Anterior Ethmoid Research Articles

Computed tomography analysis of the anterior ethmoid genu of the frontal recess in non-diseased sinuses.

Knowledge of anatomical variations of the frontal recess and frontal sinus and recognition of endoscopic landmarks are vital for safe and effective endoscopic sinus surgery. This study revisited an anatomical landmark in the frontal recess that could serve as a guide to the frontal sinus. Prevalence of the anterior ethmoid genu, its morphology and its relationship with the frontal sinus drainage pathway was assessed. Computed tomography scans with multiplanar reconstruction were used to study non-diseased sinonasal complexes. The anterior ethmoidal genu was present in all 102 anatomical sides studied, independent of age, gender and race. Its position was within the frontal sinus drainage pathway, and the drainage pathway was medial to it in 98 of 102 cases. The anterior ethmoidal genu sometimes extended laterally and formed a recess bounded by the lamina papyracea laterally, by the uncinate process anteriorly and by the bulla ethmoidalis posteriorly. Distance of the anterior ethmoidal genu to frontal ostia can be determined by the height of the posterior wall of the agger nasi cell rather than its volume or other dimensions. This study confirmed that the anterior ethmoidal genu is a constant anatomical structure positioned within frontal sinus drainage pathway. The description of anterior ethmoidal genu found in this study explained the anatomical connection between the agger nasi cell, uncinate process and bulla ethmoidalis and its structural organisation.

CS-6 A case of poorly differentiated chordoma with systemic metastasis

A case report: The patient was a 32-year-old man with diplopia. He was diagnosed as sphenoid sinusitis on MRI by a local doctor and visited an otolaryngologist. MRI showed extensive extension of neoplastic lesions from the clivus to the sphenoid sinus to the anterior ethmoid sinuses, bilateral cavernous sinuses, and the right medial and lateral pterygoid muscles. The right Lebiere’s lymph node was enlarged and thought to be a metastatic site. Based on the rapid growth and extension of the tumor, the patient was referred to the Department of Otolaryngology at our hospital on suspicion of sinonasal carcinoma. The possibility of chordoma could not be denied, so the patient was referred to our department. The patient underwent a joint endoscopic extended transsphenoidal tumor resection. The pathological diagnosis showed mitotic and necrotic features, and the majority of the cells showed highly atypical components without mucous substrate. However, brachyury, a marker for chordoma, was diffusely positive, and there was loss of INI1 (SMARCB1) expression. The final diagnosis was poorly differentiated chordoma. Postoperatively, the tumor in the right cavernous sinus grew rapidly, and the right eye became blind due to obstruction of the superior ophthalmic vein. The patient was treated with Gamma Knife as soon as possible in the hope of local control by high-dose irradiation, and after a total of three irradiations, the residual tumor shrank markedly and symptoms improved, but systemic metastasis occurred in a short period of time and the patient died. The number of cases of poorly differentiated chordoma has been reported rarely (more than 50), and it is more common in children and even rarer in adults. We report this case with a review of the literature.

Creation of a Novel Preoperative Imaging Review Acronym to Aid in Revision Endoscopic Sinus Surgery.

(1) Identify anatomic contributions to chronic rhinosinusitis (CRS) necessitating revision endoscopic sinus surgery (RESS). (2) Create a clinical acronym to guide imaging review prior to RESS that addresses pertinent sites of disease and potential sites of surgical morbidity. Ovid MEDLINE, Embase and Medline via Embase.com, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. Systematic search was performed using a combination of standardized terms and keywords. Studies were included if they investigated anatomic contributions to persistent CRS requiring RESS or the relationship between anatomic landmarks and surgical morbidity. Identified studies were screened by title/abstract, followed by full-text review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were strictly followed. In total, 599 articles met screening criteria, 89 were eligible for full-text review, and 27 studies were included in the final review. The identified anatomic sites of interests are broad; the most frequently cited anatomic region was retained anterior ethmoid cells (22/27 studies), followed by posterior ethmoid cells (14/27 studies). Using the consolidated information, a clinical acronym, REVISIONS, was created: Residual uncinate, Ethmoid cells (agger, Haller, supraorbital), Vessels (anterior and posterior ethmoid), Infundibulum, Septal deviation, I (eye) compartment, Onodi cell, Natural os, and Skull base slope and integrity. The REVISIONS acronym was developed as a tool to distill the unique anatomic contributions of primary endoscopic sinus surgery failure into a format that can be easily incorporated in preoperative radiologic review and surgical planning to optimize outcomes and minimize complications.

351 Anterior Ethmoid Artery Septal Flap for Endoscopic Reconstruction of Frontal Sinus CSF Leak

Abstract Introduction Anterior skull base cerebrospinal fluid (CSF) leaks are managed successfully with endonasal surgery. Endoscopic closure of CSF leaks from posterior table of the frontal sinus remains challenging. Vascularized Hadad-Bassagasteguy flap (HBF) reconstruction of the skull base has increased CSF closure rates but does not extend to frontal sinus. We describe our technique using septal flap pedicled by anterior ethmoid artery (AEA) for repairing frontal defects. Method Retrospective review of cases of frontal CSF leak repair using the AEA flap reconstruction. Flap design: an anterior vertical septal mucosa incision at posterior border of the frontal sinusotomy is made and extended to nasal floor. Posterior vertical incision is made 1 cm posterior to the projection of the axilla of the middle turbinate on the septum and extended to nasal floor. A horizontal incision along the nasal floor joins the two incisions. The flap is raised and rotated into the frontal sinus over the posterior table reconstructed defect. Results Three patients identified. Two males, one female, aged 11, 33 and 56. Patient histories included recurrent bacterial meningitis following head trauma, recurrent sinusitis and fronto-ethmoidal osteoma, with intraoperative CSF leak and CSF rhinorrhea due to meningoencephalocele. The three posterior wall defects were successfully repaired endoscopically with multilayer reconstruction and the AEA septal flap. Conclusions The anterior ethmoid artery septal flap can be successfully utilised for frontal CSF leak repair. Flap is conveniently located for frontal sinus defects. When the septum is intact it provides an excellent final layer as part of multilayer reconstruction.

The sinus septi nasi and other minor pneumatizations of the nasal septum.

The osseous nasal septum (NS) consists of the perpendicular plate of the ethmoid bone (PPE) and the vomer bone. Few studies evaluated the possibilities of septal pneumatization of the PPE, or adjacent to it. We aimed to observe the anatomical possibilities of NS pneumatizations. A retrospective lot of cone-beam computed tomography (CBCT) files was used. One hundred seventy-one CBCT files from 51 males and 120 females were documented. There were found 46 files that were null for septal pneumatization. The other cases (73.1%) had different septal pneumatizations extended from neighboring air spaces. Pneumatized crista galli (CG) exclusively extended from a frontal sinus was found in 7.01% of cases. The frontal sinuses had minor extensions anterior to the PPE in 7.6% of cases. Unique or double pneumatizations of the sphenoidal rostrum extending within the posterior part of the PPE were detected in 71.34% of cases. In six cases were found ethmoidal pneumatizations of the PPE, either from an anterior ethmoid cell, or from a posterior one, or from a pneumatized CG. In this last case was found a sinus septi nasi of 25.37 mm sagittal size. The supra-septal recesses of the ethmoid air cells were roofing the respective nasal fossa. As all the morphological possibilities of NS pneumatization involve the upper part of the PPE, they should be adequately discriminated anatomically, as well as when the NS and the cribriform plate of the ethmoid bone are approached surgically.

Correlation between the Opacification Degree of Paranasal Sinuses on CT, Clinical Symptoms and Anatomical Variations of the Nose and Paranasal Sinuses in Patients with Chronic Rhinosinusitis.

Objectives: This study aimed to evaluate the correlation between the opacification degree of the paranasal sinuses on computed tomography (CT) with clinical symptoms, and anatomical variations of the nose and paranasal sinuses in patients with chronic rhinosinusitis (CRS). Materials and Methods: This descriptive prospective study evaluated 100 patients (60 males and 40 females), who were diagnosed with CRS by ENT specialists according to the clinical findings, and were scheduled for a CT scan. The patients were requested to express the severity of their symptoms using a visual analog scale. The CT scans of the paranasal sinuses were assessed for the presence of anatomical variations and scored using the modified Lund-Mackay scoring system for the opacification degree of each sinus. The correlations between the anatomical variations and sinusitis, and also between the severity of symptoms/disease severity and CT scores were statistically analyzed. P<0.05 was considered statistically significant. Results: The most common symptoms were purulent (discolored) nasal drainage and nasal obstruction. Septal deviation was the most common anatomical variation. The maxillary and anterior ethmoid sinuses were the most commonly involved areas. The Spearman’s correlation coefficient showed a significant correlation between the sinus involvement and some of the evaluated symptoms, as well as certain types of anatomical variations (P<0.05). Conclusion: Some specific anatomical variations of the paranasal sinuses may predispose them to sinusitis. The CT scan score can predict the severity of many symptoms such as purulent (discolored) nasal drainage, nasal obstruction, hyposmia/anosmia, halitosis, cough, and fatigue, among the other symptoms of CRS.

A cadaveric study investigating the anatomy of the medial orbital wall.

The purpose of this study is to investigate the applicability of the current surgical guideline, known as ‘24-12-6’ surgical guideline, in the Hispanic and European populations. This guideline is used during numerous orbital surgeries and states that the distance between the anterior lacrimal crest (ALC) to the anterior ethmoidal foramen (AEF) (24 mm), the AEF to the posterior ethmoidal foramen (PEF) (12 mm), and the PEF to the optic canal (OC) (6 mm) follows a Rule of Halves. Previous studies suggest this surgical guideline is not applicable for all ethnicities; however, to our knowledge, no data has been published regarding the accuracy of this guideline pertaining to the Hispanic population. An experimental study was performed on 79 orbits (52 cadavers) donated to the Human Anatomy Program at UT Health San Antonio. The ALC, AEF, posterior ethmoidal foramen, and OC were identified; the orbit was enucleated and all remaining soft tissue removed. The distance between each landmark was recorded using a digital caliper. For all cadavers studied, the distances between the ALC, AEF, posterior ethmoidal foramen, and OC were 24.76 mm, 13.89 mm, and 7.61 mm, respectively. Thus, the ‘24-12-6’ surgical guideline was not applicable to the sample studied. Based on ethnicity data, these relationships were also not true for the European or the Hispanic populations. Therefore, significant anatomical variations exist in the current surgical guideline. Clinicians may need to adjust their methodology during surgical procedures in order to optimize patient care.

Microbiome of Unilateral Chronic Rhinosinusitis: A Controlled Paired Analysis.

The sinonasal microbiota in human upper airway may play an important role in chronic rhinosinusitis (CRS). Thus, this study aimed to investigate the human upper airway microbiome in patients with unilateral CRS, and compare the sinonasal microbiome of the unilateral diseased site with that of a contralateral healthy site. Thirty samples, 15 each from the diseased and healthy sites, were collected from the middle meatus and/or anterior ethmoid region of 15 patients with unilateral CRS during endoscopic sinus surgery. DNA extraction and bacterial microbiome analysis via 16S rRNA gene sequencing were then performed. Corynebacterium showed the highest relative abundance, followed by Staphylococcus in samples from both the diseased and healthy sites. Further, the relative abundances of Staphylococcus and Pseudomonas were significantly lower in samples from diseased sites than in those from healthy sites. Conversely, anaerobes, including Fusobacterium, Bacteroides, and Propionibacterium, were abundantly present in samples from both sites, more so in samples from diseased sites. However, the sites showed no significant difference with respect to richness or diversity (p > 0.05). Our results indicate that CRS might be a polymicrobial infection, and also suggest that Corynebacterium and Staphylococcus may exist as commensals on the sinus mucosal surface in the upper respiratory tract.

Creation and validation of a radiological checklist for functional endoscopic sinonasal surgery. A YO-IFOS initiative

BackgroundFunctional endoscopic sinus surgery might lead to dangerous complications. Studying and analysing preoperative CT scans provides surgeons with a precise knowledge of their patient's anatomy, thus reducing the risk of potential complications. Checklists highlighting key anatomical areas have been published and proven useful. However, none of these are widely accepted or systematically used in daily practice. ObjectiveIn this paper, the rhinology group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS) aim to create and validate a new checklist designed to be fast and user friendly for daily practice. MethodsTwo CT sinonasal scans were selected as test cases. Forty otolaryngologists were selected from five tertiary referral hospitals. It was a cross-sectional study; each participant was their own control. All participants completed a questionnaire after the analysis of both CT scans to prevent learning bias. The evaluation included ten items critical in endoscopic sinus surgery according to previous publications. ResultsThere were 80 evaluations. There was a significant increase in the number of correctly identified critical structures with the use of the checklist (p=.009). There was a statistically significant difference in low- experience evaluators, while it was not statistically significant for experienced surgeons. The most unanswered structures were suprabullar recess, dangerous v2 nerve, anterior ethmoid artery, dangerous vidian nerve and Onodi cell. The most wrongly identified structures were Keros type, septal deviation and cribiform middle turbinate. ConclusionThe YO-IFOS radiological checklist has proven a useful tool for correctly studying sinonasal anatomical variations. There is a clear learning component in the use of the checklist although it does not in any way exempt specialists from thorough study of sinonasal anatomy. Given the risk-benefit ratio, we strongly suggest the routine use of the checklist to systematically assess CT-scans prior to endoscopic sinonasal surgery.

Supplements and refinements to current classifications and nomenclature of the fronto-ethmoidal transition region by systematic analysis with 3D CT microanatomy

Objective: The microanatomy of the fronto-ethmoidal transition region has been addressed in several classifications. CT stereoscopic imaging (3DCTSI) provides improved display and delineates three defined complex “spaces”, the Frontal Sinus/Frontal Recess Space, the Infundibular Space of the Ethmoid Uncinate Process, and the Ethmoid Bulla Space (FSRS, IS-EUP, EB), none of which were adequately described with the “cell” terminology. We present details on the 3D microanatomy, variability, and prevalence of these spaces. Methods: 3D stereoscopic imaging displays (3DCTSI) were created from 200 datasets. The images were analyzed and categorized by a radiologist (SJZ), and consultant otolaryngologists, focusing on 3D microanatomy of the fronto-ethmoidal transition, the frontal recess/frontal sinus, and drainage pathways, in comparison to established anatomical classification systems. Results: The anterior ethmoid is subdivided into seven groups with the following core properties and prevalence: 1. The horizontal roof of the IS-EUP is attached to the superior half of the frontal process of the maxilla (19%); 2. The IS-EUP extends into the frontal recess (6.5%); 3. The IS-EUP extends into the frontal recess and the frontal sinus (18.5%); 4. A bulla is seen in the medial frontal sinus (3%); 5. The ethmoid bulla and supra bullar space extend into the frontal sinus (7%); 6. Lamellae extend into the FSRS antero-superiorly (25%); 7. FSRS expansion expands below the upper half of the frontal process of the maxilla (FSRS) (21%). Conclusion: 3-D analysis of the detailed anatomy provides important new anatomic information with the increased focus on precision surgery in the region.

Expected Costs of Primary Dental Treatments and Endoscopic Sinus Surgery for Odontogenic Sinusitis.

Treatment of odontogenic sinusitis (ODS) due to apical periodontitis (AP) is highly successful when both dental treatment and endoscopic sinus surgery (ESS) are performed. Variation exists in the literature with regard to types and timing of dental treatments and ESS when managing ODS. This study modeled expected costs of different primary dental and sinus surgical treatment pathways for ODS due to AP. Decision-tree economic model. Decision-tree models were created based on cost and treatment success probabilities. Using Medicare and consumer online databases, cost data were obtained for the following dental and sinus surgical treatments across the United States: root canal therapy (RCTx), revision RCTx, apicoectomy, extraction, dental implant, bone graft, and ESS (maxillary, ± anterior ethmoid, ± frontal). A literature review was performed to determine probabilities of dental and sinus disease resolution after different dental treatments. Expected costs were determined for primary dental extraction, RCTx, and ESS pathways, and sensitivity analyses were performed. Expected costs for the three different primary treatment pathways when dental care was in-network and all diseased sinuses opened during ESS were as follows: dental extraction ($4,753.83), RCTx ($4,677.34), and ESS ($7,319.85). ODS due to AP can be successfully treated with primary dental treatments, but ESS is still frequently required. Expected costs of primary dental extraction and RCTx were roughly equal. Primary ESS had a higher expected cost, but may still be preferred in patients with prominent sinonasal symptoms. Patients' insurance coverage may also impact decision-making. NA Laryngoscope, 132:1346-1355, 2022.

A new species of Sclerocephalus with a fully ossified endocranium gives insight into braincase evolution in temnospondyls

AbstractThe late Paleozoic temnospondyl Sclerocephalus formed an aquatic top predator in various central European lakes of the late Carboniferous and early Permian. Despite hundreds of specimens spanning a wide range of sizes, knowledge of the endocranium (braincase and palatoquadrate) remained very insufficient in Sclerocephalus and other stereospondylomorphs because even large skulls had unossified endocrania. A new specimen from a stratigraphically ancient deposit at St. Wendel in southwestern Germany is recognized as representing a new taxon, S. concordiae new species, and reveals a completely ossified endocranium. The sphenethmoid was completely ossified from the basisphenoid to the anterior ethmoid region, co-ossified with the parasphenoid, and the basipterygoid joint was fully established. The pterygoid bears a slender, S-shaped epipterygoid, which formed a robust pillar lateral to the braincase. The massive stapes was firmly sutured to the parasphenoid. In the temnospondyl endocranium, character evolution involved various changes in the epipterygoid region, which evolved distinct morphologies in each of the major clades.UUID: http://zoobank.org/5e6d2078-eacf-4467-84cf-a12efcae7c0b

To Pack a Nose: High-Fidelity Epistaxis Simulation Using 3D Printing Technology.

Initial management and stabilization of epistaxis is managed by a diverse offset of clinical providers with variable levels of training. To determine the anatomic and clinical fidelity and ease of use of a novel simulator for the training and assessment of epistaxis management skills. Qualitative Research Study using expert questionnaire's for validation of a newly developed simulator. We performed a quasi-experimental intervention with 22 otolaryngology faculty and 10 trainees who independently evaluated the simulator. Data were collected in three phases: phase 1 (preliminary evaluation), phase 2 (final expert evaluation), and phase 3 (trainee evaluation). We designed a three-dimensional (3D) printed model from a de-identified patient computed tomography scan. Artificial blood was circulated through catheters to simulate bleeding from three distinct sites (sphenopalatine, Kiesselbach's plexus, and anterior ethmoid). Four domains were assessed: "Physical and anatomic attributes," "Realism of experience," "Ability to perform tasks," and "Value and clinical relevance." Internal structure and validity were measured with Cronbach's alpha and item outfit mean-square statistics. Results from otolaryngology faculty showed very high median ratings for "Value of the simulator as a training tool" (4.0/4) and high ratings for "Relevance to practice" (4.0/4), and realism of experience (4.0/4). Responses from otolaryngology trainees demonstrated high value for clinical training (4.0/4) and high likelihood to recommend use for future trainees (4.0/4). Confidence in managing epistaxis before (1.0/4) and after (3.0/4) simulator use was statistically improved (P=.03). Using 3D printing technology, we created a novel simulator for epistaxis management. Preliminary evidence suggests the model is cost-effective, anatomically realistic, relevant to trainees' educational needs, and valuable as a training tool. 3 Laryngoscope, 132:747-753, 2022.

Endoscopic Sphenoid Sinus Anatomic Considerations: A Study on 60 Cadavers.

Introduction:Sphenoid sinus can be considered a key element in advanced sinus and skull base surgery. Due to its importance, many researchers tried to document its characteristics and evaluate possible differences among different races and populations. Materials and Methods:This study was conducted between March 2017 and December 2018 on 60 fresh adult cadavers in Tehran Forensic Medicine Center, Tehran, Iran. The evaluated variables were distances between nasal spines, posterior wall of the sphenoid, pituitary gland, and the distance between the anterior and posterior ethmoid artery and optic nerve, which were calculated using a flexible ruler through the direct length in millimeter. Another important variable was dehiscence, which was evaluated in optic and carotid artery canals. Results:After dissecting 120 sphenoid sinuses, the carotid artery was dehiscent in 24 (20%) cases, and optic nerve dehiscence was observed in 15 (12.5%) cadavers. The mean distance between the anterior wall of the sphenoid sinus and the anterior nasal spine was determined at 73.3±1.3 mm (rang: 58.3-87 mm), and the mean distance between the anterior part of the middle of the pituitary gland and the anterior nasal spine was estimated at 81.1±1.6 mm. Conclusion:According to our finding, the dehiscence of the key structural organs may be more prevalent in the Persian sphenoid sinus, which should be considered carefully in the management of related pathologies.

A third hand to the surgeon: the use of an endoscope holding arm in endonasal sinus surgery and well beyond

BackgroundExtended endoscopic endonasal operations of the sinuses and the frontal skull base require a bimanual action of the surgeon in many cases. Thus, typically an assistant guides the endoscope and centers the field of view. In this study, we investigate in which cases an endoscope holding arm can be used alternatively.Materials and methodsThe electromagnetic system ENDOFIXexo was used in different surgical interventions of the paranasal sinuses and beyond questioning ergonomics and geometrical limitations. The realized degrees of freedom were documented, and a topography of possible applications compiled.ResultsThe presented system is limited by the anatomy of the anterior ethmoid and dynamic working conditions in the sagittal direction. Especially in extended interventions in the posterior ethmoid, in which parts of the nasal septum have been resected and a static position of the endoscope is desired the surgeon can greatly benefit from the robotic arm. Moreover, through the high flexibility of the endoscopic arm surgeries of the pharynx and larynx were performed, questioning the current gold standard of microscope-assisted surgical procedures.ConclusionUnder the impression of an urging staff shortage and due to its unlimited patience, the ENDOFIXexo arm seems promising. Taking into account the complex anatomy and the limited access, we especially see a favorable field of application in the surgery of the pituitary gland and skull base tumors.

The role of supraorbital ethmoid cell and the significance of a proposed classification of the anterior ethmoid artery in endoscopic sinus surgery

Objective:To investigate the role of the supraorbital ethmoidal cell（SOEC） in identifying the frontal sinus ostium（FO） and the anterior ethmoidal artery（AEA） in endoscopic sinus surgery, and to evaluate the clinical significance of a proposed endoscopic classification of AEA. Methods:The clinical data of 116 patients with chronic rhinosinusitis were collected. Thirty-six patients（47 sides） with SOEC and DraftⅡA frontal sinusotomy were included. The radiological-anatomical relationship between SOECs and FO, AEAs were recorded. Endoscopic classification of AEA was proposed according to the relationship between the AEA and the ethmoidal roof（EF）: type 1, the AEA prominence did not extend beyond the lateral one-third of the EF; type 2, that exceed the lateral one-third but not beyond two-thirds of the EF; type 3, that exceed the lateral two-thirds of the EF. Results:The incidence of SOECs was 26.1%（47/180） of the DraftⅡA operating sides. On computed tomography images, seven sides of FO were occupied by supra agger frontal cells or supra bulla frontal cells; the other 40 sides（85.1%） were immediately anterior to the SOECs. The AEAs were 100% located near the posterior margins of SOECs with 6（12.8%） running under the EF and 41（87.2%） low-lying distant from the EF. Under endoscopy, the identification rate of SOECs was 89.4%（42/47）, and five（10.6%） SOECs were not confirmed due to edematous mucosa, bleeding, and other reasons. The identification rate of the AEA was 76.6%（36/47）, of which type 1, type 2 and type 3 accounted for 41.7%（15/36）, 38.9%（14/36） and 19.4%（7/36） respectively. After removing the frontoethmoidal cells, all the FO were located anteriorly or anteromedially to the SOECs. All the identified AEAs were located in the posterior boundary of the SOEC openings at the level of the anterior ethmoidal foramen. Conclusion:The SOEC is a reliable landmark for locating the FO and the AEA in endoscopic sinus surgery. The new endoscopic classification of AEA helps the surgeon dissect the frontoethmoidal region precisely.

Two Cases of Isolated Frontal Septal Cell Inflammation Treated with the Draf IIb Procedure

The frontal septal cell (FSC) is a medially based air cavity of the anterior ethmoid or the inferior frontal sinus, located in the interfrontal sinus septum. FSC pathologies are extremely rare although they are common frontal recess cells. We report on two patients with isolated FSC sinusitis presenting with frontal headache who were treated with Draf IIb endoscopic sinus surgery (ESS). Paranasal sinus computed tomography of the patients revealed a clear frontal sinus and FSC soft tissue density. The patients underwent a Draf IIb procedure through left-sided approach to treat FSC inflammation. After surgery, the patients no longer complained of headache, and the widened outflow tract was maintained without narrowing in endoscopic views during 2 years of follow-up. When a patient presents with continuous frontal headache, FSC inflammation should be considered. It can be successfully treated by Draf IIb ESS. (J Clinical Otolaryngol 2021;32:85-89)

Middle turbinate concha bullosa and its relationship with chronic sinusitis: a review

&lt;p class="abstract"&gt;Sinonasal diseases are serious health issues found in the clinical practice. Sinonasal diseases are often associated with anatomical variants in the sinonasal tract. There are numerous sinonasal anatomical variants found frequently in computed tomography (CT) scans of the paranasal sinuses. Middle turbinate concha bullosa is a common anatomical variant found in the nasal cavity. Pneumatization of the middle turbinate is called as concha bullosa. The pneumatization of the middle turbinate is mostly via the anterior ethmoidal air cells. Pneumatizations through posterior ethmoid air cells are also reported. There are three types of concha bullosa such as lamellar, bulbous and extensive. Majority of the patients with middle turbinate concha bullosa are asymptomatic. Sometimes this is accidentally detected during proper evaluation of the headache. Sometimes the middle turbinate concha bullosa is associated with chronic sinusitis. However, there are very few literatures which correlate the middle turbinate concha bullosa and chronic sinusitis. Although chronic sinusitis is a clinical diagnosis, the imagings like CT scan are useful to assess the extent of the disease and demonstrate the sinonasal anatomy. CT scan of the paranasal sinuses and diagnostic nasal endoscopy are important tests useful for evaluation of the middle turbinate concha bullosa and its relations with chronic sinusitis. This review article discusses on the details of the middle turbinate concha bullosa and its relationship with chronic sinusitis.&lt;/p&gt;

Cell Adhesion Molecules are Upregulated and May Drive Inflammation in Chronic Rhinosinusitis with Nasal Polyposis.

PurposeChronic rhinosinusitis with nasal polyps (CRSwNP) is predominantly characterized by eosinophil- and T helper 2 cell (Th2)-biased inflammation. Integrins and intercellular adhesion molecules (ICAMs) are superfamilies of cell adhesion molecules (CAMs) that facilitate the recruitment and trafficking of immune cells and have been implicated in coordinating eosinophil and Th2 cell adhesion and signaling in asthma. The roles of CAMs in CRSwNP, however, remain poorly understood. The purpose of this study was to characterize the systemic and local expression of CAMs and identify which CAMs are potentially involved in CRSwNP pathology.Materials and MethodsA prospective observational study was conducted using peripheral blood and anterior ethmoid tissues of patients with CRSwNP (n=32) and controls (n=15). Multiplex gene analysis and Pearson correlations were performed to identify associations between systemically and locally expressed CAMs. Based on the gene expression results, immunohistochemical evaluation and quantification of cells expressing integrins ITGAM, ITGAX, and ITGB2, as well as ICAM-3 in sinonasal tissues were conducted to compare local protein expression patterns.ResultsIntegrin and ICAM genes were significantly elevated in the blood (p<0.001 to p<0.05) and sinuses (p<0.0003 to p<0.05) of patients with CRSwNP compared to controls. Strong positive correlations of genes expressed in the blood (p<0.01 to p<0.05) and sinuses (p<0.01) were observed between ITGAM, ITGAX, ITGB2, and ICAM3. ITGAM-, ITGB2-, ICAM-3-, and ICAM-3/ITGB2-positive cell counts were significantly increased in CRSwNP compared to controls (p<0.0001 to p<0.04), and a positive correlation between ICAM-3/ITGB2- and ITGAM-positive cell counts was observed (p<0.02).ConclusionThe systemic and local expression of ITGAM, ITGB2, and ICAM-3 is significantly upregulated in CRSwNP, suggesting that integrin complex ITGAM/ITGB2 and ICAM-3 serve a potential role in inflammation-mediated signaling in CRSwNP.

Long Term Outcomes of Nasoseptal Perforation Repair With an Anterior Ethmoidal Artery Flap.

Nasoseptal perforation repair is a challenging condition with no standard technique for repair recognized. A case series of consecutive patients who underwent nasoseptal perforation repair with an anterior ethmoidal artery flap was conducted. Demographic data, preoperative features of the perforation and postoperative outcomes were analyzed. Closure rate, complications and persistence of nasal symptoms were documented. Thirty-two patients were included in the study. The average perforation diameter was 1.48 cm (range: 0.4-3 cm). Iatrogenic trauma was the most common cause (56% of patients). Nine cases ended up being idiopathic. The overall closure rate was 81%, but 87.5% when perforation had a 2-cm diameter or less. Of the six failures, 2 were due to flap necrosis and 4 to a residual anterior perforation. Despite the persistence, 2 patients solved their symptoms. One patient underwent revision surgery. The anterior ethmoidal artery flap is a reliable and minimal invasive technique for closure of symptomatic perforations. For defects larger than 2 cm, a lower success rate and additional reconstructive measures should be considered. Objective questionnaires are needed in order to evaluate functional outcomes.