Osteomeatal Complex Research Articles

A CBCT Study for Anatomic Variations of Osteomeatal complex in Patients With Cleft Lip and Palate.

To evaluate the anatomy and variations of osteomeatal complex (OMC) by comparing patients with nonsyndromic cleft lip and palate (CLP) and control group. This case-control study was retrospectively analyzed using cone-beam computed tomography data. Istanbul University Faculty of Dentistry Department of Dentomaxillofacial Radiology. The study was conducted with 100 patients (44 females, 56 males) with CLP and 100 patients in the control group, which matched gender and age (with a maximum difference of 3 years). OMC variations are grouped as follows: ethmoidal, conchal, uncinate process, and septal variations. Then, we evaluated the presence of these OMC variations and compared them between the two groups. The McNemar's test was used to determine any significant differences between the groups for all indices at the 95% confidence level. The most common anatomic variation in this study was Agger nasi cell (97%) and concha bullosa (97%) in the patients with CLP, while Agger nasi cell was the most common variation (99%) in the controls. Moreover, the atelectatic uncinate process was the least observed variation in both groups (1%). The incidences of paradoxical concha (58%;42%), bifid concha (29%;11%), deviated nasal septum (92%;80%) were significantly higher in the CLP group (p < 0.05). The statistically significant results found when comparing OMC anatomy between the two groups reveal the importance of three-dimensional evaluation before functional endoscopic sinus surgery in patients with CLP.

RISK FACTORS INVOLVED IN RECURRENCE OF CHRONIC RHINOSINUSITIS AFTER FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN KASHMIRI POPULATION.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases, which is defined as an inflammation of the nose and paranasal sinuses. Computed tomography (CT) scan of paranasal sinuses has become mandatory for all patients undergoing functional endoscopic sinus surgery (FESS), which is, nowadays, regarded as the gold standard for treatment of CRS after a trial of medical treatment. Our aim in this study is to explore the risk factors and anatomical findings on CT scan of CRS patients who had recurrence after undergoing FESS in Government Medical College,Srinagar . METHODS: A retrospective chart review study was conducted in the department of otolaryngology head and neck surgery,GMC Srinagar, to assess the risk factors of patients with recurrent CRS after FESS. The study included all patients, who were adults 18 years of age and above of both genders that had FESS after a diagnosis of CRS between 2017 and 2019. RESULTS: The study identified 129 patients with CRS, of which 19 (14.79%) patients had recurrence after FESS. Various risk factors were taken into consideration such as age, gender, airway and inflammatory autoimmune diseases, smoking, type of sinusitis, and anatomical variations and findings on CT scan. However, only fungal type of sinusitis was found to be a significant risk factor of a recurrent CRS. Anatomical findings on CT scan postoperatively were mucosal thickening, nasal polyps, nasal septum deviation, and obliterated osteomeatal complex. CONCLUSION: CRS patients were assessed for various risk factors of recurrent CRS. The overall incidence of recurrent CRS was 14.79%. Fungal rhinosinusitis was found to be a significant risk factor. The most common anatomical findings on CT scan postoperatively were mucosal thickening in paranasal sinuses followed by nasal polyps.

Ethmoidal silent sinus syndrome after nasal swab test.

This study reported the case of a healthy male in his 40s who presented with a 3-month history of frontal headache and post-nasal drip, which did not improve with oral antibiotics. One month prior to the onset of the symptoms, he underwent a nasopharyngeal swab testing for SARS-CoV-2 (which yielded a negative result) for a history of malaise and cough. The patient claimed that the swab insertion into the nasal cavity was particularly painful on the left side. Sinus computed tomography (CT) scan showed deformity of the left middle nasal turbinate with occlusion of the osteomeatal complex, resulting in ethmoid silent sinus syndrome. This study makes a significant contribution to the literature because nasopharyngeal, midturbinate and anterior nasal swabs have been recommended as initial diagnostic specimen collection methods by the US Centers for Disease Control and Prevention (CDC) for the coronavirus disease 2019. These methods require introducing an instrument into the nasal cavity, potentially leading to adverse effects due to the delicate and complex nasal anatomy. However, complications related to swab testing for respiratory pathogens have not yet been fully discussed in the literature.

EVALUATION OF DIAGNOSTICNASAL ENDOSCOPY AND CTSCAN IN VARIOUS SINONASAL DISEASES

Objective:To evaluate role of Diagnostic Nasal Endoscopy and CT scan in various Sinonasaldiseases with regards to diagnosis and surgical intervention. Patient and methods:This prospective study was carried out in Department of ENT, A.N.M.M.C.H., Gaya on 200 patients with clinical evidence of sinonasal disease who had presented between March 2016 to February 2019. All patients were evaluated with DNE using 0 degree 4mm endoscope and CT scan with 3 mm coronal cuts. Result: Female patients(56%) were more as compared to male(44%) with majority between 21 - 40 yrs. Most common finding on Diagnostic Nasal Endoscopy(DNE) was mucopurulent discharge in middle meatuswhile on CT Scan was maxillary sinusitis(60%). Sinonasal polyp detection was better with DNE.CT has better detection rate of anatomical variation of osteomeatal complex. Conclusion : DNE has become initial tool for diagnosis as it is cost effective and office based procedure. In patients where surgical intervention is required, CT scan has advantage as it provides detailed understanding of anatomical variations. So bothDNE and CT scan should be used in collaborative fashion. Source Of Support:Patients of A.N.M.C.H., Gaya. Conflict Of Interest:None.

Maxillary sinus cyst as a risk factor for osteomeatal complex block

Introduction: Cysts of the maxillary sinuses are found in about 10% of the population. There is a necessity to clarify indications for cyst removal taking into account its size. The purpose of the study to clarify the indications for surgical treatment of maxillary sinus cysts as a risk factor for sinus drainage disorders in the development of maxillary sinusitis. Methods and materials: 57 people (92 sinuses) were examined. There were 20 patients (40 sinuses) with acute rhinosinusitis, 22 patients (22 sinuses) with post-augmentation sinusitis, and 15 (30 sinuses) almost healthy individuals among them. Prediction of the cyst size, which can lead to blockage of the maxillary sinus ostium, was performed by direct measurement on coronary sections at the ostiomeatal complex level distance from the surface of the mucoperiosteum in the area of the alveolar recessus to the lower surface of the mucosal surface in the area of the ostium. The obtained data were verified by calculation method taking into account the height of the sinus at the level of the osteomeatal complex, the magnitude of possible mucoperiosteum edema in the alveolar recessus and ostium in acute rhinosinusitis and post-augmentation sinusitis, as well as the magnitude of mucoperiosteum elevation due to sinus lift. Results: It was found that the vertical size of the cyst, which can potentially lead to blockage of the maxillary sinus ostium in acute rhinosinusitis is 21.2±0.8 mm, 14.7±1.1 mm in sinusitis after augmentation of the maxilla, and 28.5±0.7 mm in practically healthy individuals. The calculated values are 18.5 mm, 14.0 mm and 24.5 mm, respectively. In case of acute rhinosinusitis, the distance from the apex of the cyst to the surface of the mucous membrane of the ostiomeatal complex area may decrease by 12.8 mm, and in sinusitis after sinus lift it may decrease by 20.4 mm. Conclusions: To assess the potential of the ostiomeatal complex block by a cyst located in the alveolar recessus in acute rhinosinusitis, its vertical size is really important according to coronary sections of at the ostiomeatal complex level corresponding to the location of 5-6 teeth of the upper jaw. The indication for removal of the cyst of the alveolar recessus of the maxillary sinus, as a factor that may worsen the course of acute rhinosinusitis due to the anastomosis block, is its size exceeding 20 mm, and 15 mm for patients who plan to sinus lift.

A Comparative Study of Interventions of Middle Turbinate Medialization in Endoscopic Sinus Surgery.

The shape and position of middle turbinate play an important role in ventilation and drainage of the osteomeatal complex. The preservation of middle turbinate is one of the major goals of functional endoscopic sinus surgery (FESS). Middle turbinate intervention is essential to prevent obliteration of osteomeatal complex. The aim of this prospective study is to postulate which middle turbinate intervention is most effective and compare the results with conventional technique. In this randomized controlled study, 60 patients were included of the age group of 15-60years who presented to the Otorhinolaryngology OPD of our institute between November 2017 to June 2019 with symptoms of chronic sinusitis with clinical and radiological evidence and who underwent FESS. The patients were divided into three group, Group A-Bolgerization (n = 20), Group B-Vicryl-conchopexy (n = 20) and Group C-No intervention, Control group (n = 20). The patency of middle meatus and the status of middle turbinate (medialized or lateralized or neither of the two) was ascertained postoperatively. Improvement in symptoms was also evaluated. The middle turbinate was medialized in 90% of Group A and 95% of Group B cases. The middle turbinate was neither medialized nor lateralized in 70% of patients in Group C. 70% of the patients in Group A and 80% of patients in Group B had complete improvement in symptoms with no recurrence of sinusitis compared to Group C in which only 50% of the patients had improvement in symptoms due to development of synechiae. Medialization of the middle turbinate should be considered as one of the essential steps of FESS as it helps in improving the surgical outcome.

Incidence of Agger Nasi cells and Haller cells in Computed Tomography of Paranasal Sinuses

Introduction Agger nasi and haller cells are few of the common anatomical variants of Paranasal Sinuses (PNS) . They can cause obstruction of osteomeatal complex and frontal recess and can cause refractive sinusitis. Also these variants can lead to complications during procedures like Functional Endoscopic Sinus Surgery (FESS). Hence, complete knowledge about these variants and imaging features help in early diagnosis and also helps in avoiding complications during surgery. Materials and Method A retrospective study of 100 patients conducted during the period from January 2021- April 2021 in Saveetha Medical College and Hospital. All the patients included in the study were referred from the department of otorhinolaryngology for Computed Tomography of PNS. All the images were individually analysed and evaluated for occurrence of Agar Nasi cells and Haller cell variants. Results Out of the study population of 100 patients, 56% of the patients were observed for Agger Nasi cells and 19% of the patients were observed for Haller cells. Conclusion Our study concludes that agger nasi and haller cells are found in a significant proportion of the study population. Hence, Identifying these anatomical variants with great accuracy will help in diagnosing and appropriate management of refractive sinusitis and also be critical in supporting surgeons in tailoring surgery for patients when done preoperatively and thereby avoid fatal complications during procedures (1).

MUCORMYCOSIS EFFECTS ON TURBINO SEPTAL COMPONENTS-OUR EXPERIENCE.

Introduction: Mucormycosis is a aggressive and most dangerous type of oppurtunistic Fungal infection. This disease starts commonly from Nose and Para nasal Sinuses. Many a times Middle Turbinate alone and some time both Middle and Inferior Turbinate are affected. This Fungi invades the Arteries more than the Veins and produce Thrombus and further reduces blood supply to concerned region and later on resulting in Necrosis of soft and Hard tissues , which was seen clinically as Black coloured “ Eschar”, the characteristic Endoscopic nding of Mucormycosis. Objectives: To Study about the effects Mucormycosis in the Turbinate, Septum and Floor of Nasal Cavity and to know the Effect of Septal Deviation in development of Sinusitis and further development of Mucormycosis. Study Design: Analytical Study, Retrospective Study. Materials And Method: This study was conducted in Govt Thanjavur Medical College, in Department of E.N.T and Head and Neck Surgery, from May 2021 to July 2021. Total Number of cases taken for study was 81 cases. Cases with Orbital and Pterygo Palatine Fossae and Infra Temporal Fossae involvement and Intra cranial involvement are excluded from the study. All cases are subjected to DNE and classied according to ndings. All cases under went Endoscopic Sinus Surgery and tissues sent for HPE and Fungal culture, followed by Systemic Amphotericin and Regular Post Operative Follow up for 4-6 weeks. Results: Males are involved more in numbers (48) than Females. Commonest age group involved are 21 to 40years. Strong Positive association present between Post Covid-19 status and Diabetes. Middle Turbinate involved in more number (34cases), followed by Inferior Turbinate (21 cases) and Septum (18 cases). Most common Anatomical factor present are High Septal Deviation (60 cases) and Osteo Meatal Complex (OMC) crowding (56 cases). Discussion: Mucormycosis is a Fulminant Fungal infection, which is common in Immunodecient individuals. Patients with Uncontrolled Diabetes Mellitus, on Prolonged Steroid therapy and Post COVID_19 status are very much prone for this infections. Angio invasion to Arteries and the resultant formation of Thrombi and Gangrene of involved areas is characteristic of Mucor. Black coloured dead tissue is called as ESCHAR. Depending upon the Arterial involvement Anterior half of Middle Turbinate or Posterior half of Middle Turbinate is involved, Posterior half of septum or entire septum is also involved. High septal deviation gives indirect disturbances to Osteo Meatal Complex functions resulting in development of Sinusitis and further chances of developing Mucormycosis. Early Surgical debridement of dead tissues followed by Inj.Amphotericin is very important in restriction of Disease spread. Proper management of predisposing factors and Postoperative Regular Weekly follow up and Endo Cleaning reduces the Recurrences. Conclusion:In our Study Males are affected more in numbers. 21-40 years are affected more. High Septal Deviation and OMC crowding are present in more number of patients which was responsible for the development of Acute Sinusitis. Post Covid status and Uncontrolled Diabetes was the commonest Predisposing factor the development of Mucormycosis. Middle Turbinate was involved more in numbers followed by Inferior Turbinate and Septum. Routine Examination followed by Nasal Septal Correction plays a major preventive role in development of sinusitis and further dreaded complications like Mucormycosis. Adequate Glycemic Control and Inj Amphotericin plays important role in the management of Mycormycosis. Regular Follow up with Endo Cleaning is reduces the chances of Recurrence.

Does Degree of Nasal Septal Deviation Measured with CT PNS have a Role in Management of Deviated Nasal Septum?

Deviated nasal septum is one of the most commonly encountered nasal anatomical abnormalities. Various studies showed that deviated nasal septum results in the osteo-meatal complex disease and compensatory turbinate hypertrophy. But only a few studies described the association between type and degree of angle of deviated nasal septum and measured the angle of septal deviation and explore its effect in causation of nasal symptomatology. Hence, this study was undertaken with the aim to study the relation between type and degree of septal deviation with nasal symptomatology and to measure the degree of septal deviation. This was an observational study and data collection was done from August 2017 to August 2019. A total 52 patients with symptomatic deviated nasal septum were studied. Higher septal deviation caused symptoms in 73% of cases and severe degree of angle of septal deviation caused symptoms in 63% of cases. High and severe deviated nasal are more associated with nasal symptoms. Therefore, we could derive a correlation between the cases with higher septal deviation and incidence of nasal symptoms.

Incidence of concha bullosa and its role in chronic rhinosinusitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pneumatization of nasal turbinates is called concha bullosa. Most often it involves the middle turbinate and is one of the commonest variants of sinonasal anatomy. Bulbous and extensive type of concha bullosa may lead to narrowing or even complete blockage of osteomeatal complex. This alters the normal airflow and drainage pathways of mucous, resulting in mucosal edema which obstructs the ethmoidal infundibulum and osteomeatal obstruction leading to sinusitis. The aim of the study was to determine the incidence of concha bullosa and assess its role in causation of chronic rhinosinusitis. The objective was to determine the incidence of concha bullosa and assess its role in chronic rhinosinusitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study of 120 patients suffering from chronic sinusitis of age group 18 years to 70 years old were taken between March 2018 to January 2021 at Malla Reddy institute of medical sciences (MRIMS) who had nasal symptoms significant enough to warrant a CT paranasal sinus (CT PNS) with positive findings. All PNSs involved were identified for sinus disease. Concha bullosa identified and graded into small, moderate and large. Patients with history of previous nasal surgeries were excluded.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our study showed 54% cases of chronic sinusitis with concha bullosa.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Concha bullosa may be one of the predisposing factors of chronic rhinosinusitis and hence surgical manipulation by functional endoscopic sinus surgery (FESS) is important to prevent recurrence of sinusitis.&lt;/p&gt;

A comparative study of synechiae formation in endoscopic septoplasty with and without intranasal splints

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Septoplasty is the treatment of choice for deviated nasal septum. Deviated nasal septum can be C shaped or S shaped leading to unilateral or bilateral nasal obstruction. Septal spur may also require surgery. Sometimes deviated nasal septum may block osteomeatal complex leading to chronic sinusitis. For the evaluation of nasal cavities preoperatively computed tomography (CT) paranasal sinuses and diagnostic nasal endoscopy is done. Diagnostic nasal endoscopy done after two weeks of surgery. The objective of the study is to compare the efficacy of intranasal splints in the prevention of nasal synechiae following septoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 100 patients undergoing septoplasty under general anesthesia from March 2018 to March 2019 were enrolled. Patients with nasal septal deviation and aged between 18-50 years were included in the study. All surgeries were performed by consultant ear, nose and throat (ENT) surgeons under general or local anesthesia. Institutional ethical committee approval was obtained for the study. Informed consent was obtained from all patients. Patients with age under 18 years or over 50 years were excluded for the study. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Septoplasty with intranasal splints reduce the formation of synechiae in 48 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Usage of intranasal splints indicates a decrease in the postoperative formation of synechiae after septoplasty.&lt;/p&gt;

Aspergillosis of the Maxillary Sinus Associated With Dental Implant.

Aspergillosis is a fungal disease caused by the fungus Aspergillus; this disease frequently involves the lungs and occasionally the maxillary sinus. Aspergillosis in the maxillary sinus usually has the characteristics of a noninvasive form. It has been suggested that spores of aspergillus can be inhaled into the maxillary sinus via the osteomeatal complex or via an oroantral fistula after dental procedures, such as an extraction. However, maxillary aspergillosis related to implant installation has rarely been reported. This report regards unusual cases of maxillary aspergillosis associated with dental implant therapies in healthy patients. The cases were successfully treated with the surgical removal of the infected or necrotic tissues.

Nasolacrimal Duct Obstruction and Frequency of Agger Nasi Cell and other Anatomical Field Variations: A Controlled Study in Northern Iran

In this study, we aimed to find the frequency of agger nasi cells (ANC) and their correlation with other anatomical anomalies in dacryocystorhinostomy (DCR) candidates, compared with a control group. The study was conducted on 42 patients with nasolacrimal duct obstruction who underwent DCR surgery. Also, 80 C.T. of healthy sex- and age-matched subjects were selected as the control group. Paranasal sinuses computed tomography scanning was performed preoperatively, and abnormalities including ANC, concha bullosa, osteomeatal complex disease (OMC), nasal septum deviation, and polyposis were investigated and registered. Radiologic findings showed ANC presence in 83.3% of cases, and frequency of concha bullosa was 23.8%, and OMC disease, septal deviation, and nasal polyposis recorded as 11.9%, 85.7%, and 14.3%, respectively. In the control group, ANC was found in 52 subjects (65%), and the difference was statistically significant (P=0.036). There was no significant correlation between the presence of ANC and the coexistence of other mentioned anatomical changes as attributing factors for NLD obstruction. The frequency of ANC was much higher in patients with NLD obstruction compared with the control group, but its association with other anomalies was non-significant.

Partial Middle Turbinectomy Versus Medialization Suturing of Middle Turbinate in the Management of Sinonasal Polyposis: A Comparative Study.

The main goals of endoscopic sinus surgery (ESS) is, to enlarge the sinus ostia. Most common cause of failure of ESS is lateralization of the middle turbinate causing recurrent blockade of osteomeatal complex (OMC) and recurrence of disease. Many techniques have been described for preventing lateralization of the middle turbinate. We compared the postoperative outcomes following endoscopic sinus surgery (ESS) for sinonasal polyposis (SNP) with medialization suturing of middle turbinate and partial middle turbinectomy. 60 patients who underwent ESS for SNP were divided into three groups, Group A (Medialization suturing of the middle turbinate with septum), Group B (partial middle turbinectomy) and Group C (control-no middle turbinate intervention). Preoperative Lund Kennedy scoring, Lund McKay scoring, SNOT 22 scoring was done. Post-operatively, Lund Kennedy scoring was done at 1st, 4th, 12th week and SNOT 22 scoring was done at 4th, 12th week. Statistical analysis and comparison of data between the groups was done. Both the techniques, helped to improve OMC patency, mucosal healing, and to minimize adhesions. Medialization of the middle turbinate helped in improvement of SNOT 22 and Lund Kennedy scores in the postoperative period as compared to the non-interventional group. However, between the two middle turbinate interventional groups there was no statistically significant difference. Achieving middle meatal patency by middle turbinate interventions improves the postoperative outcomes. However, long-term follow-up studies are recommended for evaluation of efficacy of these techniques and to look for recurrence of disease in SNP.

Assessment of odontogenic changes in computed tomography of patients with chronic sinusitis

IntroductionChronic sinusitis can be caused by both laryngological and dental factors. The number of odontogenic sinusitis (OS) in last decades is increasing and seems to be underrated. A unique developmental and microbiological factors causing OS require a different therapeutic approach.Material and methodsThis study evaluated tomography examinations of 500 patients with a clinical diagnosis of chronic sinusitis. The patients were referred by laryngologists, neurologists, and maxillofacial surgeons. The scans were reanalyzed in view of the presence of odontogenic and laryngological pathologiesResultsAmong the 500 patients, 19,6% showed no inflammatory changes in the mucosa of the paranasal sinuses. All patient groups had numerous teeth missing, ranging from 27.3% to 33.2%. Most common odontogenic pathologies were periapical changes (28,8%) and the presence of teeth after improper endodontic treatment (24,2%). In the group in question dental implants (0,4%) and maxillary sinus augmentation (2,8%) were a marginal etiological factor.ConclusionsComputed tomography allows a thorough assessment of odontogenic changes. Obstruction of osteomeatal complex does not have direct influence on OS development. 43,2 % of the patients with chronic sinusitis have OS. It can be diagnosed in 50,8% of isolated right, 39,0% of isolated left and 57,8% of bilateral maxillary sinusitis patients. The results of this study can be used by dentists, maxillofacial surgeons and otolaryngologists to improve the standard of diagnosis and treatment in case of chronic odontogenic sinusitis.

Impact of septoplasty alone or with endoscopic sinus surgery for treatment of chronic rhinosinusitis with deviated septum

BackgroundChronic rhinosinusitis represents an important health care problem in the world. Deviated nasal septum leads to increased chance of impaired mucociliary clearance, osteomeatal complex obstruction, and development of rhinosinusitis. Studies have revealed the role of septoplasty in curing chronic rhinosinusitis in patients with significant septal deviation. The purpose of this study is to reveal the role of septoplasty alone or combined with functional endoscopic sinus surgery in improving the outcome of chronic rhinosinusitis in patients with significant septal deviation.ResultsPostoperative computed tomography findings in group A (underwent septoplasty only) were mild opacity of ethmoid (25%), sinus mucosal thickening (15%), and occluded osteomeatal complex with discharge (25%). Postoperative computed tomography findings in group B mild opacity of ethmoid (30%), sinus mucosal thickening (20%), and occluded osteomeatal complex with discharge (30%). The Sino-Nasal Outcome Test score in group A decreased significantly from 85.75 to 28.85 (P < 0.05). In group B (underwent combination of septoplasty and functional endoscopic sinus surgery), the Sino-Nasal Outcome Test score also decreased significantly from 87.75 to 32.55 (P < 0.05). The improvement was 85% in group A and 80% in group B.ConclusionThe post-operative improvement has no significant difference between the two groups. Hence, we suggest that septoplasty alone can be adequate for the treatment of chronic rhinosinusitis with septal deviation.

Computed Tomographic Comparison of Length, Width and Angulation of Ethmoidal Infundibulum in Patients With and Without Maxillary Sinusitis.

Ethmoidal infundibulum (EI) is an important part of the osteomeatal complex, which provides the main pathway for the maxillary sinus drainage. This study aimed to compare the length, width, and angulation of EI in patients with/without maxillary sinusitis using computed tomography (CT). This cross-sectional study evaluated 818 spiral CT scans of patients with/without maxillary sinusitis (n = 409 maxillary sinuses in each group) classified according to the clinical symptoms and the Lund-Mackay score for mucosal thickening. The degree of mucosal thickening (on axial and coronal sections), anatomical variations namely concha bullosa (CB), ethmoidal bulla (EB), and Haller cells (HCs), the form of EI (on coronal sections), the length, width and angulation of EI, and degree of nasal septal deviation (on coronal sections) were all evaluated. Data were analyzed by parametric and non-parametric tests (alpha = 0.05). The frequency of EB (P < 0.001), EI form (P < 0.001) and HC (P = 0.011), and the length and width of EI (P < 0.001) were significantly different in patients with and without maxillary sinusitis. The length and width of EI were significantly correlated with the degree of mucosal thickening (P < 0.01). The frequency of CB (P = 0.002), EB (P < 0.001), and HC (P = 0.002), and the EI form (P < 0.001) were significantly different in groups with different degrees of mucosal thickening. EI was wider and shorter in patients with maxillary sinusitis. By an increase in mucosal thickness, the length of EI decreased while its width increased. Also, the frequency of EB and HC, and the EI form were significantly different in the two groups.

Влияние формы средней носовой раковины на развитие рецидивирующего риносинусита

In the presence of a paradoxically curved middle nasal turbinate, treatment tactics may be different. To achieve the best effect in the treatment of chronic rhinosinusitis, in some cases, a complete resection of the middle nasal turbinate is performed. However, in this group of patients in the postoperative period, complaints may appear from the quality of nasal breathing, which is associated with the development of paradoxically difficult breathing, when with sufficient passage of the air jet, the patient complains of difficulty in nasal breathing. Also, these patients are characterized by a decrease in the sense of smell. It is important that the absence of the middle nasal turbinate during repeated surgical interventions deprives the surgeon of an important anatomical landmark. We want to share a clinical example in which we received a positive outcome of surgical treatment in a patient with chronic left-sided rhinosinusitis in the presence of a paradoxically curved middle nasal turbinate and a slightly deviated nasal septum. In order to restore ventilation of the anterior group of the paranasal sinuses, the lateral part of the paradoxically curved middle nasal turbinate was removed with its preservation and expansion of the natural anastomosis of the maxillary sinus. In the postoperative period, the patient noted a significant improvement in her condition and did not make any previous complaints. This clinical case demonstrates that the middle nasal turbinate plays an important role in the functioning of the nasal cavity, in particular the osteomeatal complex, and in various anatomical variants can disrupt its work, both in combination with other structural features of the lateral nasal wall, and in isolation. In this connection, during the surgical treatment, a sparing, organ-preserving technique was chosen in order to preserve the functions of the middle turbinate, which in the postoperative period led to the achievement of a stable positive result.

A Retrospective Study on Anatomical Variants of the Uncinate Process: What the Radiologist Needs to Inform the Surgeon?

Introduction: Uncinate Process (UP) is a crucial component of the anterior Osteomeatal Complex (OMC), which is a key area for the drainage and ventilation of the anterior group of paranasal sinuses. Aim: To determine the prevalence of various anatomic variants of the UP, like its varying superior attachment to vital structures like the lamina papyracea, skull base or the middle turbinate, angulation (medial or lateral), pneumatisation (uncinate bulla) and atelectatic UP using Computed Tomography (CT) images of the paranasal sinuses. Materials and Methods: A retrospective cross-sectional study was conducted in the Radiodiagnosis department of a Tertiary care hospital from December 2019 through January 2020, to determine the prevalence of various anatomic variants of the UP. CT scans of the paranasal sinuses of 200 patients (males 102; females 98) in the age group of 17-70 years, were analysed in coronal view of bone window and the superior attachments of UP were classified based on the Stammberger and Hawke classification. Results: Of the total 200 images (400 sides), type I attachment to the Lamina Papyracea (LP) was most frequent 64.5% in 258 number of cases. Least common variation was the Type II attachment to the skull base 5% in 20 cases. UP pneumatisation (uncinate bulla) was less commonly seen variation in 25 cases. Normal vertical orientation of the UP was seen in 34 cases, Only two cases each of horizontal lateral and medial angulation and in both cases findings were unilateral. Conclusion: In order to determine the prevalence of various anatomic variation of the UP, especially its various superior attachments, the study examines the CT images of 200 patients and found that the variations in superior attachment found to be more frequent than the other variations and the commonest was the Type I, attachment to the LP directly or indirectly by attaching to the Agger Nasi Cells (ANC).

A Retrospective Study on Anatomical Variants of the Uncinate Process: What the Radiologist Needs to Inform the Surgeon?

Introduction: Uncinate Process (UP) is a crucial component of the anterior Osteomeatal Complex (OMC), which is a key area for the drainage and ventilation of the anterior group of paranasal sinuses. Aim: To determine the prevalence of various anatomic variants of the UP, like its varying superior attachment to vital structures like the lamina papyracea, skull base or the middle turbinate, angulation (medial or lateral), pneumatisation (uncinate bulla) and atelectatic UP using Computed Tomography (CT) images of the paranasal sinuses. Materials and Methods: A retrospective cross-sectional study was conducted in the Radiodiagnosis department of a Tertiary care hospital from December 2019 through January 2020, to determine the prevalence of various anatomic variants of the UP. CT scans of the paranasal sinuses of 200 patients (males 102; females 98) in the age group of 17-70 years, were analysed in coronal view of bone window and the superior attachments of UP were classified based on the Stammberger and Hawke classification. Results: Of the total 200 images (400 sides), type I attachment to the Lamina Papyracea (LP) was most frequent 64.5% in 258 number of cases. Least common variation was the Type II attachment to the skull base 5% in 20 cases. UP pneumatisation (uncinate bulla) was less commonly seen variation in 25 cases. Normal vertical orientation of the UP was seen in 34 cases, Only two cases each of horizontal lateral and medial angulation and in both cases findings were unilateral. Conclusion: In order to determine the prevalence of various anatomic variation of the UP, especially its various superior attachments, the study examines the CT images of 200 patients and found that the variations in superior attachment found to be more frequent than the other variations and the commonest was the Type I, attachment to the LP directly or indirectly by attaching to the Agger Nasi Cells (ANC).