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.

A CBCT Study for Anatomic Variations of Osteomeatal complex in Patients With Cleft Lip and Palate

Objective To evaluate the anatomy and variations of osteomeatal complex (OMC) by comparing patients with nonsyndromic cleft lip and palate (CLP) and control group. Design This case-control study was retrospectively analyzed using cone-beam computed tomography data. Setting Istanbul University Faculty of Dentistry Department of Dentomaxillofacial Radiology. Patients The study was conducted with 100 patients (44 females, 56 males) with CLP and 100 patients in the control group, which matched gender and age (with a maximum difference of 3 years). Variables OMC variations are grouped as follows: ethmoidal, conchal, uncinate process, and septal variations. Then, we evaluated the presence of these OMC variations and compared them between the two groups. Statistical analysis The McNemar's test was used to determine any significant differences between the groups for all indices at the 95% confidence level. Results The most common anatomic variation in this study was Agger nasi cell (97%) and concha bullosa (97%) in the patients with CLP, while Agger nasi cell was the most common variation (99%) in the controls. Moreover, the atelectatic uncinate process was the least observed variation in both groups (1%). The incidences of paradoxical concha (58%;42%), bifid concha (29%;11%), deviated nasal septum (92%;80%) were significantly higher in the CLP group ( p < 0.05). Conclusions The statistically significant results found when comparing OMC anatomy between the two groups reveal the importance of three-dimensional evaluation before functional endoscopic sinus surgery in patients with CLP.

A Clinical Study of Different Modalities for the Management of Chronic Maxillary Sinusitis

Background: Chronic maxillary sinusitis is a very common presentation in otorhinolaryngology clinics. It has diverse aetiology and varied symptoms at presentation. Its treatment requires a comprehensive approach for successful outcomes. We in the present study tried to evaluate the aetiology of chronic maxillary sinusitis and outcomes of treatment of chronic maxillary sinusitis. Methods: Patients presenting with clinical features of Chronic rhinosinusitis of all age groups and sexes were included in the study. The patients were subjected to general examination from head to toe which included the examination of the Respiratory system and cardiovascular system. ENT examination along with head neck was done. X-Ray (Water's view), C.T Scan PNSCoronal, and Sagittal sections for selected patients. Results: Antibiotics, antihistamines, decongestants, steam inhalations, and in some cases intranasal steroids (Budesonide, Beclomethasone, Fluticasone). Surgery: Antral wash n=16 cases, Intranasal Antrostomy n=2 cases, Caldwell Luc n=2 cases, Maxillary sinoscope n=2 cases, FESS n=38 cases involvinguncinectomy, middle meatal antrostomy, anterior ethmoidectomy, posterior ethmoidectomy, sphenoidotomy, frontal sinus infundibulotomy, and polypectomy. Conclusion: The commonest organism responsible was streptococcus pneumoniae. Improvement in the diagnostic techniques and availability of nasal endoscopy and CT scan which can show clearly the anatomy of osteomeatal complex has led to better management of the disease. Nasal endoscopes have allowed a meticulous delicate removal of the diseased mucosa which preserving the normal mucosa and structures consequently the postoperative complications are very few and most of the cases get relief from the symptoms of the disease

Maxillary sinus cyst as a risk factor for osteomeatal complex block

Introduction: Cysts of the maxillary sinuses are found in about 10% of the population. There is a necessity to clarify indications for cyst removal taking into account its size. The purpose of the study to clarify the indications for surgical treatment of maxillary sinus cysts as a risk factor for sinus drainage disorders in the development of maxillary sinusitis. Methods and materials: 57 people (92 sinuses) were examined. There were 20 patients (40 sinuses) with acute rhinosinusitis, 22 patients (22 sinuses) with post-augmentation sinusitis, and 15 (30 sinuses) almost healthy individuals among them. Prediction of the cyst size, which can lead to blockage of the maxillary sinus ostium, was performed by direct measurement on coronary sections at the ostiomeatal complex level distance from the surface of the mucoperiosteum in the area of the alveolar recessus to the lower surface of the mucosal surface in the area of the ostium. The obtained data were verified by calculation method taking into account the height of the sinus at the level of the osteomeatal complex, the magnitude of possible mucoperiosteum edema in the alveolar recessus and ostium in acute rhinosinusitis and post-augmentation sinusitis, as well as the magnitude of mucoperiosteum elevation due to sinus lift. Results: It was found that the vertical size of the cyst, which can potentially lead to blockage of the maxillary sinus ostium in acute rhinosinusitis is 21.2±0.8 mm, 14.7±1.1 mm in sinusitis after augmentation of the maxilla, and 28.5±0.7 mm in practically healthy individuals. The calculated values are 18.5 mm, 14.0 mm and 24.5 mm, respectively. In case of acute rhinosinusitis, the distance from the apex of the cyst to the surface of the mucous membrane of the ostiomeatal complex area may decrease by 12.8 mm, and in sinusitis after sinus lift it may decrease by 20.4 mm. Conclusions: To assess the potential of the ostiomeatal complex block by a cyst located in the alveolar recessus in acute rhinosinusitis, its vertical size is really important according to coronary sections of at the ostiomeatal complex level corresponding to the location of 5-6 teeth of the upper jaw. The indication for removal of the cyst of the alveolar recessus of the maxillary sinus, as a factor that may worsen the course of acute rhinosinusitis due to the anastomosis block, is its size exceeding 20 mm, and 15 mm for patients who plan to sinus lift.

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).

A comparative study of synechiae formation in endoscopic septoplasty with and without intranasal splints

<p class="abstract"><strong>Background:</strong> Septoplasty is the treatment of choice for deviated nasal septum. Deviated nasal septum can be C shaped or S shaped leading to unilateral or bilateral nasal obstruction. Septal spur may also require surgery. Sometimes deviated nasal septum may block osteomeatal complex leading to chronic sinusitis. For the evaluation of nasal cavities preoperatively computed tomography (CT) paranasal sinuses and diagnostic nasal endoscopy is done. Diagnostic nasal endoscopy done after two weeks of surgery. The objective of the study is to compare the efficacy of intranasal splints in the prevention of nasal synechiae following septoplasty.</p><p class="abstract"><strong>Methods:</strong> 100 patients undergoing septoplasty under general anesthesia from March 2018 to March 2019 were enrolled. Patients with nasal septal deviation and aged between 18-50 years were included in the study. All surgeries were performed by consultant ear, nose and throat (ENT) surgeons under general or local anesthesia. Institutional ethical committee approval was obtained for the study. Informed consent was obtained from all patients. Patients with age under 18 years or over 50 years were excluded for the study. </p><p class="abstract"><strong>Results:</strong> Septoplasty with intranasal splints reduce the formation of synechiae in 48 patients.</p><p class="abstract"><strong>Conclusions:</strong> Usage of intranasal splints indicates a decrease in the postoperative formation of synechiae after septoplasty.</p>

Aspergillosis of the maxillary sinus associated with dental implant

Aspergillosis is a fungal disease caused by fungus aspergillus ; this disease frequently involves the lungs and occasionally the maxillary sinus. Aspergillosis in the maxillary sinus usually has the characteristics of a non-invasive form. It has been suggested that spores of aspergillus can be inhaled to the maxillary sinus via the osteomeatal complex or via through an oroantral fistula after dental procedures such as an extraction. However, maxillary aspergillosis related to implant installation has rarely been reported. This report regards unusual cases of maxillary aspergillosis associated with dental implant therapies in healthy patients. The cases were successfully treated with the surgical removal of the infected or necrotic tissues.

Incidence of concha bullosa and its role in chronic rhinosinusitis

<p class="abstract"><strong>Background:</strong> Pneumatization of nasal turbinates is called concha bullosa. Most often it involves the middle turbinate and is one of the commonest variants of sinonasal anatomy. Bulbous and extensive type of concha bullosa may lead to narrowing or even complete blockage of osteomeatal complex. This alters the normal airflow and drainage pathways of mucous, resulting in mucosal edema which obstructs the ethmoidal infundibulum and osteomeatal obstruction leading to sinusitis. The aim of the study was to determine the incidence of concha bullosa and assess its role in causation of chronic rhinosinusitis. The objective was to determine the incidence of concha bullosa and assess its role in chronic rhinosinusitis.</p><p class="abstract"><strong>Methods:</strong> A retrospective study of 120 patients suffering from chronic sinusitis of age group 18 years to 70 years old were taken between March 2018 to January 2021 at Malla Reddy institute of medical sciences (MRIMS) who had nasal symptoms significant enough to warrant a CT paranasal sinus (CT PNS) with positive findings. All PNSs involved were identified for sinus disease. Concha bullosa identified and graded into small, moderate and large. Patients with history of previous nasal surgeries were excluded.</p><p class="abstract"><strong>Results:</strong> Our study showed 54% cases of chronic sinusitis with concha bullosa.</p><p class="abstract"><strong>Conclusions:</strong> Concha bullosa may be one of the predisposing factors of chronic rhinosinusitis and hence surgical manipulation by functional endoscopic sinus surgery (FESS) is important to prevent recurrence of sinusitis.</p>

Assessment of odontogenic changes in computed tomography of patients with chronic sinusitis

IntroductionChronic sinusitis can be caused by both laryngological and dental factors. The number of odontogenic sinusitis (OS) in last decades is increasing and seems to be underrated. A unique developmental and microbiological factors causing OS require a different therapeutic approach.Material and methodsThis study evaluated tomography examinations of 500 patients with a clinical diagnosis of chronic sinusitis. The patients were referred by laryngologists, neurologists, and maxillofacial surgeons. The scans were reanalyzed in view of the presence of odontogenic and laryngological pathologiesResultsAmong the 500 patients, 19,6% showed no inflammatory changes in the mucosa of the paranasal sinuses. All patient groups had numerous teeth missing, ranging from 27.3% to 33.2%. Most common odontogenic pathologies were periapical changes (28,8%) and the presence of teeth after improper endodontic treatment (24,2%). In the group in question dental implants (0,4%) and maxillary sinus augmentation (2,8%) were a marginal etiological factor.ConclusionsComputed tomography allows a thorough assessment of odontogenic changes. Obstruction of osteomeatal complex does not have direct influence on OS development. 43,2 % of the patients with chronic sinusitis have OS. It can be diagnosed in 50,8% of isolated right, 39,0% of isolated left and 57,8% of bilateral maxillary sinusitis patients. The results of this study can be used by dentists, maxillofacial surgeons and otolaryngologists to improve the standard of diagnosis and treatment in case of chronic odontogenic sinusitis.