Ethmoid Research Articles

Side- and Sinus-Specific Relationships between Chronic Rhinosinusitis and Ischemic Stroke Using Imaging Analyses.

Recent studies have reported chronic rhinosinusitis (CRS) as an independent risk factor for stroke. However, the association with stroke depending on the affected sinuses has not been explored. This study aimed to elucidate the side- and sinus-specific relationship between CRS and ischemic stroke through imaging analyses. We retrospectively reviewed the medical records of patients who were diagnosed with ischemic stroke at a tertiary center. CRS was defined as having a total score of greater than or equal to 4, according to the Lund-Mackay scoring system, through brain magnetic resonance imaging or computed tomography. We investigated the side- and sinus-specific correlation between CRS and ischemic stroke. Subgroup analyses were performed for different age groups. CRS prevalence in patients with ischemic stroke was 18.4%, which was higher than the previously reported prevalence in the general population. Overall, there was no correlation between the directions of the CRS and ischemic stroke (p > 0.05). When each sinus was analyzed, the frontal (Cramer's V = 0.479, p < 0.001), anterior (Cramer's V = 0.396, p < 0.001)/posterior (Cramer's V = 0.300, p = 0.008) ethmoid, and sphenoid (Cramer's V = 0.383, p = 0.005) sinuses showed a statistically significant correlation with the side of stroke, but the maxillary sinus (Cramer's V = 0.138, p = 0.208) did not. In subgroup analyses, a significant right-side correlation between the two diseases was observed in the older-age subgroup (≥65 years old, Cramer's V = 0.142, p = 0.040). Diabetes mellitus (odds ratio = 1.596, 95% confidence interval = 1.204-2.116) was identified as an independent risk factor for having CRS in patients with ischemic stroke. CRS of the frontal, anterior/posterior ethmoid, and sphenoid sinuses has a directional relationship with ischemic stroke. Our results on which sinuses correlate with stroke advocate for the active surveillance of CRS in patients at high risk of ischemic stroke.

OSteosarcoma of Ethmoid Sinus-A Rare Entity.

Osteogenic sarcoma of the Craniofacial region are uncommon.They have been mainly reported in the mandible and the maxilla, Primary osteosarcoma arising from ethmoid sinus is an extremely rare condition. We report a case of 34 year old male, presented with gradually increasing swelling over the right medial canthus with history of double vision for one year. Clinically we thought it was a mucous retention cyst in the ethmoid area. After doing Contrast enhanced CT, we proceeded with transnasal endoscopic removal of the cyst. Histopathological examination of the specimen surprisingly turned out to be a low grade Osteogenic sarcoma. Patient was treated with adjuvant chemotherapy.

Unsupervised clustering analysis based on multidimensional features reveals distinct clinical characteristics and associated factors of different phenotypes in patients with chronic rhinosinusitis with nasal polyp

Objective: To utilize routinely available clinical parameters to uncover the clinical features of different clusters in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) through unsupervised clustering analysis. Methods: The clinical data from 155 CRSwNP patients undergoing nasal endoscopic surgery at Renmin Hospital of Wuhan University from 2021 to 2023 were prospectively collected, including 112 males and 43 females, aged from 7 to 87 years. Unsupervised clustering analysis was conducted using various clinical parameters, including age, gender, smoking and drinking history, local eosinophil (EOS) and neutrophil (NEU) counts, comorbid allergic rhinitis (AR), comorbid asthma, recurrence status, serum-specific IgE, total IgE, cytokine levels, peripheral blood EOS count and percentage, Lund-Mackay CT score, the ratio of CT scores for the maxillary sinus and ethmoid sinus (E/M ratio), visual analogue scale (VAS) score, Lund-Kennedy endoscopic score, and other common clinical indicators to elucidate the clinical characteristics of each cluster. Statistical analysis was conducted using GraphPad Prism 9.5 software. Results: Hierarchical clustering analysis identified four main clusters (Cluster A1-A4), showcasing distinct characteristics such as mild nasal polyps with higher peripheral blood cytokines levels, nasal polyps accompanied by allergies and asthma, a subtype of nasal polyps with high recurrence rates dominated by neutrophils, and nasal polyps with high eosinophil levels. Further subset clustering revealed two clusters of mild polyps (Cluster B1-B2) featuring high cytokine expression and comorbid AR; and two clusters of severe polyps (Cluster B3-B4) presented with severe symptoms, high Lund-Mackay CT score, and high Lund-Kennedy endoscopic score. Variations between Cluster B3 and B4 included symptom complexity, the degree of eosinophil infiltration, and the probability of comorbid asthma. Further clustering analysis for eosinophilic nasal polyps revealed a cluster characterized by highly neutrophilic infiltration and recurrent nasal polyps. The comprehensive analysis of multi-index correlations demonstrated valuable insights into the relationships between common clinical parameters of nasal polyps, providing valuable information for a deeper understanding of the pathogenesis of CRSwNP. Conclusion: The clustering analysis in this study categorizes CRSwNP patients into different clusters based on clinical features and disease outcomes, providing a new perspective for more precise clinical treatment strategies.

Characterizing immune microenvironment cell composition of chronic rhinosinusitis with nasal polyps based on mass cytometry technology

Objective: To analyze the cellular composition characteristics of the nasal tissue immune microenvironment in patients with control, chronic rhinosinusitis without nasal polyps (CRSsNP), non-eosinophilic chronic rhinosinusitis with nasal polyps (neCRSwNP), and eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) using mass cytometry flow technology. Methods: Thirteen CRS patients who underwent endoscopic nasal surgery at the Department of Otorhinolaryngology Head and Neck Surgery of Peking Union Medical College Hospital from March to December 2022 were recruited, including 8 males and 5 females, aged 22.3 to 58.3 years. Three control mucosae were obtained from normal ethmoid or sphenoid sinuses of patients with benign tumors of the temporal fossa or non-functional pituitary adenomas who underwent endoscopic surgery, excluding allergic rhinitis and sinusitis. Sixteen clinical tissue samples (3 of control, 3 of CRSsNP, 4 of neCRSwNP, and 6 of eCRSwNP) were prepared into single-cell suspensions. Mass cytometry flow detection was performed using a combination of 42 molecular markers to analyze the differences in cell subpopulations among the groups. Data were analyzed using GraphPad Prism 9. Results: Based on the mass cytometry flow results, cells from control, CRSsNP, neCRSwNP, and eCRSwNP were divided into seven main cell subgroups, with detailed subgrouping of T/NK cells and myeloid cells. In T/NK cells, compared with the control group, the number of NK CD56bright cells increased in the CRSsNP group, while NK CD56dim cells decreased; compared with the CRSsNP group, the eCRSwNP group showed a decrease in NKT cells and CD4+Tem cells; compared with the CRSsNP group, the eCRSwNP group showed a significant increase in CD25 expression within Treg cells; compared with the CRSsNP group, the eCRSwNP group showed a significant decrease in Tbet expression in CD8+Teff cells and CD8+TRM cells; in eCRSwNP, the expression of CD103 in CD8+TRM cells was significantly lower than in CRSsNP. In myeloid cells, compared with the other three groups, the eCRSwNP group showed a significant increase in macrophages and a significant decrease in cDC1 and monocytes; compared with the control group and CRSsNP, the eCRSwNP group also showed a significant decrease in resting state macrophages; compared with the CRSsNP group, the eCRSwNP group showed a significant decrease in the level of CX3CR1 within cDC2 and monocytes; the expression levels of NLRP3 in cDC2 and macrophages in the eCRSwNP group were significantly higher than in the other three groups; compared with the control group, the expression levels of Gata3 in cDC2 and macrophages in the eCRSwNP group were also significantly increased; additionally, the expression of CCR2 within monocytes in the eCRSwNP group was lower than in the CRSsNP group. In ILC, compared with the control group, the expression of CCR6 decreased in the eCRSwNP group. Conclusions: Compared with the control group, CRSsNP, and neCRSwNP, eCRSwNP shows an increase in macrophage number, a decrease in cDC1 and resting state macrophages, and depletion of protective cells CD103+CD8+TRM. Additionally, the expression levels of CCR2 and CX3CR1 in monocytes of eCRSwNP are decreased.

Topical Application of 5-Fluorouracil for the Treatment of Sinonasal Adenocarcinoma and Inverted Papilloma.

Sinonasal tumors represent a rare and heterogeneous group of rhinologic neoplasms. Even with advancements in surgical approaches, mortality rates of patients with sinonasal adenocarcinoma (SNAC) have not significantly improved and persistently high rates of recurrence in certain patients with inverted papilloma (IP) are seen. The use of 5-fluorouracil (5-FU) has been successfully described as an adjuvant treatment of SNAC and in the prevention of IP recurrence. This review aims to present the current evidence on the management of SNAC and IP with topical 5-FU. A three-author independent literature review was conducted to identify research involving the use of topical 5-FU for the treatment of SNAC and IP. A total of nine papers on the treatment of SNAC and IP were collected. The earliest study looking at the combination of adjuvant low-dose radiation and topical 5-FU for adenocarcinoma of the ethmoid sinus showed a 5-year survival rate of 100%. A follow-up study evaluating a similar protocol reported adjusted disease-free survival at 2, 5, and 10 years of 96%, 87%, and 74%, respectively. Similar results have been demonstrated for adjuvant 5-FU use following endoscopic resection and have even been described in the novel setting of transcutaneous 5-FU delivery following frontal trephination. Topical 5-FU has also been described in the treatment of aggressive IP. The largest case series described the use of 5-FU for eighteen cases and demonstrated only a single recurrence. The use of topical 5-FU currently represents an underutilized therapeutic modality within the treatment of rhinologic neoplasms. Available literature suggests that neoadjuvant use of topical 5-FU can improve survival and decrease recurrence for SNAC and IP. However, the small sample sizes prevent advocation for routine use in the general population and further research on 5-FU is necessary.

Epidemiologic Trends in Human Papillomavirus–Associated Sinonasal Squamous Cell Carcinoma

Sinonasal squamous cell carcinoma (SNSCC) is the most commonly encountered cancer within the sinonasal cavity. Ongoing research has sought to ascertain the potential role of human papillomavirus (HPV) in the pathogenesis of SNSCC. To assess trends in HPV-associated and HPV-independent SNSCC over time, including assessment of clinical demographics, treatment patterns, and survival. This cohort study used patient data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program database between 1975 and 2018. Anatomic sites with a greater predilection for HPV positivity (ie, nasal cavity, ethmoid sinus) were used as a surrogate for HPV-associated SNSCC; meanwhile, patients with SNSCC in the other subsites were classified into the HPV-independent group. Data were analyzed from August 2022 to May 2023. Clinical demographics and mortality trends over time were described for the HPV-associated and HPV-independent groups and further stratified according to stage on presentation. The study population consisted of 3752 patients with SNSCC (mean [SD] age at diagnosis, 65.7 [13.3] years; 2417 [64.4%] male), with 1983 (52.9%) having HPV-associated SNSCC and 1769 (47.1%) with HPV-independent SNSCC. Patients with HPV-associated subsites compared with patients with HPV-independent SNSCC were more likely to present with localized disease (838 [42.3%] vs 162 [9.2%]), whereas more patients in the HPV-independent group than HPV-associated group presented with regional disease (1018 [57.5%] vs 480 [24.2%]). Incidence-based mortality was stable over time within the HPV-associated group (0.32%) and, conversely, showed a significant decrease within the HPV-independent group (-2.29%). Patients with HPV-associated SNSCC had a higher 5-year overall survival when compared with the HPV-independent group (62% vs 35% [difference, 27 percentage points; 95% CI, 23-31 percentage points]). The better 5-year overall survival in the HPV-associated group vs HPV-independent group was present across all disease stages (localized: hazard ratio [HR], 2.67; 95% CI, 1.96-3.65; regional: HR, 1.53; 95% CI, 1.29-1.82; and distant: HR, 1.97; 95% CI, 1.52-2.55). This cohort study showed that the proportion of HPV-associated SNSCC rose over time associated with both a rise in the proportion of nasal cavity SNSCC and a decrease in HPV-independent maxillary sinus SNSCC. These data suggest that HPV-associated SNSCC has a distinct demographic and prognostic profile, given the improved survival seen in patients with HPV-associated SNSCC.

Double Reinforcing Strategy with Perpendicular Plate of Ethmoid in Asian Secondary Unilateral Cleft Rhinoplasty: A Finite Element Analysis.

Deviation and asymmetry relapse after secondary unilateral cleft rhinoplasty with septal extension graft is a common yet serious problem especially among Asian patients. Therefore, finding an effective approach to reduce deformity relapse remains a great challenge to plastic surgeons. In this study, authors established finite element models to simulate different nasal cartilage-corrected options and different reinforcing strategies in secondary unilateral cleft rhinoplasty. A load of 0.01N was given to the nasal tip to simulate the soft tissue pressure, while two loads of 0.5N were separately given to the anterior and posterior part of the septal extension graft to simulate the rhinoplasty condition. Maximum deformations were evaluated to make stability judgments. The maximum deformation of different cartilage correction models in ascending order was: UCL deformity with septum correction, normal nasal cartilage, UCL nasal deformity, and UCL nasal deformity with lower lateral cartilage correction. When applied L-strut reinforcement graft was harvested from the perpendicular plate of the ethmoid bone, the maximum deformation of the models decreased significantly, and strong fixation of the septum could further enhance this decreasing effect. Correcting the septum and lower lateral cartilage together could improve the structural stability and symmetry in secondary unilateral cleft rhinoplasty. To keep the corrected septum stable and thus reduce deformity relapse, reinforcing the L-strut with perpendicular plate of ethmoid graft while strongly anchoring the septal cartilage to the anterior nasal spine was proved to be effective in both finite element analysis and clinical observation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Retrospective Study of Imaging of Invasive Rhino-Orbital-Cerebral Mucormycosis in the COVID-19 Pandemic in a Tertiary Care Center.

Aim The study aims to analyze the imaging findings of invasive rhino-orbital-cerebral mucormycosis (ROCM) in patients who had COVID-19. Materials and methods This retrospective descriptive study was done on confirmed (culture and histopathology) patients who had a COVID-19 infection. The data was collected from the record section from May 2021 to June 2021. Imaging data were analyzed, and findings were tabulated according to statistical methods. Results Radiological evaluation, including CT and MRI, was done in 48 cases. The ethmoid sinus was the most common sinus involved in 60.41% of cases, followed by the maxillary sinus (52.09%). Unilateral pansinusitis was observed in 21 cases (43.75%). Among periantral extensions, retroantral fat involvement was the most common finding, seen in 24 cases (50%). Lamina papyracea and the walls of the maxillary sinus were involved in eight cases (16.67%). A total of 38 cases (79.17%) exhibited involvement of the extraconal compartment, while 32 cases (66.67%) showed involvement of the intraconal compartment. In intracranial involvement, infarct was noted in 13 cases (27%), and cavernous sinus involvement in nine cases (18.75%). Conclusions ROCM is a life-threatening fungal infection in immunocompromised patients, especially diabetics. Imaging of ROCM plays a pivotal role in early diagnosis, the extent of disease, surgical planning, prognosis, and the response to treatment. Radiologists must know the imaging features and patterns of extension of ROCM.

An inclusive anatomical network analysis of human craniocerebral topology.

The human brain's complex morphology is spatially constrained by numerous intrinsic and extrinsic physical interactions. Spatial constraints help to identify the source of morphological variability and can be investigated by employing anatomical network analysis. Here, a model of human craniocerebral topology is presented, based on the bony elements of the skull at birth and a previously designed model of the brain. The goal was to investigate the topological components fundamental to the craniocerebral geometric balance, to identify underlying phenotypic patterns of spatial arrangement, and to understand how these patterns might have influenced the evolution of human brain morphology. Analysis of the craniocerebral network model revealed that the combined structure of the body and lesser wings of the sphenoid bone, the parahippocampal gyrus, and the parietal and ethmoid bones are susceptible to sustain and apply major spatial constraints that are likely to limit or channel their morphological evolution. The results also showcase a high level of global integration and efficient diffusion of biomechanical forces across the craniocerebral system, a fundamental aspect of morphological variability in terms of plasticity. Finally, community detection in the craniocerebral system highlights the concurrence of a longitudinal and a vertical modular partition. The former reflects the distinct morphogenetic environments of the three endocranial fossae, while the latter corresponds to those of the basicranium and calvaria.

Based on CT imaging, surgical approach selection for frontal and ethmoid sinus osteoma

Objective:To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Methods:Using sagittal and coronal CT images, the following lines were delineated: the F-line（a horizontal line passing nasofrontal beak）, the M-line（a vertical line passing paries medialis orbitae）, and the P-line（a vertical line passing the center of the pupil）. Classification of frontal and ethmoid sinus osteomas was based on their relationship with these lines. Appropriate surgical approaches were selected, including pure endoscopic approaches, endoscopic combined with eyebrow incision approach, and endoscopic combined with coronal incision approach. This method was applied to a single center at the Third Affiliated Hospital of Sun Yat-sen University for endoscopic resection of frontal and ethmoid sinus osteoma. Case Data: Sixteen cases of ethmoid sinus osteomas were treated from January 2020 to September 2023. Among these cases, there were 9 males and 7 females, with ages ranging from 18 to 69 years, and a median age of 48 years. Results:Thirteen cases underwent pure endoscopic resection of the osteoma, while in three cases, a combined approach was utilized. Among the combined approach cases, two exceeded both the M-line and the F-line but did not cross the P-line; therefore, they underwent endoscopic combined with eyebrow incision approach. One case exceeded all three lines and thus underwent endoscopic combined with coronal incision. In all cases, complete resection of the osteoma was achieved as per preoperative planning, and none of the patients experienced significant postoperative complications. Conclusion:For frontal and ethmoid sinus osteomas, it is advisable to perform a thorough preoperative radiological assessment. Based on the size of the osteoma and its relationship to the three lines, an appropriate surgical approach should be chosen to optimize the diagnostic and treatment plan.

Characteristics and management of pediatric medial subperiosteal orbital abscesses

IntroductionSubperiosteal orbital abscesses (SPOA) are the most common suppurative complications of acute bacterial sinusitis. Medial SPOAs arise from infection of the ipsilateral ethmoid sinus and favor initial conservative management reserving surgical drainage for patients who do not demonstrate clinical improvement. No standard algorithm defining medical versus surgical treatment of medial SPOAs exist in the pediatric population. ObjectivesTo identify a size cutoff for medial SPOAs to predict the likelihood for surgical drainage. MethodsThis is a retrospective review of patients with medial SPOAs at a tertiary care center from 2003 to 2017. Diagnosis of SPOA was based on radiographic findings. Variables included are patient demographics, antibiotic therapy, surgical intervention, and length of stay. Results82 patients with a medial SPOA were included with an average age at presentation of 6.27 (range 0–15) years were included in this study. 62 patients were male (75.6 %), and 20 were female (24.4 %). The average abscess length was 16.1 mm, range 4.5–30.7 mm. The average abscess width was 4.17 mm, range 1.5–14.6 mm. The odds ratio for surgical treatment with every 1 mm increase in abscess width was 1.89 (95CI:1.33–2.69, p < 0.001). Abscesses over 3.6 mm width were 6.65 times more likely to undergo surgical drainage than those less than 3.6 mm (OR:6.65, 95CI:2.52–17.54, p < 0.001). The average(SD) length of stay was 5.4(3.0) days for patients who underwent surgery and 4.0(0.9) days for patients treated with conservative measures, p < 0.001. ConclusionMedial SPOAs greater than 3.6 mm were more likely to undergo surgical drainage; however there was no difference in the likelihood of drainage between anteriorly and posteriorly based medial abscesses. These findings help further characterize the landscape of pediatric subperiosteal abscesses that are managed with surgical drainage.

Gender Differences in Sinonasal Cancer Incidence: Data from the Italian Registry.

Although rare, sinonasal cancers (SNCs) have a high occupational attributable fraction. We applied gender-based approaches to descriptive analyses, incidence, and patterns of exposures using the Italian National Sinonasal Cancer Registry (ReNaTuNS: Registro Nazionale Tumori Naso-Sinusali). The study included 2851 SNC patients. SNC was diagnosed more often in men (73%) than in women (27%). The most frequent morphology in men was intestinal-type adenocarcinoma (33%), whereas in women, it was squamous cell carcinoma (49%). Nasal cavities were predominant in both genders (50%), ethmoidal sinus in men (24%), and maxillary in women (24%). Incidence rates were 0.76 (per 100,000 person-years) in men and 0.24 in women and increased by age, more evidently in men, peaking over 75 years in both. Occupational exposures to wood and leather dusts were the most frequent (41% for men, 33% for women). Few exposures were extra-occupational or domestic. Unlikely exposure was relevant in women (57%). The surveillance of SNC cases through a registry that allows for the identification of and compensation for this occupational disease is important in Italy, where numerous workers are exposed to carcinogens for SNC, without even being aware. Considering the rarity of the disease, particularly among women, the ReNaTuNS can provide a method to analyze gender differences.

A study of the prevalence of Onodi cells in a North Indian population

Background: Onodi cells are a type of posterior ethmoid cells which extend superior and lateral to the sphenoid sinus. As these cells have a close relationship with the optic nerve and the internal carotid artery, it becomes important to be aware about their presence preoperatively to prevent injury to these vital structures. Aim of the study was to identify the presence of the Onodi cell with computed tomography (CT) scan and to determine its prevalence and gender distribution of these cells in a north Indian population. Methods: CT scan of nose and paranasal sinuses of 300 adult patients were studied retrospectively to determine the prevalence of Onodi cells. Results: The overall prevalence of Onodi cells was found to be 20.33%. Of this, 24 (57%) were present in males and 17 (43%) in females. Out of 61 Onodi cells, 30 (49.2%) were right-sided, 10 (16.4%) left-sided, 13 (21.3%) central and 8 (13.1%) were bilateral. Conclusions: The presence of Onodi cell in every fifth person makes it important to have a knowledge of their presence preoperatively to prevent adverse surgical complications.

Long-Term Follow-Up of Post Radiation Complete Sinus Opacification in Sinonasal Cancer Patients.

Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO). A retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients' medical records. Only patients with at least 12 months of follow-up and available imaging for review were included. Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification. Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up. 4 Laryngoscope, 134:4232-4238, 2024.

The Ethmomaxillary Sinus-A False Duplicate Maxillary Sinus.

Functional endoscopic sinus surgery consistently benefits from good anatomical knowledge and modern imaging techniques. Ethmoid air cells migrate in specific topographical sites near the ethmoid. Posterior ethmoid air cells that descend into the maxillary sinus (MS) are ethmomaxillary sinuses (EMSs) that into the superior nasal meatus. Few previous studies found EMSs in 0.68% to 16.48% of cases. An EMS differs from a Haller's infraorbital cell nearing the ethmoidal infundibulum. A posterior ethmoid air cell intercalated between the ethmoid, MS and sphenoidal sinus is a Sieur's cell, but it could also be regarded as an EMS. An EMS should be discriminated from a maxillary recess of the sphenoidal sinus. An EMS could determine Onodi's maxillary bulla into the MS. The false duplicate MS described by Zuckerkandl consists of a MS draining into the middle nasal meatus adjoined by an EMS draining into the superior nasal meatus. These are separated by the ethmomaxillary septum. The latter may be confused with an intrasinus septum of the MS if the drainage pathways are not adequately documented. Therefore, a case-by-case anatomic identification of the pneumatic spaces nearing the MS should be performed before surgical endoscopic approaches of the nose and sinuses.

Screening Publicly Available CT Datasets of the Head for Potential Use in Studying Normal and Pathological Issues Related to Nasal Airflow

Objective: The purpose of this study was two-fold. First, we wanted to develop optimized strategies for evaluating publicly available CT datasets for use in simulated studies of airflow. Second, we sought to generate 3D models of the nasal cavity from these CT datasets and perform Computation Fluid Dynamics (CFD) modeling of airflow in the generated models. This work lays the groundwork for future investigations into studying diversity in airflow patterns and rates, analyzing microparticle and odorant deposition, how anatomical variations relate to difference in airflow and pathologies, and the role of comparative CFD analyses in surgical planning. Methods: 490 CT scans were downloaded from the CQ500 repository dataset and evaluated for effectiveness in building digital models of the nasal airway. Scans were digitally dissected and analyzed in 3D Slicer to determine eligibility for model creation and simulation. Eligible scans were further edited in 3D Slicer. All ethmoid air cells, sinuses and recesses were removed, as it was determined these areas do not contribute to the airflow we want to study. These reconstructed models made in 3D Slicer were further refined using the program MeshMixer. Once editing was completed in MeshMixer, STL files were imported back into 3D Slicer to be overlayed with the original STL file created directly from the CT scan to verify anatomical accuracy. Any inaccuracies were removed with further editing in MeshMixer. Models were then imported into Salome, where they were converted into “solid models” for CFD analysis. All CFD was performed in OpenFOAM, and results were visualized using ParaView. Results: Five models have been reconstructed and are being subjected to CFD analysis. To be a strong candidate for modeling, the CT scan had to include at least 230 slices, show all anatomy relevant to the study including turbinates, ethmoid air cells, the cribriform plate and olfactory region, nasal vestibules, and the nasopharynx, and display adequate detail. Of the five final models, four were deemed anatomically normal and all relevant anatomy was intact. One of the five models displayed a deviated septum. The four “normal variants” were used to predict normal patterns of airflow using Computational Fluid Dynamics (CFD). The results of these models compared with the deviated septum model show severe limitation of airflow in the deviated model, together with compensatory flow on the more open side of the airway. Relatively simple digital "corrections" were applied, which effectively recovered normal airflow. Conclusion: CT scans from the publicly available CQ500 repository dataset are effective in creating digital models of the nasal airway to be used for CFD. Computational modeling was shown to be a useful tool in understanding how nasal morphology contributed to the diversity in airflow patterns and rates, microparticle and odorant deposition. Thus far 5 CT scans out of 490 specimens were eligible for modeling; however, due to time constraints of the study, these were the only scans that were utilized. Four of these models were “normal variants” while the scan with a deviated septum was a “pathological variant.” One of the normal models is currently being run in the OpenFOAM CFD program and shows promising results with similar airflow patterns through both the left and right airways. All other models will also be analyzed in this CFD program and more rounds of CFD will be run to compare airflow dynamics for normal and pathological variants. This work provides insights into how a broad, comparative sample of subjects can be used in surgical planning and in understanding the physiological consequences of potential surgical interventions. Burrell College. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Anterior Ethmoid Roof Configuration: A Computed Tomography Scan Analysis of Adult Nigerians with Chronic Rhinosinusitis

Abstract Context: The anterior skull base has been adjudged a high-risk area in endoscopic sinus and skull base surgery. Hence, an understanding of its complex anatomy is crucial if catastrophic intra-operative complications must be avoided. Aims: To identify the anatomical configurations of the anterior skull base by radiological analysis, and to determine the prevalence of its variations among adults with chronic rhinosinusitis. Settings and Design: A retrospective study of 99 adult patients with chronic rhinosinusitis who attended the Ear Nose and Throat clinic of Aminu Kano Teaching Hospital from July 2022 to June 2023. Methods and Materials: The patient’s records were retrieved, and the basic demographic data, clinical history, and examination findings were extracted. All patients had diagnostic nasal endoscopy, and computed tomography scans of the nose and paranasal sinuses which were analyzed using a computer software program. Statistical Analysis Used: The data was analyzed with SPSS version 22.0 using frequency, mean, Pearson Chi-square tests and the results were presented in tables and figures. Results: A total of 99 patients’ CT scans were analyzed. There were 61 males (61.6%) and 38 females 38.4%) with a mean age of 31.7 years. 37 (37.4%) and 62 (62.6%) of patients had asymmetry and symmetry in the fovea ethmoidalis respectively. The anterior ethmoid artery was found coursing through the anterior ethmoidal air cells in 73 (36.9%) and along the anterior skull base in 125 patients (63.1%). Kero’s classification showed types I in 140 (70.7%), type II in 54 (27.3%) and type III in 4 (2.0%). Conclusion: This study found that a significant proportion of the study population had ethmoid roof asymmetry and the anterior ethmoid artery was found coursing through the anterior ethmoidal air cells respectively.

The relationship between optic nerve and Onodi cells on CT scan

The Onodi cells, also known as sphenoethmoidal air cells, are a variant of the most posterior ethmoid cells and are closely related to the optic canal. The presence of Onodi cells may increase the risk of optic nerve injury and result in confusion with sphenoid sinuses during endoscopic sinus surgery, leading to the oversight of sphenoid sinus pathology. The aim of the study was to examine the characteristics of Onodi cells and their relationship with the optic nerve on CT scans. A cross-sectional study was conducted, analyzing CT scans of paranasal sinuses in 196 posterior ethmoid air cells from 98 patients (30 males and 68 females) aged 18 or older, without abnormalities in the paranasal sinuses and optic nerve anatomy. The prevalence of Onodi cells was 38.78%, with 26.32% on the left, 44.74% on the right, and 28.94% bilaterally. Onodi cell pneumatization was observed in the order of Type I &gt; Type II &gt; Type III on both sides. The most common relationship between Onodi cells and the optic nerve was Type A on both sides. The incidence of the optic nerve bulging into Onodi cells was 50%, and the exposure of the optic nerve into Onodi cells was 7.89%. The study investigated the prevalence and relationship between Onodi cells and the optic nerve. CT scans proved to be a crucial diagnostic tool in providing essential information about Onodi cells before surgery.

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.

Computed Tomographic Study of Frontal Sinus Cells and Opacification as Per the International Frontal Sinus Anatomy Classification.

International frontal sinus anatomy classification (IFAC) was introduced in 2016 to standardize the nomenclature of the cells in the frontal recess region, facilitate better communication between surgeons and precision in surgical planning, and improve surgical teaching. This study aims to estimate the radiological prevalence of the different frontal recess cells according to the IFAC and to evaluate the relationship of these cells with the frontal sinus opacification in patients with chronic rhinosinusitis. In this study, 90 participants diagnosed with chronic rhinosinusitis (CRS) who underwent computed tomogram (CT) of the para nasal sinuses were enrolled consecutively. The CT images were were studied in detail using RadiAnt DICOM viewer. The frontal recess cells were grouped as per the IFAC guidelines and their respective prevalence was calculated. The frontal recess cells were grouped as per the Opacification or mucosal thickening within these cells and the frontal sinuses were noted. A multivariate logistic regression analysis was done to evaluate the association between frontal sinus opacification and presence of various IFAC cells. A total of 640 IFAC cells were documented in 180 sides, of which 326 were anterior cells, 263 were posterior cells and 51 were medial cells. The most prevalent cell was the agger nasi cells(ANC), present in 91.7% of 180 sides, the supra agger nasi cells(SANC), Supra agger nasi frontal cells(SAFC), supra bulla cells(SBC), supra bulla frontal cells(SBFC), supra orbital ethmoidal cells(SOEC) and frontal septal cells(FSC) were present in 47.8%,37.8%, 65.6%,28.9%, 51.1% and 28.3% respectively. There was no significant association of presence of IFAC cells and frontal sinus opacification except for SBFC(p = 0.038). A significantly higher number of diseased frontal recess cells were seen with involved frontal sinuses when compared with non-involved frontal sinuses across all types of IFAC cells. The ANC were the most prevalent among all the IFAC cells and the FSC were the least prevalent. There was no significant association with the presence of different types of IFAC cells and frontal sinus opacification except for SBFC. However, there was a significantly higher number of diseased IFAC cells associated with frontal sinus opacification than in those without frontal sinus opacification.