​Comparative Evaluation Of Pre-Operative Multidetector Computer Tomography Findings And Intraoperative Endoscopic Sinus Surgery Findings With Regard To Osteomeatal Complex In Patients With Chronic Rhinosinusitis

Background and Objective: Background and objective of the study were to determine how well the pre-operative multidetectorrow computed tomography (MDCT) findings and intraoperative endoscopic sinus surgery findings correlate in patients withchronic rhinosinusitis (CRS) and to assess the various anatomical variations of the osteomeatal complex in these patients.Materials and Methods: A total of 100 patients falling within the inclusion criteria with diagnosed CRS who had given consentfor participating in this study were analyzed. The study period was from January 2016 to December 2016. In these patients, adetailed history and examination were done, counseled regarding the necessity of MDCT scan imaging of the nose and sinusesand further about the need for endoscopic evaluation and functional endoscopic sinus surgery (FESS). Scans were evaluatedpreoperatively as per Lund–Mackay CT scan score and anatomic variants regarding OMC were noted. Later, intraoperativefindings were noted, and kappa statistics was used to analyze the agreement between MDCT and intraoperative endoscopicfindings.Results: Agger nasi, concha bullosa, medial and lateral deviation of the uncinate process and paradoxical middle turbinateshowed a very good correlation of agreement between pre-operative CT scan and operative findings. Excellent correlationwas found in case OMC obstruction, and there was a very good correlation of agreement between pre-operative CT scan andoperative findings.Conclusion: MDCT shows an increased sensitivity compared to routine CT in detecting OMC obstruction, and it had a verygood correlation with intraoperative findings. There was an excellent correlation between MDCT and intraoperative findingsin cases of all anatomic variants studied except concha bullosa. In conclusion, MDCT can help clinicians to better predict theOMC status pre-operatively and thereby guide FESS

Importância do complexo osteomeatal no planejamento do levantamento de seio maxilar / Importance of the evaluation of the osteomeatal complex in the planning of maxillary sinus lift

O desvio de septo nasal, concha bolhosa e a obstrução do óstio são alterações do complexo osteomeatal, que podem interferir no volume dos seios maxilares, em sua oxigenação, drenagem adequada de fluidos e nos resultados de cirurgias nessa região. A adoção de um protocolo de avaliação do complexo osteomeatal envolvendo uma equipe multidisciplinar no planejamento de cirurgias de levantamento de seio maxilar pode proporcionar a diminuição do surgimento de complicações pós-operatórias relacionadas à drenagem e ventilação, prejudicadas pelo desvio de septo nasal, concha bolhosa e obstrução do óstio.

Nasal septum deviation, concha bullosa and ostium obstruction are alterations of the osteomeatal complex that may interfere with the volume of the maxillary sinuses, their oxygenation, adequate drainage of fluids and the results of surgeries in this region. The adoption of a protocol for evaluation of the osteomeatal complex involving a multidisciplinary team in the planning of surgeries of maxillary sinus can provide a reduction in the appearance of postoperative complications related to drainage and ventilation impaired by nasal septum deviation, concha bullosa and obstruction of the ostium.

Correlation of anatomical variations of Paranasal sinuses and Chronic Rhinosinusitis

Background: The anatomy of the nose and paranasal sinuses is complex, and many anatomical variations have been thoroughly studied. There is impact of these variations on the occurrence and severity of sinusitis. Computed Tomography (CT) scan is the modality of choice for evaluation of variable anatomical variations and different forms of sinusitis. Materials and methods: The aim of this research was to study the relation between recurrent sinusitis and anatomical variations of the osteomeatal complex and nasal structures by CT. A cross section prospective observation study was performed. We collected data of 120 patients subjected to CT of the paranasal sinuses. Result: Anatomical variations found by CT, nasal septal deviation represented the most common variation (75%), followed by concha bullosa and uncinate hypertrophy. Conclusion: There was a statistically significant correlation between nasal septal deviation, uncinate process anomalies and some patterns of sinusitis with the p value = <0.05.Computed tomography of the paranasal sinus has improved the visualization of paranasal sinus anatomy and variations and has allowed greater accuracy in evaluating paranasal sinus disease.

A Computerized Tomographic Study of Uncinate Process of Ethmoid Bone.

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.

Biometría etmoidal, del complejo osteomeatal y sus variantes anatómicas: estudio en cadáveres / Ethmoidal and osteomeatal complex biometry and its anatomical variations: cadavers study

La anatomía del etmoides y del complejo osteomeatal ha sido la base fundamental de muchos avancescientíficos especialmente en el campo de la cirugía endoscópica. Por ello el objetivo del presente trabajo es describir la anatomía etmoidal, del complejo osteomeatal y sus variantes anatómicas en los cadáveres del anfiteatro de la Universidad del Rosario, un estudio observacional descriptivo tiposerie de casos donde se tomaron 20 cabezas, se hicieron disecciones y mediciones en ellas. Se evaluó la concordancia interobservador e intraobservador en las variables numéricas con el paquete SPSSversión 11.5, se halló el coeficiente de correlación intraclase (CCI), el intervalo de confianza (IC) tomando significativo CCI > 0.6; y para las variables categóricas el test de concordancia Kappa, a un nivel de significancia de cinco por ciento (0.05). De los resultados finales, se encontraron promedios para la apófisis Crista Galli de longitud ancho yprofundidad. Para la lamela lateral se encontró mayor frecuencia el Keros II en 45% seguida de Keros I (42,5%) y en menor frecuencia Keros III en 12,5%. Se halló el promedio de la longitud antero-posterior y supero-inferior de los cornetes superior, medio y supremo. Se describieron seis variantes anatómicas de la forma del cornete superior y se encontraron cinco variantes anatómicas de la forma del cornete medio. El cornete supremo se encontró en el 15% de los especímenes y se encontraron dosformas del mismo. Fueron observadas 10 variantes anatómicas de la inserción superior de la apófisis unciforme y ocho tipos de inserción inferior del mismo. Se creó una clasificación de la inserción inferior de la apófisis unciforme con respecto al ostium del seno maxilar...

Ethmoidal and osteomeatal complex anatomy had been fundamental base of several scientific advances, especially in endoscopic sinus surgery. The objective of this study is to describe ethmoidal anatomy, osteomeatal complex and its anatomical variations in corpse´s anphitheater of the Rosario University; in an observational descriptive studytype case series. Twenty heads (20) were evaluated with interobserver and intraobserver measures in numercial variables with SPSS version 11.5, it was obtained the intraclass correlation coefficient (ICC), the confidence interval (CI) with significance ICC>0,6 and categorical Kappa variable test with levelof significance of five percent (0.05).Of the final outcomes, Crista galli process wide and depth length was obtained. Lateral lamella was more frequent Keros type II (45%) than type I (42,5%) and type III (12,5%). For the superior, supreme and middle turbinates was found its length and incidence. Six anatomical variations of the superior attachment of the uncinate process and five anatomical variations of the form of middle turbinate weredescribed. The supreme turbinate was found in 15% of the specimens and there were two forms of it. Ten anatomical variations of the superior attachment of the unciform process and eight types of its inferior attachment were found. It was created a new classification of inferior attachment of uncinate process with relation to the maxillary ostia...