomeatal complex, which further impairs drainage of the other sinuses into this area.

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Evaluation of Anatomical Variations in Maxillary Sinus and Management of Chronic Sinonasal Disease

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/680 ◽

2021 ◽

Vol 10 (38) ◽

pp. 3351-3355

Author(s):

Ganesh Manohar Vihapure ◽

Akshay Sorade ◽

Kaenat Ahmed ◽

Lakshmi Sravya Yarlagadda ◽

Khaleel Basha Munnaru

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Anatomical Variations ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Successful Outcome ◽

Operative Care ◽

Number Of Patients

BACKGROUND The paranasal sinuses (PNS) have various anatomical difference. Computed tomography (CT) is an excellent means of providing anatomical information of this region, disease extent, assisting endoscopic evaluation and guiding treatment. Functional endoscopic sinus surgery (FESS) has become an increasingly popular treatment for chronic sinus diseases. CT of the paranasal sinuses has become a roadmap for FESS. The present study focuses on the assessment of the efficacy, safety and benefits of functional endoscopic sinus surgery in cases of maxillary pathologies and also study the anatomical variations in maxillary sinus in computed tomography and its usefulness in planning and management of chronic sinonasal diseases. METHODS It was a prospective study and a total of 80 patients were included in this study from July 2019 to June 2020 in the Otolaryngology Department, KIMS, Karad. Standard surgical steps were applied in each case according to the extent of disease. All patients underwent standard post-operative care. All findings were recorded and studied. RESULTS Total number of patients were 80. Of which, 31 (38.75 %) patients were operated for ethmoidal polyp, 24 (30 %) for chronic rhinosinusitis, 10 (12.5 %) for antrochoanal polyp, 9 (11.25 %) for rhinosporidiosis and 6 (7.5 %) for inverted papilloma. Postoperative complications were periorbital echymoses (13 %), synechiae (2.5 %), epiphora (2.5 %), infection (2.5 %), hemorrhage (4 %). Complete relief of symptoms were noted in 81.67 % cases. CONCLUSIONS Successful outcome and patient satisfaction post treatment can be obtained by careful evaluation and patient selection by history, examination and most importantly, proper imaging of the sinuses. KEY WORDS Maxillary Sinus, Sinusitis, Nasal Polyp, Paranasal Sinus Disease, Computed Tomography (CT)

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Agreement between cone-beam computed tomography and functional endoscopic sinus surgery for detection of pathologies and anatomical variations of the paranasal sinuses in chronic rhinosinusitis patients: A prospective study

Imaging Science in Dentistry ◽

10.5624/isd.2020.50.4.299 ◽

2020 ◽

Vol 50 (4) ◽

pp. 299

Author(s):

Nafiseh Nikkerdar ◽

Nastaran Eivazi ◽

Mohana Lotfi ◽

Amin Golshah

Keyword(s):

Computed Tomography ◽

Prospective Study ◽

Cone Beam Computed Tomography ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Anatomical Variations ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Cone Beam ◽

A Prospective Study

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172121 ◽

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.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195697 ◽

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

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

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