Middle Turbinate Research Articles

Analysis of predisposing factors in unilateral maxillary sinus fungal ball: the predictive role of odontogenic and anatomical factors.

The pathogenesis of maxillary sinus fungal ball (MSFB) is explained by aerogenic and odontogenic factors. We evaluated the predisposing factors, including intranasal anatomical and dental factors for increased diagnostic accuracy. In this study, 117 patients who underwent endoscopic sinus surgery for unilateral MSFB were included. Preoperative computed tomography (CT) scans were used to analyze the presence of anatomical variations (anterior and posterior nasal septal deviation (NSD), concha bullosa (CB), infraorbital cell (haller cell), paradoxical middle turbinate, everted uncinate process and MS size). Dental factors including history of dental procedures and findings on CT scans were reviewed. Anterior and posterior NSD toward non-affected side were significantly associated with the presence of FB. The presence of CB and infraorbital cell was higher in the non-affected side rather than in the lesion side. Compared to non-affected MS, FB-presence MS was shallower and had a larger height to depth ratio. The presence of dental history was significantly higher on FB-presence MS than non-affected MS. In multivariable analysis, posterior NSD toward non-affected side, dental history increased the aOR of MSFB, while the presence of CB and infraorbital cell decreased the aOR of MSFB. The occurrence of MSFB seems to be associated with ipsilateral odontogenic factors, followed by anatomic variations including posterior NSD toward non-affected side and absence of CB and infraorbital cell.

The Benefit of Middle Turbinate Stabilization during Functional Endoscopic Sinus Surgery, A Comparative Study

Background: The laterlization of middle turbinate and adhesion to the lateral nasal wall is a common coplication of fuctional endoscopic sinus surgery (FEESS) result in failure of initial procedure and obstruction of osteomeatal complex. Current procedure for middle turbinate medialization, include creation of controlled synaechia between middle turbinate and nasal septum (bolgerization) and fixation of middle turbinate to nasal septum by suturing using absorbale vicryl suture (conchopexy). Objective: Is to compare between FESS with middle turbinate fixation to the septum by conchopexy or bolgerization technique to prevent laterlization of middle turbinate and thier impact on postoperative symptoms and signs and conventional FESS without fixation of the middle turbinate to the septum. Patients and Methods: The current stydy include 80 patients, they were divided into 3 groups, Group 1, include 30 patients underwent conventional FESS with medialization of middle turbinate only, using middle meatal pack, lest for 2 days. Group2, included 25 patients underwent FESS with Bolgerization method. Group3, included 25 patients underwent FESS with conchopexy by suturing the middle turbinate to the septum. Preoperative, postoperative, symptoms and endoscopy findings were compare among all the 3 groups. Result: Significant improvement is achieved in all groups and this improvement was founds to be significant stastically for nasa obstruction, nasal discharge, olfactory function, (P > 0.001)and for facial pain (P = 0.009). Bolgerization technique had better result in improving olfactory disturbance as compared to other methods. The pstoerative endoscopic findings improvement score was stastically significant for all groups with (P = 0.002) for the 1st group and (P = 0.001) fore the 2nd and 3rd groups. Regarding synaechia and laterlization of middle turbinate, in group 3 one of the patient had laterlization and synaechia between the middle turbinate and the lateral nasal wall (4%), 4 patients in group 2 (16%), and 10 patients in group 1 (33.3%). Conclusion: Conchopexy and Bolgerization are effective method to stabilize middle turbinate and preventing middle turbinate laterlization and synaechia following FESS with highly significant improvement of postoperative symptoms and endoscopic findings.

Rhinogenic Contact Point Headache – a Review

Headache is a universal symptom in the course of everyone's life. There are myriads of causes for headache ranging from simple migraine, tension headache, refractory errors in the eye, temporomandibular joint arthralgia, and myofascial spasm to severe form of headache by brain tumors. The anatomical variations in the nasal cavity result in mucosal contact between the opposing surface and cause rhinogenic contact point headache (RCPH). RCPH is a new type of headache in medical literature. The pathogenesis of the RCPH is still the subject of controversy. Nose has diverse anatomical variations. Deviated nasal septum or spur, middle turbinate concha bullosa, and enlarged bulla ethmoidalis are the common anatomical variation in the nasal cavity which can cause RCPH. Diagnostic nasal endoscopy and computed tomography scan are helpful to confirm the mucosal contact points inside the nasal cavity. The precise excision of the contact points with the help of endoscopic approach in patients of RCPH is very effective. Clinicians should not ignore the anatomical variation of the nasal cavity during management of the headache. There is not much literature for RCPH indicating that this clinical entity is neglected. This review article presents an overview of the current aspect of RCPH.

Peri-operative measures to prevent middle turbinate lateralisation and adhesion formation in endoscopic sinus surgery—a systematic review of the literature

Peri-operative measures to prevent middle turbinate lateralisation and adhesion formation in endoscopic sinus surgery—a systematic review of the literature

Gross and Histological Studies of the Nasal Turbinates in Yankasa Sheep ‎‎(Ovis aries) in Maiduguri, Nigeria

The present study was aimed at describing the anatomy of the nasal turbinates in adult Yankasa sheep using sectional anatomical planes and light microscopy. A total of 5 heads were used. The gross observations of the nasal turbinates were presented in midsagittal and serialized transverse sections. The nasal cavity comprised of dorsal, middle and ventral nasal turbinates. These turbinates were delineated by dorsal, middle, common and ventral nasal meatuses and presented distinct morphological details at different levels of the sectional planes. Microscopically, the mucosal lining of the nasal turbinates was divided into stratified squamous keratinized epithelium in the vestibular portion, pseudostratified columnar epithelium in the respiratory portion and olfactory pseudostratified columnar epithelium in the olfactory portion of the nasal cavity. The propria submucosa consisted of loose irregular connective tissue, having connective tissue cells, fibers, cavernous veins and cartilages. whereas the deeper part presented mixed glandular tissue of simple acinar and coiled tubular glands. The study provided basic information on gross and microscopic anatomy of the nasal turbinates in Yankasa sheep, which could serve as reference for clinical interpretation of diagnostic images of the head region of the Yankasa sheep, and for comparative anatomical studies.

Does Rhino-genic Headache Improve after Endoscopic Concha Bullosa Surgery in the Adult Patients?

Background: Pneumatizaton of Middle Turbinate (MT) is one of the common anatomical variations of the Nasal cavitynamed Concha Bullosa. It may be presented with facial pain or headache. There are several surgical techniques to treatConcha Bullosa.Aim of the study: This is to evaluate the improvement of Rhino-genic headache after endoscopic Concha Bullosa surgeryin adult patients.Patients and methods: A prospective comparative study was designed in the Department of Otolaryngology at Al-Jerahat Teaching Hospital in Medical City and private hospital, Baghdad, Iraq, from March 2019 to August 2020. Fortypatients suffering from headaches of Rhino-genic origin of more than six months duration were enrolled in the currentstudy. Nasal examination by zero-degree endoscope revealed unilateral or bilateral MT enlargement with mucosalcontact points to the Osteo-Meatal Complex or the Nasal Septum. All the patients had Nasal and Para-Nasal sinusesCT scan and xylocaine-xylometazoline test. The Forty patients were allocated into two groups, group A patients treatedby Partial Lateral Middle Turbinectomy (PLMT). The 20 patients in group B had been subjected to Middle TurbinateTransverse Excision (MTTE). Patients followed-up every week in the first month and then every two weeks for the nexttwo months. The headache assessment was achieved preoperatively using the Visual Analogue Scale (VAS) and at thethird postoperative month. Statistical analysis was done using the Chi-square test to compare the VAS scores in group Apatients at the third postoperative month to group B patients, and P-value was calculated.Results: Fifty percent of the patients treated by PLMT became free of headache, 35% had a mild headache, and 15%moderate. In contrast, 85%of the patients subjected to MTTE became headache-free, and 15% still with mild headache (Pvalue= 0.031).Conclusions: MTTE is a better option than PLMT in relieving headaches due to contact between Concha Bullosa andOsteo-Meatal Complex or Nasal Septum.

Features of inhalant allergy on nasal endoscopy: a systematic review and meta-analysis.

Nasal endoscopy is increasingly accessible to ENT surgeons. The characteristics of the allergic upper airway are not well recognised. MEDLINE (1946-2021), EMBASE (1974-2021), and the Cochrane Library were searched on 16th November 2021 to identify articles that reported endoscopic findings of patients with documented allergy who had undergone nasal endoscopy. The review followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Meta-analysis was performed by pooling sensitivities and specificities using the hierarchical summary receiver operating characteristics model. A total of 4108 articles were identified, of which 15 manuscripts met the inclusion criteria. The included studies involved 4660 patients who had undergone nasal endoscopy. Middle turbinate (diffuse/polypoid) oedema (sensitivity 58.0%, specificity 84.5%), watery secretions (sensitivity 65.7%, specificity 76.5%), inferior turbinate hypertrophy (sensitivity 86.2%, specificity 32.2%), and unspecified turbinate hypertrophy (sensitivity 82.0%, specificity 42.9%) were identified as the features with the highest predictive value of inhalant allergy. Diffuse or polypoid oedema of the middle turbinate or watery secretions seen on nasal endoscopy can be a useful adjunct in the identification and diagnosis of inhalant allergy. These clinical features should be part of the diagnostic workup for patients that includes a clinical history and surrogate markers of allergic sensitisation from the skin and serum.

Establishment of a culture system for human nasal mucosa organoids with controllable differentiation

To establish a culture system for human nasal mucosal organoids with controllable differentiation to reproduce the structure and function of the source tissue through staged expansion-differentiation culture. Fresh samples of surgically resected middle turbinate and nasal polyp tissues were collected, from which the nasal mucosa epithelial cells were isolated by enzymatic digestion and filtration for continuous culture at the air-liquid interface for expansion (EO group) or staged culture for expansion and differentiation (DO group). Immunohistochemical staining was used to characterize the structure, cellular composition and ciliary function of nasal mucosal organoids in the two groups. The secretion function of the differentiated nasal mucosal organoids in DO group was evaluated using PAS staining. Both of the two organoid culture systems yielded vacuolar or solid spherical 3D organoids, and their diameters increased progressively with time. On day 16 of culture, more vacuolar organoids occurred in DO group, while more solid spherical organoids were seen in EO group, and the proportion of vacuoles was significantly greater in DO group than in EO group [(54.67±13.26)% vs (21.67±8.57)%, P < 0.05]. Short tandem repeat (STR) test of the nasal mucosal organoids and the source tissue showed a 100% match between them. On day 21 of culture, scanning and transmission electron microscopy of the nasal mucosal organoids identified ultrastructure of cilia in DO group and short villi structure in most of the organoids in EO group. Immunohistochemical staining showed positivity for P63 (basal cells), β-tubulin (ciliated columnar cells), and MUC5AC (goblet cells) in the organoids. Compared with those in EO group, the organoids in DO group showed significantly greater percentages of ciliated cells [(7.95±1.81)% vs (27.04±5.91)%, P < 0.05] and goblet cells [(14.46±0.93)% vs (39.85±5.43)%, P < 0.05) with a similar percentage of basal cells [(56.91±14.12)% vs (53.42±15.77)%, P > 0.05]. The differentiated nasal mucosal organoids in DO group were positively stained for glycogen. The staged expansion-differentiation culture method allows more stable and prolonged growth of the cultured cells in vitro to produce organoids with controllable differentiation closely resembling the morphological structure and functions (ciliary function and secretory function) of the source tissue.

Compositional Alterations of the Nasal Microbiome and Staphylococcus aureus-Characterized Dysbiosis in the Nasal Mucosa of Patients With Allergic Rhinitis.

Host-microbial commensalism can shape the innate immune response in the nasal mucosa, and the microbial characteristics of nasal mucus directly impact the mechanisms of the initial allergic responses in the nasal epithelium. We sought to determine alterations of the microbial composition in the nasal mucus of patients with allergic rhinitis (AR) and to elucidate the interplay between dysbiosis of the nasal microbiome and allergic inflammation. In total, 364,923 high-quality bacterial 16S ribosomal RNA-encoding gene sequence reads from 104 middle turbinate mucosa samples from healthy participants and patients with AR were obtained and analyzed using the Quantitative Insights into Microbial Ecology pipeline. We analyzed the microbiota in samples of nasal mucus from patients with AR (n=42) and clinically healthy participants (n=30). The Proteobacteria (Ralstonia genus) and Actinobacteria (Propionibacterium genus) phyla were predominant in the nasal mucus of healthy subjects, whereas the Firmicutes (Staphylococcus genus) phylum was significantly abundant in the nasal mucus of patients with AR. In particular, the Ralstonia genus was significantly dominant in the clinically healthy subjects. Additional pyrosequencing data from 32 subjects (healthy participants: n=15, AR patients: n=17) revealed a greater abundance of Staphylococcus epidermidis, Corynebacterium accolens, and Nocardia coeliaca, accounting for 41.55% of mapped sequences in the nasal mucus of healthy participants. Dysbiosis of the nasal microbiome was more pronounced in patients with AR, and Staphylococcus aureus exhibited the greatest abundance (37.69%) in their nasal mucus, in association with a positive response to house dust mites and patients' age and height. This study revealed alterations in the nasal microbiome in the nasal mucus of patients with AR at the levels of microbial genera and species. S. aureus-dominant dysbiosis was distinctive in the nasal mucus of patients with AR, suggesting a role of host-microbial commensalism in allergic inflammation.

Role of mitomycin-C to reduce post FESS adhesion and ostial stenosis

The aim of this study is to determine adhesion formation rate and antrostomy closure rate after the use of Mitomycin-C in patients underwent FESS. This is a prospective case control study conducted at ENT Department Lyari General Hospital, Karachi, Pakistan. Fifty one patients included with diagnosis of bilateral chronic rhinosinusitis or allergic fungal sinusitis and were the surgical candidate, underwent bilateral Functional Endoscopic Sinus Surgery (FESS). The patients were evaluated using Lund-Mackay staging system prior to surgery. At the completion of surgery Mitomycin-c (MMC) was applied in one nasal cavity the other nasal cavity served as a control. Among fifty one patients both nostrils were used hence we have 51 cases and 51 controls. The patients were followed for a minimum period of three months after surgery. Subjective improvement of symptoms were recorded as well as rigid nasoendoscpic examination was also performed regularly. The adhesion formation rate in MMC applied nasal cavities was 11.7% as compared to 64.7% of controls. The middle meatal antrostomy closure rate was 41% and 5% in controls and MMC applied group respectively. Hence mitomycin-c application has shown benefit in reducing post FESS ostial stenosis and adhesion formation between middle turbinate and lateral nasal wall. Application of Mitomycin-C has impact on reducing post FESS adhesion formation and middle meatal antrostomy closure.

A Potential Role of B7-H4 Expression in Predicting the Recurrence of Chronic Rhinosinusitis with Nasal Polyps.

BackgroundChronic rhinosinusitis with polyps (CRSwNP) is a common chronic inflammatory disease of the nasal cavity and sinuses with a high rate of postoperative recurrence. In this study, we aim to investigate the expression of B7-H4 in CRSwNP and its association with postoperative recurrence.MethodsA total of 80 CRSwNP patients, including 40 primary CRSwNP (pCRSwNP) patients and 40 recurrent CRSwNP (rCRSwNP) patients, 27 chronic rhinosinusitis without polyps (CRSsNP) and 32 healthy controls (HC) were enrolled in this study, and the serum, nasal polyps and middle turbinate tissue samples were collected. Peripheral and tissue B7-H4 expressions were detected by enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) and immunofluorescence, and their clinical values in predicting postoperative recurrence of CRSwNP were evaluated.ResultsWe identified significantly higher tissue B7-H4 mRNA levels in the CRSwNP group than in the HC group, and elevated B7-H4 levels were associated with tissue eosinophil count and percentage (r = 0.469, P < 0.001; r = 0.521, P < 0.001). B7-H4 mRNA and protein levels were significantly higher in the rCRSwNP group than the pCRSwP group. Multivariate analysis and receiver operating characteristic (ROC) curves showed that tissue B7-H4 levels were associated with postoperative recurrence in patients with CRSwNP (P < 0.05). In addition, serum B7-H4 levels were significantly increased in the CRSwNP group than the CRS and HC groups, especially in the rCRSwNP group (P < 0.05), and the ROC curve presented a predictive ability of serum B7-H4 in predicting postoperative recurrence.ConclusionOur results indicated that B7-H4 level was clearly enhanced in CRSwNP patients and associated with postoperative recurrence. Serum B7-H4 might serve as a simple and convenient biomarker for early predicting postoperative recurrence in CRwNP patients.

Clinical Significance of Nasal Pathologies in Transnasal Transsphenoidal Pituitary Surgery

We evaluated the frequency of nasal pathologies and the significance of surgical access to the sellar region in patients who underwent an operation for sellar mass using the endonasal and microscopic transsphenoidal approaches. We retrospectively evaluated all patients who underwent surgery for pituitary macroadenoma using microscopic (n=78) and endonasal (n=20) transsphenoidal approaches. Patients' epicrisis, preoperative, and postoperative imaging as well as their operative notes were reviewed. Nasal pathologies and surgeries performed before or during the pituitary surgery were also documented. All endonasal surgeries were binostril and performed jointly by an ear, nose, and throat specialist and neurosurgeon. To determine the feasibility of endonasal and microscopic approaches, we developed an algorithm using the septum deviation classifications to determine the need for septoplasty. The most common nasal pathology was septum deviation (n=17; 17.3%). Of the other nasal pathologies, 6 cases (6%) were chronic sinusitis and 2 were (2.1%) middle turbinate bullosa. The preoperative evaluation of patients undergoing endonasal transsphenoidal surgery by an ear, nose, and throat surgeon allows for the detection and treatment of nasal pathologies that may lead to serious perioperative and postoperative complications. Evaluating patients with septum deviation using our classification will help determine the necessity of preoperative or perioperative septum surgery, depending on the preferred pituitary surgical method.

Relationship between the Superior Attachment of the Uncinate Process and Pneumatization of the Middle Turbinate—A Radiological Study

Objective: the superior attachment of the uncinate process (SAUP) is highly variable. Lateral types of SAUP are associated with frontal rhinosinusitis. SAUP in the middle turbinate is more common when the middle turbinate is aerated. We aim to refine these findings by studying the relationship between the SAUP type and the different subtypes of pneumatization of the middle turbinate. Methods: 200 CT sinonasal scans were analyzed by an otolaryngologist and a radiologist. All CT scans were analyzed to study the type of the middle turbinate concha bullosa and lamellar cell and the type of SAUP. Results: 379 sides were analyzed. The prevalence of the various types of SAUP were: Type I: 43.80%, Type II: 22.16%, Type III: 16.36%, Type IV: 3.69%, Type V: 9.76%, and Type VI: 4.22%. When studying the pneumatization of the middle turbinate and the SAUP types, we only found a statistically significant association between the lateral attachment of the uncinate process and the presence of a lamellar cell (p = 0.029). Conclusion: lateral types of SAUP are more likely in the presence of a lamellar cell. This finding, therefore, renders checking for lateral SAUP types in the presence of a lamellar cell even more relevant than when studying the pre-surgical CT scan. In those cases, it is advisable to perform a careful and complete uncinectomy.

The anatomy of the foramina and efferent nerve fibers from the pterygopalatine ganglion in posterolateral nasal wall.

BackgroundThe advance of endoscopic surgery has enabled selective section of the postganglionic nerve branches from pterygopalatine ganglion (PPG) as a modification of the vidian neurectomy. Recent microanatomic studies have suggested that the nasal mucosa is also innervated by multiple efferent rami associated with the sphenopalatine artery (SPA) in the procedure “posterior nasal neurectomy.” This anatomic cadaveric study aims to identify all postganglionic nerve fibers in the lateral nasal wall which should inform future surgical procedures aimed at interrupting these nerve fibers.MethodsTwo cadaver heads, with a total of three individual sides, were dissected. All neurovascular structures penetrating the vertical plate of palatine bone were carefully identified following meticulous removal of the overlying mucosa layers. The efferent nerve fibers were identified and dissected back to their origin—the PPG or greater palatine nerve.ResultsSeveral foramina with efferent PPG nerves were identified on the vertical plate of the palatine bone and medial pterygoid plate. The superior, middle, and inferior turbinates (IT) were innervated by efferent nerves from the PPG via the anterior region of the SPA. The IT was innervated from nerves originating from behind the SPA through bony foramina. The lateral wall of inferior meatus was innervated by efferent nerves that originated from greater palatine nerve and pharyngeal nerve.ConclusionThis study demonstrated the anatomical positions of the postganglionic nerves that innervate the lateral nasal wall. These nerves are located anterior to the SPA as well as posterior to the SPA, where they penetrate the palatine bone.Level of evidence: NA.

Choanal Polyps Originating from Unusual Sites: A Rural Tertiary Care Center Experience.

Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction ( n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus ( n = 6), middle turbinate ( n = 3), posterior septum ( n = 3), sphenoid sinus ostium ( n = 1), and inferior meatus ( n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp ( n = 12), actinomycosis ( n = 1), and rhinosporidiosis ( n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.

Anatomical, histochemical and surface ultrastructural characteristics of cavum nasi of the common quails (Coturnix coturnix. Erlangeri).

Ten normal, mature and common quails were used to study in detail the gross anatomy, histochemical and surface ultrastructural characteristics of the nasal cavity. The relationship between the structure and function of the nasal cavity also were assessed. The quail nasal cavity was divided into the vestibule, nasal cavity proper and fundus. The nasal cavity began rostrally by two slit-like external nares located laterally in the middle third of the upper beak. A previous authors stated that no rostral concha but the current study record that the rostral nasal concha was located opposite the nostrils and exhibited a C-shaped appearance in transverse section and was 5 mm long and 3 mm wide. The middle nasal concha was narrow and elongated. The caudal nasal concha was spherical, located caudodorsal to the rostral nasal concha and measured 2 mm in diameter. The infraorbital sinus was a roughly triangular cavity situated immediately rostral to the orbit. The histological and surface ultrastructural study of the nasal cavity of common quail did not studied previously. Histologically, the cavum nasi was composed of three regions: vestibule, respiratory and olfactory. The vestibule was lined with stratified squamous epithelium that was keratinized rostrally and non-keratinized caudally. The respiratory region was covered by pseudostratified columnar epithelium. Intra-epithelial mucous glands were present in the respiratory region and displayed a strong reaction with Alcian blue. The lining epithelium in the olfactory region was pseudostratified and contained olfactory, supporting and basal cells.

Contributions of the rostral vs. middle conchae in temporal countercurrent exchange in the domestic chicken

The nasal conchae in extant endothermic vertebrates have been hypothesized to contribute to heat conservation during breathing at low ambient temperatures and heat dissipation at high ambient temperatures. In birds, the rostral and middle conchae in the nasal cavity increase surface area of the respiratory epithelium while decreasing the distance between the epithelium and the respiratory airstream. This improves the efficiency of heat and water transfer between them during temporal countercurrent exchange. To determine the role of each concha, we used surgical ablation to remove either the rostral conchae or both rostral and middle conchae in juveniles of the domestic chicken, as well as performing sham surgery on the control group (n=8, n=6, n=8, respectively). Using fast‐response thermocouples, we measured exhaled air temperature measurements at the external nares and glottis to determine heat and water savings in different portions of the upper respiratory tract. Measurements were taken in adult chickens under mild sedation within the ambient temperature (Ta) range of 10‐40°C and relative humidity of 30%. We expected that minimum exhaled air temperatures (Te) in animals which had undergone conchaectomies would be higher than those of the control group, especially in individuals with both the rostral and middle conchae removed. As expected, Ta had a significant effect (MANOVA, p&lt;0.0001) on the efficiency of heat exchange in the nasal cavity, with the most pronounced (Ta‐Te) difference at the lowest Ta (10°C), and the least at the highest Ta (40°C). We also found surgical treatment had a significant effect, with double conchaectomised animals having higher Te’s than either the sham (p&lt;0.05) or single conchaetomised (p&lt;0.01) animals. Surprisingly, there was no significant difference between the latter two treatment groups. We found a significant interaction between Ta and surgical treatment (p&lt;0.001), Ta and animal sex (p&lt;0.01), and treatment and sex (p&lt;0.05), Hens had slightly higher Te’s than roosters. Whether this was an effect of body mass, breathing rate, or cranial thermal windows (comb, wattle) remains to be determined. Overall, our data suggest that the middle conchae makes a significant contribution to the efficiency of the temporal countercurrent exchange in the nasal cavity, but the rostral conchae does not. Which begs the question – why did the rostral concha evolve?

Using of panoramic and posteroanterior cephalometric radiographs to identify the optimal nasal passage for nasotracheal intubation.

Selecting the optimum nasal passage for nasotracheal intubation is quite important in the maxillofacial surgeries for the success of intubation and the reduction of potential complications such as nasal mucosal laceration, epistaxis, avulsion of the inferior and middle turbinates, and septal laceration. The present study evaluates standard panoramic radiographs (PR) and posteroanterior cephalometric radiographs (PACR) to determine the optimal nasal passage for nasotracheal intubation and compares the results with those of routine anesthesiological occlusion and spatula tests (ST). The results of occlusion tests (OT), ST, and radiological assessments of 60 patients prior to nasotracheal intubation were compared with the nasal endoscopic assessment results, and complications were evaluated. There was no significant association between the OT and nasal endoscopy results (P = 0.075). A significant association was found between the ST and nasal endoscopy results (P = 0.000), and between the radiological assessments and the nasal endoscopy results (P = 0.000). Compatibility with nasal endoscopy was 54% when the occlusion and ST were evaluated together, 75% when the OT and radiological assessments were evaluated together, and 86% when the ST and radiological assessments were evaluated together. The highest level of compatibility was 92% when all the tests were evaluated together. The simple tests alone were found to be inadequate for the selection of the optimal nasal passage. Evaluation of PR and PACR, which are commonly used in maxillofacial surgeries, together with simple anesthesiological examination tests would increase nasotracheal intubation success and decrease complications.

Evaluation of Paranasal Sinus Volumes and Anatomic Variations in Patients With Rhinogenic Headache

Background: Rhinogenic headache is a common finding that may occur due to features related to the nasal cavity and paranasal sinuses without any underlying rhinological disease. It is thought that paranasal sinus volumes and anatomical variations may have an effect on this symptom. The aim of this study is; to investigate the paranasal sinus volumes and remarkable anatomical variations in patients with rhinogenic headache. Materials and methods: Paranasal sinus tomography images and hospital files of 72 patients who were referred to the otolaryngology department were evaluated retrospectively. The volumes were calculated by the sinus volume index method and the presence of septal spur, concha bullosa, onodi cell, haller cell, agger nasi cell and paradoxical middle turbinate were evaluated as anatomical variations. As the control group, the data of 40 patients who were operated with open technique rhinoplasty for esthetic purposes were taken and the results were compared statistically. Results: The frontal sinus volume index was 4.57 cm3 in the patient group and 6.02 cm3 in the control group, and this difference was statistically significant. No significant difference was found between the two groups in other paranasal sinus volumes. The presence of septal spur was observed more frequently in the patient group, and this result was found to be statistically significant. There was no significant difference between the two groups regarding other anatomical variations. Conclusions: The low sinus volume may have an effect on the formation of rhinogenic headache. The presence of a septal spur may create a possible mucosal contact point, leading to rhinogenic headache.

Peri and Postoperative Compli-cations of Endoscopic Posterior Limited Septoplasty Versus Con-ventional Method Septoplasty in Endoscopic Nasal Surgery

Background: A significant percentage of patients undergone endoscop-ic sinus surgery has septal deviation, that disturb adequate access to the osteomeatal complex or to the region of axilla of the middle turbinate. The good exposure is the most important key to a successful surgery. Straightening such a deflection improve the access to the work site on the lateral wall of the nasal cavity. Objective: To compare the peri and post operative complications be-tween conventional septoplasty (cottle's method) and the endoscopic posterior limited septoplasty in endoscopic sinus surgery. Patients and Methods: Forty patients (all of them had a limited posterior nasal septal deviation ,nasal and paranasal sinus pathology in addition to septal deformity),were selected and divided randomly into two equal groups, (by the type of surgery for septal correction. group A which underwent conventional (Cottle's septoplasty), while group B that had endoscopic type septoplasty). All patients were assessed in the otolaryn-gology department in AL- Immamain Al khadimain medical city, from October 2016 to November 2017.patients were evaluated pre and post operatively by clinical and endoscopical examination, and followed in a period of 1week, 1month and 3months post operatively. Results: Functional endoscopic sinus surgery was the most primary sur-gery done, followed by Dacrocystorhinostomy and Endoscopic spheno-palatine artery ligation .Most common intraoperative complication was mucosal flap tear which observed more in conventional group, .Regarding mean operative time for limited septoplasty it was shorter in endoscopic group .Synechia and delay wound healing as a post opera-tive complication was more in endoscopic group, while hematoma and perforation was more in conventional group. Conclusion: During endoscopic sinus surgery, limited posterior septal deviation can be corrected by endoscopic method which provides better direct visualization of the deviation, more conservative surgical manipu-lation, shorter in time and less intra and post-operative complications. Keywords: Functional Endoscopic Sinus Surgery( FESS), Dacrocysto-rhinostomy (DCR), ostiomeatal complex(OMC), deviated nasal sep-tum(DNS)