Tomography Of Paranasal Sinuses Research Articles

Relationship of the optic nerve to the posterior paranasal sinuses among patients visiting a tertiary hospital of Gandaki Province of Nepal: A CT scan anatomic study

Introduction: Functional Endoscopic Sinus Surgery (FESS) has popularly been used for the effective treatment of paranasal sinus disorders and for the removal of tissue obstructing the osteo meatal complex and the facilitation of drainage. However, almost 16% to 50% of all the complications of the FESS have orbital involvement. The complications are due to the wide variation in the anatomy of the sphenoidal and posterior ethmoidal sinuses. This study aimed to find the prevalence of types of relationships that optic nerves have with the sphenoid sinus and also the prevalence of anatomical variation in sphenoid sinus. Methods: This is the descriptive cross-sectional study conducted over 210 participants appearing for CT scan imaging of paranasal sinuses. CT scan of paranasal sinus was performed with 5 mm thickness and then reconstructed to 1.5 mm thickness and evaluated to find the relationship of optic nerve with the paranasal sinuses according to Delano et al. classification. Prevalence of Onodi cells and anterior clinoid process pneumatization was also evaluated for variation in sphenoid sinus. Results: This study found that bilateral optic nerve of Type-I was found in 82.38% people followed by Type-IV in 14.29%. While, Type-III was completely absent in the study population. Prevalence of Onodi cells was 10.95% and that of ACP pneumatization was 6.67%. Conclusions: Variation in relationship of Optic Nerve with paranasal sinuses found with Type-I being the most common.

Anatomical variations in pneumatization types and volume of sphenoid sinus in a subset of Pakistani people.

To evaluate the relationship between volume and pneumatization pattern of sphenoid sinus using computed tomography images. The prospective, cross-sectional study was conducted at the Radiology Department of Dow University of Health Sciences, Karachi, from October 2020 to February 2021, and comprised patients of either gender aged 20-70 years who were subjected to computed tomography of paranasal sinuses. The scans were analysed for sphenoid volume and four pneumatization types of sphenoid sinus, including Type-I conchal, Type-II presellar, Type-III sellar and Type-IV postsellar. Significant differences in sphenoid volume and pneumatization pattern were noted. Data was analysed using GraphPad Prism 9. Of the 300 patients with mean age 39.28±10.99 years171(57%) were males and 129(43%) were females. The mean sphenoid volume in males was 11.01±3.50cm3 compared to 7.7±2.13cm3 in females. The majority of sinuses presented postsellar pneumatization type 192(64%), followed by sellar 84(29%), presellar 26(8.7%) and conchal pneumatization 2(0.7%). Significant difference in volume was observed with respect to gender and typology of the sphenoid sinus (p<0.001). There was a significant relationship of sphenoid volume with and gender and pneumatisation variants, confirming the significance of ethnic heterogeneity.

Anatomical Variations on NCCT Nose and Paranasal Sinuses and Their Relation with Symptoms of the Patients: A Retrospective Analysis

Background: There are various bones around the nasal cavity that pneumatize to form the paranasal sinuses; namely, maxilla, ethmoid bone, frontal bone, and sphenoid bone. The CT scan of nose and paranasal sinus is the gold standard investigation for the patients of chronic rhino-sinusitis (CRS). Objective: This study was conducted with aim to determine the prevalence anatomical variation of Nose and Paranasal Sinuses on CT-scan and their relation with symptoms. Methods: A retrospective study was conducted among 200 patients over a period of one year (2022-2023). Patients with various symptoms of chronic rhinosinusitis were subjected to non-contrast enhanced Computed Tomography of nose and paranasal sinuses. Results: In our study 56% patients had septal deviation with most common C shaped deviation followed by S shaped deviation. 99.5% patients have agger nasi cells. The attachment of uncinate process was to the lamina papyracea in 83.0%, followed by the base of skull in 13.0%. The least common types were free uncinate process in 1.5%. The prevalence of concha bullosa was found 16.5%. However, paradoxical turbinate was present in 2.0% subjects. The incidence of Haller cells was found to be 5.0% and Onodi cells were found in 4.5%. The type of frontal cell was Agger Nasi followed by a Supra-bullar. In Sphenoid sinus, commonest type was pre-sellar type of pneumatisation. Conclusion: Our study concluded these various anatomical variations and its prevalence. The relation of variations with disease symptomatology is inconclusive.

Achieving clinical remission in asthma with mepolizumab: a subanalysis on vitamin D as a predictor of response

Objective Mepolizumab, an anti-IL-5 monoclonal antibody, has shown promise in reducing exacerbations and steroid dependency in severe eosinophilic asthma. This study aims to evaluate the effectiveness of mepolizumab in achieving clinical remission in asthma over 12 months and explore Vitamin D levels as a predictor of response. Method We assessed Asthma Control Questionnaire (ACQ) scores, spirometry, number of exacerbations, oral corticosteroid (OCS) use, and inhaled corticosteroid (ICS) use in 32 patients, observing significant clinical improvements. Data were collected 1 year prior to starting mepolizumab and one year after starting mepolizumab. Nasal polyps were not seen in all the patients, and computed tomography of para-nasal sinuses are not available for all the patients, so nasal polyps status are not evaluated to avoid any bias. Result Our results indicate that 12 patients achieved clinical remission after starting mepolizumab, with a strong correlation between higher Vitamin D levels and positive treatment outcomes. This suggests that optimizing Vitamin D levels could enhance the response to mepolizumab in asthma patients, and help in achieving better asthma control. Conclusion Mepolizumab is an effective treatment for severe eosinophilic asthma, significantly improving clinical outcomes and reducing corticosteroid use. This study highlights the importance of Vitamin D as a predictor of response to mepolizumab, suggesting that higher Vitamin D levels may enhance treatment efficacy.

Aspirin hypersensitivity diagnostic index (AHDI): Invitro test for diagnosing of N-ERD based on urinary 15-oxo-ETE and LTE4 excretion.

15-oxo-eicosatetraenoic acid (15-oxo-ETE), is a product of arachidonic acid (AA) metabolism in the 15-lipoxygenase-1 (15-LOX-1) pathway. 15-oxo-ETE was overproduced in the nasal polyps of patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD). In this study we investigated the systemic biosynthesis of 15-oxo-ETE and leukotriene E4 (LTE4) and assessed their diagnostic value to identify patients with N-ERD. The study included 64 patients with N-ERD, 59 asthmatics who tolerated aspirin well (ATA), and 51 healthy controls. A thorough clinical characteristics of asthmatics included computed tomography of paranasal sinuses. Plasma and urinary 15-oxo-ETE levels, and urinary LTE4 excretion were measured using high-performance liquid chromatography and tandem mass spectrometry. Repeatability and precision of the measurements were tested. Plasma 15-oxo-ETE levels were the highest in N-ERD (p < .001). A receiver operator characteristic (ROC) revealed that 15-oxo-ETE had certain sensitivity (64.06% in plasma, or 88.24% in urine) for N-ERD discrimination, while the specificity was rather limited. Modeling of variables allowed to construct the Aspirin Hypersensitivity Diagnostic Index (AHDI) based on urinary LTE4-to-15-oxo-ETE excretion corrected for sex and the Lund-Mackay score of chronic rhinosinusitis. AHDI outperformed single measurements in discrimination of N-ERD among asthmatics with an area under ROC curve of 0.889, sensitivity of 81.97%, specificity of 87.23%, and accuracy of 86.87%. We confirmed 15-oxo-ETE as a second to cysteinyl leukotrienes biomarker of N-ERD. An index based on these eicosanoids corrected for sex and Lund-Mackay score has a similar diagnostic value as gold standard oral aspirin challenge in the studied group of patients with asthma.

Anatomical Variations Detected in Computed Tomography of Paranasal Sinuses

Anatomical Variations Detected in Computed Tomography of Paranasal Sinuses

Preliminary study on AI-assisted diagnosis of bone remodeling in chronic maxillary sinusitis

ObjectiveTo construct the deep learning convolution neural network (CNN) model and machine learning support vector machine (SVM) model of bone remodeling of chronic maxillary sinusitis (CMS) based on CT image data to improve the accuracy of image diagnosis.MethodsMaxillary sinus CT data of 1000 samples in 500 patients from January 2018 to December 2021 in our hospital was collected. The first part is the establishment and testing of chronic maxillary sinusitis detection model by 461 images. The second part is the establishment and testing of the detection model of chronic maxillary sinusitis with bone remodeling by 802 images. The sensitivity, specificity and accuracy and area under the curve (AUC) value of the test set were recorded, respectively.ResultsPreliminary application results of CT based AI in the diagnosis of chronic maxillary sinusitis and bone remodeling. The sensitivity, specificity and accuracy of the test set of 93 samples of CMS, were 0.9796, 0.8636 and 0.9247, respectively. Simultaneously, the value of AUC was 0.94. And the sensitivity, specificity and accuracy of the test set of 161 samples of CMS with bone remodeling were 0.7353, 0.9685 and 0.9193, respectively. Simultaneously, the value of AUC was 0.89.ConclusionIt is feasible to use artificial intelligence research methods such as deep learning and machine learning to automatically identify CMS and bone remodeling in MSCT images of paranasal sinuses, which is helpful to standardize imaging diagnosis and meet the needs of clinical application.

Three-Dimensional Segmentation of Equine Paranasal Sinuses in Multidetector Computed Tomography Datasets: Preliminary Morphometric Assessment Assisted with Clustering Analysis.

The paranasal sinuses, a bilaterally symmetrical system of eight air-filled cavities, represent one of the most complex parts of the equine body. This study aimed to extract morphometric measures from computed tomography (CT) images of the equine head and to implement a clustering analysis for the computer-aided identification of age-related variations. Heads of 18 cadaver horses, aged 2-25 years, were CT-imaged and segmented to extract their volume, surface area, and relative density from the frontal sinus (FS), dorsal conchal sinus (DCS), ventral conchal sinus (VCS), rostral maxillary sinus (RMS), caudal maxillary sinus (CMS), sphenoid sinus (SS), palatine sinus (PS), and middle conchal sinus (MCS). Data were grouped into young, middle-aged, and old horse groups and clustered using the K-means clustering algorithm. Morphometric measurements varied according to the sinus position and age of the horses but not the body side. The volume and surface area of the VCS, RMS, and CMS increased with the age of the horses. With accuracy values of 0.72 for RMS, 0.67 for CMS, and 0.31 for VCS, the possibility of the age-related clustering of CT-based 3D images of equine paranasal sinuses was confirmed for RMS and CMS but disproved for VCS.

Chronic Rhinosinusitis with Extensive Recurrent Bilateral Nasal Polyposis-Third Times The Charm

The prevalence of recurrence in chronic rhinosinusitis with nasal polyposis (CRSwNP) is up to 40% after 18 months. Compliance to continuous medical therapy postoperatively is crucial to ensure disease resolution. CRSwNP endotype type 2 which is more common in Caucasian had shown higher recurrence. We report a case with third recurrence and the possible risk factors. A 37-year-old male smoker presented with rhinorrhea, bilateral facial pain, and anosmia for 3 years. He had two previous sinus surgeries and septoplasty. His nasal symptoms recurred a few months after both surgeries. Due to the recent pandemic, he defaulted on follow up. Rigid endoscopy at initial presentation revealed bilateral grade 2 nasal polyps which progressed to grade 4 despite medical polypectomy. Computed tomography of paranasal sinus showed pansinusitis with bilateral extensive polyposis, with presence of frontal intrasinus calcification possibly due to chronic sinusitis or fungal infection. He contracted Covid-19 category 2A infection two months before his planned surgery. The patient underwent bilateral endoscopic sinus surgery revealing extensive polyposis occupying all paranasal sinuses and the nasal cavity, completely obstructing the nasal. Intraoperative blood loss from the mucosa of the sinuses amounted to 2 liters without any arterial bleeding, causing an increase in operative time due to persistent need to secure hemostasis. Histopathological findings showed benign inflammatory polyps. There were reactionary polyps seen in bilateral maxillary sinuses and ethmoids at 2 weeks post operatively. A short course of steroid and chlarythromycin were given to prevent progression of polyps. At 5 weeks post operative, he reported on return of smell, and no more nasal blockage. We discuss the risk factors and endotypes of nasal polyps in recurrence cases with the operative challenges in revision endoscopic nasal surgery. In conclusion, recurrence nasal polyps after revision surgery is multifactorial with some possible prevention.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S55

Comparative Cross Sectional Prospective Study of Anterior Skull Base Thickness in Spontaneous Cerebrospinal Fluid Rhinorrhoea vs Matched Controls.

Cerebrospinal fluid (Csf) leak is the leakage of CSF from subarachnoid space into the nasal cavity.Csf rhinorrhoea is classified as traumatic and non traumatic causes (Ommaya et al. J Neurol Neurosurg Psychiatry 31(3):214, 1968). Spontaneous csf leaks occur due to increased intracranial pressure. Early diagnosis of spontaneous csf leaks may prevent complications like meningitis. This was a cross sectional prospective study done in a tertiary care hospital. Group A-spontaneous csf leak patients and Group B- Non csf leak matched controls. The anterior skull base thickness from fovea ethmoidalis, cribriform plate and lateral lamella were compared between the groups using high resolution computed tomography of paranasal sinus with 2mm cuts. The anterior skull base thickness was measured by a senior radiologist in our tertiary centre. In this study, total of forty six patients were included, twentythree in each group. The Mean age in Group A and Group B was 48.95 and 48.78 respectively. Body mass index (BMI) was compared between the two groupsand spontaneous csf leak patients had higher value than non csf leak controls. The mean anterior skull base thickness of Group A (cribriform plate-0.56mm, lateral lamella-0.66mm, Fovea ethmoidalis-0.91mm) was lower than Group B (cribriform plate-0.86mm, lateral lamella-0.84mm, Fovea ethmoidalis-0.97mm) which was statistically significant (p value-< 0.05).

Multidetector Computed Tomography Used in Evaluation of Olfactory Fossa Depth in a Tertiary Hospital in Eastern Region of Nepal: A Descriptive Cross-sectional Study.

Olfactory fossa (OF) is a depression in most infero-medial portion of anterior cranial fossa formed by cribriform plate, crista galli and lateral lamella of cribriform plate (LLCP). LLCP being thinnest and extremely variable parts, more prone for iatrogenic injury during sinus surgery in case of asymmetric and deep OF. Multidetector computed tomography (MDCT) is frequently used imaging modality in the evaluation of paranasal sinus. The objective of the study is to classify the OF depth according to the Keros classification. In this ethically approved prospective, cross-sectional descriptive study, CT scan was done in 530 consecutive patients from February 2022 to July 2023. Coronal CT images of paranasal sinuses and nose were used to measure the OF depth. The data collected was analyzed using SPSS. Out of 530 patients included in this study, 310 (58.49%) were male and 220 (41.51%) were female with mean age of 40.46±11.56 years. Total of 1060 olfactory fossa were analyzed with mean depth of 4.96±1.88 mm. In our study, 310 (29.24%) had type I, 730 (68.88%) had type II and 20 (1.88%) had type III according to Keros classification. Keros type II OF is more common. The dangerous type III OF having low prevalence, more commonly seen on right side and in males.

Efficacy of endoscopic sinus surgery in management of odontogenic maxillary sinusitis after control of dental pathology

BackgroundOdontogenic sinusitis (ODS) has clinical features like rhinogenic sinusitis. Although it is usually unilateral, diagnostic overlap could happen. However, ODS necessitates different management which includes dental intervention to eliminate the dental infection source. In some patients, ODS may persist even after management of dental pathology. The aim of this study was to assess the clinical features, and diagnostic criteria of ODS that is persistent after management of dental pathology, and to evaluate the efficacy of endoscopic sinus surgery (ESS) as a therapeutic option of the disease.MethodsTwenty patients were included in this study. All patients were presented with ODS refractory to medical treatment after management of their dental problems. Clinical features of the patients were analyzed. Also, endoscopic nasal examination and computed tomography of paranasal sinuses (CT) were performed for all patients. ESS were used, with widening of the maxillary ostium for drainage. Follow-up was carried out for at least 6 months.ResultsAll patients had unilateral disease, with 3 main complaints: malodourous nasal discharge (90%), facial pain (75%), and nasal obstruction (45%). Endoscopic nasal examination showed either middle meatal purulence (70%) or polypoid mucosa (30%). CT showed either thickened maxillary sinus mucosa (50%), or complete maxillary opacity (50%) with retained foreign body in 2 patients (10%). After ESS, all patients reported relieve of their sinonasal symptoms, and nasal endoscopy showed patent middle meatus, with one patient demonstrated adhesions between the middle turbinate and lateral nasal wall which was asymptomatic.ConclusionPrior dental intervention is a suspicious diagnostic landmark for ODS, and unilateral foul nasal discharge is the main prevalent complaint. Nasal endoscopy usually shows purulence or polypoid mucosa in the middle meatus, and CT is a good diagnostic tool for ODS. ESS with good widening of the maxillary ostium is an effective therapeutic option for those patients.

Traditional game of spinning top gone wrong: Short communication of a pediatric facial penetrating injury

Introduction A spinning top is a traditional game in some countries. The top is often made of wood or mud and the bottom is made of a sharp metal pin. Penetrating injuries can occur if the spinning top is incorrectly thrown. Case report We report a spinning top penetrating injury on the nose of an 8-year-old girl. Clinical examination revealed a spinning top that had penetrated her nasal bridge. Plain computed tomography (CT) of paranasal sinuses revealed a spinning top with its sharp pointed nail penetrating through the left nasal bone into the left nasal cavity. Examination under general anesthesia and rigid nasoendoscopy showed the tip of spinning top situated in between middle turbinate and nasal septum. The spinning top was then removed following the direction of entry. Discussion While air gun pellet facial injuries in pediatric patients have been reported, other playthings as culprits of facial penetrating injuries is still unheard of. Projectile objects can easily penetrate pediatric facial skeleton due to thinner facial bones. It is vital to exclude life- and sightthreatening injuries first, followed by imaging to assist decision-making and surgical planning. Computed tomography (CT) imaging is the gold standard for the radiographic evaluation of facial injuries. It assists in evaluating trauma extent, trajectory, depth, and course of foreign body. Following that, examination under anaesthesia including rigid nasal endoscopy is warranted. Conclusion We would like to highlight the importance of parental supervision and the value of pre-operative imaging. Neglecting seemingly harmless children’s toys can potentially cause fatal injuries.

Ultra-low-dose photon-counting CT of paranasal sinus: an in vivo comparison of radiation dose and image quality to cone-beam CT.

This study investigated the differences in subjective and objective image parameters as well as dose exposure of photon-counting CT (PCCT) compared to cone-beam CT (CBCT) in paranasal sinus imaging for the assessment of rhinosinusitis and sinonasal anatomy. This single-centre retrospective study included 100 patients, who underwent either clinically indicated PCCT or CBCT of the paranasal sinus. Two blinded experienced ENT radiologists graded image quality and delineation of specific anatomical structures on a 5-point Likert scale. In addition, contrast-to-noise ratio (CNR) and applied radiation doses were compared among both techniques. Image quality and delineation of bone structures in paranasal sinus PCCT was subjectively rated superior by both readers compared to CBCT (P < .001). CNR was significantly higher for photon-counting CT (P < .001). Mean effective dose for PCCT examinations was significantly lower than for CBCT (0.038 mSv ± 0.009 vs. 0.14 mSv ± 0.011; P < .001). In a performance comparison of PCCT and a modern CBCT scanner in paranasal sinus imaging, we demonstrated that first-use PCCT in clinical routine provides higher subjective image quality accompanied by higher CNR at close to a quarter of the dose exposure compared to CBCT.

Examination of ethmoidal roof regarding Keros and Yenigun classifications in a Turkish population: a computerized tomography study.

Understanding ethmoid roof morphology is crucial to prevent complications in endoscopic sinus surgery. This study aimed to evaluate the morphological properties of the ethmoidal roof regarding gender and age differences using Keros and Yenigun classifications on high-resolution computed tomography images. We retrospectively analyzed 891 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in coronal sections and the anterior-posterior length in axial planes. The study retrospectively examined CT images of paranasal sinuses of patients living in the eastern Anatolian region of Turkey. In both Keros and Yenigun Classifications, the most common class was type 2, and the least common class was type 3. According to Keros et al.'s method, no significant difference was observed between men and women (p = 0.698). However, according to Yenigun et al., the average values of women in terms of the anterior-posterior distance of the ethmoid roof were significantly higher than men (p = 0.001). When examined according to age, a very low, negative correlation was revealed regarding Keros and Yenigun classifications (p = 0.047 and p < 0.001 retrospectively). According to Keros and Yenigun's classification, there was no significant difference between the left and right sides (p = 0.488 and p = 0.919, respectively). The morphological properties of the ethmoidal roof have importance to be considered for preoperative planning. Studying larger patient groups and meta-analyses that gather various research results about this subject might help better understand the ethmoidal roof morphology among populations.

РОЛЬ МСКТ И МРТ В ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ ОСЛОЖНЕНИЙ СРЕДНЕЙ ЗОНЫ ЛИЦА У ПАЦИЕНТОВ С ПАТОЛОГИЕЙ ГРИБКОВОЙ ЭТИОЛОГИИ

Abstract. Introduction. Fungi are one of the constituents of an ecosystem. There are about 250 known human- pathogenic fungi species: From the widely spread Candida to the pathogene of aspergillosis that may lead to fatal consequences in certain conditions. Studies performed by Russian and foreign authors show the increase in the frequency of chronic sinusitis determined by the presence of fungi or fungal-microbial associations. Aim of this study is to perform the differential diagnosis of midface complications in patients with fungal pathology according to multispiral computed tomogrsphy and magnetic resonance tomography. Materials and Methods. A retrospective study was conducted based on the findings of multispiral computed and/or magnetic resonance tomographies of 68 patients. Presence of a fungal process was confirmed by histopathologic, mucroscopic, and cultural investigations. Results and Discussion. Histological investigations of surgical specimen detected the presence of fungal bodies formed by mycelium, i.e., a cluster of densely, compactly located fungal flocci in 28 of 48 (58.3 %): In 28 patients with maxilla sinus lesions, in 14 patients with sohenoidal sinus lesions, and in 5 patients with ethmoidal sinus lesions. In case of acute invasive fungal rhinosinusitis, the computed tomography of paranasal sinuses detected mucosal thickening and the bone density decrease associated with an erosive process. Unilateral lesions, erosions, and thinning of the sinus bone walls. According to magnetic resonance tomography, there was low signal in T2 mode, which is determined by the high concentrations of various metal elements in fungi, as well as by a high protein level and low free water contents in mucine. Conclusions. Visualization is essential to staging the disease and assessing the involvement of deeper structures, which may be clinically unmanifest. Although both computed tomography and magnetic resonance tomography are useful, the contrast-enhanced magnetic resonance tomography is the method of choice and helps assess the spread of the disease, especially regarding the deep extension into maxilla-facial area and brain.

МУЛЬТИМОДАЛЬНАЯ ВИЗУАЛИЗАЦИЯ ОСЛОЖНЕНИЙ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ, ПЕРЕНЕСШИХ COVID-19

Abstract. Introduction. COVID-19 is widely known as a disease that causes respiratory dysfunction. However, it is also associated with many extrapulmonary manifestations and complications, such as gastrointestinal and hepatocellular complications, neurological diseases, and maxillofacial complications. Aim of this study was to describe the MSCT and MRI findings in 56 patients with COVID-19-associated rhino-orbital mucormycosis. Materials and Methods. CT and/ or MRI imaging was performed on 56 patients with diabetes mellitus who recovered after having been diagnosed with COVID-19 and had maxillofacial complications. Results and Discussion. All patients had sinusitis and ophthalmic symptoms. In all patients, there were the sequential anatomical lesions of nasal cavity, maxillary sinus, orbits, and lattice cells. Conclusions. Computer tomography or magnetic resonance imaging can be used to evaluate the spread of rhino-orbital mucormycosis to detect bone destruction, infiltration, and tissue invasion. Computer tomography of paranasal sinuses is the method of choice at suspicion on mycotic infections, such as rhino-orbital mucormycosis. It is recommended to perform magnetic resonance tomography of soft tissues at suspicion on mycotic invasion beyond paranasal sinuses.

Schwannoma of Nasopharynx-A Rare Case with A Complex Presentation.

Nasopharyngeal tumors are rare, and schwannomas originating from this location are extremely uncommon. Schwannomas are tumors arising from the Schwann cells of peripheral nerve sheath which are neuroectodermal in origin. These are benign, slow growing, well-encapsulated tumors and are mostly seen in the head and neck region. We present a rare case of schwannoma with nasopharynx as its epicenter in an elderly female patient who presented with complaints of hematemesis, bilateral nasal obstruction and stertorous breathing. Diagnostic nasal endoscopy revealed a smooth mucosa covered globular mass occupying bilateral choana. Contrast-enhanced computed tomography of Nose and paranasal sinuses revealed a homogenous mass occupying the entire nasopharynx extending into the nasal and oropharyngeal cavities. The patient underwent Trans-nasal Endoscopic excision under general anesthesia. Nasopharyngeal tumors have a wide range of presentation and a high index of clinical suspicion combined with imaging modalities is required for diagnosis and pre operative planning. Some tumors can cause life-threatening airway obstruction due to delayed presentation and should be managed efficiently and meticulously, with endoscopic excision being a viable approach for cases confined within the nasopharynx.

Evaluation of Anatomical Variations Associated with Chronic Rhinosinusitis by Computed Tomography of Paranasal Sinuses.

Chronic rhinosinusitis (CRS) is a syndrome with multifactorial aetiology. Amongst which, anatomical variations studied by computed tomography of paranasal sinuses (CT PNS) had a high incidence which varied between 64.0% and 99.8%10. Due to such high incidence, this study is undertaken to assess the various anatomical variations and their significant association in CRS. A prospective observational study was conducted in 70 CRS patients and were subjected to CT PNS. CT PNS is studied to know the various anatomical variations & other CT findings causing CRS and then findings noted down, tabulated and statistical analysis done. All 70 CRS patients evaluated by CT PNS had one or more anatomical variations along with other findings like fungal sinusitis in 6 patients, dentigerous cyst and inverted papilloma in 1 case each. The anatomical variations observed in our study were septal deviation(62.8%), concha bullosa(52.8%), agger nasi(51.4%), pneumatized crista galli(47.1%), hyperpneumatized bulla(40%), suprabullar cells(37%), septal spur(34.3%), paradoxically curved middle turbinate(34.2%), supra orbital cells(32.8%), haller cells(31.4%), septal pneumatization(17.1%), pneumatized uncinate(13%), interfrontal septal pneumatization(13%), maxillary septations(10%), maxillary sinus hypoplasia(7.1%), frontal hypoplasia(5.7%), uncinate attached to lamina papyracea(40%), uncinate to middle turbinate(11%), uncinate to skull base(7.9%), free uncinate(41%), frontal cells type 1;2;3;4 (36%);(30%);(20%);(38.5%), onodi cells(27.1%), pneumatized anterior clinoid process(18.5%), lateral recess(15.7%), sphenoid septations attached to optic nerve(10%) and carotid(2.8%), pneumatized superior turbinate(1.4%), Sellar; Pre sellar; Post sellar sphenoid(42.8%);(5.7%);(51.4%). In our study only anatomical variations around the maxillary & Frontal sinus showed significant association with CRS. Anatomical variations around the anterior group of sinuses have a significant association with CRS.

Molecular defects in primary ciliary dyskinesia are associated with agenesis of the frontal and sphenoid paranasal sinuses and chronic rhinosinusitis.

Background: Primary ciliary dyskinesia (PCD; MIM 242650) is a rare genetic disorder characterized by malfunction of the motile cilia resulting in reduced mucociliary clearance of the airways. Together with recurring infections of the lower respiratory tract, chronic rhinosinusitis (CRS) is a hallmark symptom of PCD. Data on genotype-phenotype correlations in the upper airways are scarce. Materials and methods: We investigated the prevalence, radiologic severity, and impact on health-related quality of life (HrQoL) of CRS in 58 individuals with genetically confirmed PCD. Subgroup analysis was performed according to the predicted ultrastructural phenotype based on genetic findings. Results: Among 58 individuals harboring pathogenic variants in 22 distinct genes associated with PCD, all were diagnosed with CRS, and 47% underwent sinus surgery. A total of 36 individuals answered a German-adapted version of the 20-item Sinonasal Outcome Test (SNOT-20-GAV) with a mean score of 35.8 ± 17, indicating a remarkably reduced HrQoL. Paranasal sinus imaging of 36 individuals showed moderate-to-severe opacification with an elevated Lund-Mackay Score (LMS) of 10.2 ± 4.4. Bilateral agenesis of frontal sinus (19%) and sphenoid sinus (9.5%) was a frequent finding in individuals aged 16years or older. Subgroup analysis for predicted ultrastructural phenotypes did not identify differences in HrQoL, extent of sinus opacification, or frequency of aplastic paranasal sinuses. Conclusion: PCD is strongly associated with CRS. The high burden of disease is indicated by decreased HrQoL. Therefore, the upper airways of PCD individuals should be evaluated and managed by ear-nose-throat (ENT) specialists. Genetically determined PCD groups with predicted abnormal versus (near) normal ultrastructure did not differ in disease severity. Further studies are needed to gain evidence-based knowledge of the phenotype and management of upper airway manifestations in PCD. In addition, individuals with agenesis of the frontal and sphenoid paranasal sinuses and chronic respiratory symptoms should be considered for a diagnostic evaluation of PCD.