Paranasal Sinus Radiographs Research Articles

Antrolith: radiological diagnosis and surgical treatment – presentation of clinical cases

Introduction: Antrolith is a pathological calcified mass located in the paranasal sinuses, commonly in the maxillary sinus. When it is found in the vicinity or into the nasal cavity, it is also called rhinolith. In most of the cases, antroliths are incidentally identified through dental patients’ radiological examination. This fact underlines the need of antroliths’ detection in radiographs even by the general dentist. Objective: This paper aims to discuss the clinical and radiological diagnosis of antrolith, as well as its therapeutic methods, through the presentation of two clinical cases. Materials – Methods: Clinical cases, diagnosed with dental panoramic radiographs, radiographs of paranasal sinuses (Water’s view) and cone beam computed tomography (CBCT), are presented. Moreover, there has been conducted a review of the recent literature with scientific papers published in databases PubMed and Google Scholar. Results: Antrolith is usually an asymptomatic clinical feature, but painful symptomatology is rarely observed. Radiologically, it is mainly diagnosed with accuracy using orthopantomography and CBCT. As a pathological mass, antrolith should be differentiated from dental dysplasias, inflammatory calcifications, foreign bodies, even neoplasms in case of sizeable antroliths. The treatment choices of antroliths, depending on the severity of every clinical case, include frequent medical observation without any intervention or surgical excision techniques, most commonly the endoscopic sinus surgery or the removal through intraoral access. This article refers to two clinical cases of antroliths, one asymptomatic and one painful case, with all the diagnostic and management methodology being discussed. Conclusions: The radiological diagnosis of antroliths in conjunction with the endoscopic sinus surgery for its removal provide with the opportunity to treat and relieve patients with painful symptomatology. It is important not to be missed by the general dentist, as it may appear incidentally when evaluating panoramic radiographs. The assessment of antroliths is crucial for the differential diagnosis and its therapeutic management requires cooperation with a specialist.

Evaluation of Frontal Sinus Morphology in Gender Determination by Using PNS View in U.P. Population: A Radiomorphometric Study

Background: The importance of frontal sinuses in Forensic Radiology has been well documented. Literature revealed few studies on the morphometric analysis of frontal sinuses on paranasal radiographs in sex determination. This initiated this radiographic study with the aim of analysing the dimensions of the frontal sinuses through digital PNS radiographs for gender determination. Materials and Methods: The study group comprised 150 healthy adults of either gender over the age of 20 years. One paranasal sinus radiograph was made for each patient using the standardized radiographic technique. Digital measurements of the height, width and area of the frontal sinuses were recorded using AutoCAD 2014 software. The data collected was subjected to statistical analysis. Results: This study found an accuracy rate of 68.6% for sex determination through paranasal sinus radiographs. It was noted that the right height of the frontal sinus was a better predictor than any other parameter assessed for identifying the gender. Conclusion: From the present study, we conclude that the dimensions of frontal sinuses on PNS views can be used as an essential tool for gender determination in forensic sciences.

A prospective ten-year follow-up of patients with chronic urticaria

BackgroundChronic urticaria can be the initial clinical presentation of a number of different diseases. The objective of the present study was to report the associated diseases during a ten-year clinical-laboratory follow-up in patients with an initial diagnosis of chronic spontaneous urticaria (CSU) of unknown cause. MethodsA prospective, longitudinal cohort study with a ten-year clinical-laboratory follow-up was conducted. Patients with a history of urticarial plaques of over six weeks presenting as the only clinical symptom were selected. Individuals with other clinical conditions, urticaria of known causes or chronic physical urticaria were excluded. The following tests were initially performed: haemogram, urine type I, stool parasite exam and sedimentation rate. The following exams were ordered during follow-up: PPD; urine culture; serology tests; antithyroid and antinuclear antibodies, rheumatoid factor, lupus anticoagulant; thyroid hormones; serum immunoglobulin; paranasal sinus and thorax radiographs; testing for BK and Helicobacter pylori; and prick tests. ResultsInfections were diagnosed in 29% of patients (syphilis, parasitosis, H. pylori, urinary infection, tuberculosis, hepatitis B and C); autoimmune diseases in 21% (thyroiditis, rheumatoid arthritis and antiphospholipid antibody syndrome); primary immunodeficiencies in 4% (IgA and IgG2 deficiencies); and chronic myeloid leukaemia in 1%. At ten-years of follow-up, the urticaria diagnosis was CSU of unknown cause in 45% of the cases. ConclusionThis ten-year clinical-laboratory follow-up of 100 individuals with chronic urticaria as the initial diagnosis revealed the presence of associated diseases in over half of the cases. The most prevalent diseases were infections and autoimmune diseases besides primary immunodeficiencies and blood diseases.

A 35-year-old male with chronic cough

A 35-yr-old male was examined in the outpatient clinic of the present authors' department. He complained of a dry paroxysmal cough of indeterminate origin that he had noticed 3 months earlier. The cough was associated with a tickling feeling in the throat. There was no association between coughing flares and meals, nasal discharge, season, time of day or body posture. The patient did not recall having symptoms compatible with an upper airway viral infection in the past 3 months and reported no gastro-intestinal symptoms like daily heartburn and regurgitation. He lived in the city, was a lifetime nonsmoker, his previous medical history was unremarkable and he was not taking any medication. He worked as an electronic engineer in a smoke- and dust-free environment and exhibited a type A personality. Upon appearance of the cough 3 months earlier, he had been examined by a physician and had since received inhaled salmeterol (50 μg b.i.d. ) and fluticasone (250 μg b.i.d. ), without improvement. A thorough physical examination and routine laboratory tests, including white blood cell count and differential, red blood cell count, erythrocyte sedimentation rate, liver and renal function tests, serum C-reactive protein and an ECG were normal. Chest (fig. 1⇓) and paranasal sinus (image not shown) radiographs were taken. Ear, nose and throat assessment was unremarkable. After discontinuing treatment with inhaled salmeterol and fluticasone, simple spirometry pre- and post-bronchodilator (four puffs of 100 μg salbutamol) and bronchoprovocation challenge with methacholine were performed (fig. 2⇓). The patient was given a peak flow meter and during a monthly observation period his diurnal peak flow variation was below 5% (data not shown). Fig. 1— Chest radiograph showing a) posterior-anterior view and b) lateral view. Fig. 2— Pulmonary function tests of a) flow–volume plot and b) volume–time curve. …

Nasal Cytology in the Diagnosis and Treatment of Sinusitis in Atopic and Nonatopic Children

To investigate the value of nasal cytology in the diagnosis of sinusitis and follow-up of atopic and nonatopic children before and after treatment and to compare the nasal cytologic findings with the radiologic findings. Open randomized investigation. Ministry of Health, Ankara Diskapi Children's Hospital. Fifty-five children with bronchial asthma and/or allergic rhinitis followed by the Allergy Department of the Ministry of Health, Ankara Diskapi Children's Education and Research Hospital and 35 control children were evaluated for the following parameters: symptoms and signs of sinusitis, total serum immunoglobulin E level and eosinophil count, skinprick tests to common allergens, paranasal sinus radiographs, and nasal cytology (by the Rhinoprobe [Synbiotics Inc. London] method and wax paper blow). Nasal cytology, radiologic findings, and treatment. There were no significant correlations between radiologic and cytologic findings in any of the groups (p > .05). In both atopic and nonatopic chronic sinusitis patients, the Rhinoprobe method had results similar to the radiologic findings, and there was a significant relationship (p < .05). Nasal cytology is still a diagnostic tool in the follow-up and evaluation of chronic sinusitis in atopic children but should not be considered an adequate alternative to sinus radiography.

Inter-Observer and Intra-Observer Variability In the Assessment of The Paranasal Sinuses Radiographs

The aims of this study are to determine the intra-observer and inter-observer agreement between the two radiologists when reporting the Waters view and 3 views series of the paranasal sinus radiographs. To also determine whether a single Waters view is adequate for diagnostic purpose of sinusitis. 90 sets of paranasal sinuses radiographs were reported by two radiologists independently. The results revealed that the intra-observer and inter-observer agreement varied from almost perfect to good for maxillary and frontal sinuses, but poor for sphenoid and ethmoidal sinuses. Therefore, a single waters view is an acceptable strategy for diagnosing sinusitis for the maxillary and/or frontal sinuses but not for the ethmoid and sphenoid sinuses.

Influence of film digitization on radiological interpretation

Our objective was to evaluate the influence of changing from analogue to digital imaging on interobserver and intraobserver image interpretation. Three radiologists interpreted 96 three image series of occipitomental radiographs of paranasal sinuses from the films and from the corresponding digitized images from the screen. Images were classified according to degree of abnormality as either normal, with mucosal thickening of less than 5 mm, with mucosal thickening of 5 mm or more, total opacity, air-fluid level or polyp or cyst of maxillary sinuses. In the present study we found that there were more differences between two radiologist's interpretations with a single method than in a single radiologist's interpretations between the methods, although radiologists interpreted fewer pathological findings from the digitized images than from the corresponding films. Our data show that the results of image interpretation are preferentially dependent on the reader rather than on the method of reading.

Cheilitis granulomatosa of Melkersson-Rosenthal syndrome: Treatment with intralesional corticosteroid injections

BackgroundMelkersson–Rosenthal syndrome may manifest as the classical triad (orofacial edema, facial nerve palsy and stable lingua plicata) but monosymptomatic manifestations or combinations of typical symptoms are not infrequent. The available therapeutic options provide only limited success or temporary benefit Case reportA 20-year-old man presented with a 7-month history of recurrent episodes of swelling of the upper lip without pain, burning or local pruritus. No causative factors, such as food, drugs or latex, or physical, chemical or emotional conditions could be identified. The patient had been treated with oral antihistamines and corticosteroids with no clinical improvement. Physical examination showed firm edema without fovea, limited to the central area of the upper lip without epidermal changes or symptoms on palpation. The patient had a previous history of facial palsy 6 years previously and recurrent episodes of herpes simplex labialis. Skin prick tests with inhalant aeroallergens, food, latex and Anisakis allergens were negative. Laboratory investigation revealed normal complete blood count, erythrocyte sedimentation rate, thyroid hormones, biochemistry, complement components (C3, C4 and C1-esterase inhibitor) and CH50, rheumatoid factor, antinuclear antibodies, immune complexes, protein electrophoresis and immunoglobulins. Thorax and paranasal sinus radiographs were clear. Biopsy of the involved area of the lip showed edema with lymphocytic and plasma cell infiltration and mononuclear perivascular infiltrates without granulomas, suggesting initial granulomatous cheilitis. Because the patient showed lack of response and/or poor tolerance to prior treatments (deflazacort, clofazimine and metronidazole), intralesional triamcinolone injections were administered with satisfactory response from the first session ConclusionsResponse to available treatments for Melkersson-Rosenthal syndrome is highly variable. In the present case, intralesional triamcinolone injections were effective

Use of Radial Forearm Free Flap With Palmaris Longus Tendon in Reconstruction of Total Maxillectomy With Sparing of Orbital Contents

Nasal paragangliomas are extremely rare. The most adequate treatment is total excision. After surgical excision requiring total maxillectomy, there has been no ideal technique for reconstruction. A 47-year-old man was admitted to our clinic because of recurrent epistaxis, which lasted for 2 months. He was also suffering from nasal airway obstruction. The physical examination revealed a mass originating from the medial aspect of the middle turbinate of the right nasal cavity. It invaded the anterior maxillary wall and hard and soft palate. Endoscopic examination showed that the mass pushed the nasal septum to the left side and protruded into the nasopharynx. The mass was fleshy and had a rich capillary network. Conventional paranasal sinus radiographs were normal. Computerized tomography of the skull showed the mass protruding into the nasopharynx. A total maxillectomy was performed. Histopathological evaluation showed neoplastic tissue consisting of round, oval, or slightly elongated cells, altogether of a rather monomorphous appearance, tending to arrange themselves in clusters adjacent to or around capillary blood vessels. The blood vessels were numerous and branched. Reticulum staining showed a typical Zellballen arrangement of the neoplastic cells to provide a firmer basis for the diagnosis of paraganglioma. To reconstruct the total maxillectomy defect, a radial forearm free flap with the palmaris longus tendon was elevated to inlay the nasal cavity and the oral cavity and to suspend the ocular globe. The flap was placed into the defect, and the palmaris longus tendon was medially and laterally anchored to the periosteum of the frontal bone to suspend the ocular globe in the orbital cavity. One part of the skin island was used to close the defect of the nasal mucosal cavity, and the other part was used to repair the oral mucosal defect of the palate. Consequently, speech was considered near normal; the patient was able to eat an unrestricted diet and to retain both solid and liquid food inside the oral cavity without drooling, and there was no diplopia or enophthalmos. Six months later, porous polyethylene was inserted and fixed to the zygomatic bone with a miniplate and miniscrews to restore malar contour. No further procedure was believed to be necessary later on. Two years later, a satisfactory and functional esthetic result was obtained, providing an acceptable suspension of the ocular globe and filling of the total maxillectomy defect. We believe that a total maxillectomy is indicated if it is needed in nasal paragangliomas and that microsurgical repair with the composite radial forearm-palmaris longus free flap has several advantages: 1) it can offer en bloc reconstruction of the entire defect after a total maxillectomy in terms of good function and cosmesis; 2) it can repair mucosal defects; and 3) it can anchor and suspend the ocular globe in its original anatomical location, protecting against gravity through the sling effect of the palmaris longus tendon. The composite radial forearm-palmaris longus free flap has not been described previously for suspension of the ocular globe.

Osteochondroma of the coronoid process (Jacob's disease)

J Oral Maxillofac Surg 60:1354-1356, 2002

Clinical features and characteristics of paranasal sinus effusion in allergic sinusitis

Plain paranasal sinus radiographs including occipitofrontal and occipitomental views often show abnormal shadows in patients with allergic rhinitis. For that reason, the relationship between chronic sinusitis and allergy has been discussed for many years. Type I allergy is thought to be involved in the sinusitis which is called allergic sinusitis. However, there is not enough information pertaining to this disorder. In order to determine the clinical feature and the characteristics of paranasal sinus effusion in allergic sinusitis, we investigated the differences between 20 patients with allergic sinusitis and 20 with non-allergic chronic sinusitis used as controls. Clinical symptoms (nasal discharge, nasal obstruction, headache, postnasal discharge) and anterior rhinoscopic findings (nasal discharge, nasal edema), clinical examinations (type of x ray maxillary sinus shadow, bacteriology of nasal discharge), and pathological features of the paranasal sinus effusion were examined and compared in the two kind of sinusitis. Pathological findings of the effusion sampled from 14 patients with allergic sinusitis and 15 with non-allergic sinusitis included the number of eosinophils, activated eosinophils and neutrophils, concentrations of interleukin (IL)-1 beta, IL-4, IL-5, IL-8, and concentrations of leukotriene C4/D4/E4 and prostaglandin E2. The incidence and degree of postnasal discharge as a symptom and a nasal finding were lower in allergic sinusitis patients than in the controls. Microorganisms were detected less frequently in the allergic group. The number of eosinophils, activated eosinophils and neutrophils was higher in the paranasal sinus effusion of the patients with allergic sinusitis. The concentrations (ng/mg of protein) of IL-1 beta and IL-8 showed no difference between the two groups, but IL-4, and IL-5 were more prevalent per mg of protein in the effusion of allergic sinusitis patients. These findings suggest that the clinical features of allergic sinusitis include a low incidence and degree of postnasal discharge and a low rate of detection of bacteria, and that the sinus effusion is characterized by the presence of more eosinophils, activated eosinophils, and IL-5 than in those of chronic sinusitis.

Computed Tomography (CT) Scan Findings of the Paranasal Sinuses in Cystic Fibrosis

Nearly all patients with cystic fibrosis (CF) have abnormal findings on plain paranasal sinus radiographs. To establish this relationship more accurately, 58 CF patients with nasal symptoms were evaluated with paranasal sinus computed tomography (CT). Bilateral medial displacement of the lateral nasal wall in the middle meatus and uncinate process demineralization were seen in 43 patients (74%). Three patients (5%) had unilateral displacement and uncinate demineralization. Ten patients had maxillary sinus opacification, two patients (3.5%) had unremarkable paranasal sinuses on CT, and another patient (2%) had normal findings on one side. Although the vast majority of CF patients do have paranasal sinus abnormalities, we found on CT scan a progression of abnormalities that range from normal sinuses to pansinus disease, and in 74%, bilateral medial displacement of the lateral nasal wall and uncinate process demineralization.

Contribution of chest and paranasal sinus radiographs to the management of acute asthma.

In order to evaluate the clinical utility of chest and paranasal sinus radiographs on admission in cases of acute asthma, the radiographs of adult patients admitted to our hospital for acute asthma over a period of 1 year were studied. The findings were specified afterwards by a senior diagnostic radiologist and their impact on the management of asthma was evaluated by reviewing the medical records of the patients retrospectively. Abnormalities were detected in 50% of the chest radiographs (55 of 110) and these resulted in management changes in 5% of cases (6 of 100). Abnormalities in any paranasal sinuses were detected in 85% of the sinus radiographs (93 of 100), and maxillary sinus abnormalities in 63% (70 of 100). 29% of the sinus abnormalities (32 of 110) resulted in an immediate alteration in treatment. Hence abnormalities were more common in the paranasal sinus radiographs than in the chest radiographs (p < 0.001), and the impact of the sinus radiographs on the treatment of asthma was also greater (p < 0.001). We recommend that while obtaining a chest radiograph routinely may be advisable in severe cases of acute asthma, at least when the patient is admitted to hospital, serious thought should be given to routinely obtaining a sinus radiograph in these cases as well.

Sinus Aspirates and Radiographic Abnormalities in Severe Attacks of Asthma

We evaluated the occurrence of abnormalities in paranasal sinus radiographs in acute asthma by taking a radiograph of the sinuses of 110 consecutive patients admitted to a medical ward a total of 149 times for asthma. Maxillary sinus infection was assessed by taking aspirate from radiologically abnormal maxillary sinuses. An abnormal finding in any paranasal sinus was detected on 87% (130 of 149) of admissions and the yield of maxillary aspirate was macroscopically mucous, purulent or mucopurulent in 60% (42 of 70) of aspirates. A positive bacteriological culture was obtained from 23 aspirates and a virus was detected in 15, there being 7 aspirates in which both a bacterium and a virus could be detected. Although the correlation between radiographic findings and the aspirates was not very close we conclude that radiographic abnormalities of the paranasal sinuses are common in acute asthma as are infections of maxillary sinuses with an abnormal radiographic finding. There is an obvious need to look for sinusitis when a patient with an exacerbation of asthma is being evaluated.

Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination.

To identify the most useful clinical examination findings for the diagnosis of acute and subacute sinusitis. Prospective comparison of clinical findings with radiographs. General medicine clinics at a university-affiliated Veterans Affairs Medical Center. Two hundred forty-seven consecutive adult men with rhinorrhea (51%), facial pain (22%) , or self-suspected sinusitis (27%) (median age, 50 years; median duration of symptoms, 11.5 days). Patients were examined by a principal investigator (86%) or by a staff general internist, internal medicine resident (postgraduate year 2 or 3), or physician assistant, all blinded to radiographic results. All examiners recorded the presence or absence of 16 historical items, 5 physical examination items, and the clinical impression for sinusitis (high, intermediate, or low probability). The criterion standard was paranasal sinus radiographs (4 views), which were interpreted by radiologists blinded to clinical findings. Thirty-eight percent of patients meeting entrance criteria had sinusitis. Sensitivity, specificity, and likelihood ratios were measured for clinical items. Logistic regression analysis showed five independent predictors of sinusitis: maxillary toothache (odds ratio, 2.9), transillumination (odds ratio, 2.7), poor response to nasal decongestants or antihistamines (odds ratio, 2.4), colored nasal discharge reported by the patient (odds ratio, 2.2), or mucopurulence seen during examination (odds ratio, 2.9). THe overall clinical impression was more accurate than any single finding: high probability (likelihood ratio, 4.7, intermediate (likelihood ratio, 1.4), low probability (likelihood ratio, 0.4). General internists, focusing on five clinical findings and their overall clinical impression, can effectively stratify male patients with sinus symptoms as having a high, intermediate, or low probability of sinusitis.

Sinusitis, otitis and adenotonsillitis in children: a retrospective study.

A retrospective study of 93 cases in which ventilating tubes were required in the therapy of persistent otitis media. Paranasal sinus radiographs, antral washes and cultures of positive washes were used to demonstrate active sinusitis associated with persistent otitis media. Other factors are also of importance, such as allergic or other immune-related disease processes. However, active sinusitis was demonstrated in 25-49% of the cases studied, depending on criteria used.