Anterior Ethmoid Sinus Research Articles

Approach to frontal sinus via five frontal sinus drainage pathways.

This study aimed to validate a method for successful frontal sinus surgery. The method classifies the frontal sinus drainage pathway (FSDP) into five categories based on three bony walls of the anterior ethmoid sinus, including the uncinate process (UP), accessory uncinate process (UPa), and basal lamella of the ethmoid bulla (BLEB), which was tested in actual surgical procedures. This study analyzed 53 sides of 48 patients who underwent frontal sinus surgery between October 2022 and March 2023. We classified the FSDPs using preoperative computed tomography (CT) and multiplanar reconstruction (MPR). During surgeries for FSDPs located anterior to the BLEB, we used a two-step method involving resection of the turbinal UP, followed by upward resection from the lower edge of the ethmoidal UP. For FSDPs located posterior to the BLEB, we resected the BLEB at the superior semilunar recess. We confirmed the origin of each of the five types of FSDP during surgery. These origins, which were located at the lowest part of the anterior ethmoid, could be identified in the early stages of ethmoid sinus surgery before proceeding to the frontal recess area. The origins of the five types of FSDP, classified based on the bony walls, can be clearly and accurately identified during surgery. This provides a reliable method for preoperatively predicting and locating the inferior end of the FSDP (origin), without extensive manipulation of the cells formed in the frontal fossa.

Maxillary Antrostomy Versus Complete Sinus Surgery for Odontogenic Sinusitis With Frontal Sinus Extension.

Endoscopic sinus surgery (ESS) is often necessary when managing odontogenic sinusitis (ODS), but ESS extent for ODS with extramaxillary sinus involvement has been incompletely studied. This study compared outcomes after wide maxillary antrostomy (MA) alone versus complete ESS for ODS with frontal sinus involvement. A multicenter prospective cohort study was conducted on patients with uncomplicated ODS (no extrasinus spread) who underwent ESS when computed tomography demonstrated maxillary, anterior ethmoid (AE), and frontal sinus opacification. Multiple preoperative and postoperative variables were recorded, including 22-item sinonasal outcome tests (SNOT-22) and endoscopic findings. Ultimate SNOT-22 and endoscopic resolution, and time to SNOT-22 and endoscopic resolution were compared between patients who underwent MA alone versus "complete" ESS (maxillary, ethmoid, frontal; not sphenoid). Of 70 patients, mean age was 59.2 years, and 55.7% were male. Thirty-five underwent MA alone, and 35 had complete ESS. At first postoperative visits (mean 9.3 days), AE sinus purulence was more likely resolved after complete ESS compared with MA (97.1% vs. 71.4%, p = 0.006). However, time to resolution of AE purulence was comparable by 6 weeks postoperatively (p = 0.158). There were no significant differences in times to foul smell resolution and achieving ≥9 point SNOT-22 reduction (p > 0.05). For ODS with frontal sinus involvement, MA alone and complete ESS both resulted in rapid and long-term symptomatic resolution. While ultimate resolution of sinus purulence was equivalent between surgery groups, complete ESS did lead to faster resolution of frontoethmoidal purulence in a significant number of cases. 2 Laryngoscope, 2024.

Retrospective Study on the Prevalence of Haller Cells Using Cone Beam Computed Tomography.

The paranasal sinuses are cavities filled with air located within specific bones, namely the frontal, ethmoidal, maxillary, and sphenoidal sinuses. The ethmoidal sinus is composed of three groups: anterior, middle, and posterior, which are found on both sides. Haller cells (HC), also known as infraorbital ethmoid cells, are projections of the anterior ethmoid sinus that extend into the floor of the orbit and the upper part of the maxillary sinus. Infraorbital ethmoid cells have been associated with several disease conditions and symptoms, such as sinusitis, headaches, orofacial pain, and mucoceles. Consequently, determining the frequency and form of HC is crucial. The objective of the study was to determine the frequency, form, and clinical significance of Haller cells (HC) using cone beam computed tomography (CBCT). This retrospective study analyzed 100 cone beam computed tomographic (CBCT) images, with an equal distribution of 50 males and 50 femalesfrom the age range of 19 to 70 years. The images were randomly selected from the CBCT archives. The participants were chosen according to the specific criteria for inclusion and exclusion established for the study. The collected data were subjected to statistical analysis utilizing the Chi-square test, independent student t-test, one-way ANOVA test, Cohen's Kappa statistics, and intraclass correlation coefficients. The occurrence of Haller cells (HC) was found to be 73%, with 32 cases observed in males and 41 in females. Among the 73 patients with HC, 52 (71%) had unilateral HC, while 21 (28.76%) had bilateral HC. Regarding the shape of the HCs, 31 (42.46%) were teardrop-shaped, 26 (35.61%) were oval-shaped, and 16 (21.91%) were round-shaped. Additionally, out of the 73 cases of HC, 69 (94.52%) were unilocular, and four (5.47%) were multilocular. Furthermore, the average dimensions of HC were greater in males than in females, regardless of whether the cells were distributed unilaterally or bilaterally. The interobserver agreement between observers one and two showed complete consistency, and our study found that the assessment of the dimension of HC had outstanding interrater reliability. The findings of this study indicate that CBCT is highly effective in visualizing and accurately delineating Haller cells in a significant number of patients. It is essential for oral physicians and oral radiologists to be aware of these anatomical structures to accurately identify them. This awareness will enable them to provide a comprehensive differential diagnosis for individuals experiencing orofacial pain and discomfort that may be attributed to the presence of Haller cells.

A computerized tomography-based study of anatomical variations of the ethmoidal uncinate process

Background: The uncinate process is very relevant with respect to the ventilation and drainage of the frontal, maxillary and anterior ethmoid sinuses in the osteomeatal complex. Aims and Objectives: The study was conducted with the aim to examine and assess various patterns of upper attachment of the ethmoidal uncinate process. The secondary objective of the study was to study the incidence of pneumatization of the uncinate process. Materials and Methods: With the objective to study the various patterns of upper attachment of the uncinate process, the study was conducted at the Department of Ear, Nose, and Throat (ENT) Head and Neck Surgery, at Government Medical College, Doda, J and K, India. The period of study was from November 2020 up to November 2021. The study involved 100 patients who had presented to the ENT outpatient with nasal and or sinus-related complaints. Results: The study included 58 males and 42 females. Among the various patterns, it was the type-2 pattern of the uncinate attachment that was the most prevalent (42%). This was followed by a type-1 pattern (attached to the lamina papyracea) (16%) and then a type-6 pattern (14%). Type-3 in 4%, type-4 in 3%, and type-5 in 7%. In 14% of the cases, there was no upper attachment of the uncinate process. The pneumatization of the uncinate process was noted among 42 of the uncinate processes that we studied. The pneumatization was unilateral in 41% and bilateral in 59% of the uncinate process. The patients with a pneumatized uncinate process had more severe clinical presentation. Conclusions: A thorough computerized tomography scan assessment of the attachments of the uncinate process and its variations aids in minimizing damage to the related landmarks during the surgery and helps minimizing the chances of iatrogenic trauma to the nasolacrimal duct, medial orbital wall, and other surrounding structures. It can also assist in figuring out the likely cause of refractory sinusitis.

Computed Tomography Signs of Sinonasal Inflammation in Patients with Acute Dacryocystitis.

Nasal and paranasal sinus abnormalities may be related to nasolacrimal duct obstructive disease but are strongly debated. Data of acute disease stage are lacking. The purpose of this study was to determine if there are correlations between radiologic signs of sinus inflammation and acute dacryocystitis (AD). This cross-sectional controlled study was conducted at Wenzhou, Zhejiang Province, China from February 2021 to November 2023. Forty-four consecutive patients with AD and 50 consecutive patients with orbital tumors (the control group), who completed preoperative computed tomography scans, were enrolled to evaluate the extent of their inflammatory sinonasal disease by the modified Lund-Mackay score system. The inflammation signs of the paranasal sinuses (total mean sinus scores, 95% CI [0.00, 2.00]; P < 0.001), namely the anterior ethmoid sinus(95% CI [0.00, 1.00]; P < 0.001), the posterior ethmoid sinus(95% CI [0.00, 0.00]; P = 0.003), the frontal sinus (95% CI [0.00, 0.00]; P = 0.02), and the ostiomeatal complex (P < 0.001) were more extensive in patients with AD when compared with the controls. The disease course was negatively correlated with the anterior ethmoid (P = 0.03) and frontal scores (P = 0.01). The symptom of eyelid swelling was positively correlated with the anterior ethmoid (P = 0.03), ostiomeatal complex (P = 0.004), and total sinus scores (P = 0.005). Inflammatory sinus disease was found to be more frequent in patients with AD, which was gradually alleviated with the prolongation of the disease course. The mutual spread of inflammation particularly in the acute course may play an important role in lacrimal duct obstructive disease.

Pediatric Unilateral Chronic Sinusitis: Clinical and Radiological Patterns Compared to Adults.

Upper respiratory tract infections and sinusitis are more prevalent in children than in adults. Unilateral sinusitis is not uncommon disease. Our aim was to analyze the disease characteristics in children with unilateral sinusitis and compare them with those of adults. This study included 124 patients with unilateral chronic sinusitis divided according to age into two groups: pediatric group ≤18 years (66 cases) and adult group >18 years (58 cases). The groups were compared in terms of demographic data, side, clinical manifestations and radiological findings. In pediatric patients, the most common inflammatory pathology was antrochoanal polyps, followed by allergic fungal sinusitis. On the other hand, chronic sinusitis without nasal polyps is the most common in adults, followed by antrochoanal polyps. The mean duration of clinical manifestations before diagnosis in pediatric patients was significantly shorter than that in adults (P=0.001). The most common symptoms in both pediatric and adult patients were anterior nasal discharge and nasal obstruction. Proptosis was significantly higher in pediatric group than in adult group (P=0.015). On computed tomography (CT), the most commonly affected sinus in both pediatric and adult patients was the maxillary sinus followed by the anterior ethmoid sinus. Bone expansion, erosion and involvement of adjacent structures were significantly higher in pediatric patients (P=0.028, 0.027 respectively). Pediatric patients have a high incidence of antrochoanal polyps and allergic fungal sinusitis as unilateral inflammatory lesions. These lesions require surgical management. Inflammatory paranasal sinus lesions in pediatric patients have a shorter duration of clinical manifestations and a higher incidence of bone erosion and involvement of adjacent structures; therefore, early diagnosis and management prevent complications.

Evaluation of computed tomography (CT) findings in patients with symptomatic deviated nasal septum and their correlation with intraoperative findings

AimTo evaluate the computed tomography (CT) findings in patients having a symptomatic deviated nasal septum (DNS) and their comparison with intraoperative findings.MethodsCross-sectional, observational study done in the department of ENT and HNS at a tertiary care center, over a period of 16 months. Patients presenting with nasal obstruction as the chief complaint and findings of deviated nasal septum on anterior rhinoscopy without clinical features of chronic rhinosinusitis (CRS) were included in the present study. All patients underwent CT scans of paranasal sinuses (PNS) as per the govt. scheme for approval of surgery. Surgery was planned as per the indication based on history, clinical examination, and non-contrast CT scan PNS findings. The average duration from CT scan to surgery was 4.5 weeks.ResultsAll 200 (100%) patients had DNS with inferior turbinate hypertrophy in 103 (52.5%), concha bullosa in 22 (11.0%), pneumatized superior turbinate in 6 (3.0%), and PMT (paradoxical middle turbinate) in 22 (11.0%). On comparing CT scan findings with intraoperative findings, it was found that maxillary sinus involvement had been seen in 28 (14.0%) patients on CT scan and only 8 (4.0%) patients intraoperatively. Similarly, CT scan involvement compared to and intraoperative involvement of anterior ethmoidal sinus was seen in 20 (10.0%) compared to 6 (3.0%) patients intraoperatively, posterior ethmoid in 12 (6.0%) compared to 3 (1.5%) frontal sinus in 4 (2.0%) compared to 1 (0.5%), sphenoid in 11 (5.5%) compared to 2 (1.0%), and osteomeatal complex (OMC) in 27 (13.5%) compared to 6 (3.0%) patients intraoperatively. Involvement of PMT, enlarged inferior, and concha bullosa was similar on CT scan and intraoperatively.ConclusionFrom this study, we concluded that a preoperative CT scan is a poor tool in predicting sinus disease in patients without clinical features of sinus disease and has a limited role in patients with symptomatic DNS. Insurance companies and government agencies should review their policies of ordering CT scans for approving septal surgeries.

Sinonasal Hamartoma and Chronic Laryngeal Edema Causing Severe Dyspnea.

Sinonasal hamartomas, according to the 5th edition of the World Health Organisation classification of head and neck tumours are divided into respiratory epithelial adenomatoid hamartoma (REAH), seromucinous hamartoma and chondromesenchymal hamartoma. Seromucinous hamartoma are benign proliferations of small eosinophilic glands surrounded by fibrous stroma and cuboidal cells. Hamartomas of the nasal cavity and paranasal sinuses are rare entities, clinically presenting as sinonasal polyposis. A 79- year-old female patient was referred to our emergency room due to severe dyspnea. Anterior rhinoscopy revealed unilateral greyish polypoid mass obstructing the middle, inferior and common nasal meatus. Systemic corticosteroids and oxygen therapy were administered under observation. Computerized tomographic imaging of the paranasal sinuses with contrast on all three planes showed an opacified polypoid mass in all meatus and the maxillary, anterior ethmoidal and sphenoidal sinus posteriorly extending to the choanae. On the coronal plane a widening of the olfactory clefts about 12mm was described. FESS visualized that the polypoid mass originated from the posterior septum and extended to all meatus anteriorly and to the choanae posteriorly. The polypoid lesion was endoscopically completely excised. Histopathological analysis revealed a seromucinous hamartoma. Seromucinous hamartoma are rare benign tumors of the sinonasal region with potential of malignant alteration. Unfortunately, they share symptoms and clinical appearance with other benign conditions of the sinonasal region. Therefore, it is even more important to consider them as a differential diagnose.

ASSESSMENT OF OUTCOME OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN PATIENTS WITH CHRONIC SINUSITIS WITH OR WITHOUT SINONASAL POLYPOSIS

Introduction:- Chronic rhinosinusitis is a multifactorial disease causing inammation of sino-nasal mucosa. Functional endoscopic sinus surgery (FESS) causes less morbidity, complication and less recurrence rates. This study aims to assess various presenting symptoms, nasal endoscopic and Computed tomography (CT) ndings, to compare relief of various symptoms &amp; to conrm the effectiveness of FESS as standard modality of treatment. Methodology:- In this study we include 100 cases of chronic sinusitis with or without sinonasal polyposis age between 15 to 65 years attending otorhinolaryngology outpatient department which full our inclusion criteria &amp; undergoing Functional endoscopic sinus surgery. All the patients were pre- &amp; post-operatively evaluated clinically using Rhinosinusitis symptom inventory score in to major &amp; minor criteria, radiologically and endoscopically. The overall result reveal male is to fe Results:- male ratio was 1:1.27. Preoperatively on CT scan and endoscopic examination most commonly involved sinus was max illary sinus 99% &amp; anterior ethmoid sinus (70%), most common anatomical variation was Deviated nasal septum/spur seen in (98%) &amp; Concha bullosa in (82%). Most common symptoms observed was Nasal obstruction (93%), headache (81%) &amp; Nasal discharge (72%). Post-operatively 91.66% of the patients were asymptomatic at the end of the 3 months with p value &lt;0.0001 (statistically signicant) and 8.33% of patients were still symptomatic at the end of 3 months. No major complication directly related to FESS occurred. Conclusion:- In conclusion FESS is minimally invasive, safe and effective procedure &amp; has better impact in relieving symptoms of chronic rhinosinusitis, as it clears only the involved sinus pathology, establishing normal mucociliary drainage of the paranasal sinuses

Assessment of factors influencing the olfactory bulb volume in patients with post-viral olfactory dysfunction.

To investigate the factors influencing the volume of the olfactory bulb (OB) in patients with post-viral olfactory dysfunction (PVOD). We collected 92 olfactory bulb volumes from patients with PVOD who underwent a sinus computed tomographic and magnetic resonance imaging (MRI) scan of the head and collected clinical information including gender, age, disease course, minimal cross-sectional area, nasal airway resistance, and olfactory function. OB volume was measured in MRI and the scans were evaluated according to the Lund-Mackay (LM) scoring system. Male patients with PVOD had a larger OB volume (β = 0.284, P < 0.05). OB volume was smaller in patients with a longer course of olfactory dysfunction (β = -0.254, P < 0.05). According to the LM scoring system, patients with a higher anterior ethmoidal sinus score had smaller OB volume (β = -0.476, P < 0.05). The study revealed that gender, disease course, and the score of anterior ethmoidal sinusitis can affect the OB volume in patients with PVOD.

Anatomical landmarks for localisation of the anterior ethmoidal artery: a combined radiological and cadaveric (endoscopic) study

PurposeThe anterior ethmoidal artery is a major surgical landmark that is susceptible to iatrogenic injury during surgery of the anterior ethmoidal sinus, frontal sinus, and skull base. The present study aimed to define the location of the anterior ethmoidal artery in relation to specific anatomical landmarks using radiological imaging and endoscopic dissection.MethodsEighty-six anterior ethmoidal arteries were assessed using computed tomography scans (bilateral analyses) and forty anterior ethmoidal arteries were assessed using cadaveric specimens (bilateral analyses). The skull base, anterior nasal spine, anterior axilla of the middle turbinate, and nasal axilla were morphometrically analysed to determine their reliability as anterior ethmoidal artery landmarks.ResultsDistances to the skull base, anterior nasal spine, and nasal axilla displayed statistically significant differences between sexes and sides (p < 0.05). All landmarks demonstrated excellent reliability as anatomical landmarks for the localisation of the anterior ethmoidal artery, radiologically and endoscopically (ICC values ranged from 0.94 to 0.99).ConclusionThe middle turbinate axilla was the most reliable landmark, due to the lack of statistically significant differences according to sex and laterality, and the high inter-rater agreement between measurements. Anatomical knowledge of variations and relationships observed in the present study can be applied to surgeries of the anterior ethmoidal sinus, frontal sinus, and skull base to improve localisation of the anterior ethmoidal artery, preoperatively and intraoperatively, and avoid iatrogenic injury of the vessel.

Hallazgos nasosinusales por tomografía computada en dacriocistitis crónica pediátrica.

To evaluate the preoperative tomographic characteristics of the nose and paranasal sinuses of children with chronic dacryocystitis. Prospective, observational, cross-sectional, and descriptive study. CT scans of the paranasal sinuses of patients candidates for endoscopic dacryocystorhinostomy were evaluated for two years. Demographic characteristics, radiological findings, inflammatory processes and anatomical variants were identified using the Lund-Mackay classification. Statistic analysis. Stata 10.0, descriptive analysis, Student's t: mean difference and χ2. Logistic studies to estimate the probability between variables. 27 men and 11 women (n = 38) were included. Of these, 22 had unilateral and 16 bilateral nasolacrimal duct involvement. Lund-Mackay score range: 2-20. Eleven patients had associated pathology. The most affected were anterior and maxillary ethmoidal sinus (69%), osteomeatal complex (68%), posterior ethmoidal (51%). Patients with severe rhinosinusitis are 12 times more likely to develop dacryocystitis than patients with < 12 points. Men presented greater severity, affectation, and clinical repercussion. There is radiological rhinosinusal involvement in dacryocystitis, which must be evaluated and treated preoperatively to avoid postoperative complications or reinfections.

Relationship of Lesion Location to Postoperative Steroid Use in Eosinophilic Chronic Rhinosinusitis.

Eosinophilic chronic rhinosinusitis (ECRS) is known to recur after surgery. The treatment choice for recurrent ECRS, such as oral steroids or biological agents, must be chosen carefully, and identifying the lesion location may be useful. This study aimed to evaluate the postoperative course of ECRS patients and assess the relationship between endoscopic lesion location and postoperative oral steroid use. Patients with chronic rhinosinusitis who underwent bilateral endoscopic sinus surgery from April 2018 to March 2020 were divided into two groups based on the presence or absence of oral steroid use after surgery. The primary endpoint was the lesion location on endoscopic findings during surgery: middle turbinate, middle meatus, superior turbinate, superior meatus, nasal septum, and sphenoethmoidal recess. Subjective symptoms, blood tests, and computerized tomography (CT) findings (Lund-Mackay score) were evaluated as secondary endpoints. Among 264 patients, 88 were diagnosed histologically with ECRS (mean 48.98 ± 1.40 years, 67 males/21 females). Twenty-three patients were steroid-using, 65 were steroid-free, and six stopped attending their appointments. Patients with sphenoethmoidal recess lesions were significantly more likely to require steroids (p=0.019). There was a significant association between steroid use and younger age (p=0.041), olfactory dysfunction (p=0.021), and all sinuses (Frontal sinus: p < 0.001, Anterior ethmoid sinus: p=0.002, Posterior ethmoid sinus: p=0.011, Maxillary sinus: p=0.018, Sphenoid sinus: p=0.034, Total score: p < 0.001). A sphenoethmoidal recess lesion was a risk factor for requiring postoperative steroids. Young age, olfactory dysfunction, and preoperative severe CT findings were also significant risk factors. 3 Laryngoscope, 133:2511-2516, 2023.

Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses.

To evaluate the outcome of endoscopic dacryocystorhinostomy (En-DCR) with mucosal anastomosis in chronic dacryocystitis patients, with various categories of ethmoid sinuses. Between July 2015 and September 2019, 1439 adult patients, representing 1623 affected eyes, presented with chronic dacryocystitis and were scheduled for En-DCR. The categories of ethmoid sinuses were preoperatively determined, using computed tomography-dacryocystography (CT-DCG), and were classified as category 1 (C1), category 2 (C2), and category 3 (C3). No sinuses anterior to the posterior lacrimal crest defined as C1. Sinuses found between the anterior edge of the lacrimal bone and the posterior lacrimal crest defined as C2. Sinuses found anterior to the lacrimal bone suture defined as C3. At the end of surgery, the dacryocyst and nasal mucosa were anastomosed in C1, and the dacryocyst mucosa and anterior ethmoid sinus were anastomosed in C2 and C3 ethmoid sinus patients. The surgical success rate and related complications, in patients with 3 categories of ethmoid cells, were monitored and documented. Postoperative data was obtained for 179 C1 affected eyes, 878 C2 affected eyes, and 432 C3 affected eyes. The overall success rate of En-DCR was 93.0% (1385/1489). Additionally, the success rates were comparable among the different ethmoid categories at 12mo post operation. We demonstrated that the major reason for surgical failure was intranasal ostial closure, due to granulation or scar tissue. En-DCR is a feasible and highly effective primary treatment for chronic dacryocystitis. To ensure surgical success, the surgery protocol must be designed in accordance with the category of ethmoid sinuses present in individual patient.

Papillary Thyroid Carcinoma Metastatic to the Frontal Sinus and Frontal Recess: Case Report.

We describe an extremely rare papillary thyroid carcinoma metastasic to the paranasal sinuses and our surgical management. A 39-year-old patient with a history of papillary thyroid carcinoma diagnosed five years earlier who presented with symptoms of chronic sinusitis. Medical imaging demonstrated opacification of the frontal sinuses and the anterior ethmoid sinus without signs of angiogenesis, bone destruction or calcification. Biopsy under general anesthesia revealed presence of papillary thyroid carcinoma cells. Treatment consisted in sinus endoscopic surgery with Draf III procedure followed by 131I therapy. To our best knowledge, this is the first described case of papillary thyroid carcinoma metastatic to the frontal sinus and frontal recess.

3D CT stereoscopic imaging: observations of the frontal and anterior ethmoid sinuses development from birth to early adulthood

Objective: Our objective is to provide observations demonstrated with 3Dimensional Computed x-ray Stereoscopic Imaging (3DCTSI) in the evaluation of the anterior ethmoid and frontal sinus development from birth to age 18. Methods: This is a retrospective evaluation of patient’s CT studies performed over a fifteen-year period, reported as normal studies, and included 53 patients (142 sides) from birth to age 18. Results: At birth, there are two spaces covered by folds, the uncinate and bulla lamellae. The spaces communicate with the Middle Meatus (MM) through the emerging ethmoid infundibulum (EI) and the retrobulbar recess space (RBRS). In the first month after birth, an expansile and breakdown developmental phase blend and continue throughout the growth into the teenage years. The 3D images reveal dark lamellar structures, on the surface of the medial lamina papyracea as well as bridging the broken spatial outlines. The dark lamellae represent the mucosal lamina propria, in unossified lamellae and are the origin of permanent spatial walls. From ages 4 to 18 years, initially, the frontal recess (FR) and later the MM penetrate into the cancellous frontal bone creating the frontal Sinus (FS), the frontal septum (FS), Inter-Frontal Sinus Septal Cell (IFSSC), as well as the Fronto-Ethmoidal and Frontal Bulla Spaces. Conclusion: 3DCTSI is the first intuitive imaging modality to reveal the microanatomical development of the anterior ethmoid and frontal sinus anatomy.

Anterior ethmoid and frontal sinus drainage pathways: five patterns formed and defined by their bony walls

PurposeTo perform endoscopic sinus surgery safely and effectively, surgeons need to visualize the complex anatomy of the anterior ethmoid and frontal sinus region. Because this anatomy is so variable and individualized, the foundation of understanding lies in identifying, following, and visualizing the drainage pathway patterns and anticipating possible variations.MethodsWe studied 100 sides (50 cases: 22 male, 28 female, aged 12–86, average age 46.5 years, ± 19.5) using computed tomography (CT) and multiplanar reconstruction (MPR) to identify and classify the drainage pathways leading to the frontal sinus and anterior ethmoidal cells.ResultsAnalysis revealed five patterns of drainage pathways defined by their bony walls: between the uncinate process and the lamina papyracea [UP–LP]; between the uncinate process and the middle turbinate [UP–MT]; between the uncinate process and the accessory uncinate process [UP–UPa]; between the uncinate process and the basal lamella of the ethmoidal bulla [UP–BLEB]; and between the basal lamella of the ethmoidal bulla and the basal lamella of the middle turbinate [BLEB–BLMT]. In most cases, BLEB formed the posterior wall of the drainage pathway of the frontal sinus, indicating BLEB could be one of the most important landmarks for approaching the frontal sinus.ConclusionsAs endoscopic sinus surgery depends on an understanding of this anatomy, this study may help surgeons to identify and follow the drainage pathways more accurately and safely through the anterior ethmoid to the frontal sinus.

Comparison of sinus distribution between nasal irrigation and nasal spray using fluorescein-labelled in patients with chronic rhinosinusitis: A randomised clinical trial.

This study aims to compare the potential sinus distribution between high-volume nasal irrigation and nasal spray in chronic rhinosinusitis (CRS) patients who have not undergone sinus surgery. A randomised clinical study was conducted at the Otolaryngology-Head & Neck Surgery Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. Forty patients undergoing endoscopic sinus surgery (ESS) for CRS. Thirty-eight patients met the inclusion criteria and were randomly assigned to receive nasal irrigation or nasal spray mixed with fluorescein sodium preoperatively. The primary outcome was the mean difference in the staining score of fluorescein in all sinuses between the two groups. The total fluorescein staining score for all sinuses in the nasal irrigation group was significantly higher than the score from the nasal spray group, with a mean difference score of 2.90, 95% confidence interval: 1.22-4.58, p=.001. The most significantly affected sinuses were the maxillary and the anterior ethmoid sinuses, while the frontal and sphenoid sinuses had only minimal staining from both techniques. Nasal irrigation is a potential route to deliver drugs into the sinus in unoperated CRS patients. However, it is not considered a superior method to nasal spray in the most challenging anatomical areas, that is, the frontal and sphenoid sinuses.

Immunoglobulin G4-related disease presenting with hypertrophy and sclerosis of the inferior turbinate.

Immunoglobulin G4-related disease (IgG4-RD) is a novel clinical disease entity characterized by elevated serum IgG4 concentration and tumefaction or tissue infiltration by IgG4+ plasma cells.1 We report the case of a 56-year-old man who presented with nasal obstruction for 5 years. Rhinoscopy revealed hypertrophy and sclerosis of the inferior turbinate, whereas computed tomography revealed inflammation of the anterior ethmoid sinus and frontal sinuses. An endoscopic inferior turbinectomy was performed, and IgG4-RD was definitively diagnosed based on the histopathological features of the turbinate tissue. Prednisolone was administered postoperatively. IgG4-RD presenting with hypertrophy and sclerosis of the inferior turbinate is rare. Awareness of IgG4-RD originating in the sinonasal cavity is essential to avoid delayed diagnosis.

Clinical and Laboratory Features of Various Criteria of Eosinophilic Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

ObjectivesThe aim of this study was to evaluate the differences in clinical and laboratory features between eosinophilic chronic rhinosinusitis (ECRS) and non-ECRS and to compare diagnostic criteria for ECRS.MethodsWe compared clinical features and/or laboratory findings classified as ECRS and non-ECRS according to various diagnostic criteria (histological and clinical). We also analyzed studies to compare endoscopic findings, symptom scores, laboratory findings, and computed tomography (CT) findings between ECRS and non-ECRS.ResultsOur search included 55 studies with 6,143 patients. A comparison of clinical features and/or laboratory criteria with histological criteria showed no significant differences in nasal symptom scores and CT scores according to criteria. Serum eosinophil levels showed differences across the criteria, with ECRS consistently characterized by higher serum eosinophil levels than non-ECRS. Among the four criteria, the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) criteria and tissue eosinophilia (≥70) were associated with decreased olfactory function. In laboratory findings, the eosinophil percentage (standardized mean difference [SMD], 1.561; 95% confidence interval [CI], 1.329–1.794; P<0.001) and eosinophil count (SMD, 1.493; 95% CI, 1.134–1.852; P<0.001) of eosinophils were higher in ECRS than non-ECRS. In clinical findings, nasal symptom scores (SMD, 0.382; 95% CI, 0.156–0.608; P<0.001), endoscopic nasal polyp scores (SMD, 0.581; 95% CI, 0.314–0.848; P<0.001), and olfactory dysfunction (SMD, 0.416; 95% CI, 0.037–0.794; P=0.031) were higher in ECRS than in non-ECRS. With regard to CT findings, the whole-sinus opacification score (SMD, 0.824; 95% CI, 0.588–1.059; P<0.001) was higher in ECRS than in non-ECRS. In particular, there were significant differences in anterior ethmoid sinus and sphenoid sinus opacification.ConclusionECRS and non-ECRS differ in their clinical and laboratory features. When histological confirmation is difficult on an outpatient basis, ECRS could be diagnosed using clinical features and/or laboratory findings.