ABSTRACT
Background: Ethmoid Skull Base (ESB) is anarticulation of ethmoid roof with Lateral Lamella ofCribriform plate (LLCP). An increased LLCP heightwas observed to increase the vulnerability of ESB tosurgical injuries. Aim and Objectives: The present studywas undertaken to analyze the configuration of thelateral lamella of cribriform plate, the ethmoid roof withrespect to Keros type of olfactory fossa. Material andMethods: Aretrospective Computed Tomographic (CT)study was done with 60 Coronal Paranasal Sinuses(PNS) scans and LLCP height was determined bysubtracting Medial Ethmoid Roof Point (MERP) fromCP heights and classified according to Keros. Thedifference between Medial Ethmoid Roof Point(MERP) and Lateral Ethmoid Roof Point (LERP)heights in both anterior and posterior planes indicatesthe direction of ethmoid roof slope. Results: Theaverage height of the LLCP was between 1.53 to 8.55mm with a mean (SD) of 3.77 mm 1.66 and majoritybelonged to Keros type I. Overall mean differencebetween LERP and MERP was 5.43 0.74 mm inanterior and 4.43 0.63 mm in posterior planes. In boththe planes irrespective of the sides the height of theLERPwas higher in relation to medial side. Conclusion:Keros type I was the most common type and the slope ofanterior ethmoid roof is steeper compared to posterior.This preoperative knowledge about the configuration ofLLCPas well as the ethmoid roof contour is vital duringendonasal ethmoidal surgeries.
ABSTRACT
Background: The uncinate process is an important landmark in the anatomy of osteo-meatal complex of frontal recess which also plays a vital role in the ventilation of middle meatus and sinuses. Its superior attachment shows great anatomic variability. The aim of this study was to observe and classify superior attachment and presence of pneumatisation in uncinate process. Materials and methods: Computed tomographic images of paranasal region from 100 patients were studied retrospectively. In 100 patients, 54 belonged tomale and 46 female and were in the age group of 11 to 75 years with an average of 32.7 years. The superior attachment of uncinate process was observed and tabulated according to Landsberg and Friedman classification and pneumatisation of uncinate process was also noted. The results were analysed statistically. Results: The superior attachment of uncinate process was observed in 200 sides out of 100 patients and its attachment to the agger nasi cells (type - 2) was found in 36% while its attachment to lamina papyracea (type – 1) and to middle turbinate (type – 6) were found in 19% and 20% respectively. Uncinate process ending at the junction of middle turbinate with cribriform plate (type – 4), at the ethmoid skull base (type – 5), bifurcating towards lamina papyracea and junction of middle turbinate with cribriform plate (type – 3) were seen in 2%, 8% and 5% respectively. In 11%, the superior end showed no attachment to surrounding structures. The uncinate process was pneumatised in 34 of 200 sides (17%), among which 45.5% was unilateral and 54.5% bilateral. Conclusion: Preoperatively evaluating variations of uncinate process and its pneumatisation helps to avoid intraoperative damage to surrounding structures. The detailed knowledge of extent of uncinate process may also help to deduce the reason for refractory chronic sinusitis.
ABSTRACT
Pancreas divisum is a congenital anomaly of the duct system of pancreas that occurs due to the failure of fusion of dorsal and ventral pancreatic ducts. This anomaly has been hypothesized as the predisposing factor for chronic, recurrent and idiopathic pancreatitis. During routine dissection, we observed 2 cases of complete type of pancreas divisum. In the observed cases, the patent dorsal pancreatic ducts terminated onto minor duodenal papilla and measured 15.6 cm and 17.3 cm respectively. The patent ventral pancreatic ducts measured 3.2 cm and 2.7 cm respectively and terminated onto the major duodenal papilla after joining with common bile duct. The major papillae were antero-superiorly related to minor papillae and the distance between them measured 4.3cm and 1.4 cm respectively. Awareness and timely detection of this commonly occurring pancreatic anatomical anomaly helps the clinicians to prevent or manage potential recurrent pancreatitis.