Paranasal Research Articles

Effects of volume ratios of tongue and oral cavity on upper airway in skeletal Class II cases

Abstract Background The relationship between tongue volume and oral cavity volume (TV/OCV) ratio and upper airway volume is of great interest especially in skeletal Class II cases because they are commonly associated with retruded mandible as seen in Class II div. 1. It results in backward displacement of the tongue and hyoid bone causing reduction in the upper airway volume. This reduction in the upper airway volume is a causative factor for some common respiratory disorders such as obstructive sleep apnea syndrome. Aim The present study was carried out to find the effect of tongue size and oral cavity size and their ratio on the upper airway volume in skeletal Class II cases. Methods A cross-section study was performed on cone beam computed tomography images of 40 skeletal Class II patients whose age ranges from 17 to 22 years old. The volume of the nasopharyngeal airway, oropharyngeal airway, hypopharyngeal airway, nasoethmoid cavity (nasal cavity and ethmoid sinus), right and left maxillary sinus and oral cavity airway were calculated by using materialize Mimics Medical, Version 21.0. Correlation of each segment with TV/OCV ratio was detected. Results It was found that TV/OCV ratio had a significant positive correlation with TV (P < 0.05). TV/OCV ratio had a highly significant negative correlation with oral cavity airway volume (P < 0.001). Conclusions These findings reflect the relationship of TV/OCV and their ratio on the upper airway especially in skeletal Class II malocclusions.

The human craniospinal venous system and its influence on postural intracranial pressure: a review.

The cerebral and spinal venous systems have similar functions but unique anatomical and physiological properties. CSF occupies space in the cranial and spinal vaults, is continuously produced, and has many roles, including maintaining a favorable environment for CNS structures. The influence of the cerebrospinal venous system on CSF dynamics has been theorized since the 1940s. Newer studies suggest venous outflow pattern alterations in response to changes in body position. However, the relationship of postural cerebrospinal venous outflow shifts with and their influence on CSF homeostasis is not well understood. The authors searched the published literature related to the anatomy and function of vertebral venous plexus (VVP), CSF, and positional cerebral venous flow characteristics. A comprehensive collection of literature was compiled and reviewed, and the relationship between cerebrospinal and venous system changes and alterations in body positions, with an emphasis on the craniocervical system, is discussed. The VVP is a network of valveless veins extending from the sacrum to the cranium that are interconnected with the cranial dural sinuses. The internal VVP occupies space within the extradural spinal canal and functions to return spinal venous blood to the heart, but it has additional properties, including the capability of bidirectional venous flow, an intraspinal dilatory capacity, and a role in cerebral venous outflow. When one rises to the upright position, CSF shifts toward the spinal canal and force vectors change, leading to reduced intracranial CSF pressure; simultaneously, cerebral venous outflow shifts from the jugular vein to the VVP outflow pathway. The venous outflow shift mechanism and its purpose are poorly understood. The authors review the known physiology of the system, identify gaps in knowledge to direct future research, and propose an interpretation of these data, concluding that position-dependent CSF and cerebrospinal venous shifts are part of a complementary positional craniospinal pressure regulation system that must be kept in balance for optimal CNS function. Current knowledge of the cerebrospinal venous anatomy, dynamic flow characteristics in response to gravity, and the venous system's influence on CSF suggests that the VVP plays a role in influencing CSF pressure, and the authors hypothesize that it plays a role in supporting intracranial pressure in the upright body posture. Further research is needed to better characterize the functional relationship of the VVP to CSF dynamics as well as identify potentially related disease states.

Multicompartmental Paranasal Sinus Osteoma Complicated by Frontal Bone Hyperostosis, Intracranial Mucocele, and Inflammatory Pseudotumor

Parasinusal osteoma complicated by intracranial and orbit extension, cranial vault hyperostosis, intracranial mucocele and inflammatory pseudotumor is exceptional. A 68-year-old man complaining a long history of progressive proptosis and recurrent episodes of keratoconjunctivitis of the left eye, with restriction in upward gaze, was observed. Contrast-enhanced magnetic resonance imaging revealed a frontal sinus lesion extending to the left anterior fossa and orbit, featuring intracranial cystic component and heterogeneous contrast-enhancement. Head computed tomography confirmed the double calcific-cystic nature of the lesion. A left supraorbital-pterional approach allowed the complete resection of mucocele and drilling of intracranial and orbital osteoma, including the intra-sinusal component. The frontal sinus was cranialized and a flap of pericranium, reinforced by Gelfoam sponge, was reflected on the anterior cranial base/orbital roof. The postoperative course was uneventful; MRI depicted resolution of the proptosis. The histologic examination was in favor of parasinusal osteoma associated to intracranial mucocele, frontal bone hyperostosis and inflammatory pseudotumor.

Assessment of Quality of Life after Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis

Abstract Background: Chronic rhinosinusitis is the most common otolaryngologic disease that has a great impact on patient’s quality of life. Patients refractory to medical therapy require functional endoscopic sinus surgery (FESS). Aim: To evaluate and compare the disease specific quality of life in patients of chronic rhinosinusitis pre operatively and after FESS using the Sino Nasal Outcome Test 22 (SNOT 22). Patients and Methods: This prospective longitudinal study was conducted on 30 patients with chronic rhinosinusitis. History, clinical, diagnostic sinonasal endoscopy and radiological findings were recorded. For assessing the quality of life, the SNOT-22 questionnaire was used preoperatively and after 1 week, 1 month and 3 months after undergoing FESS. Results: About 43.3% of the patients were males and 56.7% were females. Seventy percentage were between 18 and 30 years. Nasal obstruction was the most common presenting symptom (96.6%), followed by nasal discharge (80%). Diagnostic sinonasal endoscopy and non-contrast computed tomography scan of paranasal sinuses reflected the extent of the disease. The mean pre-operative SNOT-22 score was 40.4 ± 12.06 and a decrease in mean post-operatives scores was observed during their post-operative visits at 1 week (11.77 ± 3.39), 1 month (4.67 ± 2.77) and 3 months (2.47 ± 1.28) which were statistically significant. Conclusion: Chronic rhinosinusitis patient’s refractory to medical treatment showed statistically significant improvement in their quality of life after undergoing FESS.

Is the Morphometry of Paranasal Sinuses Valid for Age and Gender Determination in a Sample of Egyptian Children Population?

Is the Morphometry of Paranasal Sinuses Valid for Age and Gender Determination in a Sample of Egyptian Children Population?

Non-keratinizing squamous cell carcinoma – A rare variant of sinonasal tract malignancy invading orbit: A case report and review of literature

This case report presents a rare case of orbital invasion from non-keratinizing squamous cell carcinoma (NKCa) of paranasal sinuses. A male patient presented with painful bleeding from a mass near the left eye, blood-stained discharge from the left nostril, fatigue, and weight loss. There was a heterogenous lesion inferomedial to the left eye, inside the left nostril, and in the oral cavity. Palpable neck lymph nodes, computed tomography scan showing a bone-eroding lesion, histopathology, and immunohistochemistry findings suggested malignancy of the NKCa variant. Immediate chemotherapy showed improvement after the first cycle, and the patient is under regular follow-up.

Anatomical Variations Detected in Computed Tomography of Paranasal Sinuses

Anatomical Variations Detected in Computed Tomography of Paranasal Sinuses

Multidetector computed tomography evaluation of optic nerve canal in relation to posterior paranasal sinuses in Nepalese people

Multidetector computed tomography evaluation of optic nerve canal in relation to posterior paranasal sinuses in Nepalese people

Expression and clinical significance of serum squamous cell carcinoma antigen（SCCAg） in sinonasal inverted papilloma

Objective:To compare the expression levels of SCCAg in inverted papilloma of the nasal sinuses and other sinuses and sinus masses. To investigate the correlation between the expression of SCCAg in sinonasal inverted papilloma and outcome. Methods:Sixty-eight patients with unilateral nasal and sinus masses admitted to the Otorhinolaryngology Center of the Affiliated Hospital of Guangdong Medical University from September 2020 to February 2023 were randomly selected, including 31 patients with inverted papilloma （experimental group） and 37 patients with unilateral nasal and sinus masses excluding inverted papilloma （control group）. The application of automatic chemiluminescence immunoassay to test the serum SCCAg of the experimental group before surgery and 1 week after surgery, and the control group to measure the serum SCCAg before surgery. Clinical data were also collected. Results:There was no significant difference between the experimental group and the control group in gender and preoperative peripheral blood inflammatory indicators. However, there was significant difference in age and preoperative serum SCCAg level（P<0.001）. The serum SCCAg levels of the experimental group before and 1 week after surgery were significantly different（P<0.001）. The positive predictive value, negative predictive value, sensitivity and specificity of serum SCCAg in the diagnosis of varus papilloma were 92.6%, 85.4%, 77.4%, 94.6% and 0.72, respectively. The effect of serum SCCAg in the diagnosis of varus papilloma was analyzed by drawing the subject's working characteristic curve, and the area under the curve was 0.968（P<0.001）. When serum SCCAg greater than 2.7 ng/mL, the sensitivity and specificity were 67.7% and 94.6%, respectively. There was statistical significance in serum SCCAg levels between patients with and without recurrence（P<0.05）. Conclusion:The level of SCCAg in unilateral nasal and sinuses tumors, excluding squamous cell carcinoma, was significantly increased in inverted papilloma. The detection of serum SCCAg can be used as a simple and cost-effective auxiliary diagnostic tool for patients with nasal inverted papilloma before operation. Significant differences in preoperative and postoperative levels can be used for preliminary evaluation of surgical efficacy. Monitoring the serum SCCAg level in patients with inverted papilloma after surgery can predict recurrence and provide a simple and feasible method for postoperative follow-up.

Evaluation of infraorbital canal types and their relation with adjacent structures: A cone beam computed tomography study

Aim: This study aims to analyze infraorbital canal (IOC) types in patients with cone beam computed tomography (CBCT) records and to investigate the potential relationship between adjacent structure variations such as mucosal thickening, Haller cells, sinus septa, middle turbinate pneumatization (MTP) and IOC types. Methods: Bilateral evaluation of 197 CBCT records was conducted to assess mucosal thickening, Haller cells, sinus septa, middle turbinate pneumatization (MTP), and IOC types. IOC types were categorized into three classes based on their extent of protrusion into the maxillary sinus: type 1, entirely within the sinus roof; type 2, located below and adjacent to the sinus roof; and type 3, suspended from the sinus roof and descending into the sinus cavity. Results: The distribution of IOC types was as follows: 67.5% for type 1, 22.6% for type 2, and 9.9% for type 3. No significant correlation was observed between IOC types and MTP, mucosal thickening, or the presence of Haller cells. However, a significant relationship was noted between Type 3 IOC and the presence of septa. The occurrence of septa in the maxillary sinus was 8.3% for type 1 IOCs, 13.5% for type 2 IOCs, and 43.6% for type 3 IOCs (p

Study on the Effectiveness of Radiological Technologist’s Thyroid Shielding in Pediatric Paranasal Sinus X-ray Examination

Study on the Effectiveness of Radiological Technologist’s Thyroid Shielding in Pediatric Paranasal Sinus X-ray Examination

To Study The Role Of Concha Bullosa In The Aetiology Of Deviated Nasal Septum (DNS) And Sinusitis

AIMS AND OBJECTIVES : To study the role of concha bullosa in the devlopment of deviated nasal septum(DNS) and sinusitis. MATERIAL METHODS: 235 CT scans of paranasal sinuses done from March 2022 to November2022 were studied and evaluated for the presence of concha bullosa, DNS andsinusitis. RESULTS: Among 235 CT scans concha bullosa was found in 74(31.4%)patients.Among these patients, concha bullosa coexisting with DNS was found in56(75.7%) patients.Now, among these air column between concha bullosa and theseptum was found in 43 (76.7%) patients.Sinus disease was present in 48(64.8%)patients. CONCLUSION: Concha bullosa has a strong association with the existence ofconcomitant DNS.However, the presence of air column may exclude the role ofconcha bullosa in the aetiology of DNS. Presence of concha bullosa may predisposeto Sinusitis. KEYWORDS: concha, DNS, sinusitis,

Anatomical variations of sphenoid sinus in terms of volume and protrusions of optic nerve/internal carotid artery in a subgroup of Pakistani population.

To compare the volume of sphenoid sinus with protrusions of optic nerve and internal carotid artery in both males and females. The cross-sectional study was conducted from October 2020 to February 2021 at the Radiology Department of Dow University of Health Sciences, Karachi, and comprised males and females aged 20-60 years having no sphenoid sinus bony abnormality. Sphenoid volume and optic nerve and internal carotid artery protrusions were examined in the computed tomography scans of the paranasal sinus. Based on the protrusions, the scan findings were split into four groups: Group 1 had no protrusion, Group 2 had optic nerve protrusion, Group 3 had internal carotid artery protrusion, and Group 4 had protrusions of both the optic nerve and the internal carotid artery. Data was analysed using GraphPad Prism 9. Of the 300 subjects, 171(57%) were males and 129(43%) were females. The overall mean age was 39.27±10.9 years. There were 147(49%) subjects in group 4, followed by 72(24%) in group 3, 42(14%) in group 2 and 39(13%) in group 1. Statistically significant difference was observed between sphenoid volume across the study groups for both male and female subjects (p<0.001). There was significant relationship between internal carotid artery and optic nerve protrusions and sphenoid volume.

Factors influencing residual plus moist HS-W calcium alginate packing material after endoscopic sinus surgery

ObjectiveThis study aims to evaluate the presence of residual Plus Moist HS-W (PM), a novel calcium alginate packing material, during the initial postoperative visit following endoscopic sinus surgery. The research aims to identify factors that influence the quantity of remaining PM. MethodsA retrospective review of medical records was conducted for patients who underwent middle meatus packing with PM. ResultsA total of fifty-two patients (representing 92 sides of paranasal sinuses) were included in the analysis. The remaining PM was classified as follows: absent (0) in 41 out of 92 cases, minimal (1) in 22 out of 92 cases, moderate (2) in 15 out of 92 cases, and substantial (3) in 14 out of 92 cases. Notably, all three patients who underwent Draf III surgery exhibited a significant amount of PM during their initial visit, with two patients classified as grade 2 and one patient as grade 3. Other factors investigated were found to be unrelated to the persistence of PM. Removal of all PM was achieved effortlessly using suction under flexible endoscopy. ConclusionThis study highlights the efficacy of PM in post-endoscopic sinus surgery care. It is important to limit an amount of PM, particularly in Draf III procedures.

Diagnostic accuracy of double density sign on CT scan of para-nasal sinuses for fungal sinusitis taking microbiology culture as gold standard.

To compare double-density sign on non-contrast computed tomography scan of paranasal sinuses with fungal sinusitis on histopathology. This prospective study was conducted at the Shifa International Hospital, Islamabad, Pakistan, from July 1, 2021, to June 30, 2023, and comprised patients of either gender aged 20-60 years who were set to undergo functional endoscopic sinus surgery. Demographic characteristics and non-contrast computed tomography scan findings were recorded preoperatively, while microbiological and histopathology results were recorded post-operatively. The microbiological finding was taken as the gold standard. Data was analysed using SPSS 23. Of the 201 patients, 123(61.2%) were males and 78(38.8%) were females. The overall mean age was 41.62±8.52 years. The diagnostic accuracy of a double-density sign on computed tomography scan showed sensitivity 90%, specificity 90.8%, positive predictive value 84%, and negative predictive value 94.4%. A higher rate of sensitivity and specificity indicated that non-contrast computed tomography scan was an effective modality that could be used for the diagnosis of fungal sinusitis.

Ewing's Sarcoma of Maxillary Sinus.

Ewing's sarcoma is a small round cell tumor commonly involving long bones. Head and neck involvement is seen less frequently with maxillary sinus being the rarest site. Here we report a case of a12-year-old female patient presented with left side facial swelling for 3 weeks duration which was diffuse and hard on palpation. CT and MRI of Nose & para nasal sinus revealed a mass lesion in the left maxillary sinus infiltrating and eroding the orbital wall and extending intracranially. Biopsy from the lesion revealed Ewing's sarcoma with strong positivity for CD-99 marker. Patient was referred to radiotherapy due to extensive disease at younger age. The CT and MRI along with HPE and IHC markers enables early diagnosis and prompt treatment that leads to better survival and prognosis, as unlike Ewing's sarcoma of long bones, that metastasize early. The combined chemoradiotherapy is now the standard line of treatment along with close follow up for at least 2 years.

Nasal Cavity and Paranasal Sinus Cancer: Diagnosis and Treatment.

The purpose of this review is to analyze the diagnosis and treatments of the sinonasal malignant tumors throw systematic reviewed literature. The systematic review of the literature was performed according to PRISMA guidelines. Total 11,653 cases of five article were analyzed. The cohort of 3824 cases received appropriate treatment. The most frequent histotype of the group of sinonasal malignancies was squamous cell carcinoma. Squamous cell carcinoma was represented by 54%. The other histopathological subtypes were esthesioneuroblastoma with 9,9%, melanoma 9,8%, adenocarcinoma 7,5%, sarcoma 7,3%, adeno cystic carcinoma 7,1%, sinonasal undifferentiated carcinoma 3,9%, sinonasal neuroendocrine carcinoma 2,8% respectively.All 772 cases of total 3824 were treated only surgically. All 62 cases of total 3824 were treated without surgery, 20 cases with proton technique and SFUD, and 42 cases with proton technique and IMRT. The other 2990 cases of total 3824 were treated with multimodality treatment. The diagnosis and treatment of sinonasal cancers require a interdisciplinary approach and multimodality treatment.

A rare case of invasive mucormycosis with thrombosis of cerebral vasculature in diabetic ketoacidosis

Mucormycosis is a rare fungal infection. It is an aggressive angio invasive infection hence if left untreated is always fatal. This necrotising infection commonly involves the nose, paranasal sinuses, orbits and brain. Uncontrolled diabetes, immunosuppression, transplant recipients, COVID-19 infection are the commonest risk factors. Most common form is rhino orbital cerebral involvement. Antifungal agents along with surgical debridement is the mainstay of treatment. We are reporting such a case of invasive mucormycosis in a young diabetic male to stress the importance of clinical examination and early recognition of clinical signs of this rare invasive infection and aggressive management.

Endoscopic Sinus Surgery in the Management of Inflammatory Sinonasal Disease

Background: Inflammation of the nose and paranasal sinus is a clinical problem frequently encountered in the practice of otolaryngology in our country. Endoscopic sinus surgery is a minimally invasive technique for the evaluation and treatment of inflammatory sinonasal disease. Endoscopic sinus surgery is used to restore sinus ventilation and normal function of sinuses.Objectives: To see the outcome of endoscopic sinus surgery associated with inflammatory sinonasal diseases.Materials and Methods: It is a prospective observational study carried out in ENT &amp;Head Neck Surgery of Shaheed Suhrawardy Medical College Hospital Dhaka from April 2016 to September 2016.Fifty(50) patients were enrolled in this study. Data was collected by Structural Questionnaire.Result: The majority of patients were 21-30years age group. The mean age group was 35.32 years, Male: male-to-female ratio was 1.3:1. The Majority of cases were antrochoanal polyps followed by an ethmoidal polyp, chronic maxillary sinusitis, and fungal rhinosinusitis. The majority of patients came with nasal obstruction and nasal discharge. Polyp was found in the majority of cases. A major complication was found in hemorrhage. Symptomatic improvement was found following endoscopic sinus surgery. KYAMC Journal Volume: 14, No: 04, January 2024: 226-233.

Clinical Manifestations of Runny nose among Patients Attending Baqubah Teaching Hospital

Background: The runny nose refers to a discharge (fluid) coming from the nasal passages.Runny nose is associated with inflammation and swelling (congestion) of the inner lining of the nasal passages and sinuses. May associated with atopic condition the patient complain from nasal obstruction, runny nose, episode of sneezing, and nasal pruritis. Objective: To examine the demographic distribution, clinical features, and age disparities among male and female patients with Runny nose (Rhinorrhea). Patients and Methods: A study was done on 100 AR patients at Baqubah Teaching Hospital. Information on demographics, clinical symptoms, and age variations between males and females were gathered and examined through the use of descriptive statistics and independent sample t-tests. Results: The Findings revealed that most of the subjects were women (56%) and homemakers (38%), with an average age of 29.73 years. Frequent symptoms comprised of sneezing (93%), runny nose (83%), itchy nose (74%), and stuffy nose (92%). There was no notable variation in age between males and females (p = 0.139). Conclusion: Clinical symptoms of runny nose are often recognized consist of rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation and pruritus of the nasal mucosa, conjunctiva and oropharynx with history of allergic rhinitis. Conditions commonly associated with allergic rhinitis include asthma, sinusitis, allergic conjunctivitis and atopic dermatitis. Long standing disease can lead to mucosa remodeling, atrophic skin changes, nasal infection and overall increased morbidity.