Sinus Drainage Pathway Research Articles

Anticongestion therapy of sinusitis in children

Sinusitis is one of the most common respiratory diseases in children. Swelling of the nasal mucosa and paranasal sinuses accompanies sinusitis; but this is not only a symptom, edema leads to blockage of the normal sinus drainage pathway, which is key in the pathogenesis of sinusitis. Decongestants are considered a key treatment for sinusitis because they improve the function of the sinuses. According to EPOS-2012, treatment of acute sinusitis in children up to 5 days includes nasal lavage, decongestants, and in the absence of effect within 10 days, endonasal corticosteroids are added to the treatment. Decongestants are prescribed from the onset of sinusitis in children. They not only alleviate the annoying manifestations of nasal congestion, but also keep unlocked paranasal sinuses, prevent the progression of sinusitis to bacterial and prevent complications. In the treatment of sinusitis, we successfully combine the benefit of decongestants (rapid, relatively shortterm anti congestion) with the effect of endonasal corticosteroids (slow, relatively long-acting anti congestion). The article shows our algorithm of topical sinusitis treatment.

Endoscopic management of frontal sinus CSF leaks

IntroductionEndoscopic management of frontal sinus cerebrospinal fluid leaks has become the gold standard of treatment, with high success rates and low morbidity. The aim of this study is to review our experience in managing this challenging condition. ObjectiveTo review our experience in treating frontal sinus cerebrospinal fluid leaks through an endonasal endoscopic approach. MethodsA retrospective evaluation of patients undergoing endoscopic surgery for frontal sinus cerebrospinal fluid leaks was performed. Demographics, defect location and etiology, surgical and reconstructive technique, complications, and postoperative followup were examined. ResultsTwenty-two patients with a mean age of 40.4 years were treated surgically by the senior author between 2015 and 2019. Cerebrospinal fluid leak was either traumatic (17) or spontaneous (5). Successful first-attempt endoscopic repair was accomplished in all cases. A combined endoscopic-trephination approach was necessary in 5 patients (22.8%). No serious complications were reported, and frontal sinus drainage pathway was patent in all our cases. Revision surgery was necessary in only 2 patients for synechia formation. The mean patient followup was 22.7 months (range: 7 − 41 months). ConclusionProgress in the field of endoscopic surgery has shifted the paradigm, establishing endoscopic repair of frontal sinus leaks as the standard of care. A few remaining limits of this approach could be addressed by combining endoscopy with frontal trephination.

Association between the insertion type of the uncinate process and the development of Frontal Sinus Mucoceles - is there a relationship?

BackgroundThe frontal sinus drainage pathway is formed by either the ethmoid infundibulum or the middle meatus, which depends on the superior insertion of the uncinate process. According to Landsberg & Friedman the are 6 types of superior uncinate process insertion.The aim of this study is to find an association between the uncinate process insertion type and the development of frontal sinus mucoceles. MethodsFifty sinus CT scans were analysed. Exclusion criteria were previous nasal surgeries, malignancy, polyposis and an insufficient image quality. Superior insertions of the uncinate process were analysed according to the Landsberg & Friedman classification. The results were tabulated and analysed using SPSS 25.0. ResultsThe analysis revealed type 1 insertion in 6% of the CT scans, type 2 in 32%, type 3 in 26%, type 4 in 0%, type 5 in 28% and type 6 in 8%. Despite 44% of the CT scans with frontal sinus mucocele showing a type 2 insertion of the uncinate process, both the Chi-Square test and the Cramer's V test showed no statistical significance (p>.05). Logistic regression also showed that uncinate process insertion type does not influence the likelihood of development of frontal sinuses mucoceles. ConclusionsThe insertion of the uncinate process does not influence the development of frontal sinus mucoceles.

Anticongestion therapy of sinusitis in children

Sinusitis is one of the most common respiratory diseases in children. Swelling of the nasal mucosa and paranasal sinuses accompanies sinusitis; but this is not only a symptom, edema leads to blockage of the normal sinus drainage pathway, which is key in the pathogenesis of sinusitis. Decongestants are considered a key treatment for sinusitis because they improve the function of the sinuses. According to EPOS-2012, treatment of acute sinusitis in children up to 5 days includes nasal lavage, decongestants, and in the absence of effect within 10 days, endonasal corticosteroids are added to the treatment. Decongestants are prescribed from the onset of sinusitis in children. They not only alleviate the annoying manifestations of nasal congestion, but also keep unlocked paranasal sinuses, prevent the progression of sinusitis to bacterial and prevent complications. In the treatment of sinusitis, we successfully combine the benefit of decongestants (rapid, relatively shortterm anti congestion) with the effect of endonasal corticosteroids (slow, relatively long-acting anti congestion). The article shows our algorithm of topical sinusitis treatment.

Platelet-rich plasma nasal packing in endoscopic sinus surgery

Introduction: Synech ia and scarring are the most common complications encountered after endoscopic sinus surgery that may result in occlusion of sinus drainage pathway, leading to recurrent symptoms and subsequent surgical failure. Platelet‑rich plasma (PRP) has been used in many aspects of medicine to accelerate healing, avoid bleeding, and prevent synechia.

Frontal Sinus Preservation During Cerebrospinal Fluid Leak Repair.

To validate the repair of frontal sinus cerebrospinal fluid (CSF) leaks with preservation of frontal sinus drainage pathway (FSDP), independently of the approach used, and to establish the indications and limits of the endoscopic approach. A retrospective evaluation of patients undergoing surgery for frontal sinus CSF leaks was performed. Demographics, indications for both endoscopic/combined endoscopic and open approaches, complications, methods for maintaining FSDP, and perioperative outcomes were examined. Fifty-three patients (average age 45 years) with frontal sinus CSF leaks were treated surgically from 2000 to 2018. All CSF leak repairs were successful at the 1st attempt with a mean follow-up of 76.8 months (range 4-227 months). Etiology was spontaneous (14), traumatic (26), and iatrogenic (13). In 17 patients, a purely endoscopic approach was performed, while an endoscopic endonasal orbital transposition procedure was added in 4 out of this group. In 23 patients, a combined endoscopic and osteoplastic procedure was employed, while in 13 patients a combined craniotomy and endoscopic procedure was performed. All frontal sinuses remained patent except for 2 cranialization patients. With contemporary endoscopic instrumentation and techniques, endoscopic closure of frontal sinus CSF leaks even in the far superolateral wall is feasible in selected patients. However, the surgeon should consider the option of combining an external approach when required. Preserving the FSDP should be the main aim regardless of the approach.

Three-dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC).

Two major classifications of frontoethmoidal cells, Lee and Kuhn and the IFAC (International Frontal Sinus Anatomy Classification), distinguish anterior, posterior and medial cells. The European anatomical position paper includes also lateral cells. According to the IFAC, anterior cells push the frontal sinus drainage pathway (FSDP) medially, posteriorly or posteromedially. Posterior cells push the FSDP anteriorly. The only medial cell, pushing the FSDP laterally is the frontal septal cell, which is attached to or located in the interfrontal sinus septum. The aim of this study was to verify the IFAC and characterise cells, which are inconsistent with this classification. A radioanatomic analysis. Tertiary university hospital. One hundred and three Caucasian adult patients with no inflammatory changes in paranasal sinuses CT. Results of assessment of multiplanar reconstruction of thin slice CT. Two types of cells that cannot be classified using the IFAC were found: (a) Lateral cells extending between the skull base and the anterior buttress, pushing the FSDP anteromedially or medially, present in 34 (16.5%) of the sides, (b) Paramedian cells: medially based, not adjacent to the interfrontal septum, pushing the FSDP laterally and posteriorly, present in 33 (16%) of sides. Suprabulla cells and suprabulla frontal cells were found to push the FSDP in directions other than anterior 28% and 31% of the time respectively. Neglecting lateral and paramedian cells may lead to inconsistent results between radioanatomical studies and impede communication between surgeons. They should be included in existing classifications of frontoethmoidal cells.

Anatomical Variation in the Drainage Pattern of Frontal Sinus – A Cadaveric Study

Abstract Background A proper and detailed knowledge about the frontal sinus drainage pathway is essential for the radiologist to interpret the computed tomography scan of the paranasal air sinuses to find out normal and variant in the anatomy of frontal sinus ostium, and also for the surgeons to do endonasal sinus surgery particularly in the frontal sinus area with enough confidence and to give good postoperative result. With this background, the present study was focused to study the variation in the drainage pattern of frontal sinus in relation to uncinate process in cadaveric specimens. Materials and Methods The midsagittal section of head and neck portion of 40 cadaveric specimens with intact frontal sinus and frontal sinus drainage pattern were selected. By careful dissection, pattern of frontal sinus drainage was identified and pattern of drainage of frontal sinus in relation with uncinate process was studied. Result Frontal sinus drainage pattern is anteromedial to uncinate process (Type 1) in 28 specimens (70%) and posterolateral to uncinate process (Type 2) in 12 specimens (30%). Conclusion The results of our study show that the frontal sinus drainage pattern is more commonly present anteromedial to uncinate process compared with posterolateral position. This variation in the drainage pattern of frontal sinus should be kept in mind by the radiologist to give proper radiological interpretation and by the surgeons to avoid intraoperative complications and also to give good postoperative result.

The Anterior Ethmoidal "Genu": A Newly Appreciated Anatomic Landmark for Endoscopic Sinus Surgery.

Human sinonasal anatomy varies widely between patients, challenging surgeons operating in the sinuses. Ethmoid sinus anatomy is so variable it has been referred to as a labyrinth. Accordingly, reliable, consistent anatomic landmarks aid surgeons operating in this region. The goal of this investigation was to explore our observations and hypothesis that the ethmoidal bulla and the uncinate process are not entirely separate structures but rather attach, and the attachment could potentially provide a landmark for surgeons performing ethmoid and frontal recess surgery. Ethmoid sinus anatomy was studied in 57 sinonasal complexes through a variety of methods including gross anatomic dissection, endoscopic dissection and 3D CT stereoscopic imaging. The uncinate process and ethmoidal bulla were noted to fuse at the superior aspect of the hiatus semilunaris in 57/57 cases, forming a genu-like feature in the anterior ethmoid. This consistent anatomic feature related closely to the frontal sinus drainage pathway, which drained medial to it in 44/57 (77%) cases. The anterior ethmoidal "genu" appears to be an excellent anatomic feature that surgeons can use during ethmoid and frontal recess surgery. High resolution 3D stereoscopic CT scan is capable of demonstrating sinonasal anatomy in a detailed fashion previously only achieved by cadaveric dissection. This technology can potentially allow for a virtual dissection of a patient's anatomy prior to surgery and could improve minimally invasive procedures and reduce complications. Clin. Anat. 32:534-540, 2019. © 2019 Wiley Periodicals, Inc.

A Radiological Study Assessing the Prevalence of Frontal Recess Cells and the Most Common Frontal Sinus Drainage Pathways.

To date, there are numerous studies documenting the prevalence of frontal recess cells, but only 1 study using the newly developed International Frontal Sinus Anatomical Classification (IFAC) system. The identification of the frontal cells and their influence on the frontal drainage pathway plays an important role in endoscopic frontal sinus surgery. The aim of this study is to document the radiological prevalence of various types of frontal cells, as classified by IFAC and the most common frontal sinus drainage pathways based on its anatomic relationships with these cells. Using a novel preoperative virtual planning software (Scopis Building Blocks), consecutive computerized tomography scans of the sinuses of patients were analyzed for the prevalence of frontal cells, as classified by the by IFAC, and the frontal sinus drainage pathways at the Ear Nose Throat Hospital of Ho Chi Minh City, Vietnam. In this study, 208 computed tomography scans of consecutively selected frontal sinuses of 114 patients were included for analysis. The agger nasi cell was present in 95.7% of reviewed scans. The frontal cells prevalence was as follows: supra agger cell (SAC): 16.3%, supra agger frontal cell (SAFC): 13%, supra bulla cell (SBC): 46.2%, supra bulla frontal cell (SBFC): 4.3%, supra orbital ethmoid cell: 17.3%, and frontal septal cell: 10.6%. The most common frontal sinus pathway type in relation to frontal cells was medial to SAC (70.6%), medial to SAFC (81.5%), anterior to SBC (88.5%), and anterior to SBFC (100%). In cases that had 2 frontal cells group, the drainage pathway was medial to SAC/SAFC and anterior to SBC/SBFC in most cases. This study documents the prevalence of frontal cells (classified by IFAC) using a novel preoperative virtual planning software in the Vietnamese population. It demonstrates predominantly medial anteromedial frontal drainage pathways as related to these frontal cells.

Preoperative computed tomography evaluation of the paranasal sinuses: what should the physician know? - pictorial essay.

The introduction of functional endoscopic sinus surgery in the 1980s brought about a drastic change in the treatment of patients with rhinosinusitis, improving quality of life through the removal of pathological processes or anatomical variations that obstruct the drainage pathways of the paranasal sinuses. However, despite the routine use of computed tomography in the anatomical evaluation of the paranasal sinuses, most radiological reports still do not provide sufficient information to guide the surgical planning. The objective of this pictorial essay was to demonstrate, through computed tomography, the main anatomical variations of the paranasal sinuses, the recognition of which is fundamental for preoperative planning, in order to avoid treatment failure and iatrogenic complications.

Synedra, a free digital imaging viewer, is relevant in assessment of frontal sinus drainage pathway

Objective The aim was to evaluate the most relevant free radiological digital imaging and communications in medicine (DICOM) software in analysis of air cells related to the frontal sinus drainage pathway (FSDP). Background DICOM is the leading standard for computed tomography (CT) scan image data management in different paranasal sinuses and rhinology practice. Patients and methods In the present prospective randomized case-series study of 51 patients scheduled for CT scan for nose and paranasal sinuses, six DICOM image viewers (Onis, Synerdra, 3D-Slicer, InVesalius, RadiAnt, and Philips) were compared by two expert head and neck radiologists for analysis of CT FSDP anatomy using modified Bent–Kuhn classification, which presents a total score for 10 commonly used radiological parameters. Each was scored from 0 to 10, and a total score and mean were calculated. Results Synedra software had the highest total mean scores (64.5/100) followed by RadiAnt (45/100), 3D-slicer (29.5/100), Onis (16/100), and Invesalius (15/100), with the least being Philips (14.5/100). Conclusion Synedra could be a relevant free DICOM viewer for analysis of air cells related to the FSDP.

Teaching Residents Frontal Sinus Anatomy Using a Novel 3-Dimensional Conceptualization Planning Software-Based Module.

The Frontal Sinus Masterclass (FSMC) is an effective method for teaching frontal sinus anatomy. A third party developed new software using the same 3-dimensional building block concept. The authors sought to determine whether the use of the software for the educational module yielded similar results to the original FSMC, which used wooden blocks. The study was performed at a sinus course for residents. A precourse test assessed the ability to decipher frontal sinus anatomy prior to the course. Computed tomography (CT) scans of the sinuses were evaluated in triplanar view, and participants attempted to reconstruct the anatomy using the new software. Subsequently, the course instructor explained the anatomy and showed a short corresponding surgical video of the frontal sinusotomy. Cases progressed in anatomical difficulty and inflammatory load. A postcourse test determined knowledge after the course. In sum, 50 residents completed the pre- and postcourse tests. Overall scores increased from 60.5% to 65.2% ( P = .004). Subanalysis also demonstrated improved ability to locate the frontal drainage pathway from 32.5% to 46% ( P = .011) and label the frontal recess cell structures from 64% to 67.6% ( P = .045). There is minimal literature on proven methods for teaching frontal sinus anatomy. Objectively, participants of the modified FSMC simulation training using new software improved their ability to recognize cells of the frontal recess on CT scans. They especially exhibited better localization of the frontal sinus drainage pathway. Subjectively, participants reported benefit from the course and felt they would be better surgeons.

Anatomical terminology of the internal nose and paranasal sinuses: cross-cultural adaptation to Portuguese.

IntroductionFunctional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the “European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses”, aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language.ObjectiveTranscultural adaptation of the anatomical terms of the nose and paranasal cavities of the “European Anatomical Terminology of the Internal Nose and Paranasal Sinuses” to Portuguese.MethodsA group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith.ResultsThe results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms “inferior turbinate”, “nasal septum”, “(bone/cartilaginous) part of the nasal septum”, “(middle/inferior) nasal meatus”, “frontal sinus drainage pathway”, “frontal recess” and “uncinate process” be standardized.ConclusionWe have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil.

Design of cross-sectional anatomical model focused on drainage pathways of paranasal sinuses

Objective:To design and produce cross-sectional anatomical models of paranasal sinuses for the purpose of demonstrating drainage pathways of each nasal sinus for the young doctors. Method:We reconstructed the three-dimensional model of sinuses area based on CT scan data, and divided it into 5 thick cross-sectional anatomy models by 4 coronal plane，which cross middle points of agger nasi cell, ethmoid bulla, posterior ethmoid sinuses and sphenoid sinus respectively. Then a 3D printerwas used to make anatomical cross-sectional anatomical models.Result:Successfully produced a digital 3D printing cross-sectional models of paranasal sinuses. Sinus drainage pathways were observed on the models. Conclusion:The cross-sectional anatomical models made by us can exactly and intuitively demonstrate the ostia of each sinus cell and they can help the young doctors to understand and master the key anatomies and relationships which are important to the endoscopic sinus surgery.

Anatomical relations between the frontal sinus drainage pathway and the agger nasi cell

Anatomical relations between the frontal sinus drainage pathway and the agger nasi cell

The application of 3D reconstruction in investigating the frontal sinus drainage pathway based on computer tomography data

Objective:The aim of this study is to explore the value of 3D reconstruction technology based on computer tomography data in understanding the frontal sinus drainage pathway. Method:Three-dimensional reconstruction of DICOM data from 100 cases of sinus CT was performed by using Mimics 19.0 software. The 3D models were used to study types, the relative locations of frontal sinus and recess cells as well as the influence of the frontal sinus drainage pathway. Result:The 3D model of frontal sinus, frontal recess cells and frontal sinus drainage pathway were reconstructed successfully. Among them, the incidence of nasal cavity was 95.5% (191/200), nasal cavity was 31.5% (63/200), nasal cavity on the frontal air room was 24.5% (49/200) supra bulla cells were 54% (108/200), supra bulla frontal cells were 14.5% (29/200), supraorbital ethmoid cells were 20.5% (41/200), and the rate of frontal septal cells were 4% (8/200). It visually demonstrated the relationship between the frontal recess and the frontal sinus drainage channel. Conclusion:The 3D reconstruction technology based on computer tomography data not only helps us to understand the anatomy of the frontal sinus, the relative position of the frontal crypt and the effect on the frontal sinus drainage channel, but also provides a new method for preoperative planning and intraoperative guidance to endoscopic frontal sinus surgery.

The Terracol and Ardouin developmental model of frontal sinus drainage pathway and surrounding spaces: a radiologic validation.

The complexity of the frontal sinus drainage pathway (FSDP) can be challenging even for expert surgeons. Several classifications have been proposed to simplify the understanding of FSDP, whose anatomical variability can be simplified based on the knowledge of its developmental mechanisms. Cone-beam computed tomography studies performed at the Unit of Radiology of the University of Brescia between March and November 2012 were retrospectively analyzed. FSDP was classified as medial or lateral to the vertical portion of the uncinate process and the following anatomical variants were studied: agger nasi cell, Kuhn's cells, suprabullar cell, supraorbital ethmoid cell, suprabullar frontal cell, and frontal septal cell. The developmental model of the FSDP proposed by Terracol and Ardouin was analyzed and expected associations between the position of the drainage pathway and anatomical variants were formulated. Statistical associations between anatomical variants and the position of FSDP were calculated and compared with expected associations to validate the developmental model. The anatomical variants of FSDP statistically validated the developmental model of Terracol and Ardouin. Knowledge of the possible developmental patterns of FSDP helps the surgeon in the understanding of the complexity of the frontoethmoidal region.

Teaching frontal sinus anatomy using the frontal sinus masterclass 3- D conceptualization model.

Frontal sinus anatomy is complex and often is a difficult subject to both teach and learn. The traditional surgical dogma of "see one, do one, teach one" is impractical and dangerous in the frontal sinus. Based on the building block three-dimensional conceptualization module, the Frontal Sinus Masterclass (FSMC) was created to teach this anatomy. Study was performed at two academic centers among second- to fifth-year otolaryngology residents. A pretest assessed knowledge prior to the course. Computed tomography scans of the sinuses were evaluated in triplanar view, and participants attempted to reconstruct the anatomy. Subsequently, the course instructor explained the anatomy using the building block method and showed a short video of the surgical dissection, pointing out relevant anatomy. Cases progressed in anatomical difficulty and inflammatory load. A posttest determined knowledge after the course. Thirty of 50 participating residents completed the pre- and posttests (14 junior, 16 senior residents). Correct identification of the frontal sinus drainage pathway increased from 42% to 63% correct (P = 0.054). Anatomical assessment increased from 61% to 68% correct (P = 0.047), and overall assessment increased from 52% to 66% correct (P = 0.016). Objectively, participants of the FSMC expanded on their ability to recognize cells of the frontal recess on CT scans. Before the class, residents could answer less than half of the answers correctly, and by the end of the class they were answering over two-thirds of these complex questions correctly. Subjectively, participants reported benefit from the course and felt they would be better surgeons. NA. Laryngoscope, 128:1294-1298, 2018.

Comparative Evaluation of Anatomical and Pathological Features on Computed Tomography Scan with Intraoperative Findings in Frontal Sinus Pathology

ABSTRACT To compare the anatomical and pathological features on computed tomography (CT) scan with intraoperative findings in cases of frontal sinus disease. This prospective study was conducted in a tertiary referral center, and a total of 30 patients who were refractory to conservative medical treatment undergoing endoscopic sinus surgery for frontal sinus disease were included in the study. Preoperative CT scans were done with axial and coronal cuts with a sagittal reconstruction to obtain a better idea about the frontal recess anatomy. The areas that were studied preoperatively on CT scan were frontal sinus pathology, pattern of sinus involvement, superior attachment of uncinate process, frontal sinus drainage pathway, agger nasi cell, frontal cell, frontal bullar cell, and supraorbital ethmoidal cell. A good correlation was obtained between the CT findings and intraoperative findings. How to cite this article Chakraborty S, Verma D, Lade H, Malik NUD. Comparative Evaluation of Anatomical and Pathological Features on Computed Tomography Scan with Intraoperative Findings in Frontal Sinus Pathology. Clin Rhinol An Int J 2017;10(1):6-10.