Paranasal CT Scans Research Articles

Persistent Idiopathic Facial Pain After a Coronavirus Disease 2019 Diagnostic Nasopharyngeal Swab

Nasopharyngeal swabs are commonly performed in the medical field and have recently been used regularly for coronavirus disease 2019 diagnostic testing. Recently, a patient visited our clinic due to left facial pain, which developed immediately after receiving a nasopharyngeal swabbing and has been persistent for four months. A sinonasal endoscopic examination and paranasal (PNS) CT scan were performed to evaluate the abnormalities in the sinonasal cavity. We identified a severe septal deviation, which had come into contact with the medial mucosa of the left inferior turbinate, forming a mucosal contact point suggesting a previous trauma due to the nasopharyngeal swabbing. We suspected that blind nasopharyngeal swabbing induced mucosal damage on the previously deviated septum, causing a mucosal contact point. Additionally, we suggest that healthcare workers be educated on facial pain as one of the nasopharyngeal swab-related complications.

CT imaging features of paranasal sinuses in children with primary ciliary dyskinesia

Background Primary ciliary dyskinesia (PCD) causes impaired mucociliary clearance and results in chronic pulmonary and sinonasal symptoms. Objectives To study the CT imaging features of paranasal sinuses in children with PCD. Materials and methods 17 PCD patients ranged from 4 to 13 years, a mean age of 7.9 ± 3.3 years, were included in the final analysis. Patients with non-PCD chronic rhinosinusitis (CRS) who accepted maxillary balloon catheter dilation were included in the control group. Paranasal sinuses CT scans were scored according to the Lund–Mackay staging system. The correlation between age and Lund–Mackay score was analyzed. Results 100% (17/17) had rhinosinusitis, 52.9% (9/17) had lung consolidation, 64.7% (11/17) had atelectasis, 35.3% (6/17) had bronchiectasis, and 47.1% (8/17) had a history of neonatal respiratory distress. The mean Lund–Mackay score of PCD patients was 14.2 ± 3.1, that of non-PCD CRS patients was 14.6 ± 5.5, the difference was not significant (p = .79). There was a significant inverse correlation between age and Lund–Mackay score in PCD patients (r = −0.530, p = .029) but not in non-PCD CRS patients (r = −0.168, p = .519). Conclusion Radiographic severity of rhinosinusitis in PCD patients was similar to the control population but decreased with age. Significance First time to propose radiographic severity of rhinosinusitis in pediatric patients with PCD might decrease with age.

The Risks of Complications During Endoscopic Sinus Surgery in Cystic Fibrosis Patients: An Anatomical and Endoscopic Study.

An increasing proportion of adult cystic fibrosis (CF) patients is being referred to endoscopic sinus surgery (ESS) in order to relieve the symptoms of chronic rhinosinusitis (CRS). Given that CFTR mutations profoundly alter sinonasal development, we want to explore the relationship between their peculiar surgical anatomy and the risk of postoperative complications. Retrospective case-control study. Paranasal sinuses CT scans of 103 CF adult patients with CRS were compared to those belonging to a cohort of 100 non-CF adult patients to explore their anatomical differences. Secondly, CF and non-CF patients who received primary/revision ESS were analyzed in order to assess their preoperative CT scan in terms of surgically relevant variants, and according to the CLOSE checklist. Surgical outcomes were statistically compared in order to explore the differences between groups. CF group presented more frequently with smaller and less pneumatized paranasal sinuses and a higher Lund-Mckay score compared with controls. No anatomical differences emerged in terms of genotype stratification. Non-CF CRS patients undergoing ESS showed a significantly deeper olfactory fossa and a more frequent supraorbital pneumatization compared to CF patients (P < .001 and P=.031, respectively). Whereas this latter group underwent more often aggressive surgical procedures (P=.001), no difference in terms of postoperative adverse events was found (P=.620). Despite receiving more often aggressive ESS procedures, adult CF patients do not show an increased risk of postoperative complication and this may be linked to a different proportion of anatomical and surgically-relevant variants. 4 Laryngoscope, 131:E2481-E2489, 2021.

Computer Tomographic study of Anatomic Variations of Paranasal Sinuses in Libyan Population and their Clinical Correlation

Introduction: In the era of Functional Endoscopic Sinus Surgery, precise knowledge of paranasal sinus anatomy and variations are essential for the surgeon. The multi-slice computed tomography is the imaging modality of choice provides accurate evictions of the anatomy, the anatomical variants and the extent of the disease in paranasal sinuses, such a method allowing their accurate identification with high anatomical details. Some of these variants may predispose to sinus diseases or become of high risk for injuries and complication during surgical procedure, therefore, the study of anatomic variants of paranasal sinuses is important in the preoperative endoscopic surgery. Objectives: The purpose of this study is to assess the frequency of anatomic variants and their clinical importance. Materials and methods: This retrospective study was conducted at the Department of Radiology, Benghazi Medical Center, Benghazi, Libya. Data comprised the paranasal sinus computed images of 112 patients (46 males and 66 females) analyzed for the presence of anatomic variants and associated sinus pathology. Results: Our results showed that the most common anatomical variants was deviated nasal septum (60.7%) with slight higher incidence on left side, followed by concha bullosa (22.3%), other variants found were absent frontal sinus (18.8%), Nasal spur (14.3%) , Agger nasi cell (16.1%), Haller cell (5.4%), Onodi cell (2.7%), accessory ostia of maxillary sinuses (10.7%), accessory middle nasal concha (1.8%), paradoxical middle turbinate (1.8%), nasal septum pneumatization (5.4%), Crista galli pneumatization (2.7%), pneumatization of hard palate (1.8%) and pneumatization of clinoid process (6.3%). (53.6%) patients suffered from sinusitis, the results showed that the most common sinus involved was maxillary sinus. Conclusion: Anatomical variations of PNS are quite common. Analysis of every paranasal CT scan obtained for sinusitis for the presence of different anatomic variants is of questionable value unless endoscopic surgery is planned to reduce the risk of intraoperative complications.

The Trend of Changes in Paranasal CT Scan in Patients with Hematologic Malignancy Under Chemotherapy

ObjectivesThe aim of this study was to evaluate the clinical significance of early screening of computerized tomography scan of paranasal sinuses (PNS CT) in hematologic malignancies before chemotherapy and evaluation of changes after chemotherapy and during neutropenia.MethodsAll 40 new cases of hematologic malignancies with febrile neutropenia in a teaching referral hospital between 2018 and 2019 were enrolled in this study. All of these patients underwent paranasal sinus (PNS) CT scan before chemotherapy, along with other preliminary investigations. Symptoms and signs indicating the infectious process were meticulously followed and monitored before and during chemotherapy as well as the occurrence of febrile neutropenia. All patients were clinically and radiologically evaluated regarding the presumptive diagnosis of invasive fungal sinusitis during prolonged febrile neutropenia (more than 4 days). PNS CTs before and after chemotherapy of all patients were compared by two radiologists and were evaluated based on histopathologic findings of nasal and or paranasal biopsies.ResultsAround 50% of patients with PNS CT scan abnormality suspected inflammatory process including microbial and fungal sinusitis during prolonged febrile neutropenia (more than 4 days) were confirmed that have had similar involvement before starting chemotherapy and these abnormalities have been stable with no significant changes after chemotherapy. The histopathologic examination of sinuses also showed no evidence of invasive fungal infection by endoscopic biopsy. Therefore, the abnormal findings including mucosal thickening in PNS CT during prolonged febrile neutropenia were not consistent with the confirmed invasive fungal infection. The rate of mortality was 2.5% without association with invasive fungal sinusitis.ConclusionsA considerable number of patients with underlying hematologic malignancies have paranasal sinus involvement such as mucosal thickening that may be misdiagnosed as invasive fungal sinusitis during the hazardous phase of prolonging febrile neutropenia. Thus, performing PNS CT scan before initiation of chemotherapy even though in asymptomatic patients could be helpful to decrease the number of suspected and probable cases of fungal sinusitis based on abnormal findings in PNS CT scan followed by the number of cases undergoing sinus endoscopic surgery.

Variations of Ethmoid Roof in the Iranian Population- A Cross Sectional Study.

Introduction:This study aimed to investigate the distribution of ethmoid roof variation and symmetry according to Keros classification.Materials and Methods:This cross-sectional study assessed the paranasal CT scans of 600 patients over 18 years of age with no history of surgery, trauma, or localized fracture in the ethmoid, nose, and anterior skull base. The lateral lamella of the cribriform plate (LLCP) sizes were measured and classified as Keros type I (1-3 mm), II (4-7mm), and III (8-16mm). Moreover, the symmetry was surveyed in accordance with the LLCP measurements on both sides of the ethmoid roof. These variations were analyzed regarding gender and age. Results:In total, 600 patients participated in this study out of whom 311 cases were male. According to the results, the mean age of the participants was 37.50±16.63 years. Furthermore, the mean values of the LLCP height for the right and left sides were 4.17±1.69 and 4.93±1.97 mm, respectively. Moreover, the asymmetry was observed in 38.3% of the cases, and they were classified as 36.7% Keros type I, 50.5% Keros type II, and 12.8% Keros type III. Conclusion:Keros type II and symmetry were the most common variations in this study. In addition, these variations were independent of age and gender.

Prevalence of Supraorbital Ethmoid Air Cells among Filipinos

&#x0D; Objective : This study aims to determine the prevalence of supraorbital ethmoidal cells (SOEC) among Filipinos in a single tertiary government institution. &#x0D; Methods:&#x0D; &#x0D; Study Design: Retrospective review of CT scan images&#x0D; Setting: Single Tertiary Institution&#x0D; Patients: 123 patients aged 13-years-old and above&#x0D; &#x0D; Results: A total of 474 CT scans (60 PNS and 414 Craniofacial) performed during the study period were considered, with 55 excluded for age &lt; 13, and 296 excluded for craniofacial fractures. None had congenital craniofacial deformities. Eighty-five of 123 CT scans (69.11%) or 147 of 246 sides (59.76%) demonstrated supraorbital ethmoidal cells. There were 62 (72.94%) males and 23 (27.06%) females, ages ranging from 13 to 83 (mean age between male and female was 39.53 and 43.57). The scans showed 62 (50.41%) patients with bilateral and 23 (18.70%) with unilateral SOEC. Twenty-two (25.9%) patients were identified with chronic rhinosinusitis and two of whom were considered to have maxillary sinus mass. Two out of 5 patients with SOEC presented with aplastic/hypoplastic frontal sinus.&#x0D; Conclusion: Our study suggests that Filipinos may have a higher prevalence rate of SOEC than their Chinese, Japanese and Korean counterparts and bilateral SOEC are more predominant than unilateral SOEC.&#x0D; &#x0D; Keywords: supraorbital ethmoid cell, anterior ethmoid artery, paranasal CT scan, craniofacial CT scan, frontal sinus surgery&#x0D;

Paranasal sınus fungus balls : our experıence of 19 cases and Revıew of lıterature

Introduction: Fungal sinusitis is a common disease and increasingly getting high incidence. It forms approximately 10 % of the patients requiring surgery for the nose and the sinuses. Fungal sinusitis can be mainly categorized into invasive and non-invasive types. Objectives: Sinus fungus ball is the most common form of fungal sinusitis. The aim of this study is to share our experience on patients diagnosed with fungus ball. Materials-Methods: The epidemiological data, clinical presentations, radiology, mycology and histology results of 19 patients (6 males and 13 females, age between 22 to 67) diagnosed with a fungus ball sinusitis who underwent functional endoscopic sinus surgery . All patients underwent preoperative computed tomography and were evaluated with rigid endoscopy. Paranasal CT scan was performed in all patients and various opacities were observed. Results: In 47 % the maxillar sinus (9 patients), in 15 % the ethmoidal cells (3 patients), in 32 % the sphenoid sinus (6 patients) and in 6 % concha bullosa (1 patient) were affected. FESS was performed under general anaesthesia. The diagnosis is based on histological examination of surgically removed material. Surgically removed materials were sent to the bacteriology/mycology laboratory and the histopathology laboratory for fungal cultures and histological examination. Conclusion: By reviewing 19 patients diagnosed with fungus ball after endoscopic surgery during the past 5 years, we report the clinical features along with a literature review.

Coexistence of frontal sinus hypoplasia with maxillary sinus hypoplasia: a radiological study.

The goal of this study was to determine whether frontal sinus hypoplasia coexists with maxillary sinus hypoplasia. Analyzing paranasal CT scans retrospectively, we included 86 patients who had a hypoplastic maxillary sinus at least on one side and 80 patients with bilateral normal maxillary sinuses (control group). We classified hypoplastic maxillary sinuses using the classification system previously defined by Bolgeret al. (Otolaryngol Head Neck Surg 103(5):759-765, 1990). We classified the frontal sinuses as aplastic, hypoplastic, medium-sized, and hyperplastic; as previously defined by Guerram et al. (Am J Phys Anthropol 154(4):621-627, 2014). We compared the presence of frontal sinus hypoplasia using Chi-square test between the groups. The mean age of the maxillary sinus group was 43.2 (range 18-84)years. Of 86 patients, 33 (38.4%) had unilateral and 53 (61.6%) had bilateral maxillary sinus hypoplasia. Of 139 maxillary sinuses totally included, 73 (52.5%) were type 1, 51 (36.7%) were type 2 and 15 (10.8%) were type 3 hypoplastic maxillary sinuses. Of 332 frontal sinuses totally included, 25 (7.5%) were aplastic, 32 (9.6%) were hypoplastic, 172 (51.9%) were medium-sized, and 103 (31%) were hyperplastic. Of 86 patients with a hypoplastic maxillary sinus at least on one side, 29 (33.7%) had a hypoplastic and/or aplastic frontal sinus, while 10 (12.5%) had a hypoplastic and/or aplastic frontal sinus at least on one side in control group. Incidence of frontal sinus hypoplasia and/or aplasia was significantly higher in patients with maxillary sinus hypoplasia compared to the patients with bilaterally normal maxillary sinuses (χ2 = 10.384, P = 0.001). Maxillary sinus hypoplasia has a significantly higher coexistence with frontal sinus hypoplasia. This study may have an implication for anatomical studies about the development of the paranasal sinuses and paranasal sinus surgery as well as further morphological studies.

Anterior maxillary wall and lacrimal duct relationship - CT analysis for prelacrimal access to the maxillary sinus.

The distance between the anterior wall of the maxillary sinus and the nasolacrimal duct shows a large individual variation. To evaluate the feasibility of accessing the maxillary sinus through a prelacrimal window access (PLWA), a series of 100 paranasal CT scans from adult patients was analysed retrospectively. The distance between the anterior maxillary wall and the anterior border of the lacrimal duct (= prelacrimal window) were measured in 200 sides. A distance of more the 7 mm was found in 12.5% maxillary sinuses and would enable straight forward PLWA. A distance between smaller than 7mm and larger than 3mm was present in 56.5% of sinuses, and would make surgical access more demanding. In 31.5% of maxillary sinuses the distance was smaller than or equal to 3mm and in these patients this approach would be difficult without transecting the nasolacrimal duct. Only in 12.5% of sinuses a prelacrimal endoscopic access is readily feasible, while in 56.5% temporary tear sac dislocation is required and in 31.5% lacrimal sac dislocation is always needed along with a significant amount of bone removal to enable PLWA.

Anterior maxillary wall and lacrimal duct relationship - CT analysis for prelacrimal access to the maxillary sinus

The distance between the anterior wall of the maxillary sinus and the nasolacrimal duct shows a large individual variation. To evaluate the feasibility of accessing the maxillary sinus through a prelacrimal window access (PLWA), a series of 100 paranasal CT scans from adult patients was analysed retrospectively. The distance between the anterior maxillary wall and the anterior border of the lacrimal duct (= prelacrimal window) were measured in 200 sides. A distance of more the 7 mm was found in 12.5% maxillary sinuses and would enable straight forward PLWA. A distance between smaller than 7mm and larger than 3mm was present in 56.5% of sinuses, and would make surgical access more demanding. In 31.5% of maxillary sinuses the distance was smaller than or equal to 3mm and in these patients this approach would be difficult without transecting the nasolacrimal duct. Only in 12.5% of sinuses a prelacrimal endoscopic access is readily feasible, while in 56.5% temporary tear sac dislocation is required and in 31.5% lacrimal sac dislocation is always needed along with a significant amount of bone removal to enable PLWA.

The effects of gender and age on forensic personal identification from frontal sinus in a Turkish population.

Objectives:To define the dimensions of the frontal sinus in groups standardized for age and gender and to discuss the reasons and the effects of the variations.Methods:Frontal sinus measurements were obtained from paranasal CT scans of 180 males and 180 females in the Radiology Department of Dursun Odabas Medical Center of Yuzuncu Yil University, Van, which is located in Eastern Turkey, between February and March 2016. The width and height of sinuses were measured on a coronal plane, and the anteroposterior length was measured on an axial plane. Volumes were calculated using the Hospital Information Management Systems and Image Archiving and Management System program. The Statistical Package of the Social Science version 13 was used for statistical analyses.Results:We determined differences in the frontal sinus measurements of different age groups in a Turkish adult population. Frontal sinus dimensions were usually higher in females and lower in males after 40-49 years of age than their younger counterparts, but the measurements were lower in females and higher in males in 70≤ years of age group than 60-69 years of age. Left frontal sinus was dominant in young age groups but right frontal sinus was dominant in groups 40-49 years of age or older.Conclusion:We observed crossing of the measurements between the different age groups, which we could not find clear explanations. The results of such studies may affect forensic identification from frontal sinus measurements.

Prognostic value of sinus CT scans in hematopoietic stem cell transplantation

AbstractHematopoietic Stem Cell Transplant (HSCT) causes immunosuppression and predisposition to sinusitis. CT scans are complementary exams used in the diagnosis of sinusitis; however, its use in every patient is questionable. Aimto check the usefulness of ordering a CT scan prior to HSCT and to study the relationship between anatomical variations and sinusitis. Methodprospective study in which we performed paranasal CT scans before and after HSCT, using the Lund and Mackay score. Results77.5% and 61% of CT scans showed no evidence of sinus disease before and after HSCT. CT staging was not associated with sinusitis after HSCT. Anatomical variations were related to radiographic disease severity, but not to development of sinusitis after HSCT. There was no relation between pre-CT staging and sinusitis after BMT. ConclusionCT scans are not useful for all patients before HSCT. Anatomical variation is not a predictive feature to sinusitis but it can determine its severity.

Sinonasal evaluation and treatment before liver transplantation: a retrospective review of 982 patients.

Immunosuppression after liver transplantation (LT) increases complications from infection. The usefulness of sinonasal evaluation before LT has not been fully evaluated. The aim of this study was to determine the usefulness of routine sinonasal evaluation before LT and pre-transplant treatment of sinusitis. The clinical records of 982 adult patients (age ≥18years) who underwent LT between January 1997 and June 2011 were retrospectively reviewed and analyzed. A total of 920 patients (93.7%) underwent pre-LT sinonasal evaluation, including a sinonasal symptom questionnaire, nasal endoscopy and plain X-ray. Of these patients, 269 (29.2%) had abnormal findings and underwent paranasal CT scans. Based on CT, 102 patients, including 21 with fungal ball, were diagnosed with sinusitis and 62 (60.8%) underwent LT after medical or surgical treatment for sinusitis. Another 40 patients (33 with sinusitis and 7 with fungal ball) underwent LT without treatment for sinusitis. No difference in infectious complications was observed according to sinusitis treatment type. Among chronic rhinosinusitis patients, those who underwent LT (n=48) after adequate treatment had a lower mortality rate than those who did not receive treatment (n=33) (12.5 vs. 33.3%; p=0.024). Sinonasal evaluation preceding LT did not prevent infectious complications but untreated sinusitis might be correlated with increased mortality after LT. Routine pre-LT sinonasal evaluation would be considered for safer transplantation.

Paediatric Parameningeal Rhabdomyosarcoma: A Case Report Post-multimodal Treatment

Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood, representing 5% of all childhood cancers. We are reporting an interesting case of parameningeal rhabdomyosarcoma in a child who underwent multimodal treatment. A 7 year old boy presented to our clinic with a history of bad breath, nasal obstruction and recurrent epistaxis from the left nostril for 3 months. On examination he had mild left proptosis with normal eye vision and movements, reddish left nasal mass with a smooth surface. Paranasal CT scan showed slightly enhancing soft tissue mass 72×77 mm in the nasal cavity that deviated the nasal septum to the right, extending to the nasopharynx posteriorly and to the maxillary and ethmoidal sinuses with another mass 11×16 mm extension into the orbit. Biopsy was taken and histology showed embryonal rhabdomyosarcoma. An extensive tumour debulking was done folwed by chemotherapy (vincristine, dactinomycin and cyclophosphamide) and 50 grays of radiotherapy. A surveillance CT scan a month after treatment revealed over 90% tumour reduction. All patients with metastatic disease (group IV, stage 4) are considered high risk, except children and adolescents younger than 14 years with embryonal rhabdomyosarcoma. Advances into the multimodality management have dramatically improved survival in PM-RMS from approximately 25% to 75%.

Paediatric paramenigeal rhabdomyosarcoma: a case report – multimodal treatment

Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood, representing 5% of all childhood cancers. We are reporting an interesting case of parameningeal rhabdomyosarcoma in a child who underwent multimodal treatment. A 7-year-old boy presented to our clinic with a history of bad breath, nasal obstruction and recurrent epistaxis from the left nostril for 3 months. On examination he had mild left proptosis with normal eye vision and movements, reddish left nasal mass with a smooth surface. Paranasal CT scan showed a slightly enhancing soft tissue mass 72 × 77mm in the nasal cavity that deviated the nasal septum to the right, extending to the nasopharynx posteriorly and to the maxillary and ethmoidal sinuses with another mass 11 × 16mm extension into the orbit. Biopsy was taken and histology showed embryonal rhabdomyosarcoma. An extensive tumour debulking was done followed by chemotherapy (vincristine, dactinomycin and cyclophosphamide) and 50 grays of radiotherapy. A surveillance CT scan a month after treatment revealed over 90% tumour reduction. All patients with metastatic disease (group IV, stage 4) are considered high risk, except children and adolescents younger than 14 years with embryonal rhabdomyosarcoma. Advances into the multimodality management have dramatically improved survival in PM-RMS from approximately 25% to 75%.

Is there a relationship between cribriform plate dimensions and septal deviation angle?

The aim of this retrospective study was to investigate the relationship between cribriform plate (CP) dimensions and septal deviation degree. Coronal paranasal CT scans of 99 patients were reviewed. We measured depth and width of cribriform plate on both sides and compared with septal deviation side and septal deviation degree. Deviation angles were 6.85±1.47° for right deviations; and 7.11±1.63° for the left deviations. The mean depth of CP was 5.08±1.57mm at the right side and 5.06±1.59mm at the left side; and the mean width of CP was found 4.71±1.36mm at the right side and 4.56±1.51mm at the left side. When CP dimensions were evaluated according to the septal deviation side, mean width of CP was 4.69±1.36mm at ipsilateral side (deviated side); and 4.58±1.51mm at the contralateral side. The mean depth of CP was 4.9±1.56mm at the ipsilateral side (deviated side); and 5.22±1.58mm at the contralateral side. The CP depth at the contralateral side was significantly higher than that of the ipsilateral side (deviated side). In right SD, ipsilateral and contralateral CP depth increased. As deviation angle increased, ipsilateral and contralateral CP width, right and left CP width increased. Ipsilateral and contralateral CP width; and additionally ipsilateral and contralateral CP depth increased together. In other words, right and left CP width; and CP depth increased simultaneously. It is well known that the higher incidence of intracranial penetration is on the side where the position of the ethmoid roof (ER) is lower. The presence of septal deviation, the possibility of the deeper CP at the contralateral side should be taken into consideration to avoid iatrogenic injury.

Paranasal Sinus CT Scan Changes in Children with Meningitis: A Cross Section Study, Tehran, IRAN

Background: Meningitis is the most common intracranial complication of sinusitis. Objective: Determine the frequency of sinusitis using CT scans in children with documented meningitis. Methods and materials: A prospective, cross sectional study was done in pediatric infectious ward of Rasul Hospital in Tehran, Iran during 2010-2011. In this study 65 cases with meningitis were evaluated for presence of sinusitis (according to symptoms, criteria and paranasal CT scan). Results: CSF obtained in 112 cases. Cases with meningitis aged 1 month-16 years old with a mean of 4.2 years. Definite bacterial meningitis was the final diagnosis in 40/112 patients (35.7%; missing=5). Second step: Paranasal sinus CT scan had been performed in 65 cases with final diagnosis of meningitis. Cases were between 1 month to 16 years old (mean age of 4.2 y). 51% of the patients were male and 49% were female. Bacterial meningitis was diagnosed in 55.3% (36/65) and aseptic meningitis in 44.7% (29/65). Sinuses were reported to be undeveloped in 7.6% (n=5) of younger than 4 months old cases. Sinusitis was diagnosed in 30.7% (20/65) of all cases with meningitis; 3.4% (1/29) in those with aseptic meningitis and 52% (19/36) in those with bacterial meningitis which shows significant difference between the 2 groups (P<0.05). The involved sinuses included: pan sinusitis with 15% (3/20) case. Maxillary sinusitis the most common type observed (16/20); on the next places comes; sphenoid sinusiti (7/20); ethmoeid sinusitis (4/20) and finally isolated frontal sinusitis was seen in 0% of cases. Chronic type of sinusitis was reported in 50% (n=10) of all cases. Conclusion: The prevalence of sinusitis in documented cases of meningitis (septic & aseptic meningitis) was 31%, and was more common (25%) in bacterial meningitis. Meningeal manifestations (e.g. meningeal signs and symptoms; or CSF changes) might be due to bacterial sinusitis. Most cases of meningitis in children are accompanied with sinusitis. Differentiation between the two sources and definition of the initial site of infection is always problematic. Appropriate bacterial sinusitis treatment is needed to prevent meningitis. We recommend sinus tract to be evaluated in every meningitis patient (septic or aseptic). Furthermore, adequate treatment in chronic sinusitis would help prevent readmission.

Asymmetric adenoid hypertrophy in a patient with ipsilateral rhinolithiasis: an overlooked entity?

The aim of this article is to present a rhinolithiasis patient with a significant asymmetric adenoid hypertrophy on the same side and to describe possible mechanisms for this clinical entity. Careful nasopharyngoscopy after removal of rhinolith is mandatory not to overlook significant adenoid hypertrophy which may interfere with patients’ symptoms. The role of paranasal CT scan in the diagnosis of an asymmetric adenoid hypertrophy in rhinolithiasis patients is also discussed.

CT study on morphometry of frontal sinus

The aim of this study was to determine the prevalence and morphological characteristics of the frontal sinus in an adult population. This study was conducted retrospectively on paranasal CT scans in the axial and coronal planes of 300 cases (123 male and 177 female). The mean age was 40.74 +/- 13.34 (range 20-83). Measurements of the width, height and anteroposterior length for each sinus and total width were obtained from CT scans. Measurements were compared statistically with relation to side and sex. The cases were divided into subgroups according to age for each sex and each measurement parameter was also compared among the subgroups. All measurements tended to be larger on the left side and were significantly larger in males than females. There was a significant difference in the anteroposterior lengths of right and left sides in both males and females and height for males and width for females. In both sexes, the highest values of measurements were usually observed at the 31-40 age group and there was a tendency to decrease with aging. The larger diameters of the left frontal sinus imply that it may be more possibly violated during surgical interventions. Morphometric features differed significantly in the two sexes at different ages and comparison with previous studies presented great regional variability. The size of the frontal sinus was seen to be related to age and sex. The knowledge provided in the present study is useful for some surgical procedures and widens the anthropometric knowledge of humanity.