Paranasal Sinus CT Research Articles

Utilizing radiomics for differential diagnosis of inverted papilloma and chronic rhinosinusitis with polyps based on unenhanced CT scans

To evaluate whether radiomics models based on unenhanced paranasal sinuses CT images could be a useful tool for differentiating inverted papilloma (IP) from chronic rhinosinusitis with polyps (CRSwNP). This retrospective study recruited 240 patients with CRSwNP and 106 patients with IP from three centers. 253 patients from Qilu Hospital were randomly divided into the training set (n = 151) and the internal validation set (n = 102) with a ratio of 6:4. 93 patients from the other two centers were used as the external validation set. The patients with the unilateral disease (n = 115) from Qilu Hospital were selected to further develop a subgroup analysis. Lesion segmentation was manually delineated in CT images. Least absolute shrinkage and selection operator algorithm was performed for feature reduction and selection. Decision tree, support vector machine, random forest, and adaptive boosting regressor were employed to establish the differential diagnosis models. 43 radiomic features were selected for modeling. Among the models, RF achieved the best results, with an AUC of 0.998, 0.943, and 0.934 in the training set, the internal validation set, and the external validation set, respectively. In the subgroup analysis, RF achieved an AUC of 0.999 in the training set and 0.963 in the internal validation set. The proposed radiomics models offered a non-invasion and accurate differential approach between IP and CRSwNP and has some significance in guiding clinicians determining the best treatment plans, as well as predicting the prognosis.

Use of Perpendicular Plate of Ethmoid Split Technique in Rhinoplasty and Septoplasty.

In recent years, the perpendicular plate of ethmoid (PPE) has become a prominent choice for bone-grafting materials. This study introduces the PPE split technique for efficient removal of the bony septum or the harvesting of partial PPE for septal batten grafts in rhinoplasty and septoplasty, particularly suited for cases with thick PPE. Herein, this technique was employed to minimize septal defects and prevent complications while achieving harvested bony grafts of the desired effective thickness. In this retrospective study, 36 patients underwent surgery using the PPE split technique (22 septoplasties and 14 rhinoplasties). The procedure involved detaching the PPE from the septal cartilage and performing a vertical plane osteotomy with a number 10 scalpel blade to remove bony spurs or prepare batten grafts. Paranasal sinus CT revealed that the average anteroinferior PPE thickness was 3.46 mm. This technique was used for both bony batten graft harvesting (26 cases) and bony spur removal, and septum reshaping (10 cases). Successful PPE harvesting was achieved in all cases except for three, which experienced graft breakage. This study demonstrates the viability and effectiveness of the PPE split technique as a supplementary maneuver in septoplasty and rhinoplasty procedures. Its diverse applications include reshaping, correcting deviated septum, harvesting bony batten grafts, and providing support for an aesthetically pleasing nasal profile.

Relationship of the accessory maxillary ostium to mucosal thickening and maxillary sinus cysts: a 3D segmentation study

ObjectivesWe aimed to investigate the relationship between the presence of the accessory maxillary ostium (AMO) with mucosal thickening (MT) and maxillary sinus cysts (MSCs). Study DesignThis single-center retrospective study included patients who underwent paranasal sinus CT between November 2022 and February 2023. We excluded patients with natural maxillary ostium (NMO) occlusion. Two radiologists evaluated the presence of AMOs, MT, and MSCs in CT images and measured their dimensions using a 3D volumetric analysis program. ResultsWe included 125 patients (mean age: 36.47± 16.0 years; male/female: 67/58). In total, 65 patients (52%) had single or multiple AMOs. No significant relationship was found between the presence of an AMO and the presence of MT on either side (P ≥ 0.306). There was a statistically significant difference between the presence of an AMO and MSC on the right side (P = 0.002), but not on the left side (P = 0.477). The diameter of the AMO and the distance from the AMO to the maxillary floor were not correlated with mucosal thickness or MSC volume, but the distance from the AMO to the sinus floor had a small positive correlation with total maxillary sinus volume. ConclusionThe presence of an AMO and its increased diameter may not contribute to ipsilateral maxillary sinusitis in patients whose unilateral or bilateral NMOs are not occluded.

Endoscopic trans-eustachian tube approach: identifying the precise landmarks, a novel radiological and anatomical evaluation

PurposeThe endoscopic trans-eustachian approach (ETETA) is a less invasive approach to the infratemporal fossa (ITF), providing superior exposure compared to traditional transcranial approaches. The anatomy of the pharyngotympanic (eustachian) tube and adjacent neurovascular structures is complex and requires in-depth knowledge to safely perform this approach. We present a cadaveric and radiological assessment of critical anatomic considerations for ETETA.MethodsSix adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data.ResultsAnatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube.ConclusionThe combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach.

Anteriorly Tilted Coronal CT of Paranasal Sinuses for Endoscopic Sinus Surgery.

Anteriorly Tilted Coronal CT of Paranasal Sinuses for Endoscopic Sinus Surgery.

Anatomical Variants of the Uncinate Process: A Challenge in the Endoscopic Surgery of the Nose and Paranasal Sinuses.

Importance To identify the anatomical variants of the uncinate process relevant to surgical intervention during the nose and paranasal sinus surgeries. Objective To evaluate the frequency of anatomical variants of the uncinate process in a population of northeast Mexico and compare it with another population. Methods Retrospective study, descriptive and analytical, randomly selected patients with radiological evaluation at Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico. Images were obtained from the Radiology Department. A total of 149 patients aged from 18 to 79 years with paranasal sinus-CT performed between January 2019 and December 2021 were analyzed. The variables evaluated wereuncinate process anatomical variations by age group, radiological classification of the superior attachment of the uncinate process, and morphological variations. Main outcomes and measures The primary study outcome was the determination of the most frequent insertion of uncinate process in the northeast Mexican population. Results The 149 CT scans comprised71 females with a mean age of 38.28 ± 16.7 years and 78 males, with a mean age of 41.8 ± 15.01 years. The most frequent uncinate process of superior attachment was type one, observed in 57.7% of males (n=45) and 50.7% of females (n=37) (p=0.494). Type onewas most observed on the right side (57.7%). Type four was the second most common type, present in 12.8% of males (n=10) and 12.7% of females (n=9) (p=0.82). Conclusion Knowledge about the types of variations in the insertion of the uncinate process is fundamental prior to any endoscopic sinus surgery. The surgeon must be familiar with this detail when approaching patients with sinonasal pathology.

Ultra-low-dose photon-counting CT of paranasal sinus: an in vivo comparison of radiation dose and image quality to cone-beam CT.

This study investigated the differences in subjective and objective image parameters as well as dose exposure of photon-counting CT (PCCT) compared to cone-beam CT (CBCT) in paranasal sinus imaging for the assessment of rhinosinusitis and sinonasal anatomy. This single-centre retrospective study included 100 patients, who underwent either clinically indicated PCCT or CBCT of the paranasal sinus. Two blinded experienced ENT radiologists graded image quality and delineation of specific anatomical structures on a 5-point Likert scale. In addition, contrast-to-noise ratio (CNR) and applied radiation doses were compared among both techniques. Image quality and delineation of bone structures in paranasal sinus PCCT was subjectively rated superior by both readers compared to CBCT (P < .001). CNR was significantly higher for photon-counting CT (P < .001). Mean effective dose for PCCT examinations was significantly lower than for CBCT (0.038 mSv ± 0.009 vs. 0.14 mSv ± 0.011; P < .001). In a performance comparison of PCCT and a modern CBCT scanner in paranasal sinus imaging, we demonstrated that first-use PCCT in clinical routine provides higher subjective image quality accompanied by higher CNR at close to a quarter of the dose exposure compared to CBCT.

Relationship between maxillary sinus mucosal cyst and sinus ostium 2D area in three-dimensional volumetric paranasal CT ımages.

To investigate the relationship between the maxillary sinus ostium 2D area (SOA) and the development of mucosal cysts of the maxillary sinus (MMC). Thirty patients (≥ 18years) with unilateral MMC who underwent paranasal sinus CT (PNsCT) were included in this single-center retrospective study. Non-MMC sinus was used as the control group. Cyst and air volume of the maxillary sinuses, diameter, and 2-dimensional area of the ostium of the patients were calculated in the 3-dimensional volumetric analysis program. Both correlation and linear regression model analyses were performed for the relationship between MMC and SOA. Thirty patients were included (mean age of 42.30 ± 17.62years). A total of 15/30 (50%) were male. The mean SOA in patients with MMC (8.91 ± 1.10 mm2) was lower than in patients without MMC (12.94 ± 1.35 mm2), which was statistically significant (p < 0.001). The mean sinus ostium diameter in patients with MMC (2.12 ± 0.71mm) was higher than in patients without MMC (1.91 ± 0.82mm), which was statistically insignificant (p = 0.295). There was a statistically significant, good level of negative linear correlation between SOA and total cyst volume (TCV) [correlation coefficient (r) = -0.680, p < 0.001]). As a result, the regression model consisting of "Age, Sinus air volume, and TCV" variables is a good model and has statistically significant relations with SOA. In conclusion, small SOAs contribute to the development of MMC. There was a negative correlation between SOA and TCV. In addition, 2D area measurement may be a more accurate method instead of diameter measurement.

Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study

PurposeDiagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based – DRL(DRLCI) and clinical indication – AD (ADCI) for adult CT in Brazil. MethodsThe prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. ResultsIn majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. ConclusionsThere was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.

Unravelling the Complex Relationship Between Frontal Sinus Pneumatization and Paranasal Sinus Anatomical Variants: Insights from CT Imaging.

The aim of this study was to analyse the relationship between frontal sinus pneumatization and its effect on various variations of paranasal sinuses on paranasal sinus CT scan. A total number of 100 patients (51 males, 49 females) were included in this study. Patients were divided into three groups on the basis of their frontal sinus pneumatization extent on paranasal sinus CT as Type 1 pneumatization (aplasia and hypoplasia), Type 2 pneumatization (medium) and Type 3 pneumatization (hyperplasia). The prevalence of various variations like pneumatization of upper and middle turbinate, presence of agger nasi, Haller and Onodi cell, maxillary sinus hypoplasia, extent of sphenoid sinus pneumatization, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid sinus, dehiscence and protrusion of internal carotid artery and optic nerve types were ascertained and compared within each group. The prevalence of Onodi cell, anterior clinoid process and greater wing of sphenoid pneumatization and optic nerves type 3 and 4 were higher in Type 3 frontal sinus pneumatization group as compared with other groups. Excessive pneumatization of frontal sinus has various effects on paranasal sinus variations. Surgeons dealing with endoscopic sinus surgery, maxillofacial and skull base surgery must be vigilant of association between these variations preoperatively for avoiding complications.

The Association Between Eosinophils and the Disease Process in Destructive Non-invasive Fungal Rhinosinusitis.

This study aims to investigate the significance of eosinophils in the progression and prognosis of destructive non-invasive fungal rhinosinusitis. This was a retrospective study of 126 patients who were operated on for a nasal sinus disease between 2010 and 2017; of these, 56 met the inclusion criteria. These were divided into two groups: (i) Group 1, with only the destructive non-invasive sinus polyposis type, and (ii) Group 2, with all types of nasal polyposis other than the destructive non-invasive sinus fungal polyposis type. Data including demographic data, paranasal sinuses (PNS) CT scans, pre- and post-operative eosinophils count, histopathology of polyps, and fungal cultures were collected from medical records from King Abdulaziz University Hospital, Jeddah, Saudi Arabia. A nonparametric Wilcoxon signed-rank test was used to determine a significant difference of p< 0.05. We performed multivariate analysis using repeated measure analysis of covariance (ANCOVA) and adjusted for confounders such as age, sex, pre- and post-operative IgE, fungal culture, and histopathology of the disease. Interaction between age, sex, IgE, and proportion of eosinophils was assessed at a p-value of 0.05. A significant difference was found between pre-and post-operative blood eosinophils levels in Group 1 (p= 0.01) after adjusting for confounders such as age, sex, fungal culture, pre and post IgE, and histopathology of the disease. However, no significant difference was found in Group 2 (p= 0.663) even after adjusting for age, sex, fungal culture, pre and post IgE, and histopathology of the disease. We did not find any significant interaction (P>0.05) between pre- and post-operative levels of eosinophils with age, sex, and fungal culture among Group 1 and Group 2. There is a statistically significant difference in blood eosinophils between pre- and post-operative levels in studied cases of destructive non-invasive fungal polyposis, a difference is not seen in nasal sinus polyp cases other than destructive non-invasive fungal polyposis types. High pre-operative eosinophils levels in destructive non-invasive fungal sinus polyposis types demonstrated the importance of eosinophils in the pathogenesis of this disease. The blood eosinophils can therefore be considered an important factor in the disease process and an indicator of the disease prognosis and destructive behavior.

Reduksi Dosis Serap Mata dengan Implementasi Software Organ Dose Modulation (ODM) pada Protokol CT Scan Sinus Paranasal

Background: CT Scan examination of the paranasal sinuses includes organs that are sensitive to radiation exposure, one of which is the lens of the eye whose damage can be known after radiation exposure of about 500 mGy. Currently found an alternative to reduce the dose received by patients is with Organ Dose Modulation (ODM) software This ODM serves to reduce radiation dose in the eye -18.9%, Brain -10.1%, Breast -31.3%, Lung -20.7% and Liver -24%. The purpose of this study is to determine the role of ODM software in dose reduction on CT Scan SPN, determine the amount of absorption dose profile with the implementation of ODM software, differences in anatomical image information with the implementation of ODM software and without ODM on CT Scan SPN.Methods: This type of research is quantitative with experimental studies, comparing the use of software with and without ODM to absorption dose reduction and anatomical image information of SPN. Samples using phantom performed Paranasal Sinus CT Scan procedure. Respondents consisted of 3 radiologists to assess the anatomical image of the maxillaris bone, bilateral maxillar sinus, and rice septum. Data analysis was carried out by statistical tests using SPSS Software to find the value of significance differences.Results: The use of ODM software on CT scans of the paranasal sinuses plays an important role in reducing the absorbed dose of the eye. Statistical test results showed a significant reduction in eye absorption dose (p-value 0.05). The dose profile resulting from the use of the ODM software is a decrease in the absorbed dose by the eye by 9.75%. The value of differences in SPN anatomical information using and without ODM resulted in a p-value of 1.00 (p-value 0.05).Conclusion: The value of the absorbed dose of eye radiation is significantly different with and without the use of ODM. However, there is no significant difference in the SPN anatomical image information. From the implementation of the ODM software, it can reduce the absorbed dose in the eye without reducing the anatomical image information.

Relationship Between Maxillary Fungal Sinusitis and Odontogenic Infection, Dental Implant

Background and Objectives One of the common causes of chronic bacterial sinusitis is odontogenic infection, which has recently attracted attention and many studies are being conducted. However, studies on the relationship between chronic fungal sinusitis and odontogenic infection, which are commonly encountered in clinical practice, are still lacking. In this study, we investigated the association between chronic fungal sinusitis, odontogenic infection and dental implant.Subjects and Method We retrospectively reviewed medical records and paranasal sinus (PNS) CT scans of 198 patients who were treated in our institution for maxillary fungal sinusitis between March 2010 and October 2020.Results We defined two groups of maxillary sinuses (MS) according to the presence of fungal ball (fungal group; n=204 vs. normal group; n=192). Fungal sinusitis was diagnosed in all 204 cases of the fungal group. In the normal group, the mean MS volume was 17.0±6.2 mL, and in the fungal group, the mean MS volume was 13.8±5.2 mL. The volumes of MS were statistically small in the fungal group (&lt;i&gt;p&lt;/i&gt;&lt;0.001). In 141 (69.1%) of 204 sinuses in the fungal group, findings suggestive of odontogenic infection were confirmed on the PNS CT scans and were statistically significant (&lt;i&gt;p&lt;/i&gt;&lt;0.001, odds ratio=2.537). Of 204 sinuses in the fungal group, 26 (12.7%) had dental implants and were not statistically significant (&lt;i&gt;p&lt;/i&gt;=0.107, odds ratio=1.724).Conclusion This study suggests odontogenic infection to be a risk factor for developing fungal sinusitis in the ipsilateral maxillary sinus.

Prevalence of Tonsilloliths in Chronic Rhinosinusitis: A Retrospective CT PNS Study.

To determine the prevalence of tonsilloliths in CT PNS (Computed Tomography ParaNasal Sinuses) of patients with and without features of chronic rhinosinusitis. 97 CT PNS of the patients with features of chronic rhinosinusitis were included in the study group, and 124 CT PNS of cases without features of chronic rhinosinusitis were taken as the control group. All 221 CT PNS were then evaluated for the presence of tonsillar calcifications indicative of tonsilloliths and the prevalence of the same in the study and control groups. 97 of the 221 CT PNS evaluated showed features of chronic rhinosinusitis. 60 of these 97 CT PNS showed features of tonsillolith in one or both tonsils. Of these 60 cases, 58 had maxillary sinusitis, and 17 had pansinusitis. Most of the cases had small tonsilloliths (1-3mm), and only one case had a large tonsillolith (> 6mm). At the same time, 27 out of the remaining 124 CT PNS without chronic rhinosinusitis showed the presence of tonsilloliths in one or both tonsils. The prevalence of tonsilloliths is significantly higher in patients with chronic rhinosinusitis than in the control group. The presence of tonsilloliths in patients with chronic rhinosinusitis indicates repeated inflammation of the tonsils due to sinusitis. Such chronic inflammation of the mucosa of the pharynx should prompt more aggressive treatment of chronic rhinosinusitis.

Evaluation of Olfactory Fossa Depth Using Computed Tomography in A Tertiary Center: A Retrospective Study

Introduction:Endoscopic sinus surgery is a widely utilized surgical method for addressing chronic sinonasal diseases. To prevent major postoperative problems, an anatomical understanding of its variants is necessary. Our study aims to determine the occurrence and classification of different Keros types by analyzing paranasal sinus CT scans and retrospectively evaluating the depth of the olfactory fossa in our population.Methods:This is a retrospective single-centre analytical study on 254 patients who had undergone a non-enhanced paranasal sinus CT scan for 1 year after ethical approval from the Institutional Review Committee of Nobel Medical College Teaching Hospital. The statistical program SPSS version 25 was used to conduct the statistical analysis.Results:The average depth of the right olfactory fossa (OF) was 4.4±1.44 mm on the right side and 4.5±1.5 mm on the left side. According to the Keros classification, out of a total of 254 patients, 38 patients (15%) were classified as Keros I, 193 patients (76%) as Keros II, and 23 patients (9%) as Keros III for the right lateral lamella. 44 (17.3%), 180 (70.9%), and 30 (11.8%) patients were classified as Keros I, II, and III respectively, for the left lateral lamella..Conclusions:A preoperative CT scan of the paranasal sinus is useful in assessing the architecture of the anterior skull base and making sure the surgical approach is properly planned.

Rhino-orbital Mucormycosis in an Immunocompetent Pediatric Patient, Resembling an Orbital Mass- a Case Report

Rhino-orbital mucormycosis in an immunocompetent pediatric patient can present as an orbital mass. We report a 9-year-old male that presented with periorbital swelling and limitation of left eye movement from one month ago. The patient was treated at another center with a diagnosis of mucormycosis but was referred due to worsening symptoms. Orbital and paranasal sinus CT scan revealed opacities in the left paranasal sinus and soft tissue density in the medial and inferior orbital wall. The patient underwent orbitotomy and mass debulking surgery on suspicion of a possible neoplastic mass. Pathologic evaluations revealed mucormycosis. After receiving intravenous liposomal amphotericin-B that was followed by oral posaconazole syrup for two months and sinus debridement, the symptoms regressed. In immunocompromised pediatric patients, mucormycosis should be considered in the differential diagnosis of an orbital mass.

Sinonasal Anatomy Variations on CT Scans of a Sample of Filipino Adults With Chronic Rhinosinusitis

ABSTRACT&#x0D; Objective: To determine the prevalence of sinonasal anatomic variations seen on paranasal sinus (PNS) CT scans of a sample of Filipino adults with chronic rhinosinusitis.Methods: Design: Cross-sectional study Setting: Tertiary Government Training Hospital Participants: The PNS CT scans of 51 Filipino patients with chronic rhinosinusitis with and without nasal polyposis diagnosed at our outpatien Department of Otorhinolaryngology-Head and Neck Surgery between October 2015 to December 2020 were reviewed for the presence of sinonasal anatomic variants. The prevalence of the identified variants was calculated.&#x0D; Results: The CT scans of 51 patients, 41 (80.4%) men and 10 (19.6%) women, were included. The median age was 48 years (Q25: 35, Q75: 56, IQR:21). The median Lund Mackay Score (LMS) was 15 (Q25: 12, Q75: 20, IQR:8). Majority (94%) had an LMS of ≥5. The most common anatomic variant in the study population was agger nasi (n=46/51, 90.2% present bilaterally) followed by uncinate process attachment to the lamina papyracea (n=90/102, 88.24%). The third to sixth most common findings were Keros type II classification (n=76/102, 74.51%), nasal septal deviation (n=35/51, 68.62%), optic nerve canal type 1 (n=67/102, 65.69%) and anterior ethmoid artery grade 1 (n=46/102, 45.1%), respectively. Less common variants were Onodi cell (n=13/51, 25.49% unilateral and n=10/51, 19.61% bilateral), Haller cell (n=8/51, 15.69% unilateral and n=1/51, 1.96% bilateral), supraorbital cell (n=4/51, 7.84% unilateral and n=4/51, 7.84% bilateral), middle turbinate concha bullosa (n=3/51, 5.88% unilateral and n=6/51, 11.76% bilateral), superior turbinate concha bullosa (n=2/51, 3.92% unilateral and n=1/51, 1.96% bilateral), pneumatized crista galli (n=2/51, 3.92%) and optic nerve dehiscence (n=1/51, 1.96% bilateral). &#x0D; Conclusion: In the adult Filipino population with CRS sampled in this study, the six most common sinonasal anatomic variants were agger nasi, superior attachment of the uncinate process to the lamina papyracea, Keros type II classification, septal deviation, optic nerve canal type 1 and anterior ethmoid artery grade 1. Pre-operatively, the PNS CT scan of every patient must be meticulously evaluated for the sinonasal anatomic variants to avoid surgical complications.

Риногенні орбітальні ускладнення в дітей при гострому риносинуситі

Purpose - to determine the frequency and prevalence of rhinogenic orbital complications (RОC) in children with acute rhinosinusitis (ARS) depending on their gender and age, with an analysis of the treatment performed in the pediatric ENT department. Materials and methods. A retrospective analysis of 61 patients with ROС at АRS in children who were treated in the otorhinolaryngology department of the City Children’s Hospital No. 1 in Kyiv from 2016 to 2020 was conducted. The diagnosis was established on the basis of the anamnesis, general clinical examination, endoscopic examination and radiological methods of diagnosis (X-rays or CT of paranasal sinuses). All patients received complex treatment with a parenteral antibiotic and were examined by related specialists: an ophthalmologist, a pediatrician, a neurologist or a neurosurgeon as needed. Results. The average age of the patients was 5 years and 2 months. There were 34 (55.7%) boys, 27 (44.3%) girls. In 38 (62.3%) sick children, reactive swelling of the eyelids of the right eye was diagnosed, in 22 (36.1%) reactive swelling of the eyelids of the left eye, in one (1.6%) case, periostitis of the right orbit was diagnosed. All patients with ROС on the background of АRS received parenteral antibacterial therapy with one or two drugs, among which ceftriaxone was prescribed in 98.3%, metrogyl in 41%, macrolide in 21.3%, and amoxicillin in 1.6% of cases. 3 (5%) patients underwent surgical treatment - puncture and drainage of the maxillary sinus, 2 (3.7%) sick children underwent frontotomy with sinus drainage. Complex conservative treatment without surgical intervention was effective in 56 (91.3%) patients. The average length of hospital stay was 7.7 days. Conclusions. In children with АRS, ROС occurs most often at the age of 3 to 7 years (49.2%) and manifests itself in the form of reactive swelling of the eyelids of the right eye in 62.3% and in 36.3% of the left eye. Timely antibiotic therapy in patients with АRS of children with ROС makes it possible to effectively treat this pathology without the use of surgical methods. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

SIGNIFICANCE OF NASAL SEPTUM ANGULATION AND ITS ASSOCIATION WITH RHINOSINUSITIS USING SYMPTOMS SCORES AND VISUAL ANALOGUE SCALE

Objective- The aim of the study is to determine the association of angulation of nasal septum with the severity of rhinosinusitis as measured by symptom score and visual analog score. Materials and methods- 50 patients who were diagnosed with rhinosinusitis and fullled the selection criteria were assessed for symptom score and VAS and measurement of angulation of nasal septum was performed through a coronal view of CT paranasal sinuses in bone window setting. Patients older than 18 years, diagnosed with rhinosinusit Inclusion criteria- is and carrying indications for CT scan of paranasal sinuses were included in the study. Patients with history of nasal Exclusion criteria trauma, septal surgery, septal haematoma ,septal perforation, concha bullosa, sinonasal tumors were excluded from the study. Results- The result obtained from one-way ANOVA test revealed a signicant association between category of severity of septal angulation and the symptom score of rhinosinusitis. Severity of nasal septum angulation may be signicantly asso Conclusion- ciated with severity of rhinosinusitis based on symptom score and VAS.these ndings could be used in management of patient with rhinosinusitis during functional endoscopic sinus surgery

Radiological Evaluation of Uncinate Process Variations using Multidetector Computed Tomography

Introduction: Functional endoscopic sinus surgery has emerged as a superior technique in sinus surgery with a lower incidence of associated complications as compared to traditional surgeries; however, it still carries risks of possible complications, some of which could be attributable to the variations that exist in the nose and paranasal sinus anatomy. Variations in the uncinate process, one of the important structural landmarks in functional endoscopic sinus surgery can have implications during sinus surgery. Therefore, identifying the variations in the uncinate process becomes a very important consideration. The objective of this study was to identify the variations of the uncinate process on Multidetector Computed Tomography of paranasal sinuses&#x0D; Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Birat Medical College and Teaching from December 2021 to June 2022 after obtaining ethical clearance from IRC. A total of 240 participants referred to the Department of Radiodiagnosis for CT of paranasal sinuses were included in the study.&#x0D; Results: The most frequent superior attachment of uncinate was found to be Type I and the least common was Type IV. The least frequent variation was UP pneumatisation. Most of the cases showed typical angulation followed by medial orientation and lateral orientation.&#x0D; Conclusion: Variations in the uncinate process exist and Multidetector CT is a commendable tool for identifying these variations.