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

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.

Crayon in the Orbit and Sinuses in a Pediatric Patient

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

COVID 19 & Mucormycosis- The Mystery of Intertwined Pathologies

An anesthesiologist has been constantly pushed from the domains of being a perioperative physician to that of a COVID physician in the current COVID -19 pandemic. We have been sailing uncharted water pressured to unearth the mysteries of COVID 19 for 18 months now without any definitive treatment. Come April 2021, mucormycosis had become the talk of the town! India saw an exponential rise in cases of post covid mucormycosis. Ample theories and speculations were dug out to understand if there is a causal relationship at all. The fact is mucormycosis cases did exist in the pre-covid era as well but what led to its sudden skyrocketing numbers in covid times needed some brainstorming and hence prompted me to pen this piece of write up. Dr Poonam Ghodki, Professor of Anaesthesiology in SKNMC & GH, Pune has kindly shared some brilliant inputs from her experience of managing these challenging cases on various platforms through Anaesthesiatv. She quotes that the commonly used term black fungus is a misnomer as the black fungus is a yeast with abundant melanin on the surface. Mucormycosis is a different fungal pathology that gets its characteristic appearance due to the devitalisation of affected tissues. Although ubiquitous, human beings are resistant to its deadly invasion. Under favourable circumstances, the opportunistic fungus after angioinvasion causes ischaemia and necrosis of contagious tissue forming the hallmark blackish eschar [1]. The five main types of mucormycosis described are rhino-orbitocerebral, pulmonary, cutaneous, gastrointestinal and disseminated, of which rhino-orbitocerebral has been observed to be the commonest. In the rhino-orbitocerebral variant, the fungus invades the lamina papyracea of ethmoidal sinuses and gains access to orbit leading to proptosis and blindness. It could gain entry through the cribriform plate to the brain and cause sagittal sinus thrombosis and stroke. Gaining further clarity on managing Covid 19 cases recovery increased man

Analysis of Lamina Papyracea Area and Ethmoid Sinus Volume in Indonesian Patients Undergoing Paranasal Sinus CT Scan

Of the rhinosinusitis (CRS) patients, half of whom require surgical intervention. Functional endoscopic sinus surgery (FESS) is a standard treatment of CRS and sinonasal polyposis. Orbito-ocular complications can occur during FESS. The lamina papyracea (LP) is the weakest point of the medial wall of the orbit. The variability in the size and shape of the paranasal sinuses is important in the FESS procedure. The ethmoid sinus is the most complex paranasal sinuses. Preoperative evaluation using computed tomography (CT) is mandatory for all patients undergoing FESS. This study aimed to determine the lamina papyracea area and ethmoid sinuses volume in patients who underwent a CT scan of paranasal sinuses. This study was a descriptive study on 103 patients who underwent a CT scan of paranasal sinuses in the Radiology Department of Hasanuddin University General Hospital, Makassar, from January to August 2019. The lamina papyracea area and ethmoid sinus volume were measured based on age and gender. The results showed that the average of lamina papyracea size and ethmoid sinus volume was greater in males than in females. There was a correlation between age and posterior height of left lamina papyracea (p=0.02), but no correlation between ethmoid sinuses volume and age.