Anatomical Variations Research Articles

External Occipital Protuberance Enlargement in Children: A Benign Anatomic Variant with Rare Associations

Objective − The aim of this study is to raise awareness about External Occipital Protuberance (EOP) enlargement in children, its typically benign anatomical variant, and the importance of considering associated conditions in diagnosis and management.Case Report − We reviewed the cases of four male patients, presenting with EOP enlargement. Among the cases, one involved a newborn diagnosed with Menkes disease, a rare genetic disorder affecting copper transport, which was associated with occipital exostosis. The other three cases involved adolescents with varying degrees of EOP enlargement, linked to factors such as prior trauma and excessive screen time. Conclusion − While EOP enlargement is generally a benign anatomical variant, this study underscores the importance of differential diagnosis, particularly in the pediatric population. Clinicians should be aware of the potential, albeit rare, associations with serious conditions such as Menkes disease. A comprehensive approach to diagnosis and management is recommended, especially in symptomatic cases.

Aeromedical Fitness Considerations in Myocardial Bridging: A Case Study and Literature Review

Aims: Management of cardiac disease in aeromedical expertise can be challenging for asymptomatic crew members, especially during the first aeromedical examination, myocardial bridging is a good example. Presentation of Case: A 24-year-old student pilot candidate shows repolarization disorders at the ECG in the aeromedical examination, the exploration allowed the discovery of a myocardial bridge on The Coronary computed tomographic angiography (CCTA) of the left anterior descending (LAD) coronary artery responsible for tight stenosis. Discussion: The prevalence of MB varies according to the method of investigation, ranging from 2% in coronary angiography and 19% in coronary computed tomography to 42% in autopsy.The prevalence among active civilian aircrew (pilots and cabin crew) monitored at CEMPN is 0.4%, all revealed by electrocardiogram abnormalities. MB are usually small and of no clinical significance, the myocardial bridge proximal segment has been associated with atherosclerosis. Symptomatic patients with myocardial bridges as their only cardiac abnormality may present with myocardial ischemia, acute coronary syndromes, coronary spasm, syncope or even sudden death. The initial therapeutic strategy in the treatment of MB is medical management. Revascularization is indicated by PCI or surgery, including coronary artery bypass grafting (CABG) or myotomy in the case of symptoms recalcitrant to maximal medical treatment. The aviation environment may expose aircrew to additional physiological stressors, including hypobaria, hypoxia and sustained acceleration (+Gz). Such exposure may present a risk if associated with cardiovascular abnormalities, potentially leading to incapacity to fly due to symptoms or complications of the myocardial bridge. Conclusion: The myocardial bridge is an anatomical variant rather than a congenital anomaly with varied symptomatology (ECG abnormality, stable or unstable angina or sudden death), the aeromedical decision is made on a case-by-case basis, and makes a challenge diagnostic, particularly for asymptomatic crews.

Long-term outcomes of radiofrequency ablation and cyanoacrylate closure for treatment of small saphenous veins

Aim: Superficial venous insufficiency is less prevalent in the lesser saphenous vein compared to the great saphenous vein. Treating the lesser saphenous vein often presents greater challenges due to its proximity to the sural nerve and anatomical variations. This study evaluates the long-term efficacy of radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for managing small saphenous veins and discusses our treatment approach. Material and Methods: We performed a retrospective analysis involving 137 patients (64 treated with CAC and 73 with RFA) who received treatment for small saphenous vein insufficiency at our clinic between 2014 and 2019. We assessed quality of life and clinical outcomes at 6 months, and at 1, 3, and 5 years post-treatment. Results: Our findings indicated that radiofrequency ablation showed greater improvements compared to cyanoacrylate embolization in terms of VCSS. However, over the 5-year follow-up period, recurrence rates were observed in 11 (17.1%) patients in the CAC group and 5 (6.8%) patients in the RFA group, with this difference being statistically significant (p=0.045). Conclusion: Radiofrequency ablation for treating venous insufficiency offers superior long-term quality of life benefits compared to cyanoacrylate closure, particularly after three years.

Endodontic management of distinctive anatomic aberration with maxillary 1 molar -a case report of three mesiobuccal canal on one side and taurodontism on contralateral arch

The present case describes root canal treatment in a maxillary first molar with unusual anatomy of MB3 canal in one arch and Taurodontism on the contralateral arch. Understanding the differences in root canal morphology is crucial to the success of endodontic treatment. Taurodontism in the contralateral maxillary molar is an uncommon condition. A male patient was referred for the treatment of maxillary right and left first molar tooth. Clinical examination of the pulpal floor revealed 3 orifices in the mesio-buccal root in #16 while Taurodontism in #26. The tooth was treated successfully. Anatomic variations must be taken into consideration in clinical and radiographic evaluation during endodontic treatment.

Renovascular hypertension - a primer for the radiologist.

Renovascular hypertension (RVHT) is an important cause of secondary hypertension, accounting for approximately 75% of cases. This pictorial review describes the imaging modalities used to diagnose RVHT, including ultrasound, computed tomography angiography, and magnetic resonance angiography, provides their benefits and limitations, and explores the imaging findings, diagnostic criteria, and management of multiple causes of RVHT. Atherosclerosis is the most common cause of RVHT, particularly in older individuals, while fibromuscular dysplasia is more prevalent in younger females. Less common discussed etiologies include polyarteritis nodosa, extrinsic compression, Page kidney, dissection, renal artery (RA) thrombus, and RA aneurysms. This paper also highlights the importance of recognizing anatomical variants and rare conditions that can impact diagnosis and management. While RVHT represents a minority of hypertension cases, its potential reversibility makes accurate diagnosis crucial. Treatment approaches vary based on etiology and may include medical management, angioplasty, stenting, or surgical intervention. This review aims to enhance radiologists' understanding of RVHT, facilitating improved diagnosis and patient care.

Neuroepithelial cyst causing homonymous hemianopia treated through surgical marsupialization under visual-evoked potentials: A case report

Background: Neuroepithelial cysts (NECs) are rare entities, occasionally causing neurological symptoms that can be overlooked. Case Description: A case of an occipital neuroepithelial cyst is discussed. The initial presentation consisted of mild homonymous hemianopia and gait impairment. Conservative management was suggested to start with, but at 6 months follow-up, the patient’s symptoms were worsening. Surgery was performed under general anesthetic and using visual-evoked potentials. The cyst was marsupialized and connected with subdural space, and a few samples were sent for histological analysis. The patient experienced immediate improvement in her symptoms, and the visual tests at follow-up confirmed the resolution of the previously documented hemianopia. Conclusion: NECs should be carefully assessed to rule out symptoms associated with mass effects. This case and others reported in the international literature show that occipital neuroepithelial cysts can benefit from surgical treatment with meticulous preoperative planning. The aid of neuromonitoring is crucial to identify anatomical variations and cortical functionality that are potentially distorted in the presence of these lesions.

Sex differences in overweight and obese patients undergoing high-power short-duration pulmonary vein isolation for atrial fibrillation: an observational cohort study.

Atrial fibrillation (AF) is the most common heart rhythm disorder worldwide. As treatment methods evolve, optimizing personalized therapy based on patient characteristics, such as sex, becomes crucial. This study investigates sex differences in high-power short-duration (HPSD) pulmonary vein isolation (PVI) in overweight and obese patients. We analyzed data from 189 overweight and obese patients who underwent HPSD PVI for AF, comparing demographic information, procedural details, outcomes, and complications between male and female patients. Our analysis revealed fewer women underwent PVI compared to men, with women typically older and showing more pronounced changes in the left atrial substrate. Despite these differences, the safety and efficacy of PVI were comparable between sexes, including in the BMI ≥ 30kg/m2 subgroup and after age adjustment. The findings emphasize the need for early AF screening in women to prevent treatment delays and show that considering sex-specific differences in fat distribution can improve procedural outcomes. These insights support the need for tailored management strategies for AF in overweight and obese populations, addressing sex-specific risks and anatomical variations.

VS 07 - OGC Visualisation of variant thoracic duct anatomy using mesenteric injection of Indocyanine Green (ICG) and early ligation of the high thoracic duct can decrease the occurrence of chyle leaks after robotic oesophagectomies: Insights from a single-centre case series

Abstract Background Chyle leak (CL) remains a relatively common complication following oesophagectomy, with reported incidence up to 9%, and is associated with significant clinical and financial consequences. We assess the feasibility and utility of fluorescence to visualise the thoracic duct (TD), using an easy-to perform intraoperative technique. This involves injecting ICG into the small bowel mesentery during robotic Ivor-Lewis oesophagectomy (RAMIO) and early ligation of the thoracic duct above azygos arch. Method Between 2022-2024, 36 patients undergoing RAMIO received ICG (2ml of 2.5mg/mL solution) injected in the root of jejunal mesentery by endoscopic needle injector via laparoscopic port during the abdominal phase. A minimum of 60min following injection, fluoroscopic visualisation of TD anatomy was performed with Firefly® system. During the initial phase of the thoracic stage, the thoracic duct was located in the upper mediastinum, just above azygos arch, and was securely clipped using the Hem-o-Lok® system. Results Successful TD imaging using ICG-fluorescence was achieved in all 36 patients undergoing RAMIO. Variations from the standard single duct structure were observed in 4 (11%) of patients. Specifically, two cases exhibited duct bifurcation at the level of the azygos arch, one case had branching in the lower mediastinum, and another case demonstrated branching from the main duct over the thoracic aorta. All observed branches were individually clipped with Hem-o-Lok® system. Two individuals (5.5%) experienced low-volume chyle-leak post-operatively, which was successfully managed conservatively. No chyle leaks were detected at the end of the surgery in any of the cases. Conclusion In our single-centre experience, fluorescence visualisation of the thoracic duct during RAMIO by intraoperative mesenteric injection of ICG is an easily performed, reproducible technique which can assist in the visualisation of variant TD anatomy and reduce the incidence of CL. In addition to its impact on clinical outcomes and healthcare costs, the approach can also support a better appreciation of TD anatomy among surgeons.

Audiometric Outcomes in Chronic Otitis Media with Mastoid Involvement: A Five-Year Clinical Overview

Background/Objectives. Otomastoiditis, an inflammatory condition affecting the middle ear and mastoid cells, poses significant risks for hearing impairment. This study aimed to analyze the clinical presentations, anatomical variations, and audiometric outcomes associated with acute and chronic otomastoiditis over a five-year period at the ENT Clinic of the Clinical County Emergency Hospital of Craiova. Methods. A retrospective clinical–statistical analysis was conducted on 145 patients aged 2 to 78 years, who were treated for otomastoiditis. The study involved a comprehensive review of clinical and audiometric data, with a focus on the type of hearing loss (conductive or mixed), audiometric thresholds, and the relationship between the anatomical form of the disease and the severity of hearing loss. Results. The majority of cases (93.83%) were chronic otomastoiditis, with 66.89% of patients presenting with mixed hearing loss and 33.10% with conductive hearing loss. Audiometric assessments revealed significant air conduction deficits, particularly at low and mid-range frequencies, with losses averaging 50–55 dB in cases of conductive hearing loss. Chronic cases demonstrated notable bone conduction impairments, indicating progressive cochlear damage. Statistical analysis identified a moderate correlation between the anatomical form of the disease and the severity of hearing loss, particularly in patients with cholesteatomatous-suppurative forms. Conclusions. This study underlines the critical need for the early and precise diagnosis of otomastoiditis, supported by audiometric evaluations. Our findings emphasize the substantial risk of progressive cochlear damage in chronic cases, underscoring the necessity for timely intervention to mitigate long-term hearing loss. These results offer valuable insights for clinicians, potentially guiding improved therapeutic approaches and contributing to enhanced patient outcomes in managing chronic otomastoiditis.

Development of age-specific population-based paediatric computational phantoms for image-based data mining and other radiotherapy applications

Objective.Computational anatomical models have many applications in paediatric radiotherapy. Age-specific computational anatomical models were historically developed to represent average and/or healthy individuals, where cancer patients may present with anatomical variations caused by the disease and/or treatment effects. We developed RT-PAL, a library of computational age-specific voxelized anatomical models tailored to represent the paediatric radiotherapy population.Approach.Data from patients undergoing craniospinal irradiation (CSI) were used (n = 74, median age 7.3y, range: 1-17y). The RT-PAL phantoms were generated using groupwise deformable image registration to spatially normalize and average a sub-set of twenty clinical CTs and contours (n = 74, median age 7.7y, range: 3-14 y). To assess their anatomical and age-dependency plausibility, the RT-PAL models were compared against clinical cancer patient data and two healthy population based libraries of phantoms: the International Commission on Radiological Protection (ICRP) pediatric reference computational phantoms (n = 8, median age 7.5y, range: 1-15y) and a range of 4D paediatric extended cardiac torso (XCAT) phantoms (n = 75, median age 9.1y, range: 1-18y). For each dataset, nineteen organs were segmented on all age models to determine their volume. Each set was evaluated through a linear fit of organ volume with age, where comparisons were made relative to the linear fit of the clinical data.Main Results.Overall good anatomical plausibility was found for the RT-PAL phantoms. The age-dependency reported was comparable to both the clinical data and other phantoms, demonstrating their efficacy as a library of age-specific phantoms. Larger discrepancies with the clinical, ICRP and XCAT organ data were attributable to differences in organ filling, segmentation strategy and age distribution of the datasets, limitations of RT-PAL generation methodology, and/or possible anatomical differences between healthy and cancer populations.Significance.The RT-PAL models showed potential in representing the paediatric radiotherapy cohort, who are most likely to benefit from dedicated, age-specific anatomical phantoms.

BN SO05 - Risk Factors associated with Complications Post-Laparoscopic Common Bile Duct Exploration: A Comprehensive Literature Review

Abstract Background Gallstone-related diseases, particularly common bile duct (CBD) stones, present a significant global health issue. The adoption of laparoscopic common bile duct exploration (LCBDE) has revolutionized the management of these conditions by providing a minimally invasive alternative to open surgery. This literature review aims to identify and analyze the risk factors associated with complications in LCBDE, thereby offering insights to improve patient care and outcomes. Method comprehensive search for primary research studies, systematic reviews, and meta-analyses pertaining to risk factors for complications following LCBDE. The search was conducted on PubMed, focusing on English-language articles published within the last 20 years and encompassing all age groups. Peer-reviewed journal articles were prioritized. All relevant studies reporting complications after LCBDE were eligible for inclusion if available as full texts, structured abstracts, or conference reports. The initial search yielded 826 articles. Exclusion criteria : open surgery, non-English articles, lacking full-text. A total of 29 records were identified by the literature search. Results Laparoscopic common bile duct exploration (LCBDE) is generally safe and effective, with complication rates influenced by patient and procedural factors. Older age, comorbidities, previous abdominal surgeries, high BMI, narrow common bile ducts, and difficult stones increase risks. Experienced surgeons and shorter operative times reduce complications. The transcystic approach and primary suture closure have fewer complications compared to the transductal route and T-tube drainage, respectively. Intraoperative imaging significantly reduces risks by ensuring complete stone clearance and identifying anatomical variations. Tailoring surgical approaches to patient-specific factors and leveraging surgical expertise are crucial for minimizing complications in LCBDE. Conclusion LCBDE emerges as a safe and effective therapeutic modality for addressing conditions impacting the bile ducts (31). The success and utility of LCBDE can be significantly enhanced through the meticulous optimization of patient-related, surgeon-related, and procedure-related factors. By addressing and fine-tuning these key elements, the occurrence of complications associated with LCBDE can be mitigated, thereby reinforcing its potential as a primary choice for managing various bile duct conditions. This strategic approach not only underscores the clinical efficacy of LCBDE but also advocates for its expanded utilization as a frontline intervention in the comprehensive management of bile duct disorders.

Partial volume correction for Lu-177-PSMA SPECT.

The limited spatial resolution in SPECT images leads to partial volume effect (PVE), degrading the subsequent dosimetric accuracy. We aim to quantitatively evaluate PVE and partial volume corrections (PVC), i.e., recovery coefficient (RC)-PVC (RC-PVC), reblurred Van-Cittert (RVC) and iterative Yang (IY), in 177Lu-PSMA-617 SPECT images. We employed a geometrical cylindrical phantom containing five spheres (diameters ranging from 20 to 40mm) and 40 XCAT phantoms with various anatomical variations and activity distributions. SIMIND Monte Carlo code was used to generate realistic noisy projections. In the clinical study, sequential quantitative SPECT/CT imaging at 4 time-points post 177Lu-PSMA-617 injections were analyzed for 10 patients. Iterative statistical reconstruction methods were used for reconstruction with attenuation, scatter and geometrical collimator detector response corrections, followed by post-filters. The RC-curves were fit based on the geometrical phantom study and applied for XCAT phantom and clinical study in RC-PVC. Matched and 0.5-2.0 voxels (2.54-10.16mm) mismatched sphere masks were deployed in IY. The coefficient of variation (CoV) was measured on a uniform background on the geometrical phantom. RCs of spheres and mean absolute activity error (MAE) of kidneys and tumors were evaluated in simulation data, while the activity difference was evaluated in clinical data before and after PVC. In the simulation study, the spheres experienced significant PVE, i.e., 0.26 RC and 0.70 RC for the 20mm and 40mm spheres, respectively. RVC and IY improved the RC of the 20mm sphere to 0.37 and 0.75 and RC of the 40mm sphere to 0.96 and 1.04. Mismatch in mask increased the activity error for all spheres in IY. RVC increased noise and caused Gibbs ringing artifacts. For XCAT phantoms, both RVC and IY performed comparably and were superior to RC-PVC in reducing the MAE of the kidneys. However, IY and RC-PVC outperformed RVC for tumors. The XCAT phantom study and clinical study showed a similar trend in the kidney and tumor activity differences between non-PVC and PVC. PVE greatly impacts activity quantification, especially for small objects. All PVC methods improve the quantification accuracy in 177Lu-PSMA SPECT.

Imaging in sensorineural and conductive hearing loss-an educational review.

Hearing loss is the most common sensory impairment globally and can affect all ages. It can be classified into two categories, conductive and sensorineural, though both conditions may coexist. Various causes may be responsible for hearing loss including congenital, infectious, inflammatory and neoplastic. Imaging will help detect or exclude such causes and in combination with the medical history and clinical findings, enable the necessary treatment to be initiated. Imaging also provides an accurate pre-operative anatomical road map for the surgeons to ensure the best possible surgical outcomes. The aim of this educational review is to present a range of common and rare diseases causing hearing loss and provide a brief explanation of the best imaging modalities for each. It also discusses briefly some important anatomical variants which the radiologists should highlight in their report to help prevent inadvertent post-operative complications.

Abstract 4125059: Techniques and Outcomes of Atrial Fibrillation Ablation in Patients with Persistent Left Superior Vena Cava

Introduction/Background: Persistent Left Superior Vena Cava (PLSVC) presents unique challenges for atrial fibrillation (AF) ablation due to its arrhythmogenic potential and complex anatomical variations. Understanding tailored approaches and outcomes in patients with PLSVC and AF is essential for improving procedural success and safety. Research Questions/Hypothesis: This study aims to investigate the efficacy and outcomes of tailored ablation strategies in patients with PLSVC and AF. Goals/Aims: To evaluate the procedural safety, acute success, and AF recurrence rate post-ablation in patients with PLSVC, and to determine the optimal ablation strategies for this population. Methods/Approach: This retrospective cohort study included 16 patients with PLSVC who underwent 21 AF ablation procedures between August 1, 2008, and February 14, 2024, at the Hospital of the University of Pennsylvania. Procedures involved pre-ablation imaging, 3D electroanatomical mapping, pulmonary vein isolation (PVI), and targeted ablation strategies focusing on PLSVC-related triggers. The primary endpoints were procedural safety and AF recurrence post-ablation. Results/Data: The cohort's mean age was 51.9 ± 17.9 years, 31.2% of whom were female. Triggers from the PLSVC were identified in 66.7% of procedures. Tailored ablation strategies were employed to isolate PLSVC-left atrium/coronary sinus connections or directly target the induced triggers, with a success rate of 85% in achieving isolation or targeted ablation once triggers were induced. The recurrence rate of arrhythmia post-ablation was 58.3% in the patient-based analysis and 70.6% in the procedure-based analysis. No major complications occurred. Conclusion(s): This study highlights the significance of recognizing PLSVC as a potential source of AF triggers. The single procedure success rate is low compared to patients without PLSVC. Further studies are warranted to enhance outcomes in this challenging AF population.

Enhanced Prenatal and Postnatal Development Study in Marmoset Monkeys Following Administration of Felzartamab.

Felzartamab is a recombinant fully human immunoglobulin G1 anti-CD38 monoclonal antibody under clinical investigation for immune-mediated diseases. In support of felzartamab clinical development, toxicology studies were conducted in marmoset monkeys, which was the most relevant species based on CD38 binding affinity, pharmacologic activity, and target expression. The felzartamab toxicology program included an enhanced prenatal and postnatal development (ePPND) study to identify potential reproductive and postnatal development risks. In this ePPND study, pregnant marmoset monkeys were randomized to receive vehicle (0mg/kg) or felzartamab at two dose levels (15mg/kg and 75mg/kg) twice per week until parturition, and maternal animals and infants were evaluated for 6 months thereafter. Felzartamab exposure was confirmed in maternal animals and infants in both dosing groups. Overall, felzartamab was well tolerated by pregnant animals at the evaluated doses, with no effect on body weight or body weight gain during pregnancy. No felzartamab-related effects on pregnancy loss or stillbirth rate were observed, and litter counts and numbers of liveborn infants were similar between the vehicle and felzartamab groups. Among infants, there were no felzartamab-related malformations or variations in external anatomy or skeletal morphology and no felzartamab-related observations in histopathology, hematologic and immune cell development, or humoral immune response to vaccination. In conclusion, among pregnant marmoset monkeys dosed with felzartamab, the lack of reproductive toxicity and felzartamab-related effects on offspring supports the clinical evaluation of felzartamab in women of childbearing potential and further demonstrates the suitability of the marmoset monkey for ePPND studies.

Sacralization of lumbar vertebrae-prevalence and association with low back ache and radiculopathy

Background: Low back pain (LBP) is a prevalent condition, often associated with various anatomical anomalies, including lumbar sacralization, that is, the fusion of the fifth lumbar vertebra (L5) with the sacrum. This study aims to evaluate the prevalence of sacralization among LBP patients and its relationship with radiculopathy. Methods: A retrospective study was conducted at the department of orthopaedics, Justice KS Hegde charitable hospital, from January 1, 2023, to July 31, 2024. Patients aged 18-75 years presenting with LBP who underwent lumbosacral radiographs were included. Demographic and clinical data were collected, and sacralization types were classified using the Castellvi system. Statistical analyses were performed using the chi-square test. Results: Among 771 radiographs analysed, the prevalence of sacralization was 10.1%. Most subjects were over 41 years old (81.6%), with a majority being female (54.5%). Type I A was the most common form of sacralization (30.77%). A significant association between sacralization and radiculopathy was observed, with 70 of the 78 subjects with sacralization experiencing radiculopathy (p<0.0005). Conclusions: This study indicates a noteworthy association between sacralization and radiculopathy in patients with LBP. Given the low prevalence of sacralization, the findings emphasize the importance of recognizing anatomical variations in clinical evaluations of patients with low back ache, particularly in older populations. Further research is warranted to explore the implications of these anatomical anomalies on treatment strategies and patient outcomes.

Techniques and outcomes of atrial fibrillation ablation in patients with persistent left superior vena cava.

To investigate tailored approaches, techniques, and outcomes of catheter ablation in patients with persistent left superior vena cava (PLSVC) undergoing atrial fibrillation (AF) ablation. PLSVC presents unique challenges for AF ablation due to its potential as an arrhythmogenic source and the complex anatomical variations it introduces. The retrospective cohort included 16 patients with PLSVC that underwent 21 AF ablation procedures between August 1, 2008, and February 14, 2024, at the Hospital of the University of Pennsylvania. Procedures involved pre-ablation imaging, 3D electroanatomical mapping, pulmonary vein isolation, and targeted ablation strategies focusing on the PLSVC-related ablation. The primary endpoints were procedural safety and AF recurrence postablation. The cohort's mean age was 51.9 ± 17.9 years, 31.2% of whom were female. Triggers from the PLSVC were identified in 66.7% of procedures. Tailored ablation strategies were employed to isolate PLSVC-left atrium/coronary sinus connections or directly target the induced triggers, with a success rate of 85% in achieving isolation or targeted ablation once triggers were induced. The recurrence rate of arrhythmia postablation was 46.7% in the patient-based analysis and 65% in the procedure-based analysis. No major complications occurred. This study highlights the significance of recognizing PLSVC as a potential source of AF triggers. The single procedure success rate is low compared to patients without PLSVC. Further studies are warranted to enhance outcomes in this challenging AF population.

Anatomical Variations on NCCT Nose and Paranasal Sinuses and Their Relation with Symptoms of the Patients: A Retrospective Analysis

Background: There are various bones around the nasal cavity that pneumatize to form the paranasal sinuses; namely, maxilla, ethmoid bone, frontal bone, and sphenoid bone. The CT scan of nose and paranasal sinus is the gold standard investigation for the patients of chronic rhino-sinusitis (CRS). Objective: This study was conducted with aim to determine the prevalence anatomical variation of Nose and Paranasal Sinuses on CT-scan and their relation with symptoms. Methods: A retrospective study was conducted among 200 patients over a period of one year (2022-2023). Patients with various symptoms of chronic rhinosinusitis were subjected to non-contrast enhanced Computed Tomography of nose and paranasal sinuses. Results: In our study 56% patients had septal deviation with most common C shaped deviation followed by S shaped deviation. 99.5% patients have agger nasi cells. The attachment of uncinate process was to the lamina papyracea in 83.0%, followed by the base of skull in 13.0%. The least common types were free uncinate process in 1.5%. The prevalence of concha bullosa was found 16.5%. However, paradoxical turbinate was present in 2.0% subjects. The incidence of Haller cells was found to be 5.0% and Onodi cells were found in 4.5%. The type of frontal cell was Agger Nasi followed by a Supra-bullar. In Sphenoid sinus, commonest type was pre-sellar type of pneumatisation. Conclusion: Our study concluded these various anatomical variations and its prevalence. The relation of variations with disease symptomatology is inconclusive.

Anatomical Variation of the Olfactory Fossa According to Keros and Yenigun Classifications in Karachi, Pakistan.

The goal of our research is to assess the olfactory fossa anatomical variation through Keros and Yenigun classification by computed tomography (CT) scan of paranasal sinuses (PNS), as in order for surgeons to prevent major complications, they must be familiar with its variations in anatomy during functional endoscopic sinus surgery (FESS) related to anterior ethmoidal artery injury, as its course varies with depth and length of the olfactory fossa. At Karachi's Dow University of Health Sciences (DUHS), retrospective research was carried out. From anterior to posterior, sequential coronal and axial pictures were examined, and the existence and location of further anatomical characteristics were documented. A consultant radiologist used the picture archiving and communication system (PACS) software to do the review. The depth of the olfactory fossa and anterior-posterior length were measured. We utilized OpenEpi version 3 to compute the sample size findings. The estimated sample size was calculated as 249 by taking the prevalence of 63.5% for type 2 Keros classification, with a margin of error of 6% and a confidence level. The median length for the olfactory fossa depth (Keros) for the left and right sides were 6.2 (2.2-10.9) mm and 6.0 (2.8-10.4) mm, respectively. The median anteroposterior length of the cribriform plate (Yenigun) for the left and right sides were 11.4 (6.1-19.2) mm and 11.2 (6.0-18.0) mm, respectively. According to Keros Classification, type 2 was observed as the most prevalent category on the right side for both females and males, with 97/122 (79.5%) and 106/127 (83.5%) individuals, respectively. The chi-square test was applied for the analysis of gender and classification. Keros type 2 was observed to be the most prevalent in both males and females. Similarly, type 2 was also seen to be the most prevalent in the Yenigun classification in both genders. No statistical difference was found in both classifications (p = 0.39). In most of the literature, type 2 has been the most commonly dominated type. The reason seems due to the variation in genes and anatomy of the human PNS. Preoperative planning should take the morphological characteristics of the ethmoidal roof into account. Understanding the ethmoidal roof morphology among populations may be improved by looking at bigger patient groups and meta-analyses that compile different study findings on this topic.

Factors Associated With Ocular Perfusion Measurements as Obtained With Laser Speckle Contrast Imaging.

To study the ocular and systemic factors affecting optic nerve head (ONH) perfusion data as obtained using a commercially available laser speckle flowgraphy (LSFG) device in a cohort of Caucasian subjects without ocular diseases. Also, to assess the intrasession repeatability and intersession reproducibility of ONH, macular, retinal, and choroidal perfusion. Seventy-five healthy eyes of 75 Caucasian participants underwent LSFG and spectral-domain optical coherence tomography (SD-OCT) on the same visit. Perfusion of the ONH was assessed with LSFG, and SD-OCT was used to measure peripapillary retinal nerve fiber layer thickness (RNFLT) and macular ganglion cell plus inner plexiform layer thickness (GCIPLT). The intrasession repeatability and intersession reproducibility of ONH and macular perfusion and retinal and choroidal relative flow volume (RFV) were evaluated in 20 participants measured on three different days over a 6-month period. Intrasession and intersession intraclass correlation coefficients of LSFG parameters ranged from 0.787 to 0.967 and from 0.776 to 0.935, respectively. Intersession 95% prediction intervals for the ratio of two measurements were wider for RFV indices than for ONH and macular perfusion parameters. The multiple regression analysis indicated that higher ONH perfusion was associated with younger age, female sex, smaller optic disc area, and higher RNFLT. RNFLT was an independent predictor of ONH perfusion, whereas GCIPLT was not. Each 1-µm increase in RNFLT was associated with a 0.272 arbitrary unit increase in ONH perfusion. LSFG measurements of optic disc perfusion are influenced by sex, age, and anatomical variations in optic disc area and RNFLT. Better evaluation of ocular blood flow will result in better diagnosis and treatment of various ocular diseases.