Anatomical Variations in Nose and Paranasal Sinuses in Patients Presenting with Chronic Rhinosinusitis

Introduction: The anatomy of organs of ENT is a herculeantask to understand and evaluate in the whole human anatomy.Knowledge about the possible variabilities is never complete,since there is always a scope to understand better and knowmore. Many studies have been undertaken in the past tounderstand better the already existing knowledge about thevarious anatomical details in the nose and paranasal sinusescausing chronic rhinosinusitis. The present study was carriedto know the details of variations in anatomy of nose andparanasal sinuses causing chronic sinusitis.Material and Methods: A Cross sectional study conductedover a period of two years, in patients presenting to ENTOPD with symptoms and signs and chronic rhinosinusitis, ina setting of tertiary hospital, with the requisite investigativeprotocols. Patients meeting the inclusion criteria were includedin the study and subjected to the prescribed interventions.Results: Observations gathered from this study are- of the65patients included, 86.1% had septal deformities, 58.4% hadConcha bullosa, 52.3% had Agger Nasi, 15.3% had HallerCell, 13% had Paradoxical Middle Turbinate, 4.6% hadEverted Uncinate Process, 3% had Enlarged Bulla.Conclusion: Sinonasal anatomy is different in each individual,with various combined variations also.

The CT image features of ethmomaxillary sinus and their significance in endoscopic surgery / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the prevalence and radiographic characteristics of ethmomaxillary sinus (EMS) in chronic rhinosinusitis (CRS) patients by CT scan, as well as their endoscopic surgical significance in antrostomy.@*Methods@#A retrospective analysis of 111 CRS patients who were prepared for surgery in Department of Otorhinolaryngology Head and Neck Surgery of Peking University People′s Hospital from February to December of 2017 was performed. In all CRS patients, 79 patients were bilateral CRS and 32 were unilateral. The patients were divided into two groups according to whether they had history of surgery. Only the sides with CRS were analyzed. There were 98 patients (167 sides) in the non-surgical history group and 13 patients (23 sides) in the surgical history group. The prevalence of EMS in CRS sides in the two groups was counted by analyzing the CT images. The CT image features and anatomical variations associated with EMS in CRS sides in the non-surgical history group were also analyzed. SPSS 22.0 software was used for statistic analysis.@*Results@#The prevalence of EMS in CRS sides was 21.7% (5/23) in the surgical history group and 12.0% (20/167) in the non-surgical history group. No statistically significant difference in the prevalence of EMS was found between the two groups (χ2=0.940, P>0.05). The medial-lateral diameters of the EMS ranged from 8.50 to 14.10 mm with an average of (10.38±1.69) mm (Mean±SD). The shape of the bony septum between the EMS and maxillary sinus was divided into three types: convex toward to the EMS (2 sides), convex toward to maxillary sinus (5 sides) and flat (13 sides). The Lund-Mackay (LM) scores of the maxillary sinuses in patients with and without EMS showed no statistically significant difference (1.60±0.50 vs 1.40±0.62, Z=1.285, P>0.05). The EMS obstructed the drainage of maxillary sinus posteriorly, medially and superiorly. All the EMS in diseased sides were dissected endoscopicly to improve drainage. In the non-surgical history group, the EMS coexisting anatomic variations were the Onodi cell (7/20), Haller cell (3/20), concha bullosa (6/20) and maxillary sinus hypoplasia (3/20).@*Conclusions@#There is relatively high prevalence of the EMS in CRS patients. This is adjacent to the orbit, overpneumatizes laterally and obstructs the drainage of the maxillary sinus. Complete dissection of the EMS is helpful to improve the drainage of maxillary sinus.

Lateral rhinotomy for a large, infected haller cell causing proptosis

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report a case of a large sinus Haller cell that presented with chronic rhinosinusitis and proptosis and its surgical management.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 34-year-old lady with proptosis and secondary sinusitis due to a giant infected Haller cell was successfully treated by lateral rhinotomy approach and clearance of all diseased mucosa therein into the nasal cavity.<br /><strong>CONCLUSION:</strong> Approach to diseased sinonasal structures via lateral rhinotomy is an alternative to endoscopic sinus surgery in the presence of an unusually large Haller cell.</p>

Anatomical Study of Lacrimal Passage using Computed Tomography

OBJECTIVE: We could measure diameters of lacrimal sac and surrounding bone thickness of normal Korean with accurate data by using orbital CT. METHODS: We measured the lacrimal sac, surrounding bone thickness, and frequency of Haller cell with thin-section computed tomography examinations in 115 normal Korean orbits with no signs of pathology related to the lacrimal drainage system for 1999 to 2001. RESULTS: The mean length of lacrimal sac was 10.45+/-1.96 mm, A-P width was 5.96+/-1.26 mm, L-R width was 3.72+/-0.92 mm. The surrounding bone thickness of upper portion of lacrimal sac was 6.46+/-1.40 mm, middle portion was 3.24+/-1.11 mm, lower portion was 0.78+/-0.23 mm. The frequency of Haller cell was 13.9%. The diameters of lacrimal sac and surrounding bone thickness were larger in males than females, and increasing tendency with aging. CONCLUSION: In this study, Korean lacrimal sac size was slightly smaller than the caucasian and Korean male's surrounding bone thickness was thicker than female. These data will be very helpful in making appropriate osteotomy by using the drill during dacryocystorhinostomy and avoiding unnecessary manipulation.