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.

Normal Value of Mucosal Thickness of Paranasal Sinuses, as Seen on Brain

PURPOSE: To evaluate incidentally observed thickened mucosa of paranasal sinuses on brain MRI of patients without evidence of sinusitis. MATERIALS AND METHODS: We reviewed brain MRI of 82 adults aged over 20 ; 45 were males and 37 were females. Brain axial MRI was obtained from the hard palate with 8mm thickness and 2mm gap. The mucosal thickness of incidentally observed paranasal sinuses seen on brain MRI was measured at the mostly thickened portion by T2- and T1-weighted images. RESULTS: The mean mucosal thickness at the most thickened portion of paranasal sinuses, regardless of their location was 3.5mm with S.D. of 1.5mm. The mucosal thickening was observed more commonly in maxillary (79 patients, mean 3.0mm, S.D. 1.4mm) and ethmoid sinuses (80 patients,mean 2.7mm, S.D. 1.1mm) than in sphenoid (39 patients, mean 1.6mm, S.D. 1.4mm) or frontal sinuses (38 patients, mean 1.9mm, S.D. 1.4mm). CONCLUSION: Mucosal thickening of up to 6.5mm was a common finding on brain MRI of patients without evidence of sinusitis ; accuracy was 95%.

Anatomical Relationship between the Optic Nerve and Posterior Paranasal Sinuses on Ostiomeatal Unit CT

PURPOSE: To determine the anatomic variations that can lead to optic nerve damage during the sugical treatment of posterior paranasal sinus lesions MATERIALS AND METHODS: two hundred optic nerves of 100 persons were examined using ostiomeatal unit CT (OMU CT). The anatomical features of this nerve and posterior paranasal sinuses were classified into four types : the optic nerve adjacent to the sphenoid sinus without indentation of the sinus wall (type 1); the optic nerve adjacent to the sphenoid sinus, causing indentation of the sinus wall (type 2); the optic nerve passing through the sphenoid sinus (type 3); and the optic nerve adjacent to the sphenoid sinus and posterior ethmoid sinus (type 4). Bony dehiscence around the optic nerve and pneumatization of the anterior clinoid process were also evaluated. RESULTS: The anatomical classification of the optic nerve and posterior paranasal sinuses was as follows : type 1, 1326 (66%); type 2, 60 (30%); type 3, 6 (3%), and type 4, 2 (1%). Bony dehiscence around the optic nerve had developed in 58 cases (29%) and pneumatization of the anterior clinoid process in 13 (6.5%). These conditions were most common in type 3 optic nerve, and second most common in type 2. CONCLUSION: The 2 and 3 optic nerve, bony dehiscence around the optic nerve and pneumatization of the anterior clinoid process are the anatomic variations that can lead to optic nerve damage during the surgical treatment of posterior paranasal sinus lesions. To prevent optic nerve damage, these factors should be carefully evaluated by OMU CT.

Evaluation of the Dynamic Patency of the Frontonasal Duct: Value of PNS CT Scan after Administration of anlsoosmolar Contrast Agent for Low lrritation into the Nasal Cavity

PURPOSE: To evaluate the dynamic patency of the frontonasal duct(FND) on PNS CT scan after administration ofan iso-osmolar contrast agent (lsovist) into the nasal cavity. MATERIALS AND METHODS: Coronal PNS CT scans from ten normal and 30 patients with symptoms of chronic sinusitis were obtained after administration of lsovist intothe nasal cavity, followed by Valsalva maneuver for the even distribution of the agent into the FND and sinuses. Atotal of 80 FNDs were evaluated for dynamic patency by examining the presence of the contrast agent in ducts. RESULTS: The contrast agent was visualized in 34/37 FNDs(91.9%) without ipsilateral frontal sinus it is and was visualized in 18/43 FNDs(41.9%) in cases of ipsilateral frontal sinusitis. In addition, the contrast agent within the ipsilateral frontal sinus was visualized in 8/18 FNDs(44.4%). The major causes of ductal obstruction were mucoperiosteal thickening and polypoid lesions secondary to inflammation. CONCLUSION: PNS CT scan together with the administration of lsovist, which caused minimal irritation, was useful for the evaluation of the relationship between the dynamic patency of the FND and frontal sinusitis, In addition, this study can provide the rhinologist with accurate anatomical and pathological information concerning the FND before a choice is made between endoscopic sinus surgery or medical treatment.