Relationship of the anterior ethmoid sinus to the lacrimal sac: a computed tomography study

Abstract Objective: To analyze the anatomical relationship between the lacrimal sac and the agger nasi cell on Computed Tomography (CT); to correlate the right and left sides on each scan. Methods: CT scans of adult patients were reviewed for pneumatization of the agger nasi and its relationship to the lacrimal sac. The degree of agreement between the right and left sides was also evaluated. Results: A total of 130 CT scans were examined. An agger nasi cell was found medial to the lacrimal sac in 59.23% of scans. On 86.15% of scans, pneumatization was similar on both sides. Conclusion: The agger nasi air cell is located medial to the lacrimal sac in more than half of individuals. The right and left sides exhibit the same pneumatization pattern in approximately 80% of cases. Level of evidence: 4.

A review of common anatomical variants of paranasal sinuses and nasal cavity and its frequency of occurrence as evidenced on multi-detector computed tomography

This study was carried out to know the frequency of occurrence of common anatomic variants in computed tomography of paranasal sinuses and nasal cavity. Non contrast Computed tomography (CT) of paranasal sinuses of 100 patients referred to Department Of Radiology, Saveetha Medical College were retrospectively studied. The Multi-detector computed tomography (MDCT) scans were evaluated for various anatomical variants of paranasal sinuses and nasal cavity. The frequency of occurrence was calculated in percentage.We found out that deviated nasal septum (DNS) was the most common variant in this study, seen in 86% of cases, followed by Agger nasi cells which was seen in 56% and the third most common was supra-orbital ethmoidal cells seen in 42% of the study population. All the cases included in the study, had minimum of one variant. Most of the study population showed multiple anatomical variations of paranasal sinus and nasal cavity. In conclusion, multidetector Computed tomography plays an important role is the assessment of various anatomical variants of the paranasal sinuses and nasal cavity. Pre-operative MDCT of Paranasal sinuses, gives the surgeons most if not all of the anatomical information they need to tailor surgeries. Considering the relatively high frequency of occurrence of these variants, it is essential for the radiologists to have a precise knowledge of imaging features of normal anatomy and anatomical variants of Paranasal sinuses.

Anatomy of lacrimal sac fossa affecting success rate in DCR surgery / Шинэ санаа Шинэ нээлт

Background@#Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.@*Goal@#To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach.@*Methods@#METHODS: A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2.@*Results@#There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). @*Conclusions@#A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

Anatomy of lacrimal sac fossa affecting success rate in endoscopic and external dacryocystorhinostomy surgery / Монголын Анагаах Ухаан

Introduction@#Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study.@*Goal@#To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach.@*Material and Methods@#A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2.@*Results@#There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). @*Conclusions@#A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

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.

Endoscopic Frontal Sinus Surgery through the Agger Nasi Cell / 中国微创外科杂志

Objective To discuss the effectiveness of endoscopic frontal sinus surgery through the agger nasi cell. Methods Twenty-seven patients with chronic frontal sinusitis were treated with endoscopic frontal sinus surgery. The frontal sinus was opened by resecting the agger nasi cell. Results The frontal sinus were opened successfully in all the patients. No complications occurred except periorbital bruising in 3 eyes. Nasendoscopy showed that the frontal sinus drainage pathway was normal after the operation. During a 6-month follow-up, the symptoms of the frontal sinus disappeared in 18 of the patients, improved in 7, and were not changed in 2. Conclusions Endoscopic frontal sinus surgery through the agger nasi cell is effective for chronic frontal sinusitis.The method is worth being widely used.