Sinonasal anatomy variations on CT scans of a sample of Filipino adults with chronic rhinosinusitis

Objective@#To determine the prevalence of sinonasal anatomic variations seen on paranasal sinus (PNS) CT scans of a sample of Filipino adults with chronic rhinosinusitis.@*Methods@#Design: Cross-sectional study Setting: Tertiary Government Training Hospital Participants: The PNS CT scans of 51 Filipino patients with chronic rhinosinusitis with and without nasal polyposis diagnosed at our outpatien Department of Otorhinolaryngology-Head and Neck Surgery between October 2015 to December 2020 were reviewed for the presence of sinonasal anatomic variants. The prevalence of the identified variants was calculated.@*Results@#The CT scans of 51 patients, 41 (80.4%) men and 10 (19.6%) women, were included. The median age was 48 years (Q25: 35, Q75: 56, IQR:21). The median Lund Mackay Score (LMS) was 15 (Q25: 12, Q75: 20, IQR:8). Majority (94%) had an LMS of ≥5. The most common anatomic variant in the study population was agger nasi (n=46/51, 90.2% present bilaterally) followed by uncinate process attachment to the lamina papyracea (n=90/102, 88.24%). The third to sixth most common findings were Keros type II classification (n=76/102, 74.51%), nasal septal deviation (n=35/51, 68.62%), optic nerve canal type 1 (n=67/102, 65.69%) and anterior ethmoid artery grade 1 (n=46/102, 45.1%), respectively. Less common variants were Onodi cell (n=13/51, 25.49% unilateral and n=10/51, 19.61% bilateral), Haller cell (n=8/51, 15.69% unilateral and n=1/51, 1.96% bilateral), supraorbital cell (n=4/51, 7.84% unilateral and n=4/51, 7.84% bilateral), middle turbinate concha bullosa (n=3/51, 5.88% unilateral and n=6/51, 11.76% bilateral), superior turbinate concha bullosa (n=2/51, 3.92% unilateral and n=1/51, 1.96% bilateral), pneumatized crista galli (n=2/51, 3.92%) and optic nerve dehiscence (n=1/51, 1.96% bilateral). @*Conclusion@#In the adult Filipino population with CRS sampled in this study, the six most common sinonasal anatomic variants were agger nasi, superior attachment of the uncinate process to the lamina papyracea, Keros type II classification, septal deviation, optic nerve canal type 1 and anterior ethmoid artery grade 1. Pre-operatively, the PNS CT scan of every patient must be meticulously evaluated for the sinonasal anatomic variants to avoid surgical complications.

Nasal Chondromesenchymal Hamartoma: CT and MR Imaging Findings

We report CT and MR imaging findings for a case of nasal chondromesenchymal hamartoma occurring in a 19-month-old boy. A nasal chondromesenchymal hamartoma is a rare benign pediatric hamartoma that can simulate malignancy. Although rare, knowledge of this entity is essential to avoid potentially harmful therapies.

A Clinical Analysis of Fungal Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Since its first recognition in 1885 by Schubert, the prevalence of human fungal sinusitis has increased. Recently, endoscopic sinus surgery has emerged as a successful surgical modality in the treatment of fungal sinusitis. In this study, we aimed to investigate the clinical characteristics of fungal sinusitis and evaluate the efficacy of endoscopic sinus surgery (ESS) for treating fungal sinusitis. SUBJECTS AND METHOD: Of the 8750 cases who underwent ESS between 1995 and 2003, 157 cases that were pathologically confirmed to be fungal sinusitis were retrospectively analyzed by reviewing their medical records. RESULTS: There were 52 males and 105 females patients: the age ranged from 14 to 88 years, with the mean age of 54 years. The peak incidence was found in the 70's. The most common chief complaints were nasal obstruction (44%). The number of human fungal sinusitis treated with ESS were 41 from 1995 to 1998, and 116 since 1999. Recently, the number of cases has increased. The radiological findings in these cases included haziness, calcification and bone destruction of the involved sinuses. Preoperative CT revealed mottled calcific densities within involved sinuses in 37% of the cases. During operation, fungal ball and debris were observed in 52 cases and nasal polyps in 58 cases. All patients received ESS and showed no recurrence during the mean follow-up period of 6.2 months. CONCLUSION: The review of 157 cases of fungal sinusitis revealed that the incidence was increased recently, symptoms were non-specific, CT and nasal endoscopy were excellent diagnostic tools, and that the ESS is a good modality for treatment.

A Comparison between Coronal and Axial Scans in PNS CT

BACKGROUND AND OBJECTIVES: A coronal section computerized tomography (CT) is essential for the diagnosis of paranasal sinusitis, especially in the evaluation of the ostiomeatal unit. Although the coronal scan is preferred to the axial scan, the role of the axial scan during endoscopic sinus surgery has not been thoroughly examined. The aim of this study is to compare the advantages and disadvantages of coronal and axial scans in the paranasal sinuses. MATERIALS AND METHODS: Selected for study were the coronal and axial scans of 30 preoperative sinus CTs showing minimal sinus pathology. The rates of detecting 15 anatomic structures in the coronal and axial sections were analyzed across 60 sides. RESULTS: The coronal scan was superior to the axial scan in detecting eight normal structures, including the anterior ethmoid artery, the opening of the maxillary sinus and the superior meatus (p<0.05). The axial scan was useful in showing the vertical portion of the 3rd basal lamella and the opening and the anterior wall of the sphenoid sinus (p<0.05). CONCLUSION: The coronal scan is more informative than the axial scan but has limitations in showing the structures lying on the coronal plane. The axial scan plays a complementary role in covering this limitation. Together, the coronal and axial sections of a sinus CT can help the surgeon to understand the three dimensional structure of the paranasal sinus before endoscopic sinus surgery.

Paranasal Sinus CT Scans Analysis of the Primary Maxillary Sinus Hypoplasia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Identification of primary maxillary sinus hypoplasia (PMSH) is important diagnostically and therapeutically. Recently, the clinical significance of associated abnormalities in PMSH has been suggested. The aim of this study is to investigate the incidence of PMSH, their associated abnormalities and relationship of anatomical variations and paranasal sinusitis. MATERIALS AND METHODS: We evaluated radiologic diagnostic criteria of PMSH and analyzed the relationship of the anatomical variations of nasal cavity and paranasal sinuses in paranasal sinus CT scans, retrospectively. We measured the volume estimated ratio (VER) in PMSH cases. RESULTS: The incidence of unilateral and bilateral PMSH were 11 cases (5.9%) and 10 cases (5.3%). respectively. According to the Bolger's classification, there were 13 sites (41.9%) of type I with the mean VER of 0.71, 14 sites (45.2%) of type II with the mean VER 0.50, and 4 sites (12.9%) of type III with the mean VER of 0.27. The most common anatomical anomalies in both of the unilateral and bilateral PMSH were zygomatic (90.3%) and alveolar pneumatization (90.3%); the second most common abnormal finding was high maxillary sinus floor (77.4%). Of the anatomical variations, the frequency of uncinate process abnormalities (41.9%), paradoxical middle turbinate (32.3%) and Haller's cell (19.4%) were statistically significant. CONCLUSION: These results suggest that zygomatic and alveolar pneumatization, and high maxillary sinus floor are additionally important anatomical abnormalities associated with PMSH. Careful preoperative assessment of anatomical variations in the paranasal sinus CT scans may be essential to avoid incidental iatrogenic complications during functional endoscopic sinus surgery (FESS) or Caldwell-Luc operation in patients with PMSH.

Natural Dehiscence of Lamina Papyracea with Prolapse of Orbital Content: Radiologic Evaluation / 대한이비인후과학회지

BACKGROUND: Orbital complications may be occured by means of surgical injury to lamina papyracea during endoscopic sinus surgery or intranasal ethmoidectomy. The frequency of orbital complications increases when the natural dehiscence of lamina papyracea(NDLP) with or without prolapse of orbital content into ethmoid sinus is present. OBJECTIVES: The aim of this study is to evaluate the incidence and radiologic characteristics of NDLP, and to evaluate association NDLP with anatomical variations of nasal cavity and paranasal sinuses. MATERIALS AND METHOD: The axial and coronal paranasal sinus CT scans of 183 patients with chronic paranasal sinusitis(366 sides) who had undergone endoscopic sinus surgery were retrospectively reviewed and analyzed. The incidence and radiologic features of NDLP, and the association NDLP with anatomical variations of paranasal sinus and nasal cavity were analyzed. RESULTS: The NDLP was found in 18 patients(9.8%, n=183 patients) or 22 sides(6.0%, n=366 sides). The most common site of NDLP was superior portion(45.5%) in coronal image of paranasal sinus CT scans and anterior ethmoid sinus area(68.2%) in axial image. Grade 1 of NDLP(86.4%) was observed most commonly. NDLP was not associated with anatomical variations of paranasal sinus. CONCLUSION: The incidence of NDLP with prolapse of orbital content is far beyond general expectation, and close preoperative evaluation of paranasal sinus CT scans is important to avoid possible orbital complications.