PNS CT Research Articles

The effect of nasal septal deviation on maxillary sinus volume in patients undergoing septoplasty surgery

Background: In this sudy, we aimed to determine the association between nasal septal deviation and maxillary sinus volume in patients undergoing septoplasty. Materials and Methods: 164 paranasal sinus computed tomography (PNS CT) of the patients(80 female, 84 male) undergoing septoplasty surgery were retrospective evaluated between September 2022 and September 2023. Bilateral maxillary sinuses volüme (MSV) and septal deviation angle(SDA) were calculated using the computed program. SDA was divided into right and left, also was described as mild, moderate, or severe. Results: The mean of right MSV was measured as 14.34 ± 3.91 (7.45-23) and the mean of left MSV was 15.11 ± 4.29 (6.34-24.3). The average SDA of all patients was 15.51 ± 5.22 (6.7-34). The difference between right and left MSV was measured lower in patients with mild septal deviation than in patients with moderate or severe septal deviation (p=0.016, p=0.024, respectively). In the evaluation made according to MSV, the difference values between ipsilateral MSV, contralateral MSV, total MSV and right-left MSV according to the side of septal deviation were found to be higher in men than in women (p=0.011, p=0.001, p=0.004, p

Rate, Risk Factors, and Outcomes of Invasive Fungal Infections in Patients with Hematologic Malignancies.

Background:Invasive fungal infections (IFIs) are a significant cause of mortality and morbidity in patients with hematological malignancies. Given the considerable prevalence and consequences of IFIs, hence revealing the exact cause of fungal infections, their rate, associated risk factors, and complications could contribute to reducing both financial and life costs, choosing targeted antifungal treatment, and avoiding unnecessary toxic treatments in individuals who are not suffering from mycoses. Materials and Methods:This prospective cross-sectional study was conducted in the first semester of 2019. All patients with hematologic malignancies (HM) admitted to Dr. Shariati Hospital were studied. Only those with probable/proven IFIs defined according to the last update of EORTC/MSG criteria were included in the study. The demographic and clinical data were recorded from the hospital information registration system using a questionnaire. Statistical analysis was performed using SPSS software version 24. Results: Out of 1109 HM patients hospitalized during the study period, 67 (6.04%) IFIs were diagnosed. Of these, 57 (85.04%) were aspergillosis, 7 (10.4%) were mucormycosis, and 3 patients developed other fungal infections. Males constituted 67.2% of the entire IFI population. The mean±SD age of the samples was 43.16 ± 13.8 years. The most common type of malignancy was AML. Lung imaging showed lesions associated with fungal infections in 52 cases (77.6%), with multiple nodules as the most prevalent pattern being observed in 64.2% of cases. Sinus involvement was evidenced in the PNS CT scan of 46 (68.6%) patients. The attributable mortality rate for IFIs was 62.7%. Both the types of IFI and malignancies had no significant relationship with the outcome of patients. Central venous catheter, mucositis, and antibiotic use were the most frequent risk factors. Conclusion:IFI represents a frequent complication for HM patients with high mortality. Aspergillus species are the predominant etiology in these settings. Considering our results, in high-risk patients, manifestations of warning signs in the sinus and lungs, which would not be cleared despite receiving antibiotics, should raise the possibility of IFIs.

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.

Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence.

Positive airway pressure (PAP) is an important treatment tool for patients with moderate and severe obstructive sleep apnea (OSA), and adherence to PAP significantly affects treatment outcomes. Disease severity, adverse effects, and psychosocial factors are known to predict medication adherence. Cephalometric parameters have been reported to positively correlate with upper airway collapse. However, research on the correlation between these cephalometric parameters and PAP adherence remains insufficient. This study aimed to identify this relationship. This study included 185 patients with OSA who were prescribed PAP. Polysomnography (PSG) was performed to diagnose OSA, and paranasal sinus computed tomography (PNS CT) was performed to check for comorbidities of the upper airway. In addition, cephalometric parameters such as the hyoid-posterior nasal spine (H-PNS), posterior nasal spine-mandibular plane (PNS-MP), and hyoid-mandibular plane (H-MP) were measured in the midsagittal and axial CT views. Adherence was evaluated 3-12 months after the PAP prescription. A total of 136 patients were PAP-adherent, and 49 were nonadherent. There were more males in the adherent group and a higher average height in the adherent group. The PSG results showed that the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), arousal index (AI), rapid eye movement (REM) AHI, and supine AHI were significantly higher, and the lowest oxygen saturation was lower in the adherent group. In the analysis of covariance (ANCOVA) model adjusted for sex and height, among the cephalometric parameters, H-MP was significantly longer in the adherent group (p = 0.027), and H-PNS showed a longer tendency (p = 0.074). In the logistic regression analysis model, the odds ratio (OR) and 95% confidence intervals (95% CI) of adherence and severe OSA in the third tertile compared to the first tertile of H-MP were 2.93 (1.25-6.86) and 4.00 (1.87-8.56). In the case of H-PNS, they were 2.58 (1.14-5.81) and 4.86 (2.24-10.54), respectively. This study concluded that an inferiorly placed hyoid bone in adult patients is associated with PAP adherence and disease severity.

Surgical and Radiological Differences in Intersphenoid Sinus Septation and the Prevalence of Onodi Cells with the Endoscopic Endonasal Transsphenoidal Approach.

Background and Objectives: Understanding the anatomical variation in the sphenoid sinus is important to fully expose the sellar floor and clivus. Materials and Methods: The Onodi cell and intersphenoid sinus septation based on preoperative paranasal sinus computed tomography (PNS CT) and the surgical records of 877 patients who underwent the endoscopic endonasal transsphenoidal approach (EETSA) were retrospectively reviewed. Results: An intersphenoid sinus septum (ISS) blocking the clivus was defined as a pseudoclivus. Complete and incomplete pseudoclivuses were found in 2.97% and 10.5% of patients, respectively. Intraoperative and PNS CT ISS findings differed in 17.1% of patients. Misconceptions regarding a ridge or vertical ISS and confusion between an incomplete pseudoclivus and a vertical ISS were common. Conclusions: Because intraoperative and PNS CT findings may differ, anatomical variation in the paraclival area should be evaluated carefully. A pseudoclivus mimicking the clivus is important to attain a fully exposed EETSA surgical view.

Olfactory Cleft Opacification in COVID-19 Related Smell Loss: CT Findings and Correlation With Objective Testing.

Besides the common symptoms of the coronavirus disease 2019 (COVID-19) including fever, shortness of breath, and cough, a "sudden loss of smell" has recently been added as a diagnostic symptom. The relationship between paranasal sinus computed tomography (PNS CT) and sudden loss of smell in COVID-19 was examined. Two groups were selected for the study, the COVID-19 and the control groups. The control group consisted of 40 patients who applied to our clinic with headache and therefore underwent PNS CT. The other group consisted of 40 patients with COVID-19 who were diagnosed with sudden loss of smell with the Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test. Clinical and demographic characteristics, tomography results, and olfactory test scores of patients with COVID-19 loss of smell and control group patients were recorded. The relationship between CT changes in the olfactory cleft and the degree of loss of smell was evaluated. The "Opacification in the olfactory cleft" was accepted as a positive CT finding. Comparison of patients with COVID-19 who had a loss of smell and the control group indicated that a significant difference was observed in terms of CT findings (P = .022). When we evaluated the paranasal CTs obtained from our patients with loss of smell, the CT of 13 patients showed pathological findings (P < .05). As the COVID-19 progressed (pneumonia and respiratory failure), the degree of loss of smell increased (P < .05). A statistically significant relationship was found between the CCCRC score and the presence of PNS CT findings (P = .0012). The PNS CT findings are significant in patients with COVID-19 with a loss of smell and were significantly associated with the degree of loss of smell. In patients with olfactory loss due to COVID-19, PNS CT can help in diagnosis. However, for this imaging to be diagnostic, a larger patient series is needed.

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;

A Case of Chronic Invasive Actinomycosis in the Nasal Cavity

A 57-year-old male patient with nasal congestion and nasal congestion, which occurred 1 month prior to the hospital visited. PNS CT and MRI was performed and revealed right orbital cellulitis, sinusitis and brain abcess. Surgical drainage was determined by rhinology, ophthalmology and neurosurgery. The right sphenoid sinus was identified as an open mucosal mucosa, and blackish mucosa was found on the right sphenoid sinus. Eucleation was performed. Infected orbital tissue removal and orbital abscess drainage were performed. Neurosurgery performed dura incision, drainage and removal of a large amount of abscess pattern, and duroplasty with artificial dura. Actinomyces odontolyti was identified by pus culture, and postoperative antibiotic treatment and dressing were performed, but infection aggravation persisted, resulting in deterioration of general condition, multiple organ damage, and cerebral infarction.

The surgical management of recurrent acute and chronic barosinusitis in sports self-contained underwater breathing apparatus (scuba) divers

The aim of this retrospective study is to evaluate the feasibility of functional endoscopic sinus surgery (FESS) with supplementary surgical procedures in scuba divers with recurrent acute barosinusitis (RABS) and chronic barosinusitis (CBS). In this retrospective study, 25 divers were classified into RABS (n:11) and CBS (n:14) groups. The presentation of divers have been reviewed. The PNS CT images were scored according to Lund-Mackay (L-M) system. A score has been assigned to the extent of endoscopic procedures performed. The outcome of surgery and life quality were determined by SNOT-22 and dive-related questions (DRQ) tests. The average L-M score was 3.8 ± 2 for RABS and 12.2 ± 3.4 for CBS groups. L-M score of CBS group was found to be statistically higher than RBS group (p < 0.05). The FESS score of CBS group (8.7 ± 2.4) was higher than RABS group (5.6 ± 2) which showed that the endoscopic sinus procedures were performed more extensively in CBS group (p < 0.05). The difference between the preoperative and postoperative SNOT-22 scores indicates that the degree of sinus symptoms improved better in RABS group than CBS group (p < 0.05). When DRQ test was evaluated, RABS group showed a better improvement in diving performance symptoms than the CBS group (p < 0.05). Our study demonstrated that divers with RABS and CBS can be managed successfully with FESS and supplementary surgical procedures. The improvement in the RABS group was superior to the CBS group, a difference attributed to the severity of chronic inflammation in CBS.

Does Nasal Septal Deviation and Concha Bullosa Have Effect on Maxillary Sinus Volume and Maxillary Sinusitis?: A Retrospective Study.

PurposeThis study aimed to determine whether nasal septal deviation and concha bullosa affect the maxillary sinus volume, and whether this effect is associated with the prevalence of chronic sinusitis.Materials and MethodsThis study retrospectively reviewed 209 paranasal sinus CT (PNS CT) images of patients with sinonasal symptoms from January 2017 to December 2018. The maxillary sinus volume was measured twice by a radiologist, and statistical analysis was performed using SAS 9.4.ResultsIntersex comparison of the maxillary sinus volume (on left and right sides) revealed that the volume was significantly larger on both the sides (p < 0.0001) in men compared with that in women. Concha bullosa was found to occur mainly in the concave cavity of the septal deviation (p < 0.0001). No significant association was found between nasal septal deviation and maxillary sinusitis (p = 0.8756) as well as between concha bullosa and maxillary sinusitis prevalence (p = 0.3401) or maxillary sinus volume (both: p = 0.6289, Rt.: p = 0.9522, Lt.: p = 0.9201).ConclusionAlthough nasal septal deviation and the location of concha bullosa may affect each other, maxillary sinus volume and maxillary sinusitis were neither associated with nasal septal deviation nor concha bullosa.

The effect of anatomic variations and maxillary sinus volume in antrochoanal polyp formation.

The antrochoanal polyp (ACP), otherwise known as the Killain polyp, is a benign lesion that originates from maxillary sinus mucosa, extending from the accessory ostium towards the middle meatus, and later tends to protrude posteriorly towards the choana and nasopharynx. Many studies have emphasized that its etiopathogenesis is unclear. Research suggests that chronic sinusitis and allergic rhinitis are factors that play an important role in the formation of ACP, as well as anatomical variations. In this study, we aimed to evaluate the effect of anatomical variations and maxillary sinus volume in patients diagnosed with anthrochoanal polyp. Paranasal sinus computed tomography (PNS CT) images of patients with unilateral ACP patients were examined. The non-ACP sides of the patients comprised the control group. Nasal septal deviation, agger nasi cells, concha bullosa, paradoxical middle turbinate, hyperpneumotized ethmoid bulla, uncinate pathology (medialized or pneumatized uncinate), haller cell, accessory ostium, maxillary sinus retention cyst and maxillary sinus volumes were evaluated. The study included a total of 54 patients (33 females, 21 males). Mean patient age was 22.92 ± 13.95 (range 6-56) years. Mean maxillary sinus volume was 17.88 ± 5.16 mm3 for the ACP sides and 16.37 ± 4.55 mm3 for the non-ACP sides. Maxillary sinus volume was significantly larger in the ACP side (p = 0.000). Concha bullosa was observed on the ACP side in 23 patients (42.6%) and in the non-ACP side in 21 patients (38.9%). Agger nasi cells were observed in the ACP side in 47 patients (87.0%) and in the non-ACP side in 42 patients (77.7%). Hyperpneumatized ethmoid bulla was observed in the ACP side in 14 patients (25.9%) and in the non-ACP side in 12 patients (22.2%). Haller cells were observed in the ACP side in seven patients (12.96%) and in the non-ACP side in ten patients (18.51%). Disrupted airflow of the well-developed maxillary sinus cavity due to anatomical variations seems to be an effective factor in the formation of ACP.

Correlation between the extent of pneumatization of Agger agger Nasi nasi cells and the anterior-to-posterior length of the frontal recess: A a computer-assisted anatomical study.

To explore the correlation between the volume of the aAgger nNasi (AN) cell bulge and the A-P length of the frontal recess (FR). In total, 120 patients, who underwent septoplasty, were included. All patients underwent preoperative paranasal sinus computed tomography of the paranasal sinuses (PNS CT) imaging. In total, CT data on of all 120 PNSs patients were analyzed in terms of thewith respect to the extent of pneumatization of the AN cell bulge and the A-P dimensions of the FR. Each side was analyzed separately. We included 120 patients,: 78 (65.0%) females and 42 (35.0 %) males. Their average age was 33.7 ± 11.6 years (range: 18-65 years). The mean volume of the AN cell bulge was 0.26 ± 0.4 mm3 on both the right and left sides. The A-P length of the FR was 7.7 ± 2.2 mm. No significant between-side difference in the mean volume of the AN cell bulge was apparent observed (p=0.906). This volume did not differ significantly by age or sex (p=0.844 and p=0.971, respectively). We found no correlation between the volume of the AN cell bulge and the A-P length of the FR (r = 0.098, p=0.192). In the present study, no correlation between AN cell volume and the A-P length of the FR was found. When studying the anatomical complexity of the FR, it is essential to consider the AN cell volume. We suggest that preoperative CT imaging is critical when endoscopic sinus surgery is planned. However, further studies with larger numbers of patients are needed to explore the relationship between AN cell pneumatization and the anatomy of the FR.

Radiographic Changes of the Nasal Septal Body Among Patients With Sinonasal Diseases.

Objectives This study aims to determine the anatomical changes occurring in the nasal septal body (NSB) among patients with sinonasal disease and compares the measurements obtained from patients without sinonasal disease.Methods This was a retrospective study involving review of 405 (93 without and 212 with sinonasal disease) plain paranasal sinus computed tomography (PNS CT) on coronal view at a tertiary training hospital, which was done consecutively from January 2014 to December 2015. NSB measurements from 3 areas were done: anterior part (A), located anterior and superior to inferior turbinate; middle or widest (M) part, located anterior to middle turbinate and superior to inferior turbinate and posterior (P) part, located within the anterior 1/3 of middle turbinate not going beyond the crista galli. Posterior part of septum (sP) was measured at the area of horizontal attachment of middle turbinate to the lateral nasal wall and superior turbinate to represent the less vasoactive part of the septum. Demographic data and NSB diameters were also analyzed.Results The mean NSB diameter measurements were significantly larger among the diseased group (disease vs. control; A: 6.88 mm vs. 5.92 mm, P=0.001; M: 12.74 mm vs. 10.47 mm, P=0.001; P: 8.35 mm vs. 6.79 mm, P=0.001). A similar observation in sP part (3.35 mm vs. 2.54 mm, P=0.014) was noted. When grouped by age, among the control group, older subjects had considerable decrease in NSB size in all points of measurements except for sP (P>0.05). Such reduction in size is noticeable for those in their 4th, 5th, 6th, and 7th decades of life. For the diseased group, a trend of increasing NSB and sP size was noted as the subjects are getting older. However, only the anterior part (A) of NSB reached statistical significance (P=0.016).Conclusion With aging we expect nasal mucosal atrophy among normal subjects. However, patients with chronic sinonasal disease showed thickened nasal mucosa. Further study for the reversibility of thickened mucosa is needed.

Invagination of the Sphenoid Sinus Mucosa after Endoscopic Endonasal Transsphenoidal Approach and Its Significance.

ObjectiveTo describe the clinical features of invagination of the sphenoid sinus mucosa (ISM) and compare them with other similar cases using a visual analog scale (VAS) to assess the various nasal symptoms and to discuss its clinical significance and means of prevention.Study DesignRetrospective chart review at a tertiary referral center.MethodsBetween 2010 and 2015, 8 patients who had undergone EETSA surgery displayed postoperative ISM. The comparison group consisted of 147 patients who underwent the same surgical procedures and were diagnosed with the same diseases. Pre- or postoperative paranasal sinus computed tomography (PNS CT) and VAS were performed and subsequently analyzed.ResultsThe clinical features of ISM of the sphenoid sinus showed sellar floor invagination and regenerated inverted ingrowing sphenoid mucosa on endoscopic imaging. PNS CT also showed a bony defect and invaginated air densities at the sellar turcica. Pre- and postoperative VAS scores revealed that the ISM group had much less of an improvement in headaches after surgery than that of the comparison group (p = 0.049).ConclusionISM may occur because of a change in pressure, sphenoid mucosal status, or arachnoid membrane status. Moreover, ISM is related to improvements in headaches. Therefore, EETSA patients should avoid activities that cause rapid pressure changes during the healing process. In addition, sellar reconstruction that is resistant to physical pressure changes should be mandated despite the absence of an intraoperative CSF leak.

Survey of CT practice in sudan: Updates on radiation exposure and setting national diagnostic reference levels

Introduction The increase in the use of mutislice CT in Sudan has resulted in an increased examinations frequency and population radiation burden. Dose surveys are important for medical exposure control. Purpose The aims of this survey were to updates on radiation exposure, and use the results in setting national diagnostic reference levels. Materials and methods Scan parameters were collected from 840 CT examinations in patients carried out in eight CT scanners comprising one (128 Slice), five (64 Slice) and two (16 Slice) mulitislice CT scanners in Khartoum State, Sudan. CTDIvol and DLP and effective dose were calculated by using CT-Expo 2.5 CT dosimetry software were compared with published data. Results Doses are presented Brian, PNS, and Chest, pulmonary, Abdomen-Pelvis, Pelvis, KUB and CTU CT examinations. Mean CTDIvol ranged: from 63.8 to 16.4 mGy in Brain and KUB; respectively; Mean DLP ranged from 1744 to 670 mGy.cm in CTU and Pelvic CT; respectively; While mean effective dose ranged from 21.71 to 1.96 mSv in CTU and BNS; respectively. The results presented wide variations in technique and radiation dose for similar examinations indicating significant room for dose optimisation. Conclusion 75 percentile of hospital mean doses obtained in this study were used to propose a national DRLs. Study highlighted the radiation protection challenge and dose consequences of Mutislice CT in a developing country. Disclosure Authors do not have any relationship that may bias their presentation. The increase in the use of mutislice CT in Sudan has resulted in an increased examinations frequency and population radiation burden. Dose surveys are important for medical exposure control. The aims of this survey were to updates on radiation exposure, and use the results in setting national diagnostic reference levels. Scan parameters were collected from 840 CT examinations in patients carried out in eight CT scanners comprising one (128 Slice), five (64 Slice) and two (16 Slice) mulitislice CT scanners in Khartoum State, Sudan. CTDIvol and DLP and effective dose were calculated by using CT-Expo 2.5 CT dosimetry software were compared with published data. Doses are presented Brian, PNS, and Chest, pulmonary, Abdomen-Pelvis, Pelvis, KUB and CTU CT examinations. Mean CTDIvol ranged: from 63.8 to 16.4 mGy in Brain and KUB; respectively; Mean DLP ranged from 1744 to 670 mGy.cm in CTU and Pelvic CT; respectively; While mean effective dose ranged from 21.71 to 1.96 mSv in CTU and BNS; respectively. The results presented wide variations in technique and radiation dose for similar examinations indicating significant room for dose optimisation. 75 percentile of hospital mean doses obtained in this study were used to propose a national DRLs. Study highlighted the radiation protection challenge and dose consequences of Mutislice CT in a developing country.

Computerised tomographic profile of ethmoid roof on basis of keros classification among ethnic Kashmiri’s

&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background: &lt;/span&gt;&lt;/strong&gt;The purpose of this study was to evaluate the ethmoid roof on computerized tomography of nose and paranasal sinuses of Kashmiri people and distribute them on basis of KEROS classification.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods: &lt;/span&gt;&lt;/strong&gt;Cross sectional descriptive study, the randomly selected paranasal sinus computed tomography (PNS CT) scans coronal cuts .Total of One hundred PNS CT scans done at the SMHS Hospital from April 2015 to September 2015 were reviewed, and selected for study. The bilateral heights of the lateral lamellae of the cribriform plate were obtained, independently coded, and classified according to keros.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results: &lt;/span&gt;&lt;/strong&gt;The mean height of the lateral lamella among Kashmir’s was seen to be 5.08mm and 29% of patient’s CT PNS were classified as Keros I, 61% were classified as Keros II and 10% were classified as Keros III. There was significant difference in the distribution of Keros classification between the right and left lateral lamella. There was no significant difference in the height of the lateral lamella (t-test: p=0.98 on right side &amp;amp; p =0.89 on left side) and the distribution of Keros classification (Fisher’s Exact test: p = 0.823) among younger (1-14 year) and older (&amp;gt;14 year) Kashmiri age groups. There is significant difference in the height (t-test: p=0.03 on right side and p=0.03 on left side) and the distribution of Keros classification is statistically insignificant (Fishers Exact Test: p=0.11) between Kashmiri females and males.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusions: &lt;/span&gt;&lt;/strong&gt;Preoperative assessment of ethmoid roof anatomy and keros level is mandatory for alerting the surgeon of the potential iatrogenic injury during endoscopic sinus surgeries to minimize the grave complications during ESS.&lt;/p&gt;

RETRACTED ARTICLE: Evaluation of functional rhinoplasty using the Modified Cottle test in Asian patients

MCT is a useful tool to pre-operatively determine whether internal nasal valve (INV) narrowing affects a nasal obstruction. Functional rhinoplasty seemed to produce better results than septoplasty in Asian patients with a nasal obstruction, due to INV narrowing. This study compared pre-operative modified Cottle test (MCT) findings and post-operative clinical improvement according to surgical approach in an Asian population. One-hundred and sixty-four patients who underwent septal surgery were enrolled. The clinical symptoms, radiological findings, and paranasal computed tomography (PNS CT) scan results were compared and analyzed between the MCT-positive and -negative groups, focusing on internal nasal valve narrowing. Post-operative clinical improvement were also compared based on whether septoplasty or functional rhinoplasty was performed. The MCT-positive group had significantly higher pre-operative visual analog scale scores for nasal obstruction and rhinorrhea than those in the negative group. The MCT-positive group had a significantly higher percentage of highly deviated septa on PNS CT and endoscopic findings than those in the MCT-negative group. The functional rhinoplasty group had a significantly higher MCT conversion rate (positive to negative) and improvement in nasal obstruction than those in the septoplasty group.

Is preoperative paranasal sinus computed tomography necessary for every patient undergoing septoplasty?

The aim of this study was to determine whether anterior rhinoscopy (AR), nasal endoscopy (NE) and paranasal sinus computed tomography (PNS CT) can predict other sinonasal obstructive pathologies in the setting of nasal septal deviation (NSD), and to evaluate the impact of preoperative PNS CT on the decision for a surgical procedure in patients with NSD. A total of 262 patients with NSD were evaluated using AR, NE, PNS CT, and the visual analogue scale (VAS) for nasal obstruction. The diagnostic values of AR, NE, and PNS CT for sinonasal obstructive pathologies, and the impact of preoperative PNS CT on the decision for a surgical procedure in patients with NSD were evaluated. PNS CT showed concomitant nasal pathologies in the 62 of 262 patients (23.6%) with NSD. Positive predictive value (PPV) and negative predictive value (NPV) of NE for concomitant nasal pathologies were 0.75 and 0.069, respectively. The sensitivity of NE for sinonasal pathologies was significantly higher in the patients with mild NSD than in the patients with moderate-severe NSD. The decision for a surgical procedure was changed in 22 of 262 (8.3%) patients after a PNS CT. We recommend performing preoperative PNS CTs on patients in whom septoplasty is planned, if they have obstructive middle turbinate hypertrophy, if one is unable to evaluate the middle meatus and posterior nasal cavity because of an anteriorly severe deviation or a nasal polyp, and in patients with chronic sinusitis based on clinical and endoscopic findings.

Anatomical analysis of nasal cavity in stuffy patient with snoring

The stuffy patient with snoring is common. After septal surgery, snoring symptom is improved often. So when evaluating patients with snoring for septoplasty, it is important to assess for nasal airway obstruction. In this study, we evaluated the relationship between subjective nasal obstruction and the corresponding anatomic nasal parameters in patients with nasal obstruction and snoring using PNS CT so as to acquire better result. Between March 2009 and February 2012, A total of 90 patients who underwent PNS CT imaging for preoperative evaluation were divided into 2 groups; 50 patients with nasal septal deviation who underwent septoplasty with nasal obstruction and snoring were enrolled in the study group and 40 patients without nasal septal deviation who underwent transsphenoid pituitary tumor operation without nasal obstruction were enrolled in the control group. The subjective nasal obstruction was measured by NOSE scale and NO-VAS. A preoperative coronal CT image was used for calculation of both nasal cavity cross-sectional areas at the three level of the internal nasal valve, ostiomeatal unit (OMU) and choana and used for calculation of septal deviation angle at the two level of internal nasal valve and OMU in both the study and control groups. We compared cross-sectional areas and septal deviation angles derived from both groups and evaluated the relationship between subjective nasal obstruction and the anatomic nasal parameters in the study group. In the study group, there was correlation between subjective nasal obstruction and the septal deviation angle, the sum of both nasal cavity cross-sectional areas and the larger area of both nasal cavity cross-sectional areas respectively at the OMU level. And in the same group, there was correlation between subjective nasal obstruction and the sum of both nasal cavity cross-sectional areas, the larger area and the smaller area of both nasal cavity cross-sectional areas respectively at the choana level. There was a difference between the study group and the control group in all anatomical nasal parameters (septal deviation angle, the sum of both nasal cavity cross-sectional areas and the area gap between both nasal cavity cross-sectional areas) at the three level of internal nasal valve, OMU and choana. This study indicated that the septal deviation angle and nasal cavity cross-sectional areas at the level of OMU and choana are related to subjective nasal obstruction. So when we evaluate nasal obstruction in patients with snoring, the middle and posterior part patency of nasal cavity is also important along with anterior nasal valve part. The authors have no financial interest to declare in relation to the content of this paper. No outside funding was received.

Efficacy of controlling rhinosinusitis on the prevention of complications in pituitary surgery with transsphenoidal approach

The microscopic transcolumellar transseptal transsphenoidal approach (TSA) is the one of the most widely used methods for the surgical treatment of sellar and parasellar lesions. But nasal and paranasal sinus inflammation is the relative contraindications of TSA. This study was performed to investigate the results of pre TSA treatment options according to the degree of nasal and paranasal sinus inflammation on the paranasal sinus computed tomography scan (PNS CT). From January 2005 to September 2010, 145 consecutive patients underwent operation of pituitary lesions through the TSA. The preoperative CT images for these patients were reviewed, and 26 patients were identified with sinus opacification on PNS CT. We then analyzed presenting symptoms, physical and endoscopic examination, Lund-Mackay score on PNS CT and preoperative management of the sinus problem retrospectively. Twenty-six patients had sinus opacification on PNS CT. Eight patients had the symptoms of sinusitis corresponding to PNS CT finding, so they had therapeutic antibiotics, and had TSA after symptomatic improvement. Three patients had the symptoms of sinusitis and sinus opacification with mean Lund-Mackay score of 5.33, so they underwent endoscopic sinus surgery first, and they got TSA a few months after. One patient underwent endoscopic sinus surgery and TSA simultaneously. No patient had a serious complication including intracranial infection. TSA is a relatively safe technique, but intracranial complication after surgery may be fatal. Therefore rigorous evaluation and management is mandatory. It is especially important to treat rhinosinusitis issues preoperatively. Our preliminary data may be helpful to evaluate and manage the paranasal sinus inflammation before TSA.