Superior Attachment Of Uncinate Process Research Articles

A retrospective study on variations of uncinate process of ethmoid bone using cone-beam computed tomography

Background: Uncinate process (UP) is a key landmark in the lateral wall of the nose which plays a vital role in the ventilation of paranasal sinuses and is also the first structure to be resected during functional endoscopic sinus surgery (FESS). The variations in this structure can lead to intraoperative and postsurgical complications during the FESS procedure. Aim: The aim of this study was to evaluate the variations of UP of ethmoid bone using cone-beam computed tomography (CBCT). Materials and Methods: Retrospective data of 100 cone-beam computed radiographic CBCT images of paranasal sinuses were evaluated using CS 3D version 3.10.12 software for variations in the superior attachment of UP (SAUP) using Landsberg and Friedman and the presence of pneumatization of UP. Out of 100 CBCT images, 56 were of males and 44 were of females. Statistical Analysis Used: Chi-square test was used for statistical analysis. Results: In our study, a total of 200 sides in 100 CBCT images were studied and Type I SAUP (51%) was observed as the most common type, followed by Type II (17%), Type IV (11.5%), Type III (10%), Type V (6.5%), and Type VI (4%) is the least common type observed. No statistically significant difference was observed among gender regarding SAUP. Pneumatization of UP was seen in 7% of cases, out of which 4% were in males and 3% were in females. Conclusion: Preoperative analysis of UP variations using CBCT can reduce intraoperative and postoperative complications during FESS with less radiation exposure.

Inter Observer Agreement Among Radiologist and Otorhinolaryngologists on Paranasal Sinus Computed Tomography Scans in Chronic Rhinosinusitis.

To evaluate inter observer agreement between Radiologist and Otorhinolaryngologists in identifying important structures and pathologies on pre operative computed tomography (CT) scans of paranasal sinus (PNS) in chronic rhinosinusitis (CRS). A retrospective review of CT scans PNS of CRS patients. Archived CT scans were evaluated by 3 observers, similarly experienced radiologist and otorhinolaryngologist and a less experienced otorhinolarygologist. The degree of intra- as well as inter observer agreement was assessed by Cohen's kappa statistics. A moderate and a fair inter observer agreement was noted among experienced radiologist and otorhinolaryngologist; & experienced experts and less experienced otorhinolaryngologist respectively. The greatest disagreements among all observers were found in superior attachment of uncinate process, optic nerve's relationship with sphenoid sinus and dehiscence of anterior ethmoid canal. The present study demonstrated a considerable inter observer variability among radiologists and otorhinolaryngologists, irrespective of their experience in the field of speciality. A few critically important structures which showed an unsatisfactory level of agreement and thus need to be sought after with more training and practice, were also identified. These included Keros type, optic nerve's location, dehiscence of anterior ethmoid artery, vidian and maxillary nerves, lamina papyracia defect, sphenoid sinus pneumatization and attachment of uncinate process. The study also emphasized the importance of inter disciplinary conferences for pre operative evaluation of sinus CT scans of CRS patients.

Anatomical Variations of Uncinate Process in a Tertiary Care Hospital of a Coastal city in Karnataka

Introduction: Superior attachment of uncinate process is the most important anatomical landmark in frontal recess surgery. The uncinate process is an integral struc­ture of osteomeatal complex and prevents the direct contact of the inspired air with the maxillary sinus. It acts as a shield and also plays a role in muco-ciliary activity. Anatomic variations of the uncinate process have surgical implications.
 Aim: This study was done to know the different variations of superior attachment of uncinate process.
 Materials and Methods: In this retrospective observational descriptive study, Computed Tomography (CT) scans of Para Nasal Sinuses (PNS) of 256 patients from Sept 2018 to May 2020 were studied. The results were expressed in percentages and proportions.
 Results: Among 256 CT images, 139 belonged to males and 117 females. In the CT films examined, on the right side, the most common attachment of uncinate was to lamina papyracea which was (64.8%) followed by skull base (19.5%) and to the middle turbinate(15.6%). Similar findings were seen on left side.
 Conclusion: Uncinate process shows different variations in its superior attachment. Superior attachment to lamina papyracea was the most common attachment of uncinate in our study.

A Descriptive Study of Anatomical Variations of Uncinate Process on Sinonasal Computed Tomography

Aim: The purpose of our study was to assess various anatomical variations of the uncinate process of the lateral nasal wall and to study the clinical association of its anatomical variations on computed tomography. Methods: A descriptive study of anatomical variations of the uncinate process with clinical association was undertaken in the Department of Ear, Nose & Throat of a Medical College and Tertiary Health care centre. The study was of 2 years duration and included 50 patients from August 2014-2016 and included 50 patients. Patients were selected according to a specified criteria and sinonasal computed tomography scans were undertaken with the help of Somatom Emotion 6 CT machine. Data was organised charted and analysed using statistical software SPSS 16. Results: The key findings in our study were that six types of anatomical variations of uncinate process and there frequency distribution was identified according to Landstiener and Friedman classification. Uncinate process types according to age and gender were charted and tests of association were applied. Conclusion: After statistical analysis we found no association between type of uncinate process and sinonasal symptoms. No association was seen between age and gender and variations of uncinate process. In our study, variation of superior attachment of uncinate process were found in 100% cases.

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.

Anatomical variations in superior attachment of uncinate process and localization of frontal sinus outflow tract

<p class="abstract"><strong>Background:</strong> Uncinate process (UP) is a part of ethmoid bone, which is a thin sickle shaped projection on the lateral wall of nose. UP extends from the frontal recess superiorly and inferiorly to the ethmoid process of inferior turbinate. Various studies have shown that superior attachment of uncinate process (SAUP) is the key to frontal recess region in endoscopic sinus surgeries (ESS). But these studies have yielded conflicting results, showing multiple patterns and classifications of superior attachment of uncinate process. Knowing the anatomic variations of SAUP will help the surgeon to plan the endoscopic sinus surgery and to avoid the unwanted complications. Hence this study was conducted to observe and classify the superior attachment of uncinate process and to localize the frontal sinus outflow tract<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> We did a retrospective cross sectional study, consisting of 100 patients including both sexes, above the age of 10 years. We excluded pregnant ladies, patients with prior sinus surgeries, sinonasal tumours, nasal polyposis, and craniofacial trauma<span lang="EN-IN">. </span></p><p class="abstract"><strong>Results:</strong> We observed Type I SAUP, in 67.5% (n=135) cases, Type II SAUP in 18.5% (n=37), Type III attachment in 9.5% (n =19) and Type IV in 4.5% (n=9). Bilaterally similar attachments observed in 96% cases. Rest of the cases (4%), the attachment patterns was varying between sides<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The site of SAUP is highly variable. The most common type of SAUP is Type I (67.5%) followed by Type II (18.5%), Type III (9.5%) and Type IV (4.5%)<span lang="EN-IN">.</span></p>

The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis.

The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.

A Radiological Study of Anatomical Variations of Uncinate Process

ABSTRACT Aim (a) To study the variations in the superior attachment of uncinate process. (b) Incidence of pneumatization of uncinate process was also studied. Materials and methods A total 200 sides of 100 CT scans of paranasal sinuses coronal section were studied for variations in the superior insertion of uncinate process using Landsberg and Friedman classification. Incidence of pneumatization of uncinate process was also studied. Results In our study out of 200 sides, type 6 attachment was commonest (41%) followed by types 1 and 2. Pneumatization of the uncinate was seen in very small percentage of cases. Conclusion Lateral insertion of uncinate (lamina papyracea + aggar nassi) is the commonest variant followed by the insertion into the skulbase. Pneumatization of uncinate is rare. Clinical significance Though the inferior attachment of the uncinate is almost constant the superior attachment has several variations, the knowledge of which is very important for the endoscopic surgeon to avoid intraoperative complications. How to cite this article Patla SDK, Rathnakar P, Bhat VS, Jayaramesh. A Radiological Study of Anatomical Variations of Uncinate Process. Clin Rhinol An Int J 2016;9(2):59-61.

Nasofrontal Complex Variation Frontal Sinus Drainage System Increases Frontal Rhinosinusitis Incident

BACKGROUND: This research was conducted to find out the relation of anatomy variation of nasofrontal complex on the frontal sinus drainage system with frontal rhinosinusitis incident. METHODS: This research was using cross-sectional design involving 75 patients with chronic rhinosinusitis. Coronal paranasal sinus CT scan with sagittal plane reformat was carried out to examine. The CT scan figures were analyzed from every side and there were 150 samples found as the result. Data was analyzed using chi square test. RESULTS: The research indicates that there is no significant relation between frontal cell types, agger nasi cell, chonca media bullosa with incident of frontal rhinosinusitis (p&gt;0.05). Prevalence of superior attachment of uncinate process (UP), type 1 (UP superior attachment on lamina papiracea) was found on 43 sides (28.6%), type 6 (UP superior attachment to medial turbinate) was found in 29 sides (19.3%). Prevalence of frontal rhinosinusitis was found in 42 (28%) from 150 sides. Group 1 drainage (medial side drainage; drainage to meatus medius [type 1-3]) was found in 32 sides (76.2%) and group 2 drainage (lateral side drainage; drainage to infundibulum ethmoid [type 4-6]) was found in 10 sides (23.8%). CONCLUSION: There is significant relation between frontal rhinosinusitis incident with variation of frontal sinus drainage (p&lt;0.05) and drainage on group 1 has significant existence statistically on frontal rhinosinusitis incident. KEYWORDS: frontal rhinosinusitis, anatomy variation, nasofrontal complex, frontal sinus drainage

Role of Anatomic variations of Uncinate Process in Frontal Sinusitis.

The osteomeatal complex plays an important role in the development of Chronic rhinosinusitis. The ethmoidal infundibulum is bordered medially by the uncinate process, and the anatomic relationship between the ethmoidal infundibulum and the frontal recess may depend upon the types of attachment of the uncinate process. The osteomeatal complex is the main area targeted in chronic rhinosinusitis and within it uncinate process is the first anatomical structure encountered. The aim of this study was to evaluate the types of attachment of the uncinate process and its implications in the development of sinus inflammation. The significance of anatomical variations of uncinate process in chronic sinusitis were evaluated. A prospective CT scan study on 64 patients of chronic sinusitis (128 uncinate processes) was done. The results were tabulated and analyzed using Statistical Package for Social Science 16.0. Type I superior attachment of uncinate process into the lamina papyracea was the most common variety in all ages and both sexes and a statistically significant association between Type 1 Uncinate process and frontal sinusitis was found. (P<0.05). The superior attachment of uncinate process alters the frontal sinus drainage and causes the frontal sinusitis.

Influence of Superior Attachment of Uncinate Process on Presence of Agger Nasi

ABSTRACT Objective The superior attachment of uncinate process and agger nasi (AN) cell are important landmark in frontal sinus surgery, and are in close relation to each other. The aim of the study is to investigate the relationship between the superior attachment of uncinate process (UP) and presence of AN cell. Study design A retrospective radiological study. Materials and methods Fifty patients with features of chronic sinusitis were evaluated radiographically, i.e. computed tomo graphy (CT), 100 sides, i.e. 50 scans were evaluated for superior attachment of UP and presence of AN. Chisquare test was used as statistical tool for eliciting the relationship between the two. Results The AN cell was found in 68 (68%) of 100 sides. The prevalence of AN cell according to superior attachment of UP types were 64.1% for lamina papyracea, 79.41% for skull base, 53,84% for middle turbinate. The presence of AN cell accor ding to superior attachment types of UP was not statistically significant (χ2 = 3.5925, p = 0.16592). Conclusion The AN cell found in 68 sides (68%), and there was no statistical significance between the superior attachment of UP and presence of AN cell. How to cite this article Shivaraj R, Dsouza C, Pinto G. Influence of Superior Attachment of Uncinate Process on Presence of Agger Nasi. Clin Rhinol An Int J 2015;8(3):104106.

Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis.

The objective of this study was to radiologically determine frontal sinus drainage pathway variations with respect to superior attachment of uncinate process (SAUP) and their effect on prevalence of frontal rhinosinusitis. This was a retrospective cohort study. Computed tomography scans of the 919 frontal sinus sides of 460 patients (252 female, 208 male; mean age, 35.1 ± 10.5 years) who were candidates for endoscopic sinus surgery were evaluated retrospectively between August 2012 and January 2013 by 3 radiologists to determine the SAUP types and the presence of frontal rhinosinusitis. The frontal sinus outflow tract was localized medial to the SAUP in 651 frontal sinus sides and lateral to the SAUP in 268 sides. We determined 3 types (types 7, 8, and 9) of SAUP in addition to 6 types defined in literature. The most common type of SAUP was type 3 (n = 332, 36.1%) followed by type 2 (n = 256, 27.8%) and type 7 (n = 160, 17.4%). Of the evaluated sides, 316 (34.3%) had frontal rhinosinusitis. Frontal rhinosinusitis was more common in the sides where the frontal sinus outflow tract was localized medial to the SAUP than those localized lateral (37.2% vs 27.6%, P = 0.006). Endoscopic approach to frontal recess usually requires uncinectomy, and it is necessary to know SAUP to prevent postoperative retained superior portion of the uncinate process. The location of frontal sinus outflow tract on the SAUP affects the prevalence of frontal rhinosinusitis as well. Frontal rhinosinusitis is significantly more common when the frontal sinus outflow tract was localized medial rather than lateral to the SAUP. 2b.

Anatomical variations of uncinate process observed in chronic sinusitis.

Chronic Sinusitis, an extremely persistent illness, is surgically best treated by Functional Endoscopic Sinus Surgery. The ostiomeatal complex is the main area targeted and within it uncinate process is the first anatomical structure encountered. The significance of anatomical variations concerning age and sex of uncinate process in chronic sinusitis were evaluated. A prospective study on 50 patients of chronic sinusitis (100 uncinate processes) was done. The results were tabulated and analyzed using Statistical Package for Social Science (SPSS) 16.0. Type I superior attachment of uncinate process (67%) was the most common variety in all ages and both sexes and a statistically significant relationship between Type I superior attachment of uncinate process and sex was found (p<0.05). The typical uncinate process was most common (70%) followed by medial deviation of the uncinate (24%). This difference in occurrence was significant with respect to both age and sex (p<0.05). Anatomical variations of uncinate process are not responsible for causing chronic sinusitis. Mere presence of these variations of uncinate is not an indication for FESS.