Anterior Ethmoid Cells Research Articles

Technical Quality of Contemporary Endoscopic Sinus Surgery: An Assessment by Study of Anatomical Features Needing Attention at Revision Surgery

Although technical causes of endoscopic sinus surgery (ESS) failure have long been reported, we were curious about the quality of contemporary sinus surgery. The electronic health database of Mayo Clinic, Arizona was scrutinized to identify adult patients with diffuse chronic rhinosinusitis (CRS) who underwent revision ESS between January 2019 and September 2023 with a history of bilateral full-house ESS. Anatomical features on preoperative radiology and intraoperative endoscopy were cataloged: residual uncinate tissue, maxillary antrostomy with a non-incorporated natural os, residual ethmoidal septations (three septations > 3 mm), and inadequate sphenoid osteotomy (os size < 6 mm). Sixty-nine subjects were identified. A deviated nasal septum was present in 53.6%. Residual uncinate tissue was noted in 50.7% of patients associated with missed natural maxillary os in 39.13% of antrostomies. An inadequate os diameter was noted in 63.8% of sphenoidotomies. Significant residual septations were seen in posterior ethmoidal cells in 66.7% and anterior ethmoidal cells in 62.3% of patients. Residual frontoethmoidal cells were noted in 72.4% of patients. Although the extent of ESS must be individualized, a high prevalence of features reflecting suboptimal surgery that could limit the success of ESS was identified. These findings merit further consideration for focused training during residency and continuous professional development activities.

Primary Frontal Sinus Carcinoma: A Case Report

Primary frontal sinus carcinoma is rare, with an incidence of 0.3-1% of all paranasal sinus carcinomas. We present an 84-year-old woman who, about a month ago, developed erythema and edema of the skin of the upper eyelids and glabella, accompanied by eye discharge and slight tenderness to touch. We performed an X-ray and CT examination of paranasal cavities that found no pathological changes. The patient underwent several consultations and treatments from different specialists without any effect. Due to the growth of edema and the formation of a dense lesion at the base of the nose and frontal sinus, a repeat CT examination of the paranasal cavities was performed, which established the presence of a soft tissue oval lesion frontally in the area of the glabella with dimensions of 38/36/40 mm, which infiltrates and lyses the upper part of the right nasal bone, anterior ethmoid cells, medial wall of the right orbit, and anterior wall of the frontal sinus. The patient was referred to an otorhinolaryngology clinic, where a diagnosis of low-differentiated squamous cell carcinoma was made with the help of a biopsy and immunohistochemical examination. Due to the judgment of inoperability, definitive large-fractionated percutaneous radiotherapy was performed. The presented case illustrates the need for broad differential-diagnostic thinking in cases with edema in the head region.

Multiple coexisting variations of skull and cervical spine anatomy in a symptomatic patient - uncommon or uncommonly noticed? A CT-based case study.

Among many anatomical variations of the skull and cervical spine, some may be an underlying cause of a disease, while others remain clinically silent. The estimated individual prevalences of them differ, but given the available data it is impossible to clarify how frequently they coexist with each other. The following study presents an example of seven anomalies, amongst which at least few have manifested clinically in the examined patient. A 35 y.o. Polish woman who suffered from chronic sinusitis was subjected to a computed tomography scan. Mild thickening of the anterior ethmoidal cells' mucosa, bilateral concha bullosa, paradoxical right middle turbinate, bilateral uncinate process pneumatization and arrested pneumatization of sphenoid sinus were found and addressed in context of the reported symptoms. Simultaneously other, clinically silent anatomical anomalies, were found - namely ossification of the anterior petroclinoid ligament, incomplete medial basal canal and bilateral arcuate foramen. To the best knowledge of the authors, this case report is the first to present such a coexistence of this many various anatomical anomalies, among which some played a crucial part in the chronic sinusitis experienced by the patient. Concurrence of multiple variations in the same anatomical area or functional unit may exacerbate clinical presentation of a patient. Identifying a single anomaly ought to warrant a thorough investigation into any other potentially existing variants.

Local flap reconstruction techniques after frontal sinus drainage typeII andIII according to Draf

Extended endonasal endoscopic frontal sinus surgery is characterized by bone resection beyond the lamellae of the frontal sinus and is currently classified according to Draf as typeIIa, typeIIb, modified typeIII (also referred to as typeIIc), and typeIII. This approach is indicated when the surgical goal cannot be achieved through complete removal of the anterior ethmoidal cells. Numerous studies indicate restenosis rates ranging from 7to 36%, despite creation of maximal openings. Exposed bone, which tends to epithelize slowly with significant crusting and the risk of uncontrolled wound healing depending on the local environment and other factors, is considered acontributing factor. Covering the exposed bone with mucosa can significantly reduce the risk of restenosis. Avariety of flap techniques for frontal sinus drainage in DrafIII procedures are presented, including some variants that were part of presentations at the 2023 Congress of the European Rhinologic Society in Sofia, Bulgaria. These include combinations of free mucosal grafts, pedicled mucosal flaps, and hybrids combining both techniques. Additionally, the results of current studies are presented. The results and achieved opening areas in contemporary DrafIII surgeries are significantly improved and larger compared to the early stages of these procedures. Amultitude of published studies consistently demonstrate that outcomes are markedly improved with mucosal coverage. Depending on the prevailing anatomy, mucosal conditions, and the extent of the surgical intervention, the most suitable technique should be selected. Therefore, proficiency in various methods is crucial. The use of aflap technique (free, pedicled, or combinations thereof) should be defined as the standard when performing extended frontal sinus surgery (Draf IIb, IIc, III, or endonasal frontal sinus surgery [EFSS] 4-6).

Inflammatory Modifications in Paranasal Sinuses and Ostiomeatal Complex Anatomical Variations in Jet Aircraft Pilots: A Computed Tomography Study.

Introduction Jet aircraft pilots are exposed to huge pressure variation during flight, which affect physiological functions as systems, such as the respiratory system. Objectives The objective of the present investigation was to evaluate inflammatory changes of paranasal sinuses of jet aircraft pilots before and after a jet aircraft training program, using multislice computed tomography (CT), in comparison with a group of nonairborne individuals with the same age, sex, and physical health conditions. A second objective of the present study was to assess the association between the ostiomeatal complex obstruction and its anatomical variations. Methods The study group consisted of 15 jet aircraft pilots participating in the training program. The control group consisted of 41 nonairborne young adults. The 15 fighter pilots were evaluated before initiating the training program and after their final approval for the presence of inflammatory paranasal sinus disease. The ostiomeatal complex anatomical variations and obstructions were analyzed in pilots after the training program. Results Jet aircraft pilots presented higher incidence of mucosal thickening in maxillary sinus and anterior ethmoid cells than controls. Prominent ethmoidal bulla showed significant association with obstruction of the osteomeatal complex. Conclusions Jet aircraft pilots present increased inflammatory disease when compared with nonairborne individuals. The presence of a prominent ethmoidal bulla is associated with ostiomeatal complex obstruction.

Three-Dimensional Volumetric Investigation of Onodi Cells: A Multi-Slice Computed Tomography Study.

Introduction Onodi cells (OCs) are posterior ethmoid cells that are located above the sphenoid sinus, close to or even surrounding the carotid artery and optic nerve. Objective To investigate and evaluate the volumetric variation of OCs through multi-slice computed tomography (MSCT) scans. Methods We performed a retrospective review of MSCT scans of 79 subjects, 40 male and 39 female patients, Whose age ranged from 18 to 83 (mean: 39.6) years. The volumes of the OCs on the right and left sides were measured using the ITK-SNAP software (open-source) with semiautomatic segmentation. The possible relationships involving age, gender, contact with the optic nerve, extension of the pneumatization of the posterior ethmoid cells into the clinoid processes, mucous thickening in the anterior and posterior ethmoid cells, and obliteration of the sphenoethmoidal complex were analyzed with the Pearson correlation and Chi-squared tests according to the type of data compared and logistic regression models ( p < 0.05). Results We observed that an increase of one unit in the volume of OCs also increases the chance of extension of pneumatization into the clinoid processes by 0.15% ( p = 0.001). No significant correlations were identified regarding age, gender, and volume of the OCs. Conclusion The volume of the OCs has effects on the extension of pneumatization into the clinoid processes.

EXTENSIVE PLEOMORPHIC ADENOMA APPROACHED BY LE FORT I: A CASE REPORT

Pleomorphic adenoma is a pathological entity that can reach large proportions, compromising vital functions. The Le Fort I osteotomy offers excellent access and a direct view of the operative field in order to remove palatal tumors involving the nasal cavity without creating esthetic drawbacks, increasing safety, and minimizing the possibility of recurrence. The present case is of a 56-year-old woman, presenting left nasal obstruction with a 3-year evolution. Computed tomography showed an expansible formation, undefined limits, occupying anterior and posterior ethmoidal cells on the left and signs of cervical discontinuity with an area of bone remodeling. Upon examination, a tumoral lesion measuring 6 × 4 × 3 cm was observed in the left nasal cavity. The histopathological diagnosis was pleomorphic adenoma. The lesion was surgically approached by Le Fort I with maxillary fixation by osteosynthesis plates. The 3-month follow up showed no signs of recurrence. Pleomorphic adenoma is a pathological entity that can reach large proportions, compromising vital functions. The Le Fort I osteotomy offers excellent access and a direct view of the operative field in order to remove palatal tumors involving the nasal cavity without creating esthetic drawbacks, increasing safety, and minimizing the possibility of recurrence. The present case is of a 56-year-old woman, presenting left nasal obstruction with a 3-year evolution. Computed tomography showed an expansible formation, undefined limits, occupying anterior and posterior ethmoidal cells on the left and signs of cervical discontinuity with an area of bone remodeling. Upon examination, a tumoral lesion measuring 6 × 4 × 3 cm was observed in the left nasal cavity. The histopathological diagnosis was pleomorphic adenoma. The lesion was surgically approached by Le Fort I with maxillary fixation by osteosynthesis plates. The 3-month follow up showed no signs of recurrence.

Common Drainage Pathway From Bilateral Frontal Sinuses: Lessons From 2 Cases

Primary pneumatization of the frontal bone occurs in the first year of life, but further pneumatization continues until 18 years of age. Elongation of the ethmoidal infundibulum and frontal recess, or upwards migration of the anterior ethmoidal cells has been proposed as a mechanism of frontal sinus development. The frontal sinus drainage pathway is displaced in the anterior or posterior direction depending on the pneumatization pattern of the frontoethmoidal cells. Also, frontal sinuses can be connected to the infundibulum or directly to the middle meatus depending on the superior attachment pattern of the uncinate process. Bilateral frontal sinuses are separated by their bony septum, and thus have their own drainage pathways. Contrary to this general rule, we experienced two cases of frontal sinuses that were connected to each other, showing a single drainage pathway from both frontal sinuses. We report these two cases along with a literature review.

Bilateral blindness following a stabbing assault: A case report.

IntroductionStabbing is relatively frequent in Morocco and constitutes a major public health concern. Our observation is interesting by the particularity and the aggressiveness of the trauma leading to an irreversible bilateral blindness.Case presentationThe present observation relates to a patient who was victim of a stabbing assault. The examination objectified a facial wound in front of the right lateral canthus with a broken weapon in place. An urgent craniofacial CT scan was performed showing a hyperdense penetrating path of the stabbing from the lateral wall of the right orbit, associated with a bursting of the globe, obliquely crossing the anterior ethmoid cells and severing the optic nerve on the left side. Surgical exploration was made with an extraction of the remaining part of the knife. Bilateral blindness was irreversible and the patient had a psychiatric follow up.ConclusionAggressions are a sad reality, expressing anger and violence on the part of a young adult, present in any society with often dreaded consequences.

CT SCAN EVALUATION OF CONCHA BULLOSA AND ITS CORRELATION WITH DEVIATED NASAL SEPTUM – A PROSPECTIVE STUDY

Introduction : Osteomeatal unit is a functional unit of the anterior ethmoid complex representing the final common pathway for the drainage and ventilation of the frontal, maxillary and anterior ethmoid cells .Osteomeatal complex has become an area of active radiologic and pathophysiologic investigation with the development of endoscopic sinus surgery for inflammatory sinus disease. The aim of this study was to investigate the anatomical vari Aim : ation of the middle turbinate concha bullosa , incidence of concha bullosa and its correlation with nasal septal deviation. based on paranasal sinus imaging. A prospective study was performed in the Department of ENT and Materials and Methods : Head Neck Surgery over a period of 5 years, to determine the prevalence of Concha bullosa in patients who presented to our out patient department with symptoms of nasal obstruction, headache, post nasal drainage and facial pain , and underwent CT scan of Paranasal sinuses. We evaluated 462 CT images both coronal and axial planes with a 1-3-mm slice thickness. Out of the CT scans studied of the nose and paranasal sinus of 462 patients, the prevalen Results : ce of concha bullosa was 25.5 % (118) patients .Male predominance was seen with 63 (53.3%) patients and 55 (46.6%) female patients. Concha bullosa was bilateral in 21 (17.7%) patients, and unilateral in 76 (64.4 %) patients. Mixed or extensive type of concha bullosa was seen in 56 (47.4%) patients followed by 35 (29.7%) patients having lamellar type and 27 (22.9%) patients with bulbous type.Out of 118 cases of CB, 43 (36.4%) were on left side of which 29 (67.4%) patients showed deviation of the nasal septum to right and 33 (27.9%) were on right side of which 21 (63.3%) patients had a nasal septal deviation to left. We found that there is a strong relationship between the presence of unila Conclusion : teral or dominant Concha bullosa and contralateral nasal deviation.

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.

Functional endoscopic sinus surgery (FESS) with navigation system in childhood – our experience. Presentation of clinical cases

Introduction: Functional endoscopic sinus surgery (FESS) is the gold minimally invasive standard in diagnosing and surgically treating many diseases of the nose and paranasal cavities. An advantage of FESS is the possibility of application in all age groups. Materials and methods: We observed pediatric patients attended the Otorhinolaryngology Clinic in the University Hospital “Dr. Georgi Stranski” – Pleven in 2021. FESS surgery was performed in the “Integrated interdisciplinary operating unit with navigation and telesurgery systems” at the Center of competence on personalised medicine, 3D and telemedicine, robotic and minimally invasive surgery „Leonardo da Vinci” in Medical University – Pleven. Clinical cases: Case 1: A 7-year-old male patient with orbital complication of rhinosinusitis, with left orbital preseptal cellulitis, without ophthalmoplegia or loss of vision, + ptosis of the eyelid and data on pansinuitis from CT images. Performed FESS found lysis of lamina papyracea with involvement of anterior and posterior ethmoidal cells. Postoperative treatment was done with Ceftriaxone 1g/12h i.v. for 7 days, nasal glucocorticoids and antihistamines. Case 2: A 17-year-old female patient with suggested primary ciliary dyskinesia with a recurrent rhinosinusitis, persistent nasal obstruction, and thick viscous secretions that did not respond to conservative treatment. Sweat test for cystic fibrosis (-). FESS reshaping of the natural openings of the maxillary sinuses and anterior ethmoidectomy were performed bilaterally. Conclusion: FESS is a minimally invasive method, which is suitable for application in pediatric patients. When applied by trained professionals, FESS with an integrated navigation system is optimal for the diagnosis and surgical treatment of chronic and acute rhinosinusitis in children.

Repair of internal carotid artery injury with aneurysm clip during endoscopic endonasal surgery: illustrative case

BACKGROUNDOne of the most feared and dangerous scenarios that can appear during an endoscopic endonasal surgery (EES) is the iatrogenic injury of the internal carotid artery (ICA). Several methods, along with a variety of outcomes, have been described to deal with this complication. To the authors’ knowledge, this is the first report on the use of a Yasargil-type aneurysm clip to solve an ICA injury, preserving the artery’s patency and having a long-term follow-up. The authors discuss the advantages and disadvantages of other vessel preservation techniques compared with clipping.OBSERVATIONSA visually impaired 56-year-old woman was diagnosed with a giant nonfunctional pituitary tumor that invaded the sphenoidal sinus, anterior and posterior ethmoidal cells, and both cavernous sinuses, with suprasellar extension and optochiasmatic compression. The patient underwent EES, and during the final resection phase her left ICA was injured, with massive hemorrhage.LESSONSICA injury during endoscopic skull base surgery carries high mortality and morbidity; it is essential to maintain carotid flow when possible to avoid short-term and long-term consequences. There are several techniques depicted in the literature to deal with this situation. The authors report the use of a Yasargil mini-clip to deal with the injury for a positive outcome: primary hemostasis, vessel preservation, and no postoperative complications.

FUNCTIONAL ENDOSCOPIC SINUS SURGERY

Treatment of sinonasal diseases is either conservative or surgical. The recent advances in surgical management is the use of endoscopic sinus surgery (ESS) as it causes less morbidity, complication, pain and above all, less recurrence rates. This study aimed to evaluate the effectiveness of ESS for the treatment of nasal & paranasal sinus diseases and to address the postoperative complications. A prospective study was done at the Department of Otolaryngology in Basrah Teaching Hospital in the period from January 2016 to August 2019. One hundred twenty six patients with sinonasal diseases were involved in this study, more than this number of patients was operated upon but they either refused participation in this study or dropped from follow-up. The main indications of surgery were; chronic rhinosinusitis without nasal polyp (33%), chronic rhinosinusitis with nasal polyp (28.6%), Allergic fungal sinusitis & mycetoma (17.4%), and acute recurrent sinusitis (16%). Main presenting symptoms were; nasal obstruction (85.7%), nasal discharge (69%), headache and facial pain (66.6%) and hyposmia and or anosmia (57.9%). The majority of operated upon patients were primary cases (98 patients, 77.7%), while (28 patients, 22.2%) were revision cases. The commonest causes of revision were; retained or incompletely removed uncinate process in 28.5% of cases, followed by incomplete removal or persistence of anterior ethmoid cells in 21.4% cases. In this series complications occurred in 15%, which were generally minor (9.5%), major complications occurred in 5.5% of operated upon patients. The commonest major complication is sever bleeding which was reported in 4.7% and anosmia which was reported in one patient. No CSF leak, retro orbital haemorrhage, or blindness was reported. Most of the patients in this series were improved (88.8%), complete symptom improvement occurred in (75 patients, 59.5%), partial improvement (37 patients, 29.3%), while (14 patients, 11%) were not improved. In conclusion, functional endoscopic sinus surgery is a safe surgery for sinonasal diseases, it carry good success rate with non-significant major complications. Key words: Nasal Sinus, Functional Surgery, Endoscopy

A CT Scan Study Showing Prevalence of Haller Cells in Patients with Sinonasal Complaints

Background: Anterior ethmoid cells that extend into the maxillary sinus roof are known as Haller cells. They are commonly seen on the floor of the orbit. They may cause sinusitis symptoms by blocking the infundibulum, may get infected and also sometimes complicate the Functional Endoscopic Sinus Surgery (FESS). The present study was undertaken to determine the prevalence of Haller cells on CT scans in patients having sino-nasal complaints. Subjects and Methods : This was a descriptive observational study carried out on 150 patients who presented with various sino-nasal complaints and underwent a CT Scan in the Department of Radiodiagnosis, Bangur Institute of Neurosciences, Kolkata. Their CT scans were studied retrospectively for the presence of Haller cells. Radiological variations data were summarized by routine descriptive statistics namely counts and percentages for categorical variables. Fisher’s Exact Tests and were applied to calculate the ‘p’ value to find out any statistically significant difference between males and females. Results: Haller cells were found in 12% (18 cases) in the present study, 5.33% in males and 6.67% in females. ‘p’ value in this case was 0.616 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like Haller cells are quite common and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the Haller cells in Eastern India which will definitely help the FESS surgery and its outcomes.

Endoscopic Anatomy and a Safe Surgical Corridor to the Anterior Skull Base

We describe the possibility to create precise preoperative planning for endonasal endoscopic approaches to the anterior skull base by overlapping endoscopic and radiologic anatomy. The important anatomic structures were marked. Morphometric measurements between these anatomic landmarks were performed endoscopically and compared with radiologic measurements of the same areas to ensure result compatibility. Seven cadaver heads injected intravascularly with colored silicone were used for this study. Thin-section brain and paranasal sinus computed tomography scans were obtained on all cadavers. Using 0-degree rigid endoscopes and endonasal endoscopic surgical instruments, the anterior skull base was examined binostrally in all cadavers. Bilateral middle turbinates were identified and preserved. Next, an inferior uncinectomy and middle meatal antrostomy were performed. After performing a frontal antrostomy, bilateral anterior and posterior ethmoidal cells were opened and the skull base was identified and followed to the posterior wall of the frontal sinus. A transnasal transethmoidal sphenoidotomy was done with full exposure to the entire anterior skull base. The anatomic landmarks for endonasal endoscopic skull base approaches were distinguished and measurements were made. The anterior skull base was divided into 3 compartments: anterior (area between the posterior inferior border of the frontal sinus and the course of anterior ethmoidal artery), middle (area between the course of the anterior ethmoidal artery and that of the posterior ethmoidal artery [PEA]), and posterior (area between the course of the PEA and the attachment point of the anterior border of the sphenoid sinus to the skull base) compartments. The distances between important anatomic markers and endoscopic depth measurements of this area were measured. During endonasal endoscopic anterior skull base surgery, the area between the anterior border of the sphenoid sinus and PEA artery was safe as the first dissection zone. Preoperative radiologic width and depth measurements facilitate orientation to the endoscopic anatomy during surgery and help predict the endonasal surgical corridor anatomy preoperatively.

Extraoral anatomy in CBCT – a literature review. Part 1: Nasoethmoidal region

Cone beam computed tomography has become a widely used imaging technique for dental indications. Depending on the selected size of the field of view, anatomical structures outside the dentomaxillary complex become visible. As a consequence, the clinician must be able to interpret also those anatomical regions. In this article, the anatomy of the nasoethmoidal region is presented based on a literature review. The nose is characterized by the nasal septum and the superior, middle, and inferior conchae. The turbinates may be pneumatized (concha bullosa), mainly the middle concha. The ethmoid bone has a complex morphology (ethmoid labyrinths) and contributes with its perpendicular plate to the nasal septum. Other structures of the septum include the vomer and the septal cartilage. The nasal meatuses stabilize the airflow and direct the inhaled air to the nasopharynx via the choanae. The middle nasal meatus, which is also a part of the so called ostiomeatal complex, serves as the major drainage area (semilunar hiatus) of the paranasal sinuses, i.e., maxillary sinus, anterior ethmoid cells, and frontal sinus. Posterior ethmoid cells empty into the superior meatus and the sphenoid sinus drains into the sphenoethmoidal recess, located above the superior concha. The nasolacrimal duct that is running along the middle portion of the lateral nasal wall opens into the inferior nasal meatus.

Radiological Analysis of Frontal Cells and its Association with Frontal Sinus Mucosal Disease: A Tertiary Care Hospital Based Study

Introduction&#x0D; The frontal sinus and frontal recess both have complex anatomy causing difficulty during endoscopic sinus surgeries. The term frontal cells is currently used to describe a group of anterior ethmoidal cells classified by Kuhn et al into 4 types. Though there are precise descriptions, the frequency of frontal sinus cells (FSCs) varies widely in the literature. The presence of FSCs is responsible for a narrowing of the frontal sinus outflow tract which subsequently causes a partial obstruction of drainage and aeration of the frontal sinus. Our main aim is to the see the distribution of different frontal cells in Nepali population and relation with frontal sinus mucosal disease.&#x0D; &#x0D; Materials and Methods&#x0D; This prospective, longitudinal study performed in 110 consecutive patients who underwent CT scan of nose and paranasal sinuses. The frontal cells and agger nasi cells were identified and association between the frontal cells and agger nasi cells with frontal sinus mucosal disease was analyzed with chi square test.&#x0D; &#x0D; Results&#x0D; The agger nasi was present in 83.63% CT scans whereas frontal cells were distributed in 61.82% CT (computed tomogram) scans. There was not statistical significance and any association between the frontal cells and agger nasi cells with frontal sinus mucosal disease.&#x0D; &#x0D; Conclusion&#x0D; The frontal cells and agger nasi cells distribution in Nepalese population, even though in small sample size, is similar with other studies in the literature. There is also non association of either frontal cells or agger nasi cells with frontal sinus mucosal disease.

Free nasal floor mucosal grafting after endoscopic total ethmoidectomy for severe nasal polyposis: a pilot study.

We report a novel surgical technique based on an endonasal free mucosal graft (mucoplasty) for improving clinical results and local healing in chronic rhinosinusitis with nasal polyps (CRSwNP). Patients diagnosed with bilateral CRSwNP scheduled for endoscopic sinus surgery were included. They underwent complete removal of anterior and posterior ethmoid cells, in addition to bilateral type III frontal sinusotomy. An endoscopic mucoplasty was performed in the left nasal cavity, whereas the right nasal cavity served as control. Patients were evaluated before surgery and 6 months after operation, including Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS) for olfaction, endoscopic evaluation using the Modified und-Kennedy (MLK) scoring system and healing evaluation. Ten patients (mean age 53.6 years) were included. A significa t decrease of SNOT-22 score from 57.0 (21.1) to 20.3 (20.6) (P = 0.024) and a non-significa t decrease of VAS for olfaction score from 9.3 (0.5) to 4.6 (3.9) were found. Preoperative mean MLK score was 4.9 (0.7) in the right nostril and 4.8 (1.0) in the left one. After operation, there was a greater decrease of MLK score in the left nostril than in the right (1.9 [1.0] vs. 1.3 [0.8], P = 0.034). Better healing was proved in the nostril with the mucoplasty. Endonasal mucoplasty could be an effective, safe and feasible complementary surgical procedure in the treatment of CRSwNP. The reduced local edema associated with lower amount of secretions may confer a better control in the frontal recess, orbital wall and nasal roof.

Эффективность эндоскопической риносинусохирургии при антрохоанальных полипах в детском возрасте

Antrochoanal polyps (ACP) are benign tumors, mainly originating from the maxillary sinus. The incidence in children is high – up to 35% of all chronic polypous rhinosinusitis. Endoscopic examination of the nasal cavity and computed tomography of the paranasal sinuses (PS CT) are generally used for ACP diagnostics. The medical treatment of ACP is deemed ineffective. Multiple options have been proposed for surgical treatment of ACP, including those used in children. In recent years, the role of FESS in the surgical treatment of ACP has increased. This paper provides an analysis of the efficacy of surgical treatment of 50 children with ACP at the period of 2012-2018 at Children’s Municipal Multidisciplinary Clinical Center for High Medical Technologies named after K. A. Rauhfus. All patients were operated on using endoscopic endonasal access. 40 children (80%) underwent combined access surgery. The efficacy analysis was carried out according to sino-nasal outcome test SNOT-20 (GAV), Lund-Kennedy endoscopic evaluation scores, Lund-Mackay computed tomography results evaluation scale. Our results showed the statistically significant association of improvement of all symptoms according to SNOT-20 (GAV) scale (p &lt; 0,05) after FESS. Moreover, the analysis of nasal endoscopy results showed the pronounced positive changes in the parameters of the „discharge“ and „mucosal edema“ in the postoperative period according to Lund-Kennedy scale (p &lt; 0,05). A statistically significant association of improvement of PS CT signs according to Lund-Mackay scale after FESS is also observed. The most significant changes were observed in the maxillary sinuses, anterior and posterior ethmoid cells, as well as in the osteomeatal complex on both sides, on average by –1 point (p &lt; 0,05). Therefore, FESS has proven its efficacy at ACP in children.