Ethmoid Bulla Research Articles

Fabrication and validation of a low-cost, medium-fidelity silicone injection molded endoscopic sinus surgery simulation model

Develop a low-cost, medium-fidelity model for education in endoscopic sinus surgery techniques. Establish face and content validity of the model based on the feedback of otolaryngology faculty including fellowship-trained rhinologists. Survey. A novel silicone injection molded sinus model was constructed. Three fellowship-trained rhinologists and four general otolaryngologists were recruited to perform seven tasks and provide feedback of the model's performance via a 22-question Likert survey. Those surveyed strongly agreed the sinus model is useful for basic endoscopic skill acquisition such as camera skills (86%), hand-eye coordination (100%), nasal endoscopy skills (100%). Ratings of the model for training the specific tasks were consistently high. Neutral or lower were received for inferior turbinoplasty (14%), frontal balloon task (14%), understanding the ethmoid bulla (29%), and advanced sinus techniques (57%). All faculty strongly agreed they would be interested in using the model to train residents. Simulation models have proven efficacy in endoscopic skill and procedural training. The group developed a novel low-cost, medium-fidelity sinus training model utilizing three-dimensional modeling and printing. Testing of this model revealed high ratings for both face and construct validity for a range of endoscopic procedures. Strong interest in using this model for resident training was unanimous among all survey participants. NA Laryngoscope, 127:781-786, 2017.

Classification of suprabullar pneumatization according to the skull base attachment of the second lamella.

The skull base attachment of the second lamella and suprabullar pneumatization are likely to be consistent landmarks if they are systematically classified. This study aimed to classify the pneumatization pattern according to the second lamella skull base attachment. A total of 202 computed tomography sides of 101 patients who underwent endoscopic sinus surgery were studied. Suprabullar pneumatization was defined as air cells present above the ethmoid bulla between the second and third lamellae. Its pattern was classified according to the air cell number and location as in the frontal cell classification. Type 0 suprabullar pneumatization was defined as no air cells between the ethmoid bulla and skull base; type 1, as a single suprabullar cell; and type 2, as multiple suprabullar cells above the ethmoid bulla. In type 3 pneumatization, the second lamella extended into the frontal sinus forming a frontal bullar cell. Type 2 was the most prevalent (40.1%), followed by types 1, 3, and 0 (24.3, 23.3, and 12.4%, respectively). The distance between the second lamella and anterior ethmoid artery was 8.93, 8.30, 8.50, and 11.25mm in types 0, 1, 2, and 3 pneumatization, respectively. No patients had intraoperative injuries in the anterior ethmoid artery or lateral lamella. The second lamella skull base attachment and suprabullar pneumatization pattern could be systematically classified and be a consistent landmark to identify the frontal sinus opening.

Prevalence of pneumatized uncinate process and accompanying neighboring variations.

This study aims to investigate the prevalence of uncinate process (UP) pneumatization and also to investigate the association of UP pneumatization with concurrent morphological variations in neighboring structures and the presence of maxillary sinusitis. This was a retrospective study where coronal computed tomography scans of 1,500 UPs in 750 patients (483 males, 267 females; mean age 36.3±14.7 years; range 7 to 84 years) were examined to determine the prevalence of UP pneumatization and to assess any concurrent neighboring anatomical structures and the presence of maxillary sinusitis between January 2013 and June 2013. Uncinate process pneumatization was identified in a total of 6.26% of our patients with 1.60% being bilateral, 2.53% on the right only, and 2.13% on the left side only. Other than concurrent occurrences of right maxillary sinus septa (p=0.046), growth of the right ethmoidal bulla (p=0.044) and presence of maxillary sinusitis (right side: p=0.046, left side: p=0.035) were seen. We detected a 6.2% prevalence of UP pneumatization in our study group. An abnormally sized and over-pneumatized UP can cause narrowing of the infundibulum and impaired sinus drainage. Such functional blockage can lead to recurrent maxillary sinusitis, stuffiness, and decreased olfaction.

Usefulness of three-dimensional computed tomographic anatomy in endoscopic frontal recess surgery.

The endoscopic bidimensional vision offered by the endoscope during endoscopic sinus surgery involves difficulty in visualizing surgical field depth which makes it difficult to learn this surgical technique and makes it necessary for the endoscopic surgeon to mentally create a three-dimensional (3D) picture of the paranasal sinuses anatomy. In particular, frontal recess surgery requires good knowledge of its anatomic position, also since it is necessary to use angled endoscopes, which distort the view, and angular instruments which are difficult to use. Purpose of this project is to offer to the endoscopic surgeon a detailed 3D model of the nose and paranasal sinuses with particular attention to the frontal recess. A 3D reconstruction of the frontal recess and its related structures, starting from computer tomography scans of the human skull, was realized using a professional 3D graphics software. A detailed reconstruction of the main structures which contribute to form the frontal recess was obtained. Particular attention was paid when reproducing the agger nasi cells, uncinate process, ethmoidal bulla, anterior ethmoidal cells, frontoethmoidal cells and their anatomic variants. This is the first experience reported in literature regarding this new technique of iconographic didactics applied to endoscopic sinus surgery. It represents a new frontier, which surpasses and integrates the previous didactic techniques to help the surgeon to mentally create a 3D image of the paranasal sinuses.

Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery

ABSTRACT Aims To study the anatomical variations of osteomeatal complex and the importance of preoperative computed tomography (CT) in patients with chronic sinusitis undergoing functional endoscopic sinus surgery. We studied the different variations and their frequency of occurrence. Materials and methods A total of 100 patients undergoing endoscopic sinus surgery were studied by nasal endoscopy, CT scanning, and at the time of definitive surgery, variations were recorded. Results The frequency of occurrence of sinonasal anatomical variations was septal deviation in 76%, agger nasi cells in 71%, concha bullosa in 61%, medialized uncinate process in 48%, prominent bulla ethmoidalis in 41%, paradoxical middle turbinate in 33%, accessory maxillary ostium in 28%, frontal cell in 22%, intumescentia septi nasi anterior in 21%, lateralized uncinate in 15%, pneumatized uncinate process in 4%, Haller cells in 12%, and Onodi cells in 8%. Conclusion The high incidence of variations emphasizes the need for proper preoperative assessment for safe and effective endoscopic sinus surgery. How to cite this article Narendrakumar V, Subramanian V. Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery. Clin Rhinol An Int J 2016;9(1):28-32.

How I do it: direct transnasal endoscopic posterior ethmoidectomy with the intact bulla technique

In lesions affecting both anterior and posterior ethmoids where surgery is indicated, total ethmoidectomy as part of functional endoscopic sinus surgery is the state of the art. In solo posterior ethmoid lesions, there is still controversy in terms of the most direct and least destructive approach. In these cases, it is not justified to disturb the integrity of the bulla ethmoidalis and/or the middle turbinate. In this article, a novel approach to the posterior ethmoid is presented that does not disrupt the integrity of the ostiomeatal complex.

Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center.

Aim:The study aims to report a single trainee's experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En-DCR).Settings and Design:This study was a retrospective, interventional case series.Subjects and Methods:Fifty-four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin-C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora.Results:Fifty-four eyes of fifty patients were operated, and three cases were lost to follow-up after surgery. The mean age at presentation was 34 (4–75) years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD) obstruction in 72% (39/54), acute dacryocystitis in 15% (8/54), failed DCR in 7% (4/54), and persistent congenital NLD obstruction in 5% (3/54). The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05). Anatomical and functional success rate was 94% (48/51) at 6 months follow-up period.Conclusions:Endoscopic En-DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn and perform En-DCR with acceptable success rates.

Evaluation of variations in sinonasal region with computed tomography.

To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases. The study included 400 cases (191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography (CT) examination in axial plane. Reformatted CT images were studied in all planes. Age range of the patients was 20-83 (mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell (74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus (P < 0.001). Besides, the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus, and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant (P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases (P = 0.004 and P = 0.002, respectively). Sinonasal region has a great number of variations, and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations.

Bacterial biofilms in chronic rhinosinusitis; distribution and prevalence

Conclusion: Biofilms were more prevalent in patients with CRSwNP compared to both CRSsNP and controls, and also on the ethmoid bulla compared to the middle turbinate, supporting a biofilm-related pathogenesis of CRSwNP.Objective: To investigate the prevalence of biofilms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) compared to patients with chronic rhinosinusitis without nasal polyps (CRSsNP) and controls. To examine the prevalence of biofilms in different anatomical localizations.Study design: Cross-sectional.Methods: This study comprised 27 patients with CRSsNP, 34 patients with CRSwNP, and 25 controls. Biopsies from the middle turbinate, the uncinate process, and the ethmoid bulla were harvested pre-operatively, snap frozen in isopentane, cooled, and stored at −80°C. Prepared with Invitrogens’ Baclight LiveDead kit and investigated with confocal scanning laser microscopy.Results: Biofilms were studied in 33/34 (97%) CRSwNP, 22/27 (82%) CRSsNP, and 14/25 (56%) controls. The difference in point prevalence between patients with CRSwNP vs CRSsNP (p = 0.042, χ2 = 4.12), CRSwNP vs Controls (p < 0.001, χ2 = 15.0), and CRSsNP vs controls (p = 0.047, χ2 = 3.96) were all significant. Biofilms were found in 43/54 (80%) ethmoid bulla, 39/55 (71%) uncinate process, and 31/50 (62%) middle turbinate. The difference between the ethmoid bulla and the middle turbinate locations (p = 0.047, χ2 = 3.93) was significant.

Osteomeatal Complex: A Study of Its Anatomical Variation Among Patients Attending North Bengal Medical College and Hospital.

Lateral nasal wall of each nasal cavity provides the final common pathway of drainage of the mucociliary clearance of frontal, maxillary and anterior ethmoidal air cells. Anatomical variants like concha bullosa, Haller cells, agger nasi cells, enlarged bulla ethmoidalis may obstruct the mucociliary clearance through osteomeatal complex and cause rhino sinusitis. The objectives were to find out the anatomical variation of osteomeatal complex and its dimensions when present. The present study was a descriptive, hospital based cross sectional study carried out in the outpatient departments of North Bengal Medical College and Hospital, West Bengal, India, among patients aged 15years and above. Coronal CT scan of paranasal sinus and orbit region was done. Data was collected with the help of semi structured predesigned and pretested questionnaire. Of the 44 study patients, 15.9% had concha bullosa, 11.36% had paradoxical middle concha, 27.3% had Haller cell, 18.2% had agger nasi cell. Lateral attachment and medial free margin of uncinate process were also measured in respect to medial body line. 77.3, 59.1 and 47.7% had sneezing, rhinorrhoea and headache respectively. The harmony of mucociliary clearance and obstruction free osteomeatal complex is the key factor for ventilation and drainage of maxillary, frontal and anterior ethmoidal air cells.

Evaluation of ostiomeatal complex pathology related to endoscopic sinus surgery – a retrospective analysis

Abstract BACKGROUND. The ostiomeatal complex (OMC) is the anatomical region situated between the middle turbinate and the lateral nasal wall, at the level of the middle meatus. Common anatomical variations of OMC are concha bullosa, hypertrophy of the uncinate process and of the bulla ethmoidalis and Haller’s cell. Our study was aimed to investigate the prevalence of these conditions and their relations to different symptoms. MATERIAL AND METHODS. The study is a retrospective descriptive study based on 256 files of patients who were hospitalized and treated for OMC pathology in our clinic between January 2009 and January 2014. The data acquired were included into Excel Worksheets and statistically analyzed using GraphPad Software. RESULTS. The most common finding was concha bullosa (63.67%), followed by hypertrophy of the bulla ethmoidalis (10.93%) and of the uncinate process (10.15%). Haller’s cell was found in only 3% of cases. The most common symptom for all patients was nasal obstruction, followed by nasal discharge. The majority of symptoms improved after functional endoscopic sinus surgery for OMC drainage. CONCLUSION. OMC pathology is a frequent indication for functional endoscopic sinus surgery. The most common condition that determines blockage of OMC and need for surgical treatment is concha bullosa. The most common complaint of patients with OMC pathology is nasal obstruction.

Haller' s Cells - a brief review

Haller’s cells are air cells located below the ethmoid bulla along the roof of the maxillary sinus. They have been often implicated in several sinonasal diseases. We have also discussed about the studies evaluating the prevalence of Haller’s cells using different imaging modalities and the differences of prevalence in different population based studies. In this paper we have discussed in brief the association of sinonasal pathologies with Haller’s cells

Effect of distribution of nasal polyps in ostiomeatal complex on long-term outcomes after endoscopic surgery.

The objective of the study was to elucidate the characteristics of spatial distribution of nasal polyps in the ostiomeatal complex (OMC) and the corresponding correlation with long-term quality of life in patients who underwent endoscopic sinus surgery. 107 patients with unilateral or bilateral nasal polyps who had undergone functional endoscopic sinus surgery from September 2009 to June 2010 were enrolled in this study. Distribution of nasal polyps in the study subjects was documented. Long-term quality of life assessment was carried out at 1-year after surgery by SNOT-20 analysis. Observation of a total of 214 sides of rhinal cavities revealed that nasal polyps were distributed inside the OMC at 573 sites out of the total 635 sites (90.2 %), and predominantly distributed at the middle turbinate, the ethmoid sinus, the middle meatus, the uncinate process, the maxillary sinus, and the ethmoid bulla and significantly differed from the nasal polyps which were found outside the OMC (P < 0.01). Statistical analysis indicated that pre-operative Sinonasal Outcome Test 20 (SNOT-20) scores and 1-year post-operative scores were statistically significant (P < 0.05). The score changes of the left maxillary sinus, both sides ethmoid bulla were significant, respectively (P < 0.05). Nasal polyps predominantly distribute in the OMC. The differences among the sites of nasal polyps do not significantly impact the long-term score for quality of life except for the maxillary sinus and ethmoid bulla.

Efficacy of three-dimensional endoscopy in endonasal surgery.

To examine the efficacy of a three-dimensional (3D) endoscope for endoscopic sinus and skull base surgery. The study design was a retrospective case series and qualitative research. The clinical efficacy of 3D endoscopes was examined on five cadavers. We performed conventional endoscopic sinus surgery (ESS) in five cases and hypophysectomy in two cases using a 3D endoscope. The educational advantages of the 3D endoscope were assessed using questionnaires given to the participants of cadaver dissection courses. In the posterior portion of the nasal cavity, images captured via 3D endoscopy provided a superior perception of depth of information than those via two-dimensional (2D) endoscopy. All endonasal surgeries were completed in clinical settings using a 3D endoscope without perioperative complications. In terms of the operative time and amount of bleeding, the results of 3D endoscopic surgeries were not inferior to those of 2D endoscopic surgeries. Fatigue from 3D viewing through polarized glasses did not adversely affect performance of the surgery. Moreover, questionnaires for the evaluation of educational efficacy were completed by 73 surgeons. Of the respondents, 89% agreed that 3D endoscopy provided a better understanding of the surgical anatomy than did 2D endoscopy. As for the site where 3D endoscopy would be the most useful for understanding surgical anatomy, 40% of the respondents named the skull base; 29%, the posterior ethmoid sinuses; and 26%, the sphenoid sinus; and 9%, the ethmoid bulla and middle turbinate. The 3D endoscope contributes to a more precise anatomical understanding of the posterior structures of the sinuses and skull base and ensures a more precise operation of the instruments. Thus, 3D endoscopes will likely become a standard device for endonasal surgery in the near future.

Ethmoid Drug‐Eluting Catheter for Nasosinusal Polyposis: Results after a Randomized Controlled Trial

Objectives: Assess the safety and efficacy of a drug-eluting catheter to be inserted into the ethmoid sinuses during endoscopic sinus surgery to elute triamcinolone in patients with CRSwP (nasosinusal polyposis). Methods: Prospective, randomized, controlled, double-blind, clinical trial using intrapatient control design. The study enrolled 40 patients with CRSwP undergoing endoscopic sinus surgery. In every case, after polypectomy was done to expose the ethmoid bulla, a drug-eluting catheter to elute triamcinolone (0.3 mL) was randomly applied to one nasal fossa, whereas the other was treated by conventional total ethmoidectomy. Outcome measures were visual analogue scales, Rhinosinusitis Disability Index, endoscopy, and olfactometry assessment at baseline, 3, 6, and 12 months. Safety assessments included ocular examinations at baseline and 30 days. All CT imaging was done after more than 12 months of follow-up. Results: After randomization was performed, unilateral devices were successfully placed in all patients and easily removed after 4 weeks. When comparing both nasal fossae in postoperative endoscopies at 6 and 12 months, the prevalence of edema, adhesions, and recurrent polyposis were statistically similar. Changes from baseline in patient-reported outcomes were statistically relevant in both sides. No clinically important changes in intraocular pressure occurred. CT resolution of pathology was achieved in both sides, improving Lund-Mackay scale, without significant differences. Conclusions: This trial provides clinical evidence on the safety and efficacy of a drug-eluting catheter for use in patients with CRSwP. It achieves similar results compared to complete ethmoidectomy, without any major complications.

English

In this study, we investigated the different anatomical variations and clinical modes of presentation of chronic rhinosinusitis and their association with final histopathological diagnosis. This prospective randomization research was conducted on a total of 284 patients with chronic rhinosinusitis who underwent functional endoscopic sinus surgery from March, 2009 to September, 2012. The study population (284 patients) included 170 males (59.8%) and 114 females (40.1%), with a mean age of 29 years. The most frequent symptoms were nasal obstruction (24.3%); headache (21.9%), nasal congestion (18.5%) and post nasal discharge (16.6%). The nasal septums were significantly deviated in 207 (79.2%) subjects. Inferior turbinate hypertrophy was observed in 102 (35.9%) patients. Bulla ethmoidalis was reported in 32 (11.3%) participants. Uncinate bulla and concha bullosa were identified in 12 (4.2%), 12 (4.2%) patients, respectively. According to pathological report, majority of the patients (184 patients, 64.7%) had chronic inflammation in sinuses went after polyp in 46 patients (16.9%). Our study revealed anatomical variations were common in patients with chronic rhinosinusitis. Identification of different variations will guide the surgeons during functional endoscopic sinus surgery. &nbsp; Key words: Chronic rhinosinusitis, functional endoscopic sinus surgery, anatomical variations.

Anatomic relationship of nasolacrimal duct and major lateral wall landmarks: cadaveric study with surgical implications.

Detailed knowledge of the surgical anatomic landmarks of the lateral nasal wall is important for safe and successful endoscopic sinonasal surgery. We sought to determine the relationship of major landmarks to the nasolacrimal duct (NLD). Twenty mid-sagittal head sections of 10 fresh frozen cadavers were studied after removal of the nasal septum. The insertion of the alar cartilage into the maxilla was taken as a fixed point and all measurements were performed in a defined axial plane at the level of the maxillary sinus natural ostium. Two surgeons independently recorded each measurement 3 times with an average of the readings used for statistical analysis. The overall agreement index was excellent (r = 0.84) between the observers. At the level of maxillary ostium, the mean distance from the alar rim to the NLD was 43.05 ± 4.76 mm on the right and 41.25 ± 4.56 mm on the left. The most anterior projection of the middle turbinate head was noted to be anterior to the NLD in 70% of specimens. In positional relationship, the maxillary line was posterior to the NLD in 55%, whereas the bulla ethmoidalis and the free edge of uncinate process were uniformly posterior to the NLD in all the specimens. This study provides useful anatomic and positional relationships between the NLD and major lateral wall landmarks. Although the maxillary line and the head of the middle turbinate are often considered useful guides to the position of the ipsilateral NLD, their spatial relationship to the NLD is not consistent. These landmarks, therefore, cannot be solely relied upon during surgery to avoid injury to the NLD.

Endoscopic and computed tomographic evaluation of influence of nasal septal deviation on lateral wall of nose and its relation to sinus diseases.

To correlate symptoms of deviated nasal septum (DNS) and chronic rhinosinusitis with the findings of nasal endoscopy and computed tomographic (CT) imaging. To evaluate the influence of degree of septal angle deviation on the severity of lateral nasal wall abnormalities. A prospective study was conducted on 67 patients with clinical evidence of DNS and chronic sinusitis attending ENT OPD between January 2012 and September 2013. All these patients underwent nasal endoscopy and CT scan PNS coronal sections. Direction and degree of DNS was recorded. Range of sinus mucosal thickening on CT scan films was also recorded. Chronic sinusitis is common in the age group between 21 and 40years (50.74%) with male preponderance (55.22%), chief symptoms being nasal obstruction (86.56%), headache (73.13%) and nasal discharge (52.23%). Left sided DNS is more common (64.17%). Most of the patients have moderate DNS, i.e. 6°-10° (56.7%), followed by severe (22.4%) and then mild (20.9%). DNS results in compensatory structural changes in the turbinates and/or lateral nasal wall which causes ostiomeatal complex (OMC) obstruction resulting in sinusitis. Contralateral concha bullosa and ethmoid bulla prominence was noted. Maxillary sinus is most commonly affected sinus (73.13%). Patients with increasing septal angles were associated with a higher incidence of maxillary sinus mucosal changes (p<0.05). Present study reemphasized the concept that septal deviation causes obstruction at OMC which results in an increased incidence and severity of bilateral chronic sinus disease.

Analysis of Choanal Polyps

Choanal polyps (CPs) are unilateral benign masses usually originating from paranasal sinuses. Maxillary, ethmoid, and sphenoid sinuses are involved in order of decreasing frequency. In this study, the medical records of patients operated on with a clinical diagnosis of CP between 1998 and 2011 were reviewed. A total of 98 patients with a mean age 24.3 years were analyzed. Histopathologic diagnoses were CP in 94 patients and inverted papilloma in 4 patients. The sites of origin were maxillary sinus in 89 patients (90.8%), sphenoid sinus in 6 patients (6.1%), bulla ethmoidalis, inferior concha, and uncinate process in 1 patient each (1.0%). The most common symptoms were nasal obstruction (98.0%) and postnasal drip (30.6%). The surgical approaches were endoscopic sinus surgery in 63 patients (62.4%) unilaterally and in 12 patients (11.9%) bilaterally and unilateral endoscopic sinus surgery with mini Caldwell in 26 patients (25.7%). All 3 recurrences were in pediatric patients, and the recurrence rates among pediatric patients and overall were 7.7% and 3.1%, respectively. Endoscopic sinus surgery is an effective surgical procedure for treatment of CP; however, addition of a mini-Caldwell approach is safe for antrochoanal polyp resection if the endonasal technique fails. Histopathologic examination is mandatory because inverted papillomas may present as CPs.

CT Scan Study of Influence of Septal Angle Deviation on Lateral Nasal Wall in Patients of Chronic Rhinosinusitis.

The nasal septum is an important physiological and support structure of the nose. The nasal septal deviation causes alteration in air flow, mucociliary clearance and effects structures of the lateral nasal wall causing various nasal symptoms and other sinonasal disease. A systematic analysis was performed to measure the angle of septal deviation on CT scan PNS coronal section and to evaluate the influence of increasing septal angle deviation on the severity of lateral nasal wall abnormalities. A total of 61 patients with clinical evidence of chronic rhinosinusitis refractory to medical therapy for minimum three months were included in this study. After preliminary anterior & posterior rhinoscopic examination, all patients were evaluated with nasal endoscopy & CT scan PNS coronal view. There was statistically significant increase in hypertrophy of the middle turbinates and prominence of bulla ethmoidalis with OMC impingement on the side opposite to the direction of septal deviation. No apparent statistically significant difference between ipsilateral and contra lateral side OMC disease and anterior sinus mucosal disease in relation to direction of septal deviation in various groups was seen. We concluded that there is a strong association of increasing angles of septal deviation with corresponding patterns of disease in ostiomeatal complex. The result of the present study reemphasized the fact that, obstruction at ostiomeatal complex and anterior ethmoids secondary to septal deviation is the key factor for causation of chronic sinusitis.