Nasosinusal Endoscopic Anatomy and Physiology

The present article focuses on the analysis of the nasal cavity's anatomy succinctly and descriptively. This essay was carried out through a bibliographic review, directed to the detailed anatomy of the nasal cavity, and the structures that form its sinuses. We have identified the need formore studies directed to the related anatomical area so that the improved knowledge of this region ensures a nasoendoscopic treatment with better effectiveness and no complications.

Anatomical Variations of the Middle Turbinate Concha Bullosa and its Relationship with Chronic Sinusitis: A Prospective Radiologic Study

Abstract Introduction A pneumatized turbinate, also called concha bullosa, is a normal anatomical variant of the paranasal sinus region. Depending on the site of pneumatization, the concha is classified into extensive, bulbous or lamellar type. The middle turbinate concha bullosa has been implicated as a possible etiological factor in chronic sinusitis. Objectives The aim of this study was to investigate the anatomical variations of the concha bullosa, based on paranasal sinus imaging, and its possible association with sinusitis. Methods This prospective descriptive study was performed at the Department of ENT and Head Neck Surgery over a period of one year, from 2016 to 2017. We studied the computed tomography scans of the nose and paranasal sinuses- in axial, coronal and sagittal planes-of patients who had symptoms of nasal obstruction, or headache and features of chronic sinusitis. Results Out of the 202 scans studied, the prevalence of concha bullosa was 31.7%. The concha was bilateral in 35 (54.7%) patients and unilateral in 29 (45.3%) patients. Out of 99 conchae, 54 were on the right side and 45 were on left side. Ipsilateral sinusitiswas found in 40.4% of the sides in the scans of subjectswith concha. There was no statistically significant association between any type of middle turbinate concha with sinusitis, but sinusitis was more predominant with the extensive type of concha (p > 0.05). Conclusion Multiple air cells, mucocele, pyocele and inflammatory mucosal thickenings in the concha are relatively rare. Detailed knowledge of anatomic variations of the concha bullosa is imperative for the radiologists and the operating surgeons.

Evaluation of the lateral wall of the nasal cavity in relation to septal deviation / Evaluación de la pared lateral de la cavidad nasal en relación con la desviación septal

The objective of this study was to evaluate the relationship between variations of the lateral wall of the nasal cavity and septal deviation (SD). Coronal and axial paranasal sinus CT images of 115 individuals (65 females, 50 males) were reviewed and the presence of pneumatisation and hypertrophy of the conchae was evaluated. Pneumatisation of the concha was classified as lamellar concha bullosa (LCB), bulbous concha bullosa (BCB), or extensive concha bullosa (ECB). If bulbous and extensive conchae and hypertrophic conchae were bilateral the side on which it was greatest was accepted as the dominant concha. The relationship between these variations and nasal septum deviation was also taken into account. Eighty-six (74.8 percent) of the 115 subjects had SD. Of these, 20 were not affected by the size of the middle nasal concha (MNC) or inferior nasal concha (INC). Thirty-four cases had dominant MNC, 20 had dominant INC, and 11 had both dominant MNC and dominant INC, and all of which had SD towards the opposite side. In one case there was SD towards the side in which the MNC was dominant. Our data indicate that coexistence of pneumatisation or hypertrophy of the conchae and SD was more common in adults compared to the results of similar studies conducted with a wide range of age groups, including children. Thus the presence of SD together with a large concha increases with age. A prospective study, which will include infants, will elucidate the relationship between conchae and SD.

El objetivo del estudio fue evaluar la relación existente entre las variaciones de la pared lateral de la cavidad nasal y la desviación septal. Se revisaron los senos paranasales en imágenes de TC de 115 individuos (65 mujeres, 50 varones) coronales y axiales y se evaluó en ellas la presencia de neumatización e hipertrofia de los conchas nasales. La neumatización de la concha fue clasificada como concha laminar bulosa (CLB), concha bulbosa bulosa (CBB), o concha extensa bulosa (ECB). Conchas nasales bulbosa y extensa y conchas hipertróficas eran bilaterales siendo el lado en que esta era más grande como la concha dominante. También se tuvo en consideración la relación entre estas variacio nes y la desviación del tabique nasal. Ochenta y seis (74,8 por ciento) de los 115 sujetos tenían desviación septal. De éstos, 20 no se vieron afectados por el tamaño de la concha nasal media (CNM) o concha nasal inferior (CNI). Treinta y cuatro de los casos tenía CNM dominante, 20 tenían CNI dominante, y 11 tenían tanto CNM dominante y CNI dominante, todos los cuales tenían desviación septal hacia el lado opuesto. En un caso hubo desviación septal hacia el lado en el que el CNM era dominante. Nuestros datos indican que la coexistencia de neumatización o hipertrofia de conchas nasales y la desviación septal es más común en adultos en comparación con los resultados de estudios similares realizados con una amplia gama de grupos etarios, incluidos los niños. Así, la presencia de desviación septal, junto con una gran concha aumenta con la edad. Un estudio prospectivo, que incluirá los bebés, aclarará la relación entre concha nasal y desviación septal.

Concha nasal média secundária: relato de caso / Secondary middle turbinate: case report

A concha nasal média secundária é uma rara variação anatômica na cavidade nasal, descrita pela primeira vez por Khanobthamchai et al. como uma estrutura óssea revestida por partes moles originária da parede lateral do meato médio. Na maioria dos casos relatados na literatura ocorre bilateralmente, sem complicações associadas. Neste artigo descrevemos um caso encontrado em nosso serviço, com tal variação anatômica incomum.

Secondary middle turbinate is an anatomical variant rarely observed in the nasal cavity, firstly described by Khanobthamchai et al. as a bone structure originating from the lateral nasal wall and covered by soft tissue. In most cases reported in the literature, this variant is bilateral, occurring without associated complications. In the present report, the authors describe the case of patient of their institution with such anatomical variation.

Area radiopaca mandíbulo-ptérigo-turbinal: su importancia en las telerradiografías normal lateral / Radiopaque area mandibulo-pterygo-turbinate: its importance in the teleradiographs lateral rule

La imagenología convencional es una reproducción bidimensional de una realidad anatómica tridimensional. En una radiografía convencionalse superponen imágenes radiopacas y radiolúcidas, para cuya interpretación se debe conocer en detalle la anatomía descriptivay en especial la anatomía topográfica tridimensional. De esta superposición pueden surgir imágenes que no se correspondan conelementos anatómicos ni patológicos, son las llamadas imágenes fantasmas, que pueden inducir a importantes errores de diagnóstico.Por el contrario, como las Tomografías computo asistidas (TC) y las Resonancias magnéticas nucleares (RMN) son cortes tomográficosde espesores variables y regulables, las superposiciones no se producen.En las Telerradiografías norma lateral (TRG -NL) convencionales, debido a las superposiciones se encuentra, en muchas de ellas, un árearadiopaca esferoidal que se investigó a los efectos de saber, si correspondía a un elemento anatómico, a una patología o a una imagenfantasma. Se procedió a estudiar las apófisis pterigoides, las apófisis coronoides y los cornetes inferiores, efectuando mediciones de laaltura, del ancho y del espesor de estos elementos. Sobre ellos y en un hemicráneo seco, se realizó la Técnica con alambre de cobre yen cada etapa se tomaron TRG-NL experimentales. Así mismo, se realizó una revisión bibliográfica sobre la anatomía, fisiología y patologíadel cornete inferior, llegándose a la conclusión de que el área radiopaca estudiada corresponde a la superposición bilateral de lasapófisis coronoides, de las apófisis pterigoides junto con la apófisis piramidal del palatino, de la tuberosidad del maxilar, ocasionalmentedel germen del 3er molar y de la cola del cornete inferior. A esta imagen, se le llamó área radiopaca mandíbulo-ptérigo-turbinal. De todos los elementos involucrados en la conformación de esta área se debe jerarquizar el cornete inferior y especialmente su cola...

The conventional imaging is a two-dimensional reproduction of three-dimensional anatomical reality. In a conventional X-ray images are superimposed radiopaque and radiolucent, to whose interpretation must know in detail the descriptive anatomy and especially three dimensional topographical anatomy. This overlap may arise images that do not correspond with anatomical and pathological elements, are called ghost images, which can induce significant diagnostic errors. On the contrary, such as computing assisted CT (CT) and nuclear magnetic resonances (NMR) tomographic slices thicknesses are variable and adjustable, overlaps do not occur. In lateral cephalometric standard (TRG-NL) conventional, due to overlap is found, in many of them, an area radiopaque spheroidal investigate the effects of knowing if corresponded to an anatomical element, to a pathology or a ghost image. We proceeded to study the pterygoid process, the coronoid process and inferior turbinates, taking measurements of the height, width and thickness of these elements.On them and on a dry hemicráneo, was performed technology with copper wire and at each stage were taken experimental TRG-NL.Likewise, a literature review of the anatomy, physiology and pathology of the inferior turbinate, and concluded that the radiopaque area studied corresponds to the superposition of bilateral coronoid process of the pterygoid with the pyramidal process of the palatine , the maxillary tuberosity, occasionally 3rd molar germ and tail of the inferior turbinate. This picture, was called " radiopaque area mandibulo-pterygo-turbinate ". Of all the elements involved in forming this area should prioritize the inferior turbinate and particularly its tail by the variability in shape and density, due to the presence of lymphoid follicles and arteriovenous plexus.

Histological analysis of the distribution pattern of glandular tissue in normal inferior nasal turbinates / Análise histológica do padrão de distribuição glandular em conchas nasais inferiores normais

Nasal turbinates play an important role in nasal physiology. These functions include the important function of particle filtration by the mucocilliary system. Many nasal mucosal diseases, such as rhinitis and rhinosinusitis, are directly related with structural alterations of the mucosal lining of the turbinates. AIM: To study the distribution pattern of the glandular epithelium of the lamina propria in the normal lower nasal turbinate mucosa of the anterior, medium and posterior portions. MATERIAL AND METHOD: A prospective study in which small linear fragment of the lower nasal turbinate was removed from ten patients undergoing aesthetic nose surgery. The slides were hematoxilin-eosin stained, examined histologically and photographed. Glandular epithelium was delimited individually, the total area of the lamina propria on the anterior, medium and posterior portions of nasal turbinates was calculated (µm2). RESULTS: There was no statistically significant difference in the distribution pattern of the glandular epithelium of the lamina propria. CONCLUSION: This study showed no predominance of glandular epithelium distribution in anterior and posterior portions of lower nasal turbinates in normal subjects.

As conchas nasais inferiores desempenham um importante papel na fisiologia nasal. Dentre as diversas funções, destaca-se a filtração de partículas estranhas pelo sistema mucociliar. Muitas doenças relacionadas à mucosa nasal, como rinites e rinossinusites, têm relação direta com alterações estruturais na mucosa de revestimento das conchas nasais. OBJETIVO: Verificar o padrão de distribuição do epitélio glandular da lâmina própria na mucosa de conchas nasais inferiores normais, nas suas regiões da cabeça, corpo e cauda. MATERIAL E MÉTODO: Estudo prospectivo com dez pacientes submetidos a procedimento nasal estético, dos quais retirou-se pequeno fragmento linear de concha nasal inferior. Os cortes foram corados com hematoxilina e eosina e submetidos a exame histológico. Foram delimitadas individualmente as áreas de epitélio glandular e a área total de lâmina própria da mucosa da cabeça, do corpo e da cauda das conchas nasais, que foram medidas em µm2. RESULTADOS: Não houve diferença estatisticamente significativa no padrão de distribuição do epitélio glandular da lâmina própria. CONCLUSÃO: O presente estudo mostra que não existe predomínio em uma região específica, na distribuição do epitélio glandular, nas diferentes áreas das conchas nasais inferiores no sentido ântero-posterior em pacientes normais.

Concha bulosa asociada a sinusitis crónica / Concha bullosa asociated with cronic sinusitis

Objetivo: Determinar la frecuencia de concha bulosa asociada a sinusitis crónica. Tipo de diseño: Encuesta comparativa. Material y métodos: Se estudiaron 63 pacientes en el periodo comprendido de marzo a agosto de 1997 en derechohabientes del Instituto Mexicano del Seguro Social del Centro Médico Nacional "Adolfo Ruiz Cortínes". Se formaron dos grupos: el grupo I: pacientes con sinusitis crónica pura o asociada a otra patología otorrinolaringológica, el grupo II: pacientes con otra patología otorrinolaringológica sin sinusitis asociada. A todos se les realizó tomografía computarizada de senos paranasales. Se realizó prueba exacta de Fisher para determinar las diferecias entre los dos grupos. Resultados: Se observó que en el grupro I (n=42), 7 pacientes (16.6 por ciento) presentaron concha bulosa y en el grupo II (n=21), 5 pacientes (23.8 por ciento) se relacionaron con dicha variente anatómica (p< 0.05). Del total de pacientes estudiados, 12 (19 por ciento) se asociaron a concha bulosa. Conclusión: La concha bulosa asociada a sinusitis crónica, no fue relevante en nuestro estudio

Aspectos histológicos da mucosa da concha nasal inferior em indivíduos normais / Hystopathological aspects of the nasal inferior concha mucosal in normal individuals

Os aspectos histopatológicos da túnica mucosa do 1/3 médio da concha nasal inferior foram avaliados em 3 indivíduos normais, considerando como parâmetros no plano epitelial: hiperplasia, hipertrofia, necrose, metaplasia escamosa e atrofia; no plano da lâmina própria: alteraçöes vasculares, infiltrado inflamatório, fibrose da lâmina própria, espessamento da membrana basal; no plano das células secretoras: aumento do número de células secretoras, aumento da secreçäo, aumento do muco neutro e do muco ácido intracelular. Foram demonstrados proliferaçäo vascular discreta da lâmina própria, ausência de ectasia linfática e marcado espessamento da membrana basal além da atrofia e de metaplasia escamosa importante.

Practice in middle turbinectomy

Middle turbinectomy is still a matter of controversy. Several years of experience had demonstrated that the middle turbinate can be removed to improve the nasal airway with no long-term sequelae. The present work was done on 30 patients at El-Minia University Hospital. Follow up was done for 4-24 months. Results were evaluated by direct clinical examination but more weight was given to the patients evaluation as to the success or failure of operation in terms of reduction of symptoms. The previously feared complications of crusting, dryness and atrophy do not occur as a result of middle turbinectomy