Paranasal Sinus Pathology Research Articles

Dexmedetomidine and esmolol for induced hypotension for functional endoscopic sinus surgery: A comparative study

Background: Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure performed under controlled hypotensive anaesthesia. This technique has advantage of minimal blood loss and visualize surgical field distinctly. The present study was designed to compare the efficacy of Dexmedetomidine and Esmolol for the induction of controlled hypotension in functional endoscopic sinus surgeries. Materials and Methods: A total of 80 cases with paranasal sinus pathologies posted for functional endoscopic sinus surgeries between 21-60 years were recruited. Study participants were randomly divided into two study groups i.e. group 1 administered with dexmedetomidine and group 2 administered with Esmolol. Parameters like hemodynamics, total intraoperative fentanyl consumption, duration of surgery and total blood loss were noted. Results: The mean difference of systolic blood pressure, diastolic blood pressure and mean arterial pressure was not statistically significant (P>0.05). The mean difference of heart rate between two study groups was statistically significant (p<0.05). The mean duration surgery in group 1 was 87.9 min and in group 2 was 89.5 min. The estimated blood loss was 132.2 ml in group 1 and 134.2ml in group 2. No desaturation was observed in the study participants during recovery and postoperative period. Conclusion: Both dexmedetomidine and esmolol infusion are efficacious and are safe drugs for maintaining controlled hypotension and improve the quality of surgical field. Dexmedetomidine was associated with good postoperative sedation while esmolol associated with early recovery time. Surgeon satisfaction score was similar was similar in both.

Nasal Septal Deviation and Incidental Paranasal Sinus Opacification: A Role of Computed Tomography

Background and Objectives: The purpose of this study was to investigate the prevalence of incidental paranasal sinus (PNS) opacification in nasal septal deviation (NSD) using computed tomography (CT) and to identify contributing factors.Subjects and Method: We analyzed 216 patients who underwent septoplasty for the correction of NSD and who underwent preoperative PNS CT. We assessed the prevalence of incidental PNS opacification in these patients and determined the type of NSD according to Mladina classification. We also evaluated whether the direction of NSD affected the presence of PNS opacification on CT, and whether the presence of PNS opacification was associated with other rhinologic symptoms.Results: Of 216 patients with NSD, 86 showed opacified PNS on CT. According to Mladina classification, NSD patients were classified as type I (24.1%), type II (36.1%), type III (20.8%), type IV (5.6%), type V (9.7%), type VI (2.3%), or type VII (1.4%). Patients with type II NSD showed a significantly higher incidence of PNS opacification compared with other types of NSD (p=0.001). However, the direction of NSD did not significantly influence the presence of incidental PNS opacification. Furthermore, regardless of the presence of PNS opacification, there was no significant difference in rhinologic symptoms such as olfactory dysfunction, among others.Conclusion: We found that incidental PNS opacification on CT was common in NSD patients, especially in patients with type II NSD. Thus, we suggest that CT evaluation of patients with NSD may be helpful for assessing comorbid PNS pathologies as well as objectively identifying nasal septal deformities.

The impact of pre-operative computed tomography scan in patients underwent septoplasty on the postoperative complications

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Deviated nasal septum (DNS) is one of the most frequent causes of nasal obstruction in adults. An anterior rhinoscopy (AR), which is usually the first diagnostic procedure in the evaluation of obstructive nasal pathologies, is often inadequate in the assessment of the posterior nasal cavity and the gold standard method for the evaluation of paranasal anatomy and inflammatory paranasal sinus pathologies is paranasal sinus computed tomography (PNS CT). Aim was to validate the recommendation of pre-operative computed tomography scan in minimizing post-septoplasty complications.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective record based study was conducted including all patients with clinically diagnosed DNS and undergone surgical intervention at Khamis Mushayet General Hospital. Data extracted included patients demographic data, and post-operative recorded complications and history of preoperative CT scan for evaluating and grading DNS. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total sample of 60 patients’ undergone septoplasty for DNS. Patients who undergone preoperative CT were 30. The remaining 30 patients didn’t undergone pre-operative CT for evaluation of DNS. The most diagnosed complication was nasal obstruction (28.3%) followed by external nose deformity (20%). Exact of 47% of patients had postoperative nasal obstruction didn’t undergone pre-operative CT. About 42% of those who had postoperative nasal deformity didn’t undergone CT while 33% of patient who had post-operative bleeding and septal perforation didn’t undergone CT.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In conclusion, the study revealed that preoperative CT showed insignificant efficacy in relieving nasal obstruction or minimizing postoperative complications.&lt;/p&gt;

Lateral Lamella of Cribriform Plate (LLCP): A Computed Tomography Radiological Analysis.

Spectrum of disease involves nasal passage and paranasal sinuses termed as sinonasal disease. CT is superior to other imaging modalities in the assessment of the paranasal sinuses (PNS) pathology. Functional Endoscopic Sinus Surgery (FESS) is the common modality of treatment for diseases of nose and PNS. Coronal CT images closely correlates with the surgical approach. Therefore, CT is the preferred study before FESS. The lateral lamella of cribriform plate (LLCP) is the thinnest bone in the anterior skull base and most vulnerable parts of the skull base for iatrogenic complication during FESS. Therefore, preoperative evaluation of LLCP is importance in a successful FESS. The study focused on the vertical height of the LLCP and the angulation of LLCP with CP. This study was performed retrospectively on CT images of 600 adult subjects. Chi square test and pearson correlation were used for data analysis. Type II is most prevalent type of Kero's type. There is a significant correlation between Kero's classification and Gera's classification. A positive correlation found between the vertical height of LLCP with its angle formed by CP and the correlation was found to be significant. Assessment on LLCP in its 2 aspect both vertical height of LLCP and its sloping with CP certainly gives a map to the surgeon during FESS and to improve the safety profile of the procedure.

Dexmedetomidine and esmolol for induced hypotension for functional endoscopic sinus surgery-a comparative study

Background: Functional endoscopic sinus surgery is a minimally invasive surgical procedure performed under controlled hypotensive anesthesia. This technique has the advantage of minimal blood loss and visualizes surgical field distinctly. Aim and Objectives: To compare the efficacy of Dexmedetomidine and Esmolol for the induction of controlled hypotension in functional endoscopic sinus surgeries. Materials and Methods: A total of 80 cases with paranasal sinus pathologies posted for functional endoscopic sinus surgeries between 21 and 60 years were recruited. Study participants were randomly divided into two study groups, i.e. Group 1 administered with dexmedetomidine and Group 2 administered with Esmolol. Parameters such as hemodynamics, total intraoperative fentanyl consumption, duration of surgery, and total blood loss were noted. Results: The mean difference of systolic blood pressure, diastolic blood pressure and mean arterial pressure was not statistically significant (P > 0.05). The mean difference of heart rate between two study groups was statistically significant (P < 0.05). The mean duration surgery in Group 1 was 87.9 min and in Group 2 was 89.5 min. The estimated blood loss was 132.2 ml in Group 1 and 134.2 ml in Group 2. No desaturation was observed in the study participants during recovery and the postoperative period. Conclusion: Both dexmedetomidine and esmolol infusion are efficacious and are safe drugs for maintaining controlled hypotension and improve the quality of surgical field. Dexmedetomidine was associated with good postoperative sedation while esmolol associated with early recovery time. Surgeon satisfaction score was similar was similar in both groups.

The maxillary sinus via aprelacrimal approach as agateway to the retromaxillary space and orbital floor

Endonasal surgery has emerged as the standard procedure for the majority of nasal and paranasal sinus pathologies. However, some pathological changes beyond the maxillary sinus seem to be out of the instrumental range and are addressed by open approaches. The prelacrimal approach to the maxillary sinus published by Zhou and coworkers has stimulated arapid development of various procedures in this field. In the current work, the possibilities of the prelacrimal approach are illustrated by means of three clinical cases. The prelacrimal approach enables isolated fractures of the orbital floor to be reconstructed without the risk of lower eyelid complications. Meningo- or encephaloceles in the far lateral aspects of the sphenoid sinus are comparatively well reached via endonasal, transantral, and transpterygoid approaches. Until recently, tumors beyond the maxillary sinus were the domain of open surgery, particularly when they extended laterally of the maxillary sinus. The technique of choice was either aCaldwell-Luc or amidfacial degloving approach. Many of these operations can now be performed via the endonasal prelacrimal approach, with lower morbidity and more rapid postoperative healing. The approach described herein is equal if not superior to the traditional approaches in terms of overview and accessibility.

Sphenoid sinuses: pneumatisation and anatomical variants-what the radiologist needs to know and report to avoid intraoperative complications.

Sphenoid sinuses are pneumatised structures, placed in the body of the sphenoid bone, with highly variable morphology. The strict relationships with vascular and nervous structures determine the importance of their anatomical variants in otorhinolaryngology and neurosurgery; a precise understanding of the complex anatomy and anatomic variations of these structures is pivotal for radiological diagnosis of paranasal sinuses pathology and for surgical planning, to avoid potential complications. Our aim is to describe the anatomical variants of sphenoid sinuses, and to help general radiologists and specialists in endoscopic surgery in becoming familiar with these sensitive anatomical structures. A literature search of PubMed and Embase (Elsevier) databases was performed using the keywords "sphenoid sinus" and "anatomy, "sphenoid sinus" and "anatomic variants", "sphenoid sinus", and "anatomic variations". We described the anatomical variants of the sphenoid sinuses anatomy, according to their size, shape, degree of pneumatisation, protrusion of anatomical structures into their lumen, superimposition of ethmoid cells (Onodi cells), and presence of accessory septations CONCLUSION: The information provided by this study may help in the identification and description of the anatomical variations of the sphenoid sinuses and their relationship to neurovascular structures.

Middle ear functional state in case of pathological changes of nose and throat

Objectives -to compare the functional state of middle ear in adults in case of various pathology of nasal cavity, paranasal sinuses and throat. Material and methods. In 2018-2019 period, 151 patient, aged from 16 to 70 years, was examined by acoustic impedancemetry. The patients reported the subjective satisfactory state of the acoustic organ, but had a pathology of the upper respiratory tract. Results. In the groups, there were no significant differences associated with gender. Most of the patients were of working age. In all study groups, the impaired function of the auditory tube, with various intensity, was registered, although the patients had no hearing complaints. At the same time, the acumetry and tonal threshold audiometry data indicated the normal acuity of hearing. Conclusion. Acute and chronic sinusitis was the most frequent risk factor for middle ear ventilation disorder. A quarter of patients with acute sinusitis, without otological complaints, had type B and C tympanograms. 93.7% of patients, who had undergone the surgical correction of the deviated nasal septum, did not have a middle ear ventilation disorder. Surgical intervention in the nasal cavity and oropharynx leads to a transient dysfunction of the auditory tube, but does not require special treatment due to self-recovery.

Role of Multidetector CT in Evaluation of Paranasal Sinus Pathologies with Histopathology Correlation

Role of Multidetector CT in Evaluation of Paranasal Sinus Pathologies with Histopathology Correlation

Characteristics of immune response in patients with acute chronic maxillary sinusitis associated with intra-cellular bacterial infections

Currently, chronic inflammatory pathology of paranasal sinuses mostly affecting maxillary antrum is one of the pressing issues for health care. Over the last two decades, a great etiological importance in inducing inflammation in paranasal sinuses was referred to bacterial intracellular infections caused by Mycoplasma and Chlamydia. In particular, Chlamydia, whose life cycle is closely linked to residence inside host cells defines them as pathogenic obligate intracellular gram-negative bacteria, whereas Mycoplasma is a membrane-associated microorganism able to self-replication and long persistence on host cellular membranes. Increased incidence of chronic pathology in paranasal sinuses associated with intracellular infection is shaped by a range of circumstances, primarily increased prevalence of immunocompromised subjects, worsened social and ecological conditions, uncontrolled and unjustified administration of available of antimicrobials and anti-septic agents, hormone preparations altering community of extracellular microbe populations (microbiocenoses), inhabiting natural biotope in the upper respiratory tract mucosa. These factors contribute to the lowering colony resistance, entrance and propagation of Chlamydia and Mycoplasma as a monoor mixed infection. Upon that, mixed variants of Chlamydia-Mycoplasma infection are characterized by development of more severe sinusitis accompanied with diverse complications in the lower respiratory tract, digestive tract, urinary and nerve system. There were examined 189 subjects for assessing epidemiologic characteristics and features of systemic and mucosal immune responses in patients with exacerbated chronic maxillary sinusitis associated with intracellular bacterial infection. Presence of intracellular bacterial infection was confirmed by laboratory tests: direct immune fluorescent analysis and PCR. It was found that high prevalence of Сhlamydia trachomatis, Chlamydophila pneumoniae and Mycoplasma pneumoniae in patients with exacerbated chronic inflammatory pathology of paranasal sinuses. Comparing laboratory test data for patients with identified intracellular bacterial pathogens vs. those with negative results revealed a common trend in pathologic immune-related changes that fits to typical host anti-infection response manifested by inflammatory process. Besides, we described features of immune reactivity in patients with verified Chlamydia infection including more pronounced unbalance in Т cell immunity as well as evelated parameters of humoral immunity in patients with verified Chlamydia and Mycoplasma infection.

Utility of CT Scan in Assessment of Paranasal Sinus Pathology

Utility of CT Scan in Assessment of Paranasal Sinus Pathology

Role of CT scan in paranasal sinus pathology

CT Scans use a narrow X-Ray beam that circles around the part of body to be scanned. The data is transmitted to a computer, which build up 3D cross sectional picture. Although CT Scans cannot distinguish between inflammation and infection, they correlate with extent of disease. CT Scans have been very useful in assessing severity of the disease or response to treatment in chronic Rhinosinusitis. It is also the most reliable radiological examination to identify a fungus ball. The latest CT machines allow a complete set of axial slices to be made within a few seconds. The CT scan proved to be an excellent imaging tool as it can accurately diagnose & differentiate benign & malignant lesions, can describe the masses in terms of their origin, nature, extension, & involvement. Computerized tomography (CT) is considered the gold standard for preoperative evaluation of PNS diseases for appropriate patient selection for functional endoscopic sinus surgery (FESS). CT has some medico-legal importance as well. This is a prospective study conducted on 30 patients (from September 2018 to May 2019). Both male and female patients of different age groups with clinically suspected PNS diseases were enrolled for the study. Both axial and coronal images were acquired using multi-detector CT unit. The paranal sinuses were evaluated for: mucosal thickening, wall of sinus, fluid level, soft tissue extension, hyperdensities and masses, blockage of osteomeatal complex, and pattern of bony involvement. There was a male predominance of 54% as compared to females 46%. The chief presenting complaint was of nasal obstruction (49%), followed by a headache (40.8%), nasal discharge (30.5%), facial pain (20%), and others (37.7%). The most common CT diagnosis was chronic sinusitis (13/30) followed by polyp (7/30) and fungal sinusitis (5/30). In this study, maxillary sinus (83.5%) was the most commonly involved sinus followed by ethmoid sinus (74.7%), sphenoid sinus (43.9%), and frontal sinus (54.9%).

Role of diffusion-weighted imaging in the discrimination of purulent intrasinusal content: A retrospective study.

The objective of this study was to analyse MRI with morphological (T1, T2) and diffusion sequences (DWI, b1000) in patients presenting non-aggressive patterns of sinus opacity and operated on by functional endoscopic sinus surgery (FESS). A retrospective study. Diffusion imaging in paranasal sinus pathology remains little known. To date, no imaging system is capable of determining the purulent content of a non-enhanced sinus filling. We included consecutive patients having undergone FESS in whom MRI of the paranasal sinuses was performed. Subjects were allocated to Case (pus) or Control (no pus) groups depending on sinus content found intraoperatively. FESS was performed for bacterial acute rhinosinusitis, acute exacerbations of chronic rhinosinusitis, non-purulent sinusitis, naso-sinusal polyposis, antrochoanal polyp, isolated polyp, angiomatous polyp and eosinophilic fungal sinusitis. Tumours, mucoceles and fungus balls were excluded. We analysed T1, T2, b1000 and MRI sequences and ADC map. On univariate analysis, intermediate signal in T2 and high signal in b1000 were associated with Cases (P<0.001) as were low ADC values (P<0.001). The difference in mean ADC values between Cases and Controls was statistically significant (respectively, 0.518 vs 2.041×10-3 mm2 /sec, P<0.01). On multivariate analysis, MRI with ADC<0.725×10-3 mm2 /sec and b1000_SI>brain was significantly associated with the case group. MRI with b1000_SI<brain and ADC>1.450×10-3 mm2 /sec was significantly associated with the control group. Diffusion MRI offers extremely promising results regarding content characterisation of infectious sinus diseases.

Large Sinonasal Schwannoma with Skull Base Defect: A Case Report.

Unilateral sinonasal masses account for 6% of all paranasal sinus pathologies. We are reporting a case of nasoethmoidal schwannoma with a large skull base defect. The lesion was removed endoscopically along with repair of the defect. We are highlighting the challenges faced in diagnosis and mangement of this case with an emphasis that these tumours should be considered as one of the differential diagnosis in presence of a unilateral nasal mass.

Does Endoscopic Sinus Surgery (ESS) Retrieve Mucociliary Clearance of Maxillary Sinus: Prospective Study at a Tertiary Care Hospital.

To correlate Saccharin clearance time before and after endoscopic sinus surgery (ESS) in chronic maxillary sinusitis patients. Hospital based prospective study done in the department of otorhinolaryngology at our tertiary care hospital from January 2017 to December 2017. We selected 40 patients based on inclusion and exclusion criteria. Saccharin clearance time was measured by the subjective perception of sweet taste following placement of saccharin pellet over the anterior end of inferior turbinate. It was measured preoperatively and postoperatively after 3months of ESS and the values are compared with normal uninvolved sinuses of the patients. Out of 40 patients, 26 were male and 14 were female. Normal Saccharin Clearance Time was found to be 9.50 and 9.89min with a standard deviation of 2.76 and 2.62 on the left and right side respectively. There was no significant difference between right and left side mucociliary clearance values. The respective mean preoperative and postoperative mucociliary clearance values of right and left side together were 39.5min and 17.6min among unilateral maxillary sinusitis patients, 49.69min and 20.87min among unilateral CRS with polyposis patients, 69.42min and 25.97min among bilateral maxillary sinusitis patients, 63.71min and 24.21min among CRS with bilateral polyposis patients. ESS not only treats the pathology of paranasal sinuses but also helps in returning the normal mucociliary function.

Is septoplasty effective rhinogenic headache in patients with isolated contact point between inferior turbinate and septal spur?

Rhinogenic headache is a painful sensation in the head and face due to intranasal contact point without any mass or inflammatory findings. Surgery is recommended in patients with nasal obstruction; however the approach in case of isolated mucosal contact point that does not cause obstruction is controversial. Our aim is to observe changes in the severity of headache in patients with isolated mucosal contact point and headache who do not complain of nasal obstruction. Our study included patients with unilateral headache without any nasal and/or paranasal sinus pathology. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography (CT). One hundred patients with isolated mucosal contact point without any problem in breathing were included in this study. All participants were treated by topical nasal corticosteroid for a month. Surgery was recommended to the patients with no satisfactory relieve of headache. Visual Analog Scales (VAS) were used to evaluate the severity of headache in patients at time of diagnosis (0 month), after a medical treatment (1st month) and after a surgical or medical treatment (6th month). The results were compared with each other statistically. There was a decrease in VAS values after a month of medical treatment in all patients with isolated contact point (Z = -8.352; p = 0.0). VAS values significantly improved after surgical treatment group (Z = -4.97; p = 0.0). However, VAS values of patients increased at 6th month in medical treatment group (Z = -5341 p = 0.0). After a successful surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with surgical treatment group than in the patients with medical treatment group (Z = -8.441; p = 0.0). Surgical correction provides a more effective outcome in patients with rhinogenic headache. However, it is difficult to convince that headache may improve with surgery in these patients especially with isolated mucosal contact point and without nasal obstruction. In order to prove the benefit of surgery, we believe that medical treatment can be used as a guide.

Bromelain's penetration into the blood and sinonasal mucosa in patients with chronic rhinosinusitis.

The aim of this research is to investigate penetration of Bromelain into sinonasal mucosa in patients with chronic rhinosinusitis (CRS) versus a control group. Bromelain is derived from pineapple (Ananas comosus) and has various pharmacological effects. 40 patients (20 patients and 20 controls) were enrolled in the study. Bromelain 500 mg tablet twice daily was administered for 30 days. We scored bromelain presence in turbinate and ethmoid mucosas and in the serum of both the groups. Bromelain has an excellent distribution from blood to rhinosinusal mucosa. Its diffusion ability may allow the use of bromelain as an anti-inflammatory agent in paranasal sinus pathologies.

Relation between deviated nasal septum and paranasal sinus pathology

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Deviated nasal septum is a very common finding in ENT clinic, most of the times, as incidental findings without any related symptom. Sometimes it present in association with suspiciously related sinusitis. Our study is to identify the possible association between deviated nasal septum and sinusitis, so that we can consider septoplasty alone a first surgical management for these cases without any sinus procedure or not. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A &lt;span lang="EN-IN"&gt;cross sectional case-control study&lt;strong&gt;. &lt;/strong&gt;SPSS.v22 used for data analysis&lt;strong&gt;.&lt;/strong&gt; We used Kuhn-Kinnedy staging system for sinus pathology and applied it on the osteomeatal complex (OMC) and all paranasal sinuses. Those patients with deviated septum were studied for sinus disease especially maxillary and anterior ethmoid sinuses, and those with sinus disease were studied for deviated septum. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;We studied 238 patients, 120 males and 118 females, of them 164 (control) found to have central septum (68.9%) and 74 (cases) found to have deviated nasal septum (31.1%), 42 to the right and 32 to the left. 104 candidates (43.7%) found to have sinus disease. All findings were almost equal in both genders. Of the total sample, 40% of those with central septum found to have patent OMC and normal sinus mucosa equally. Of those who have DNS (74 candidates), OMC found to be opacified in 13.5% in the ipsilateral side, and 27% bilaterally. In those with DNS maxillary sinus was diseased in 20.3% ipsilaterally, 21.2% contralaterally, and 18.5% bilaterally. Anterior ethmoid sinuses were similarly affected in 40.5% ipsilateral and contralateral to DNS. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;According to our finding, no significant association between deviated nasal and paranasal sinusitis. Attributing sinuses disease to deviated nasal septum may lead to over treatment of the patient and unnecessary surgery.&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Prospective study to compare clinical, X-ray and computed tomography findings in various paranasal sinus pathologies

Background: Paranasal sinuses (PNS) diseases are very common and comprises wide spectrum ranging from inflammation to neoplasm. Objectives: Objectives of the study were to study and compare clinical, X-ray and computed tomography (CT) findings in various PNS pathologies. Materials and Methods: A total of 50 patients presented for PNS were studied in the Department of Radiodiagnosis, Gajra Raja Medical College, from May 2015 to September 2016 using CT and X-ray imaging techniques. Detailed history and clinical examination were also done for each patient. Results: Male preponderance was noted with mean age of 36.93±18.45 years. The most common clinical presentation was headache (52%) followed by nasal obstruction (40%). Clinical findings revealed that bacterial sinusitis, fungal sinusitis, polyp, polyps with sinusitis, mucous retention cyst (MRC), MRC with sinusitis, benign lesions, benign lesion with sinusitis, malignant lesions, encephaloceles, and dyke-davidoff-masson syndrome was observed in 66%, 8%, 2%, 8%, 2%, 2%, 12%, 10%, 8%, 2%, and 2% patients, respectively. A total of 45 specific diagnoses could be made in X-ray which is in contrast to CT where a total of 56 diagnoses were made compared to clinical findings. Conclusion: CT should be the preferred modality of all imaging studies available because of its ease, availability, accuracy and precision in diagnosis of PNS pathologies.

Trigeminal autonomic cephalalgias: a review

Trigeminal autonomic cephalalgias are a group of primary headache disorders presenting as unilateral pain in the somatic distribution of the trigeminal nerve, associated with ipsilateral cranial autonomic symptoms. This clinicopathologic group includes cluster headache, paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/cranial autonomic features, which differ mainly as regards the duration and frequency of pain as well as response to treatment. These disorders are not as rare as they were thought to be and due to the severity of the pain can substantially affect the patients’ quality of life. Many other forms of primary headaches, such as migraine, trigeminal neuralgia and primary stabbing headache, as well as secondary headaches, particularly those caused by pituitary, posterior fossa, orbital, paranasal sinus and vascular pathology, need to be carefully considered in the diagnosis of trigeminal autonomic cephalalgias. Research in this field, particularly using functional neuroimaging, has resulted in a much better understanding of these disorders. Dysfunction in the nociceptive modulatory pathways in brain’s pain matrix is currently thought to produce a permissive state for the occurrence of a trigeminal autonomic cephalalgia attack, with posterior hypothalamus serving as a terminator rather than the generator of the attack. The current treatment strategies include medical and surgical approaches; of the latter, neuromodulation techniques, particularly deep brain stimulation of posterior hypothalamus, have proven to be particularly effective and promising.