Paranasal Sinus Computed Tomography Scans Research Articles

A study of the prevalence of Onodi cells in a North Indian population

Background: Onodi cells are a type of posterior ethmoid cells which extend superior and lateral to the sphenoid sinus. As these cells have a close relationship with the optic nerve and the internal carotid artery, it becomes important to be aware about their presence preoperatively to prevent injury to these vital structures. Aim of the study was to identify the presence of the Onodi cell with computed tomography (CT) scan and to determine its prevalence and gender distribution of these cells in a north Indian population. Methods: CT scan of nose and paranasal sinuses of 300 adult patients were studied retrospectively to determine the prevalence of Onodi cells. Results: The overall prevalence of Onodi cells was found to be 20.33%. Of this, 24 (57%) were present in males and 17 (43%) in females. Out of 61 Onodi cells, 30 (49.2%) were right-sided, 10 (16.4%) left-sided, 13 (21.3%) central and 8 (13.1%) were bilateral. Conclusions: The presence of Onodi cell in every fifth person makes it important to have a knowledge of their presence preoperatively to prevent adverse surgical complications.

Location of infraorbital and accessory infraorbital foramina in Iranian population: a retrospective radiological study with crucial clinical implications.

The location of infraorbital foramen (IOF) and the prevalence of accessory IOF vary among different populations. It may lead to infraorbital nerve (ION) blockage during surgery. This study aimed to assess the IOF location and AIOF frequency in Iranian people. In this retrospective cross-sectional study, 500 paranasal sinus computed tomography scans of adults were examined using the INFINITT PACS system. The distance from IOF to infraorbital margin (IOM), mid-pupillary line (MPL), midsagittal line (MSL), canine eminence (CE), and skin thickness (ST) was 8.97 ± 1.79, 5.73 ± 1.84, 24.86 ± 2.23, 20.39 ± 3.47, and 10.90 ± 2.59mm, respectively. The vertical and transverse diameters of the foramen were 3.03 ± 0.65 and 3.71 ± 0.76mm, respectively. In addition, the shape of 63.5% of the foramina was oval. The prevalence of AIOF was 9%, and its most common location was superomedial to IOF. We believe that in this study, landmarks like IOM, MPL, MSL, CE and ST could help the clinicians localize IOF and improve the ION anesthesia success rate. Furthermore, the occurrence of AIOF should be considered by physicians to reduce the chance of injuries to the infraorbital neurovascular complex.

Imaging anatomy of the vidian canal and its clinical significance.

Vidian neurectomy (VN) is an effective surgical treatment for severe allergic rhinitis (AR). However, little research has been conducted on the imaging anatomy of the vidian canal (VC). This study aimed to analyze the computed tomography (CT) imaging of the VC and its surrounding structures and investigate the morphometric characteristics and clinical significance of VN. We analyzed 118 paranasal sinus CT scans (55 male and 63 female patients), with axial, coronal, and sagittal slices being used in the study. Among the 118 patients in this study, the average length of the VC in male and female patients was 14.00±3.35 and 12.51±3.42 mm, respectively; the transverse diameter of the posterior segment of the VC in females was larger than that in males; and the length of the VC and the distance between VC and foramen rotundum (FR) in males were longer than those in females. The angle between the VC and the sagittal plane and the angle between the sphenopalatine foramen (SPF) and the VC in females were larger than those in males, and the distance between the attachment to the end of the middle turbinate (MT) and the VC was greater. Type 2 VC occupied a dominant position. The VC was mostly at the same line as the medial wall of the maxillary sinus (MS) and was located on the medial side of the medial pterygoid plate (MPTG). The highest point of the VC was mostly superior to that of the palatovaginal canal (PVC). Most of the VC was inferior to the internal carotid artery (ICA), and no cases were observed in which the VC was above the ICA. Some of the measurements of the VC and its surrounding structures were correlated. The position and morphometric information of the VC could be reflected in a CT scan, which may contribute to the evaluation of VN preoperatively and postoperatively.

Correlation of Upper Lateral Cartilage Collapse and Nasal Septal Deviation

Background and Objectives: This study aimed to elucidate the relationship between nasal septal deviation (NSD) and upper lateral cartilage (ULC) collapse.Methods: We conducted a retrospective review of 142 paranasal sinus computed tomography scans from patients who had undergone septoplasty due to confirmed NSD. The ULC angle was measured on both the narrow and wide sides of the nasal cavities, and these measurements were compared to evaluate the extent of ULC collapse in relation to the degree of NSD and patient age. The correlation between the degree of NSD and the degree of ULC collapse was also analyzed.Results: The mean ULC angle was found to be 13.4°±2.7° on the narrow side and 14.3°±2.7° on the wide side, with a statistically significant difference between the two (p<0.001). When comparing caudal and non-caudal NSD patients, there was no significant difference in the degree of ULC on either side (p=0.166). When comparing the ULC angle between two age groups (≥50 vs. <50 years), the difference in ULC angles was significantly greater in the group of patients aged under 50 years (0.3°±3.8° vs. 1.1°±2.2°, p=0.014). There was a significant positive correlation between the degree of ULC collapse and the degree of septal deviation (r=0.214, p=0.01).Conclusion: NSD was associated with ULC collapse on the narrow side and a narrow internal nasal valve area. This result indicates that clinicians should check for concomitant ULC collapse in patients with NSD.

Role of Electrodiagnostic Modalities in Detection of Nasal Septal Deviation.

Nasal Septal Deviation (NSD) is a common sign in otorhinolaryngology that can lead to facial asymmetry. In this case-control observational study, we assessed the role of EMG and NCS in the diagnosis of NSD and its effect on neuromuscular function. Participants were divided into two groups based on paranasal sinus computed tomography scan (PNS CT) results: NSD cases (n = 21) and controls without NSD (n = 13). EMG and NCS were performed on both groups to assess nasal alar muscles at the root of the zygomatic nerve. Our findings showed a significant correlation between NSD and EMG/NCS tests (P-value = 000) and a significant association between septal deviation and nasal alar lateralization (P-value = 000). EMG/NCS can be useful in assessing NSD by providing a better understanding of related neuromuscular structures and neuromuscular function of the nasal alar dilator muscles and aid in the diagnosis of NSD. Nasal Septal Deviation, EMG (electromyography), NCS (nerve conduction studies), Neuromuscular function, Facial asymmetry, Otorhinolaryngology, Paranasal sinus, Computed tomography, Nasal alar muscles, Zygomatic nerve, Nasal Obstruction, Nasal alar lateralization, Diagnosis.

Anatomical identification of supraseptal posterior ethmoid cells and its significance for endoscopic sinus surgery.

To investigate the anatomical imaging characteristics of supraseptal posterior ethmoid cells (SPEC). Paranasal sinus computed tomography scans of 153 inpatients from February 2019 to September 2021 were reviewed, and the anatomical characteristics of SPEC in the scans were collected. Supraseptal posterior ethmoid cells are posterior ethmoid (PE) cells extending medially and superiorly to the posterior superior of the nasal septum and into the sphenoid body but not close to the optic canal. The SPEC, Onodi cell, and sphenoidal sinus (SS) may appear in the posterior superior of the nasal septum, but the occurrence rate of the SPEC (5.88%; 9/153 cases) was significantly lower than that of the SS (22.88%) and Onodi cell (21.57%). The anterior SPEC is adjacent to the cribriform plate, the perpendicular plate of the ethmoid bone and the posterior ethmoidal artery (PEA). The posterior SPEC is adjacent to the SS and PE (6/9 cases), the SS and Onodi cell (2/9 cases) or the PE only (1/9 cases). The SPEC is a rare pneumatization that occurs in the posterior superior area of the nasal septum. Care should be taken to protect the skull base, cribriform plate and PEA when opening the SPEC during endoscopic sinus surgery.

Evaluation of the Image Quality of Ultra-Low-Dose Paranasal Sinus Computed Tomography Scans

Objective: We aimed to investigate the image quality of paranasal sinus computed tomography (CT) scans obtained with the “Advanced intelligent Clear-IQ Engine” (AICE) software and ultra-low dose parameters in patients with prediagnosed rhinitis, sinusitis or nasal septum deviation. Methods: The first 50 patients (31 men and 19 women, aged 18-70 years) who agreed to participate in our prospectively planned study were included in the study. Imaging of the patients was performed with a 160-slice multidetector CT device Canon Aquilion Prime SP (Canon Medical Systems, Otawara, Japan). Tube voltage of 80 kV and tube current of 40 mA were chosen. The effective radiation dose (ED) was calculated based on the “dose-length product” (DLP) information of each patient. Evaluation of images was made on reformat images made with “AiCE Bone” filter in the axial and coronal planes. All images were double-blindly evaluated by 2 radiologists out of 5 points (5 = very good; 1 = not diagnostic). The visibility of 17 bilateral important anatomical landmarks examined on paranasal sinus CT was scored (0 = not visible; 2 = completely visible). In the evaluation of images, the agreement between radiologists was evaluated with Kappa statistics. Results: The median ED value of the CT protocol was 0.015±0.001 mSv [range 0.012-0.017 mSv]. The overall image quality of the images in our study was interpreted as 4 (good) or 3 (moderate) for all patients. Inter-research agreement was 92%. Most of the anatomical landmarks evaluated were completely visible. Six (bilateral of three) anatomical landmarks could be partially visible in some patients. Conclusion: Combining the ultra-low dose CT protocol and the AiCE reconstruction algorithm makes it possible to achieve very low ED values ​​in paranasal sinus CT scans and still obtain sufficient image quality in indications such as septum deviation and sinusitis.

Diagnosis of Fungal Sinusitis; Is Fungal Culture a Must?

Objective: To determine the diagnostic accuracy of computed tomography (CT) of paranasal sinuses (PNS) in detecting fungal sinusitis keeping fungal culture as the gold standard.
 Study Design: Cross-sectional validation study.
 Place and Duration of Study: Department of Radiology, Combined Military Hospital, Rawalpindi Pakistan, from Jun 2018 to Jun 2019.
 Methodology: A total of 323 patients of either gender were included in the study (aged from 10-70 years). All the patients underwent plain CT scans of paranasal sinuses, and the CT scan findings were reported and recorded on pre-designed proforma. Results were then compared with the culture report of each patient respectively.
 Results: Among all the patients undergoing CT scans, paranasal sinuses 177 were True Positives, while 07 were False Positives. Out of a total of 139 CT scan-negative patients, 6 (False Negative) had fungal sinusitis on culture, whereas 133 (True Negative) had no fungal sinusitis on culture (p=0.001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CT scan Paranasal sinuses were 96.72%, 95.0%, 96.20%, 95.68% and 95.98%,respectively.
 Conclusion: CT scan of paranasal sinuses is a highly sensitive and accurate non-invasive investigation in detecting fungal sinusitis.

Anatomical variations of frontal sinus pneumatization: A computed tomography-based study

Background: The pneumatization of the frontal sinus is variable between individuals, including monozygotic twins. The volumetric anatomic variants of the frontal sinus are classified into aplasia, hypoplasia, medium-sized, and hyperplasia. We aimed to study the frontal sinus morphology in Omani patients using computed tomography (CT) evaluations. Methods: Retrospectively, 1220 paranasal sinus CT scans from 610 patients investigated at Sultan Qaboos University Hospital, Oman, from January 2019 to December 2020 were reviewed. The frontal sinus morphology was classified according to the classification proposed by Guerram et al. The Chi-square test was used to determine the influence of sex. Results: With regard to the unilateral occurrence, the most prevalent frontal sinus category observed was medium-sized (13.3%), followed by hyperplasia (7.9%), hypoplasia (5.4%), and aplasia (2%) categories. Similarly, in bilateral occurrence, the most common frontal sinus category observed was medium-sized (53%), followed by hyperplasia (13.1%), hypoplasia (3.4%) and aplasia (2%) categories. Right and left frontal sinus aplasia were observed in 2.1% and 1.8% of cases, respectively. In terms of sex influence, the left unilateral (p<0.01) and the bilateral hypoplasia (p<0.05) were significantly higher in females. On the other hand, the left unilateral (p<0.01) and the bilateral hyperplasia (p<0.05) were higher in males. Conclusions: The baseline data of frontal sinus category frequencies reported in the present study is helpful in the diagnostic evaluation of sinusitis in the clinical setting. The preoperative recognition of frontal sinus types, particularly frontal sinus aplasia in multiplanar CT scans, is crucial to avoid unexpected complications while performing endoscopic sinus surgery.

Development of the sphenoid sinus from newborn to age 18: A computed tomography imaging analysis

The sphenoid sinus (SS) is an important anatomical formation in terms of its location and relationship with important neurovascular structures. It is essential to evaluate the pneumatization and dimensions of the SS with Computed Tomography (CT) in the preoperative period of transsphenoidal interventions to be performed on tumors located in this region. The aim of this study was to evaluate the correlation of the volume and dimensions of the SS measured with CT with age in the period from birth to 18 years of age. In this retrospective study, a total of 360 brain, paranasal sinus, temporal bone and maxillofacial CT scans of individuals from birth to 18 years of age were evaluated. The cohort was divided into 18 groups with 20 (10 female, 10 male) patients in each age group. The height, width, length and volume values of the SS were measured on CT and their correlations with age and the differences between genders were evaluated statistically. It has been determined that the increases in the size and volume of the SS accelerate especially between 1 and 2 years of age and begins to reach adult dimensions after 12 years of age. Height and length of the sphenoid sinus showed a high correlation coefficient (r=0.717 and r=0.731 respectively) with age, while its width and volume showed a moderate correlation coefficient (r=0.662 and 0.543 respectively). There was no statistically significant difference between the genders in terms of SS height, width, length and volume. SS dimensions and volume showed a logaritmic growth pattern from birth to 18 years. The results of this study may help to better understand the normal development of SS in children and may serve as a reference for more comprehensive CT studies. In addition, it can help surgeons to evaluate the developmental characteristics of SS in surgical interventions for SS in children.

Relationships of sphenoid sinus pneumatization with internal carotid artery characteristics

ObjectiveWe explored the clinical significances of the relationships among sphenoid sinus aeration, intersphenoid sinus septum (ISS), and internal carotid artery (ICA).MethodsWe retrospectively reviewed the preoperative paranasal sinus computed tomography scans and the medical charts of 490 patients who were treated by the endoscopic endonasal transsphenoidal approach. We analyzed sphenoid sinus pneumatization, number of ISS, and positional relationships between the ICA and ISS (including ICA prominence and the thickness of surrounding bone).ResultsISS were often present in the ICAs of patients with presellar pneumatization (36.2%; p = 0.042). Sphenoid sinus pneumatization status significantly differed according to number of ISS (p < 0.001), ICA prominence (p < 0.001), ISS insertion into the ICA (p = 0.042), and distance from ISS to ICA (p = 0.004). When sphenoid sinus aeration was poor, the ICA was not prominent, and the ISS were attached to or lay close to the paraclival ICA.ConclusionsPatients with presellar pneumatization exhibited less prominent ICAs, and more ISS attached to or near the paraclival ICA, than did other patients. Therefore, particular caution is required when using the endoscopic endonasal transsphenoidal approach to treat patients with poor sphenoid sinus aeration.

Radiologic Evaluation of the Anterior and Posterior Ethmoidal Foramen and Optic Canal by Paranasal Sinus Computed Tomography Scan among Adult Filipinos

ABSTRACT Objective: To measure the average distances from anterior lacrimal crest (ALC) to anterior ethmoidal foramen (AEF), anterior ethmoidal foramen to posterior ethmoidal foramen (PEF) and posterior ethmoidal foramen to optic canal (OC) using plain paranasal sinus (PNS) computed tomography (CT) scans of adults in a tertiary private hospital in the Philippines. Methods: Design: Retrospective review of plain PNS CT scans Setting: Tertiary Private Teaching Hospital Participants: One hundred four (104) plain PNS CT scans from January 2018 to December 2020 were considered for inclusion. Results: Of the 104 PNS CT scans, 35 were excluded - seven for age less than eighteen, six for undistinguishable PEF and twenty-two for chronic rhinosinusitis. The remaining 69 PNS CT scans demonstrated identifiable structures, with overall average distances from ALC to AEF of 23.71 ± 2.43 mm, AEF to PEF of 10.87 ± 2.39 mm and PEF to OC of 7.39 ± 2.28 mm. Conclusion: Our study suggests average distances for localization of vital structures such as the anterior ethmoidal artery, posterior ethmoidal artery and optic nerve among Filipinos. Because of considerable variation between and within sexes, individual measurements should still be obtained for each patient in performing endonasal, skull base and orbital surgery.

Prospective Study to Evaluate the Role of Multidetector Computed Tomography in Evaluation of Paranasal Sinus Pathologies

Background: The use of computed tomography (CT) combined with functional endoscopic sinus surgery (FESS) has empowered the modern sinus surgeon to treat patients more effectively, facilitating reduced morbidity and complications. This study aimed to evaluate the role of multidetector computed tomography (MDCT) in the evaluation of paranasal sinus pathologies.Materials & Methods: This cross-sectional study was conducted among the adult subjects attending the department of radiology at a tertiary care center in Lucknow for CT scan of paranasal sinuses for suspected paranasal sinus pathology from August 2018 to January 2020. The study included subjects above 12 years of age visiting the facility for CT of paranasal sinuses with a suspected paranasal sinus pathology and were also undergoing FESS.Results: A total of 74 patients falling in the sampling frame were enrolled in the study. Majority of cases were aged <40 years (n=41; 55.4%). Age group of 21-30 years was most affected (24.3%). Mean age of patients was 38.39±14.48 years. Inflammatory pathologies diagnosed on MDCT-included sinusitis (n=25), sinonasal polyps (n=17), sinusitis with polyps (n=15), and mucocele (n=2), respectively. FESS/histopathological diagnosis was done in 73 cases and revealed inflammatory pathology in 59/73 (80.8%) and neoplastic pathology in 14 (19.2%) cases. FESS/histopathological break up of inflammatory pathologies included 22 cases of sinusitis, 20 cases of sinonasal polyps, 14 cases of sinusitis with polyps, and three cases of mucocele. Agreement between MDCT and final diagnosis was seen in 67/74 (90.5%) cases assessed.Conclusion: The findings of the present study showed that MDCT is a useful modality for preoperative assessment of paranasal sinuses. With its high precision in diagnosis, it can help in further treatment planning and management in patients with paranasal sinus pathologies.

Evaluation of astructured e-learning-based approach to CT anatomy of the paranasal sinuses for medical students : Apilot study

HintergrundDie radiologische Anatomie ist in vielen Ländern kein integraler Bestandteil des Medizinstudiums. Die Radiologie scheint für neue online-basierte Lehrmethoden besonders geeignet.Ziel der ArbeitDas Ziel dieser Studie ist es, die Eignung des E‑Learnings zur Einführung komplexer Lerninhalte, wie der CT-Anatomie (radiologische Anatomie in der Computertomographie), zu prüfen und zu prüfen, ob die Identifikation wichtiger anatomischer Normvarianten durch Medizinstudent(inn)en durch eine Computertomographie-Checkliste verbessert werden kann.Material und MethodenMedizinstudierende wurden gebeten, Computertomographien (CT) der Nasennebenhöhlen auf anatomische Normvarianten vor und nach der Einführung der CLOSE-Kriterien (cribriform plate = Lamina cribrosa, Lamina papyracea, Onodi-Zelle = Sphenoethmoidale Zelle, sphenoid sinus = Keilbeinhöhle, ethmoidal artery = Arteria ethmoidalis anterior) zu untersuchen. Sowohl die CT-Anatomie als auch die CLOSE-Kriterien wurden mittels E‑Learning vermittelt. Die Rate der korrekt identifizierten Normvarianten und die Ergebnisse für die einzelnen CLOSE-Items wurden ermittelt. Die subjektive Evaluation des Nutzens der Checkliste und des E‑Learnings erfolgte mithilfe eines Fragebogens.ErgebnisseZehn Studierende nahmen an dieser Pilotstudie teil. Die Rate der korrekt identifizierten anatomischen Normvarianten verbesserte sich nach der Einführung der CLOSE-Kriterien signifikant von 33,3 auf 61,1 %. Die Analyse der einzelnen CLOSE-Items zeigte eine signifikante Verbesserung für C, S und E. Die subjektive Evaluation des E‑Learnings und der CT-Checkliste waren sehr positiv.SchlussfolgerungKomplexe Lerninhalte können Medizinstudierenden mittels E‑Learning vermittelt werden, auch wenn bisher kein Vorwissen in diesem Bereich besteht. Das E‑Learning wird als angemessene Methode zur Einführung der Thematik beurteilt. Ein strukturiertes Vorgehen mithilfe der CLOSE-Kriterien kann die Erkennung anatomischer Normvarianten signifikant verbessern.

Inter Observer Agreement Among Radiologist and Otorhinolaryngologists on Paranasal Sinus Computed Tomography Scans in Chronic Rhinosinusitis.

To evaluate inter observer agreement between Radiologist and Otorhinolaryngologists in identifying important structures and pathologies on pre operative computed tomography (CT) scans of paranasal sinus (PNS) in chronic rhinosinusitis (CRS). A retrospective review of CT scans PNS of CRS patients. Archived CT scans were evaluated by 3 observers, similarly experienced radiologist and otorhinolaryngologist and a less experienced otorhinolarygologist. The degree of intra- as well as inter observer agreement was assessed by Cohen's kappa statistics. A moderate and a fair inter observer agreement was noted among experienced radiologist and otorhinolaryngologist; & experienced experts and less experienced otorhinolaryngologist respectively. The greatest disagreements among all observers were found in superior attachment of uncinate process, optic nerve's relationship with sphenoid sinus and dehiscence of anterior ethmoid canal. The present study demonstrated a considerable inter observer variability among radiologists and otorhinolaryngologists, irrespective of their experience in the field of speciality. A few critically important structures which showed an unsatisfactory level of agreement and thus need to be sought after with more training and practice, were also identified. These included Keros type, optic nerve's location, dehiscence of anterior ethmoid artery, vidian and maxillary nerves, lamina papyracia defect, sphenoid sinus pneumatization and attachment of uncinate process. The study also emphasized the importance of inter disciplinary conferences for pre operative evaluation of sinus CT scans of CRS patients.

Midnasal stenosis in adults with normative values.

Congenital midnasal stenosis has previously been described as a cause of nasal obstruction in infants, and conservative and interventional treatments have been suggested. However, midnasal stenosis in adults has not been reported and related normative measurements have not been studied. Three adult patients presented with nasal obstruction and, based on examination and radiological findings, were diagnosed with midnasal stenosis. Anatomical measurements were studied in axial and coronal computed tomography scans, and compared with findings for 161 healthy individuals. Anatomical measurements showed that the endonasal cavity was larger in males than females. The midnasal region was found to be constricted in patients compared to healthy controls. This is the first study to report on midnasal stenosis in adults and to define normative anatomical measurements in adults. In patients presenting with nasal obstruction, midnasal stenosis should be suspected during endoscopic visualisation of medially located middle turbinates and uncinate processes in nasal cavities. A definitive diagnosis of midnasal stenosis can be made by examining paranasal sinus computed tomography scans. Endoscopic middle turbinectomy, complete uncinectomy, mega maxillary antrostomy and partial anterior ethmoidectomy have been suggested to relieve midnasal stenosis.

Is there a relationship between Lund-Mackay scale, olfactory bulb depth and width, and Keros classification in patients with nasal polyps?

Abstract OBJECTIVE. We investigated the relationship between Lund-Mackay scale, olfactory bulb depth and width, and Keros classification in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). MATERIAL AND METHODS. In this retrospective study, paranasal sinus computed tomography (PNSCT) images of 47 patients with CRSwNP and 47 healthy subjects (control) were evaluated. In the CRSwNP group, PNSCT scans were assessed based on Lund-Mackay scale. In both groups, olfactory fossae (OF) depth and width, and Keros classification were evaluated. RESULTS. The total Lund-Mackay score was 17.1±5.9. There were no significant differences between OF depth and width values of the nasal polyps group and control group. For both groups, Type II Keros was the most detected type; secondly, Keros type I and rarely Keros type III were detected. There was no significant correlation between Lund-Mackay score (All items and total score) and OF depth and width, and Keros type. There were negative correlations between ipsilateral OF depth and width (p&lt;0.05), whereas there were positive correlations between contralateral OF depth and width (p&gt;0.05). Keros type was positively correlated between ipsilateral and contralateral OF depth and Keros type (p&lt;0.05). In older patients, left OF depth and Keros type decreased (p&lt;0.05). CONCLUSION. As a conclusion, there was no correlation between Lund-Mackay score and olfactory fossa dimensions (depth and width). When considering age, one could notice that Keros type decreased in older patients.

Plasma Asymmetrıc Dımethylargınıne (ADMA) and Nıtrıc Oxıde (NO) Levels ın Patıents wıth Chronıc Pansınusıtıs.

Chronic pansinusitis is a mucosal inflammation of the nose and all paranasal sinuses with severe inflammation of the upper airways. Asymmetric dimethylarginine (ADMA) is associated with oxidative stress. In this study, we aimed to examine the plasma levels and importance of ADMA and nitric oxide (NO) in patients with chronic pansinusitis. The study was conducted with a total of 64 patients. The study group included a total of 40 patients with chronic pansinusitis. (18females, 22males) (mean age 32.27 ± 10.02). The control group consisted of 24 patients (11 females and 13 males). The mean age of the patients in the control group was 31.35 ± 6.05years. Nasal endoscopic examinations were performed in patients with a history of chronic pansinusitis and symptoms of chronic pansinusitis. Later, the diagnosis of chronic pansinusitis was confirmed with coronal paranasal sinus Computed tomography scans. Plasma ADMA levels were measured by ELISA method and NO levels were measured by Griess method. Plasma ADMA and NO levels of the patients and healthy volunteers were measured and the mean plasma levels of the two groups were compared. ADMA levels were significantly higher in the group with chronic pansinusitis compared to the control group (1.23 ± 0.41μM and 0.28 ± 0.06μM, respectively) (p < 0.001), while NO levels were significantly lower in the patient group compared to the control group (7.06 ± 1.07μM and 12.25 ± 0.95, μM, respectively) (p < 0.001). Our results show that the increase in ADMA levels and the decrease in NO levels are associated with chronic pansinusitis. According to these results, increased plasma levels of ADMA in chronic pansinusitis may be useful in clinical use as a sign of increased oxidative stress.

Outcome of Orbital Complications of Acute Rhinosinusitis in Children

Background: Acute bacterial rhinosinusitis occurs commonly as a sequel to a viral upper respiratory tract infection. Spread of infection outside the sinuses to the surrounding brain and orbit results in complicated sinusitis. Complications are more common in children than adults due to anatomical and immunological factors. Objective: To identify the correlation of orbital manifestations with computed tomography (CT) scan findings in diagnosing and classifying the disease, the efficacy of various treatment modalities and the outcome of these complications in children. Methods: A prospective study of 16 patients who presented with orbital swelling and features of acute rhinosinusitis was conducted in the Otorhinolaryngology Department at Al-Imamein Al-Kadhimein Medical City from April 2014 to October 2015. A full history, ear, nose and throat (ENT) examination including naso-endoscopic examination (if possible), ophthalmological assessment and CT scan of nose and paranasal sinuses were done. Patients were classified to have either pre-or postseptal infection depending on CT findings. All patients were admitted to the ENT ward, received intravenous broad-spectrum antibiotics and supportive measures and kept under close observation with monitoring of ophthalmological manifestations and vital signs. Some patients responded to medical treatment and others required surgical intervention. All patients after recovery were discharged home on oral antibiotics for 2 weeks and followed up monthly for a total duration of 3 months. Results: The majority of patients were males (62.5%). Mean ages of patients was 8.9±2.9 years with a range (4 to 15) year. Preseptal cellulitis was more common (62.5% vs. 37.5%). Impaired visual acuity, impaired extraocular movement and proptosis were significantly associated with postseptal infections as the P values were 0.01, 0.003 and 0.003 respectively. Preseptal cellulitis responded well to medical treatment. Postseptal abscesses required surgical drainage using an external, endoscopic or combined approach. 94% of patients had complete recovery without any sequel. Conclusion: Orbital manifestations are strongly correlated with CT findings. Medical treatment is very effective for preseptal infection. The choice of surgical approach for managing postseptal infection will depend upon, the site and extension of the abscess and the state of the nasal cavity. Early and accurate management can reduce morbidity and mortality. Keywords: Orbital complications of sinusitis, pediatric rhinosinusitis, ethmoiditis Citation: Al-Hassani JMK. outcome of orbital complications of acute rhinosinusitis in children. Iraqi JMS. 2021; 19(1): 90-98. doi: 10.22578/IJMS.19.1.12

Delayed Sudden Blindness From Unilateral Ophthalmic Artery Vasospasm Following Endoscopic Sinus Surgery?

Keywords: ophthalmic artery; vasospasm; iatrogenic; endoscopic sinus surgery; blindness&#x0D; &#x0D; Endoscopic sinus surgery (ESS) is a generally benign, minimally invasive procedure used for management of paranasal sinus diseases, although complications may occur due to proximity of vital structures such as the brain, orbit and great vessels.1 The overall ESS major complication rate is 0.5-1%, of which orbital injury accounts for 0.09% due to direct trauma.2 We report a case of unilateral delayed sudden visual loss without orbital trauma observed intraoperatively or on post[1]operative imaging studies, following a seemingly routine endoscopic sinus surgery for chronic rhinosinusitis.&#x0D; CASE REPORT&#x0D; An 18-year-old lad with no significant medical history underwent ESS for bilateral chronic rhinosinusitis with nasal polyposis. (Figure 1 A-D) The surgery and recovery from anesthesia were uneventful. On the 12th hour post-operatively, the patient noted blurring of vision on the left. Ophthalmologic examination revealed hyperemic conjunctiva (Figure 2A) with visual acuity of counting fingers at 1 foot while fundoscopy showed retinal hemorrhages. Extraocular eye movements (EOM) and intraocular pressure (IOP) were normal (12mmHg). With an assessment of pre-retinal hemorrhages, 500 mg Tranexamic acid was intravenously infused, and a paranasal sinus (PNS) computed tomography (CT) scan and orbital magnetic resonance imaging (MRI) were requested. A few hours later, he complained of left eye pain with increasing intensity and further deterioration of vision. Repeat visual acuity testing showed light perception. There was now a constricted pupil, non-reactive pupillary light reflex, periorbital swelling and progression of conjunctival chemosis. (Figure 2B) The IOP of the left eye had increased to 30mmHg then progressed to 40mmHg with development of total visual loss and a lateral gaze limitation. With an impression of choroidal hemorrhage and retrobulbar hemorrhage, a lateral canthotomy relieved the eye pain.&#x0D; The contrast PNS CT scan with orbital cuts showed that the lamina papyracea was intact with no definite hemorrhagic collections in the intraconal or extraconal spaces of both orbits. (Figure 3A, B) A small hyper density along the lateral inferior margin of the left globe at the intraconal region with slight thickening of the anterior periorbital region represented the lateral canthotomy. The PNS MRI / magnetic resonance angiography (MRA) with orbital cuts showed retinal detachment and periorbital edema in the left eye. (Figure 4) A B-Scan ocular ultrasonogram showed retinal detachment and vitreous opacities. The diagnosis was ocular ischemic syndrome secondary to ophthalmic artery vasospasm, and the patient was given sublingual nitroglycerine and intravenous dexamethasone 8mg every 12 hours for 24 hours, with improvement of periorbital swelling. He was discharged after 12 days with no resolution of the unilateral visual loss.