Agger Nasi Research Articles

Design of cross-sectional anatomical model focused on drainage pathways of paranasal sinuses

Objective:To design and produce cross-sectional anatomical models of paranasal sinuses for the purpose of demonstrating drainage pathways of each nasal sinus for the young doctors. Method:We reconstructed the three-dimensional model of sinuses area based on CT scan data, and divided it into 5 thick cross-sectional anatomy models by 4 coronal plane，which cross middle points of agger nasi cell, ethmoid bulla, posterior ethmoid sinuses and sphenoid sinus respectively. Then a 3D printerwas used to make anatomical cross-sectional anatomical models.Result:Successfully produced a digital 3D printing cross-sectional models of paranasal sinuses. Sinus drainage pathways were observed on the models. Conclusion:The cross-sectional anatomical models made by us can exactly and intuitively demonstrate the ostia of each sinus cell and they can help the young doctors to understand and master the key anatomies and relationships which are important to the endoscopic sinus surgery.

The Prevalance of Paranasal Sinus Anatomic Variations on Cone Beam Computed Tomography Scan Images of Turkish Population

Objectives: The paranasal sinuses include anatomic structures at the maxillofacial region that matters great importance for the surgeons working in the maxillofacial area. The imaging of anatomic variations of the paranasal sinuses is fundamental to evaluate the predisposing factors for the pathologic changes of paranasal sinuses. The aim of this study is to investigate the prevalence of anatomic variations of the paranasal sinuses by retrospective assessment of cone beam computed tomography (CBCT) images. Methods: The paranasal sinus CBCT images of 300 adult patients who were referred to Marmara University, Faculty of Dentistry, Department of Oral Diagnosis and Radiology were evaluated retrospectively. The paranasal sinus variations and their prevalence were recorded. Results: The prevalence of concha bullosa superior was 7,7%, and concha bullosa media was 54,7%. The prevalence of infraorbital ethmoid cell was 15,3%, agger nasi cell was 52,7% and onodi cell was 52.7%. There was no significant differences prevalence of this anatomic variations between males and females or between different age groups. Conclusions: CBCT is a convenient radiographic examination to evaluate the paranasal sinus anatomic variations. Dental surgeons must be aware of such anatomic variations of the paranasal sinuses.

Anatomical variations in patients with chronic sinusitis

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">C</span><span lang="EN-IN">hronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process.<strong> </strong>Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.</span></p>

Innovative Use of Insulated Microear Ball Probe Cautery in Creation of Nasal Mucosal Flap in EnDCR.

To study the outcome and complications of endoscopic endonasal dacryocystrhinostomy without stenting. Randomised prospective observational design. Tertiary academic centre. Seventy patients, clinically diagnosed as chronic dacryocystitis with nasolacrimal duct obstruction on the basis of syringing, were enrolled. Endoscopy was done for nasal pathology especially mucosal disease, hypertrophied turbinate, DNS. Seventy-eight eyes were operated with endoscopic-dacryocystorhinostomy along with additional surgeries and periodically followed up on OPD-basis at the end of 1st week, 2nd week, 1st month and 3rd month and evaluated clinically and by syringing (Ophthalmologist) and endoscopy done, wherever required. Insulated microear ball probe cautery was used to create nasal mucosal flap in all cases. Eleven patients underwent septal surgery along with one concha bullosa and one agger nasi removal (p<0.05). Nil intraoperative complications (p<0.05) and single postoperative complication noted (p<0.05). Functional and anatomical patency found to be 100% at the end of 1st week, 98.7% at the end of 2nd week, 93.6% at end of 1st month and 91% at end of 3rd month. Nasal endoscopy showed restenosis in 1 patient at end of 2nd week, 4 patients at end of 1st month, 1 patient at the end of 3rd month along with granulation in 1 patient at the end of 3rd month. Revision surgery was done on 2 patients. Endoscopic dacryocystorhinostomy is safe and successful procedure for chronic dacryocystitis, due to nasolacrimal duct obstruction with less complications without stenting. The associated intranasal pathology, which might be the cause, can be corrected and bilateral dacryocystorhinostomy can be performed in single sitting reducing patient's morbidity and hospital stay. Use of cautery with insulated ball probe for making nasal mucosal flaps gives an precise and excellent blood less field.

Prevalence of normal anatomical variations in the region of paranasal sinuses in patients with chronic rhinosinusitis

Background: Knowledge of the anatomical relationships and the anatomical variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery. It helps surgeons to avoid the potential complications of sinus surgery and to improve success of management strategies. Objective: The objective of this study was to show how prevalent are the anatomic variations in the region of the paranasal sinuses and nasal cavity in patients with chronic rhinosinusitis. Materials and Methods: A cross-sectional study was conducted from January 2018 to July 2018 at Al-Hilla general teaching hospital. We collected data of 75 patients (who have met the clinical criteria of chronic rhinosinusitis) subjected to computed tomography (CT) of the paranasal sinuses. CT was performed using SIEMENS SOMATOM Definition AS and Philips machines. Direct coronal scans (1 mm in thickness) were made, from the anterior wall of the frontal sinus to the posterior wall of the sphenoid sinus with axial and sagittal reconstruction images. Results: Anatomical variations found in 69 patients of a total 75 patients with age range from 18 to 60 years with 92%. Among these, nasal septal deviation was the most common (seen in 54/75 patients = 72%) followed by the Agger nasi cells in 52 patients (69%), concha bullosa in 31 patients (41.3%), Haller cells in 28 patients (37%), and Onodi cells in 18 patients (24%). Conclusion: Sinonasal anatomical variations are common findings in patients with chronic rhinosinusitis. Providing information on these anatomical variations will improve the success of endoscopic sinus surgery.

Role of computed tomography in identifying anatomical variations in chronic sinusitis: An observational study

Background/Aim: Clear visualization of bony wall, mucosal layer, sinus contents, and compartment by computed tomography (CT) helps to identify the anatomical variations in chronic sinusitis (CS). We describe the clinical and radiological features in CS. Materials and Methods: We included patients of both genders aged ≥15 years, with CS. Unenhanced CT images of the nasal cavity and paranasal region were taken in coronal, complemented by axial and sagittal reconstructions. Analysis of anatomical variants was performed using a soft tissue window and a bone window. Results: Headache (64%), nasal obstruction (53%), and nasal discharge (38%) were common complaints of 100 patients (male = 52) whose mean ± standard deviation age was 32.55 ± 10.9 years. Significant mucosal thickening in at least one of the paranasal sinuses (PNSs) was seen in all except four patients. All had a minimum of one anatomical variant, 72% had >1 variant. Maxillary antra were most commonly involved (62.0%), followed by ethmoid sinuses (36.0%). Deviated nasal septum (60%) was most common, followed by concha bullosa (38%); paradoxical middle turbinate (18%), ethmoidal bulla (20%), agger nasi cells (33%), Haller cells (21%), and onodi cells (10%) were other features. All had optic nerve involvement with Type I (84%) involvement being common. Kero's classification Type I was noted in 71%. None had Type IV. Cribriform plate and carotid canal wall were normal in all while 2% had dehiscence of lamina papyracea. Conclusion: CT plays an important role in visualization of anatomical variations in PNSs, and anatomical variations particularly in the ostiomeatal complex are the key factors in the causation of CS.

The Bifurcated Frontal Sinus.

ObjectivesFrontal sinus anatomy is complex, and multiple variations of ethmoid pneumatization have been described that affect the frontal outflow tract. In addition, the lumen proper of the frontal sinus may exist as 2 separate parallel cavities that share an ipsilateral outflow tract. This variant has not been previously described and may have implications for surgical management.Study DesignCase series.SettingTertiary rhinology practice.Subjects and MethodsCases with radiographic and intraoperative findings of separate parallel tracts within a unilateral frontal sinus were identified from a consecutive series of 186 patients who underwent endoscopic sinus surgery between May 2015 and July 2016. Data were recorded including sinusitis phenotype, coexisting frontal cells, and extent of surgery.ResultsTen patients (5.4%) were identified with computed tomography scans demonstrating bifurcation of the frontal sinus into distinct medial and lateral lumens. All cases were treated with Draf 2a or 2b frontal sinusotomy with partial removal of the common wall to create a unified ipsilateral frontal ostium. Eleven sides had a coexisting ipsilateral agger nasi cell, 7 had a supra-agger cell, 8 had a suprabullar cell, and 1 had a frontal septal cell. There were no significant complications.ConclusionThe bifurcated frontal sinus is an anatomic variant that the surgeon should recognize to optimize surgical outcomes. Failure to do so may result in incomplete clearance of the sinus and residual disease. The bifurcated sinus may occur with other types of frontal sinus cells and may be safely treated with endoscopic techniques.

The Terracol and Ardouin developmental model of frontal sinus drainage pathway and surrounding spaces: a radiologic validation.

The complexity of the frontal sinus drainage pathway (FSDP) can be challenging even for expert surgeons. Several classifications have been proposed to simplify the understanding of FSDP, whose anatomical variability can be simplified based on the knowledge of its developmental mechanisms. Cone-beam computed tomography studies performed at the Unit of Radiology of the University of Brescia between March and November 2012 were retrospectively analyzed. FSDP was classified as medial or lateral to the vertical portion of the uncinate process and the following anatomical variants were studied: agger nasi cell, Kuhn's cells, suprabullar cell, supraorbital ethmoid cell, suprabullar frontal cell, and frontal septal cell. The developmental model of the FSDP proposed by Terracol and Ardouin was analyzed and expected associations between the position of the drainage pathway and anatomical variants were formulated. Statistical associations between anatomical variants and the position of FSDP were calculated and compared with expected associations to validate the developmental model. The anatomical variants of FSDP statistically validated the developmental model of Terracol and Ardouin. Knowledge of the possible developmental patterns of FSDP helps the surgeon in the understanding of the complexity of the frontoethmoidal region.

Association of Deviated Nasal Septum and Sinusitis: A Radiological Study

Introduction:Deviation of nasal septum (DNS) is the most common anatomical variant in sinonasal region. It is usually asymptomatic, but it sometimes can cause different sinonasal symptoms. The severity of the symptoms is related to associate abnormalities like agger nasi cells, onodi cells, haller cells, concha bullosa and inferior turbinate hypertrophy. Methods:Patients were retrospectively selected by a computer-assisted search of all the reports of CT scans performed with a clinical symptom referable to the sinonasal region, headache, nasal obstruction, recurrent sinusitis, chronic sinusitis, acute sinusitis, allergic sinusitis in S, Nijalinagppa Medical College and Hanagal Shri Kumareshwar Hospital & Research Centre between December 1, 2016 and November 30, 2017 to detect the presence of deviated nasal septum. A total of 524 CT studies were identified. Of these cases, studies with malignancy, motion artifacts, Traumatic fractures, polyps, post-op status were excluded. The study design did not involve any patient contact hence no approval by the local ethics committee was required. Results:The sinusitis was identified in 54 patients (10.4%). The age range was 8 to 75 years with a mean age of 33.5 years. Majority of the patients in our study belonged to 21 to 30 year age group (n=21). 36 were males, 18 were females. Midline nasal septum was seen in 31 patients, among them 14 had sinusitis and 17 showed clear sinuses. Right sided septal deviation was seen in 12 patients. Among them 11 had sinusitis and one patient showed clear sinuses. Left sided septal deviation was noted in 9 cases. Among them 6 had sinusitis and 3 showed no signs of sinusitis. S shaped septum was seen in 2 patients. Septal deviation with spur was seen in 3 patients. Sinusitis was seen in 14 patients with midline septum (45.1%). In 17 patients with midline septum there was no sinusitis (54.9%). Right sided septal deviation with associated sinusitis was seen in 11 of the total 12 cases. There was statistically significant association of septal deviation and sinusitis in our study. Conclusion:The association of midline nasal septum with sinusitis is seen in 44.1% of the cases in our study. The association of deviated nasal septum with sinusitis is seen in 81% of the cases in our study. There was statistically significant association of septal deviation with sinusitis (p value <0.05) in our study.

Relationship of Agger Nasi Cell and Uncinate Process Attachment: A Retrospective Study of Radiological Imaging in Indian Population

Relationship of Agger Nasi Cell and Uncinate Process Attachment: A Retrospective Study of Radiological Imaging in Indian Population

Anatomical Variations of Nasal Structures in Chronic Rhinosinusitis as Detected by Computed Tomography Scan

Background: There is a wide range of anatomical variations affecting the nose, paranasal sinuses (PNS) best diagnosed by Computed Tomography (CT). These variations may cause impairment of mucociliary drainage of the PNS resulting in sinusitis. Objectives: In this paper, the aim is to study the relationship of the anatomical variations of the lateral nasal wall, nasal septum and paranasal sinuses with the occurrence of chronic rhinosinusitis. Methods: The study included two groups of patients, the first has chronic rhinosinusitis while the second was without chronic rhinosinusitis. Anatomical variations of nose and paranasal sinuses which are nasal septal variations, concha bullosa, agger nasi cells, haller cells, paradoxical middle turbinatesand uncinate process variations were detected in both groups to investigate the relation between the anatomical variations and chronic rhinosinusitis. Results: A case control study was done which showed that there a significant statistical relation between nasal septal deviation and chronic rhinosinusitis. Conclusion: There was a significant relation between nasal septal deviation and chronic rhinosinusitis.

Correlation between the extent of pneumatization of Agger agger Nasi nasi cells and the anterior-to-posterior length of the frontal recess: A a computer-assisted anatomical study.

To explore the correlation between the volume of the aAgger nNasi (AN) cell bulge and the A-P length of the frontal recess (FR). In total, 120 patients, who underwent septoplasty, were included. All patients underwent preoperative paranasal sinus computed tomography of the paranasal sinuses (PNS CT) imaging. In total, CT data on of all 120 PNSs patients were analyzed in terms of thewith respect to the extent of pneumatization of the AN cell bulge and the A-P dimensions of the FR. Each side was analyzed separately. We included 120 patients,: 78 (65.0%) females and 42 (35.0 %) males. Their average age was 33.7 ± 11.6 years (range: 18-65 years). The mean volume of the AN cell bulge was 0.26 ± 0.4 mm3 on both the right and left sides. The A-P length of the FR was 7.7 ± 2.2 mm. No significant between-side difference in the mean volume of the AN cell bulge was apparent observed (p=0.906). This volume did not differ significantly by age or sex (p=0.844 and p=0.971, respectively). We found no correlation between the volume of the AN cell bulge and the A-P length of the FR (r = 0.098, p=0.192). In the present study, no correlation between AN cell volume and the A-P length of the FR was found. When studying the anatomical complexity of the FR, it is essential to consider the AN cell volume. We suggest that preoperative CT imaging is critical when endoscopic sinus surgery is planned. However, further studies with larger numbers of patients are needed to explore the relationship between AN cell pneumatization and the anatomy of the FR.

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

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 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. &lt;/p&gt;

A CT and DNE study of osteomeatal complex variations and their correlation in chronic rhinosinusitis patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;CRS is a global burden reducing the productivity at work. This study was done to evaluate the occurrence of anatomical variations of osteomeatal complex (OMC) and to assess its relation in causation of chronic rhinosinusitis in the study population. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A 100 patients diagnosed with CRS in the outdoor of Dept. Of ENT between November 2012 – November 2015 were subjected to CT Imaging and DNE and the frequency of anatomical variations and involvement of paranasal sinuses were evaluated. The correlation between them was established using chi-square test. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Agger nasi cells were the most common variant seen in 73 (73%) patients with 12% being unilateral and 61% bilateral. Other variants seen were: deviated nasal septum in 68%, uncinate process variations in 58%, concha bullosa in 30%, enlarged bulla ethmoidalis in 25%, paradoxical middle turbinate in 18%, haller’s cells in 6% and accessory maxillary ostia in 2%. &lt;span lang="EN-IN"&gt;We could establish a correlation between a few of these variants and the affected sinuses. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The importance of CT and nasal endoscopy is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease.&lt;/span&gt;&lt;/p&gt;

Influence of opacification in the frontal recess on frontal sinusitis.

This study aimed to radiologically evaluate the influence of inflammatory changes in frontal recess cells on frontal sinusitis. A total of 93 patients (186 sides) who underwent primary sinonasal surgery at Hyogo College of Medicine were enrolled in 2015 and 2016. Opacification of agger nasi, fronto-ethmoidal, ethmoid bulla, suprabullar and frontal bulla cells was determined by pre-operative computed tomography and its influence on frontal sinusitis was investigated. In all, 42 per cent of 186 sides were affected by frontal sinusitis. Agger nasi, ethmoid bulla, fronto-ethmoidal, suprabullar and frontal bulla cells were identified in 99 per cent, 100 per cent, 38 per cent, 69 per cent, and 16 per cent of sides, respectively. The presence of frontal recess cells and frontal ostium size did not significantly influence frontal sinusitis development. However, opacification of agger nasi, type 1 fronto-ethmoidal and suprabullar cells significantly influenced frontal sinusitis development. Frontal sinusitis is caused by inflammatory changes in frontal recess cells.

Comparative Evaluation of Anatomical and Pathological Features on Computed Tomography Scan with Intraoperative Findings in Frontal Sinus Pathology

ABSTRACT To compare the anatomical and pathological features on computed tomography (CT) scan with intraoperative findings in cases of frontal sinus disease. This prospective study was conducted in a tertiary referral center, and a total of 30 patients who were refractory to conservative medical treatment undergoing endoscopic sinus surgery for frontal sinus disease were included in the study. Preoperative CT scans were done with axial and coronal cuts with a sagittal reconstruction to obtain a better idea about the frontal recess anatomy. The areas that were studied preoperatively on CT scan were frontal sinus pathology, pattern of sinus involvement, superior attachment of uncinate process, frontal sinus drainage pathway, agger nasi cell, frontal cell, frontal bullar cell, and supraorbital ethmoidal cell. A good correlation was obtained between the CT findings and intraoperative findings. How to cite this article Chakraborty S, Verma D, Lade H, Malik NUD. Comparative Evaluation of Anatomical and Pathological Features on Computed Tomography Scan with Intraoperative Findings in Frontal Sinus Pathology. Clin Rhinol An Int J 2017;10(1):6-10.

A computed tomography and endoscopy assisted study of the anatomical variations of lateral wall of nose in patients of chronic rhinosinusitis- our experience at a tertiary care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Chronic rhinosinusitis (CRS) is a common and persistent illness that ENT surgeons encounter in their day to day practice. The lateral wall of the nose contains the ostiomeatal unit which is the key area targeted in the management of CRS. The lateral wall of nose shows several variations which can alter the course of the disease. It is of utmost importance for the ENT surgeon to be aware of these variations as they decide the overall line of management. The objectives of the study was to study the anatomical variations of the lateral wall of nose using computed tomography (CT) scans and nasal endoscopy in patients of chronic rhinosinusitis.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A one year study from April 2015 to March 2016 involving 50 patients attending the ENT outpatient department clinically diagnosed as CRS using the criteria of task force on rhinosinusitis were included in the present study. Patients underwent a CT scan and DNE and the anatomical variations of the lateral wall of nose were studied. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Concha bullosa was the most common anatomic variation noted in 20 (40%) of the total 50 patients. The other anatomic variations noted were uncinate process variations in 15(30%) patients, agger nasi cells in 3 (6%) patients, hypoplastic middle turbinate in 1 (2%) patient, paradoxical middle turbinate in 2(4%) patients, bulla ethmoidalis in 4 (8%) patients and Haller cells in 1 (2%) patient. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The lateral wall of nose is made up of several structures showing variations which can lead to the development CRS and affect the overall management. They should be evaluated pre-operatively in order to avoid intraoperative complications. CT scan and DNE both complement each other and effectively evaluate the anatomical variations of the lateral wall of nose.&lt;/span&gt;&lt;/p&gt;

The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis.

The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.

Evaluation of the Role of Nasal Endoscopy and Computed Tomography Individually in the Diagnosis of Chronic Rhinosinusitis.

The aims of this study were to assess the individual roles of nasal endoscopy (NE) and computed tomography (CT) in the diagnosis of chronic rhinosinusitis, to evaluate their sensitivity and specificity and determine the superiority of one over the other, if any. The study was conducted over 19months on patients above 18years of age attending the ENT OPD at Jaipur Golden Hospital, Rohini, Delhi with persistence of symptoms of chronic rhinosinusitis (CRS) for ≥12weeks. NE was done in each patient followed by NCCT-PNS (4mm cuts) evaluated with the Lund Mackay system and score ≥4 was suggestive of disease. On NE, mucopurulent discharge and edema in the middle meatus and ethmoid region were all seen in equal distribution amongst the patients. Polyps in the middle meatus were identified in the least number of patients. On observation for anatomical variants, paradoxical middle turbinate was seen in most patients and prominent agger nasi region in the least patients. On CT the order of involvement of the paranasal sinuses from most to least was-anterior ethmoids, maxillary sinus, posterior ethmoids, sphenoid and frontal sinuses. Ostiomeatal complex was involved in approximately one-third of the patients who had been diagnosed with CRS with CT. Frequency of disease on DNE and CT had a sensitivity of 72.2% and specificity of 63.6% with a p value of 0.024, and positive and negative predictive values of 61.9 and 73.7% respectively. It was concluded at the end of the study that there was a significant correlation between DNE and CT in the diagnosis of CRS.

Diagnostic Performance of Multidetector Computed Tomography (MDCT) in Diagnosis of Sinus Variations

SummaryBackgroundIn this prospective study, we looked for correlations between anatomic variants of paranasal sinuses and chronic or recurrent sinusitis.Material/MethodsTwo hundred and forty (240) patients with clinical features of chronic rhinosinusitis were examined; patients with first-onset or allergic sinusitis and pregnant females were excluded. Routine multi-slice CT of the paranasal sinuses was performed to look for mucosal disease of the paranasal sinuses, drainage pathways, and presence of anatomical variations and their relation to known sinus drainage pathways.ResultsAnatomic variations were very frequent, and we classified them into four easily recognized groups: nasal septum variations, middle turbinate variations, uncinate process variations, and ethmoidal variations. Deviated nasal septum was the most frequent variation in patients with chronic or recurrent sinusitis, and it was detected in 48.8% of cases. Agger nasi cells and concha bullosa were equally frequent (30.6%), and Haller cells were detected in 11.2%. Uncinate process variations were detected in 18.1%, and the large ethmoid bulla was detected in 10%.ConclusionsThe importance of anatomic variations is that they can compromise drainage pathway of the related sinus, which results in inflammatory sinus disease. Anatomical variations are not diseases on their own and may be present as incidental findings in patient with chronic sinusitis.