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( A) MSCT, coronal scan of PNS shows a left-sided, medially deviated uncinate process associated with bilateral ethmoidal sinusitis. (B) Endoscopic image revealed medial deviation of the left uncinate process.
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Background: In this prospective study, we looked for correlations between anatomic variants of paranasal
sinuses and chronic or recurrent sinusitis.
Material/Methods: Two hundred and forty (240) patients with clinical features of chronic rhinosinusitis were
examined; patients with first-onset or allergic sinusitis and pregnant females were excluded...
Citations
... Nghiên cứu cho thấy tổn thương xoang hàm thường gặp nhất với 95,3%, gần như thấy được ở hầu hết các trường hợp, kế đến là xoang sàng 51,3%, xoang bướm và xoang trán ít gặp hơn. Kết quả này tương tự như nghiên cứu của tác giả Ahmed M. Alsowey, thực hiện trên 240 BN, tỉ lệ tổn thương xoang hàm chiếm 81,3%, xoang sàng là 66,3% [4]. Trong nghiên cứu của chúng tôi, có 73,3% bệnh nhân có bít tắc phức hợp lỗ ngách, có thể một bên hoặc cả hai bên. ...
Đặt vấn đề: Viêm xoang mạn tính rất đa dạng về hình thái, đa dạng về nguyên nhân. Chụp cắt lớp vi tính là phương tiện tốt nhất để chẩn đoán nguyên nhân và phát hiện các bất thường giải phẫu, được xem như bản đồ trong phẫu thuật nội soi mũi xoang, nhằm xử lý tổn tương tối thiểu mà mang lại hiệu quả tối đa. Mục tiêu nghiên cứu: 1) Mô tả hình ảnh tổn thương trên phim chụp cắt lớp vi tính trong bệnh viêm xoang mạn tính ; 2) Đánh giá giá trị chụp cắt lớp vi tính trong chẩn đoán nguyên nhân viêm xoang mạn tính. Đối tượng và phương pháp nghiên cứu: Nghiên cứu tiến cứu, mô tả, cắt ngang trên 150 bệnh nhân viêm xoang mạn tính được phẫu thuật nội soi mũi xoang. Kết quả: Vị trí tổn thương: Một bên 65,3%, hai bên 34,7%. Xoang tổn thương: Xoang hàm 95,3%, xoang sàng 51,3%, xoang bướm 24%, xoang trán 10,6%. Tình trạng phức hợp lỗ ngách bị bít tắc 75,3%. Các loại dị hình thường gặp: Lệch vách ngăn 55,3%, khí hoá cuốn mũi giữa 18,6%, quá phát cuốn mũi dưới 12,2%. Đối chiếu với kết quả phẫu thuật cho thấy độ nhạy, độ đặc hiệu của chụp cắt lớp vi tính trong chẩn đoán nguyên nhân: Do nấm 93,5%, 97,5%, do răng 94,1%, 98,5%, do polyp 87,9%, 95,7%, do khối u 68,8%, 97%, do dị hình: 100%. Kết luận: Chụp cắt lớp vi tính có độ nhạy và độ đặc hiệu rất cao trong chẩn đoán nguyên nhân viêm xoang mạn tính, có thể được xem như tiêu chuẩn vàng và là một chỉ định bắt buộc trong điều trị bằng phẫu thuật nội soi mũi xoang.
... This was similar to the reported prevalence in the United Arab Emirates of 74.5% [8]. Globally, there is a high variation in the reported prevalence rates of NSD ranging from 26% to 97%, which can be explained by the extent of deviation considered in the reporting studies [9]. Among neonates in India, the prevalence of nasal septal deviation was found to be 20% diagnosed using clinical examination by Gray's struts among those aged "2" days. ...
The nasal septum is an osteocartilaginous wall that divides the nose into two nasal cavities. Asymptomatic minor deviation of the septum is considered a normal developmental variation found in the majority of the population. The reported global prevalence rates had great variation due to the extent of deviation considered in the reporting studies. Previous classification systems have been proposed to classify the nasal septal deviation according to the characteristics of the nasal septum seen horizontally and vertically. For some patients, the degree of the deviation may affect the nasal airflow causing obstruction or impairing the olfactory function. Headache, rhinosinusitis, high blood pressure, obstructive sleep apnea, and breathing sounds are also among the clinical presentations of nasal septal deviation. Clinical assessment is sufficient to make the diagnosis while imaging techniques are required for decision-making. Radiological imaging techniques such as computed tomography (CT) are used to classify and assess the severity of the deviated septum. Surgical correction is the treatment option for nasal septal deviation. Septoplasty is the most common procedure used for nasal correction with high satisfaction levels and low complication rates. In this review, we present a comprehensive summary of the concept, presentation, diagnosis, management options, and quality of life of patients with nasal septal deviation.
... The mean age was slightly higher in many studies with also slightly male dominance. In a previous study (10), they included 240 patients with chronic rhinosinusitis 57.5% were males and 42.5% were females. Their ages ranged from 20 to 61 years, with a mean age of 40.5 years. ...
... In contrast to our results, in a prior study (10), the most common clinical presentations were headache (52.5%), runny nose (35%), postnasal discharge (33.8%), and nasal obstruction (25%). Moreover, another study reported that the most common presenting symptom (12), was nasal obstruction (100%) which was present in all patients in this study. ...
... 7 Actually, Alsowey et al. have found a very good agreement between CT and endoscopy in diagnosing most anatomical variations (p < 0.001). 28 The ostiomeatal complex is a functional entity of the anterior ethmoid complex that represents the final common pathway for drainage and ventilation of the frontal, maxillary, and anterior ethmoid cells. Thus, anatomical variations that redirect nasal airflow or narrow the ostiomeatal complex have been implicated in the development of chronic rhinosinusitis. ...
... 3,22 Still, most studies mention lack of any association between septum deviation and sinus infection. Since septal deviation is a very common variation, 28 it can have a role in the development of sinusitis in association with other variations. 1 Concha bullosa is a ballooned-out middle turbinate due to pneumatization. It can be associated with other abnormal structures of the ostiomeatal complex, such as septal deviation, or independently compress the middle nasal meatus and obstruct normal air passages, causing mucosal hyperemia, inflammation changes, hypertrophy, coherence, and desiccation by blocking the ethmoid infundibulum. ...
Introduction Anatomical variations of the nasal cavity and of the paranasal sinuses are frequently encountered and play an important role in dysfunctional drainage of sinuses. However, it is not clear in the literature whether they predispose to sinus pathology.
Objectives The aim of the present review is to summarize the understanding of the association between anatomical variations of the sinonasal area and sinus pathology.
Data Synthesis The present review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed a thorough research on PubMed from October 2004 until May 2020 by using the search terms paranasal sinus anatomical variations and sinus disease, sinusitis, and mucosal disease.
Thirty studies were eligible and were included in the analysis. Overall, the studies encompassed a total of 6,999 patients included in the present review. In many studies, it has been statistically established that certain anatomical variations increase the risk of sinus disease. On the other hand, the rest of the collected studies failed to show any statistically significant correlation between anatomical variants and sinus pathology.
Conclusion The present study highlights the possible correlation between some anatomical variations of the sinonasal area and pathologies of the paranasal sinuses. Careful assessment and computed tomography (CT) in patients with chronic rhinosinusitis is needed, especially in those undergoing endoscopic surgery, to identify and treat anatomical variations in the paranasal sinuses that may be correlated with rhinosinusitis. Due to contradictory results in the literature, further research is needed to elucidate the effects of anatomical variants of the sinonasal area.
... Both direct coronal and axial scanning was performed. [10] Scanning Parameters 140kv, 200mA, .625mm section thickness, 0.625 mm interval, 10 mm beam collimation, spiral pitch factor of 0.5625. ...
... The anatomy of nose and PNS is very complicated and their anatomical variants are very frequent [10]. To evaluate the normal anatomy, its variant and to diagnose the disease at this region, physical examination and conventional radiographic examinations are not always able to provide sufficient information [11]. ...
Chronic rhinosinusitis is one of the most frequent chronic disorders which influences the patient’s quality of life significantly. The objective of this paper was to examine which are the most frequent and intensive symptoms in patients with chronic rhinosinusitis. The study done in 80 patients with clinical diagnosis of chronic rhinosinusitis that was endoscopically proven and computer tomography of the nose and paranasal sinuses. All the possible symptom was recorded in each and every patient (nasal congestion, nasal discharge, reduction or loss of smell, facial pain/pressure, headache, cough, fatigue, halitosis and ear pain/fullness) the intensity of every possible symptom was recorded. The patients were assessed properly and the intensity of their symptoms was recorded by visual analogue scale. Nasal discharge was the most frequent symptom in our study, it occurred in all 80 patients (100%), followed by nasal obstruction/ blockage in 74 patients (92.5%). Nasal discharge has been recorded as the most intensive symptom and it is significantly more intensive in comparison to nasal congestion which was the second on the intensity list. All other symptoms were significantly less frequent and less intensive.
... Anatomical changes in the sinus area may be evaluated with CT-PNS, which offers a road map for ENT surgeons. [23,24] CONCLUSION We concluded in this study that the prevalence of anatomical variants among patients of paranasl sinus was higher in which the majority of the patients had deviated nasal septum and agger nassi cells. There are several anatomical variations that may be seen in PNS. ...
Objective: The aim of current study is to determine the frequency of anatomical variants on routine CT scan observed in the paranasal sinus. Stud Design: Cross-sectional Place and Duration: The study was conducted at Radiology department of Jinnah Hospital, Lahore for the duration of nine months from January 2021 to September 2021. Methods: There were 90 sinus patients of both genders with ages 20-55 years in this study. Cases were recruited after informed written permission was obtained and data such as gender and BMI were collected. The prevalence of various anatomical variations of the sinonasal cavities was determined based on the results of the CT scans. Anatomical differences between individuals with low to no apparent imaging evidence of rhinosinusitis vs those with clinically substantial radiologic evidence of rhinosinusitis were examined in this study. SPSS 21.0 was used to analyze complete data. Results: Among 90 cases, the majority of the patients were males 63 (70%) and 27 (30%) were females with mean age 33.41±8.56 years and mean BMI 23.22 ±5.31 kg/m2. According to Kero’s classification to determine the difference in olfactory fossa depth, most of the patients 62 (68.9%) were in type II, 20 (22.2%) in type I and 8 (8.9%) in type III. In accordance with anatomical variation, we found that most of the patients 65 (72.2%) had deviated nasal septum (DNS) followed by agger nassi cells in 61 (67.8%) cases and concha bullosa in 35 (38.9%) cases. Conclusion: We concluded in this study that the prevalence of anatomical variants among patients of paranasl sinus was higher in which the majority of the patients had deviated nasal septum and agger nassi cells. Keywords: Frontal sinus, Paranasal Sinus, Maxillary sinus, Anatomical variants
... In the present study, the prevalence of Haller cells was found as 15.3%. In the literature, the prevalence of ethmoid bulla shows a wide distribution range and its frequency varies between 10% and 89% in the reported publications [32,33]. In the present study, the prevalence of ethmoid bulla was 21% and no difference was found between the genders in terms of ethmoid bulla as in the Haller cell. ...
Background
The aim of the present study was to evaluate retrospectively the frequency of anatomical variations in sinonasal region, which were frequently seen in our cases, for whom coronal section paranasal computed tomography imaging (CPNCT) was taken, as well as the correlation of these variations with age and gender and correlations of identified anatomical variations with one another.
In the study, CBCT scans of a total of 1532 (825 males and 707 females) cases were evaluated in order to determine the prevalence of anatomical variations of the nasal cavity and paranasal sinuses. All the images were taken by a multi-detector CT device (Aquilion, Toshiba medical system, Tokyo, Japan).
Results
Most frequently detected three anatomical variations were septum deviation (79.7%), concha bullosa (40.9%), and ethmoid bulla (21.0%) according to the frequency order. When the frequency of anatomical variations was evaluated according to gender, septum deviation, concha bullosa, and anterior clinoid process pneumatization were more frequently observed in males and Onodi cell in females ( p < 0.05).
When the relationships of the anatomical variations with one another were evaluated, it was found that the possibility of the presence of concha bullosa in the septum deviation cases and the presence of ethmoid bulla in the cases with Haller cell septum were higher ( p < 0.05).
In terms of the anatomical variations that were evaluated by taking age as the independent variable, a statistically significant difference was observed in pterygoid process pneumatization, Haller cell, pneumatized crista galli, ethmoid bulla, and paradoxical middle concha between the adult and children age groups ( p < 0.05).
Conclusion
In terms of the frequency of occurrence to various sinonasal region variations, statistically significant differences were observed between both genders and age groups. The correlations of the detected variations with each other were also remarkable. Consequently, it is believed that comprehensive studies and serious objective evaluations evaluating the change of frequency of anatomical variations according to age and gender besides their correlation with each other are required.
... CT-PNS is playing important role in evaluating the extent and type of anatomical variations in sinus region hence, it provides road map for ENT surgeons. 9,[15][16][17][18][19] Limitation of the study: This is a single-centered study, thus for more better and generalized results larger population size and multicenter options must be taken to authenticate study further. ...
Objective:
To determine the incidence of anatomical variants of sinonasal region and its correlation with symptoms of sinusitis.
Methods:
The study was conducted from January-June 2020 at Radiology Department of PNS Shifa Hospital, Karachi. The study involved 50 symptomatic subjects of sinusitis with age ranges from 18-60 years which were prepared for computed tomography of paranasal sinuses. The scans were reviewed for nasal-septum, turbinates, uncinate process, ethmoid air-cells along with other anatomical variants and were correlated with symptoms of sinusitis.
Results:
Out of 50 subjects, 34 were males and 16 were females with mean age of 42.68±18.22 years. Most common anatomical variants observed were agger nasi cells (64%), deviated nasal septum (56%), and concha-bullosa (46%). Statistically significant correlation existed between bilateral agger nasi cells and nasal obstruction (p=0.017, ρ= -0.336).
Conclusion:
The anatomy of sinonasal region is highly complex. However, anatomical variants can disturb the sinus mucociliary drainage pathway resulting in patient suffering. Therefore, considering the variable anatomy of sinonasal region, CT-PNS is recommended for every subject in order to avoid surgical hazards.
... The coronal views of CT scan are best for the sphenoid and the ethmoid cell variants such as the onodi cells or sphenoethmoidal cells. The modification and advancement of computed tomography has granted extensive assessment of patient's paranasal sinuses thus providing a guide map for FESS surgeons to operate effectively 15,5,13 . In a study conducted in Egypt it was reported that the frequency of agger nasi cells and CB were equally frequent (30.6%), and Haller cells were detected in 11.2%. ...
... The most common anatomical variations of maxillary sinus were reported as pneumatization of the sinus and sinus septa. The prevalence of disease process in maxillary sinus was ranged from 7.5% to 66% 15 . The most frequent pathological findings of the maxillary sinus were sinus opacification, sinusitis, and mucosal thickening 26,13 . ...
... Rysz M, Bakoñ L 52 Vincent TE, Gendeh BS 51 Amusa YB, Eziyi JA, et al. 54 Fadda GL, Rosso S, et al. 49 Adeel M, Rajput MS et al. 55 Al-Abri R, Bhargava D et al. 53 Tiwari R, Goyal R 50 Dasar U, Gokce E 19 Gouripur K, et al. 16 Alsowey AM, Abdulmonaem G et al 15 Kalaiarasi R, Ramakrishnan V et al 17 Espinosa W, Genito R et al. 26 Yazici D. 47 Shrestha KK, Acharya K et al. 48 ...
Anatomical variations are not diseases and can be found in every individual. Due to the anatomical variations, the structural changes occur in nearby anatomical relations. By keeping in mind, the vast range of anatomical variations in nasal cavity and paranasal sinuses (PNS), every case of sinusitis must be planned carefully to avoid dreadful complications of surgical procedures. Sinus anatomical variations have been associated with the etiology of sinusitis. In this regard computed tomography (CT) imaging has become an important diagnostic tool. CT Scan imaging of nose and para nasal sinuses is mandatory in patients with history of sinusitis in order to evaluate the detailed anatomy which includes normal anatomy, anatomical variations, bony details and the extent of the disease pathology. Certain anatomical variants are supposed to be a causative factor for development of sinus pathology and hence it becomes compulsory for the radiologist to be aware of the anatomical variants of nasal cavity and PNS especially if the subject is considered for surgical intervention.
... The coronal views of CT scan are best for the sphenoid and the ethmoid cell variants such as the onodi cells or sphenoethmoidal cells. The modification and advancement of computed tomography has granted extensive assessment of patient's paranasal sinuses thus providing a guide map for FESS surgeons to operate effectively 15,5,13 . In a study conducted in Egypt it was reported that the frequency of agger nasi cells and CB were equally frequent (30.6%), and Haller cells were detected in 11.2%. ...
... The most common anatomical variations of maxillary sinus were reported as pneumatization of the sinus and sinus septa. The prevalence of disease process in maxillary sinus was ranged from 7.5% to 66% 15 . The most frequent pathological findings of the maxillary sinus were sinus opacification, sinusitis, and mucosal thickening 26,13 . ...
... Rysz M, Bakoñ L 52 Vincent TE, Gendeh BS 51 Amusa YB, Eziyi JA, et al. 54 Fadda GL, Rosso S, et al. 49 Adeel M, Rajput MS et al. 55 Al-Abri R, Bhargava D et al. 53 Tiwari R, Goyal R 50 Dasar U, Gokce E 19 Gouripur K, et al. 16 Alsowey AM, Abdulmonaem G et al 15 Kalaiarasi R, Ramakrishnan V et al 17 Espinosa W, Genito R et al. 26 Yazici D. 47 Shrestha KK, Acharya K et al. 48 ...
Anatomical variations are not diseases and can be found in every individual. Due to the anatomical variations, the structural changes occur in nearby anatomical relations. By keeping in mind, the vast range of anatomical variations in nasal cavity and paranasal sinuses (PNS), every case of sinusitis must be planned carefully to avoid dreadful complications of surgical procedures. Sinus anatomical variations have been associated with the etiology of sinusitis. In this regard computed tomography (CT) imaging has become an important diagnostic tool. CT Scan imaging of nose and para nasal sinuses is mandatory in patients with history of sinusitis in order to evaluate the detailed anatomy which includes normal anatomy, anatomical variations, bony details and the extent of the disease pathology. Certain anatomical variants are supposed to be a causative factor for development of sinus pathology and hence it becomes compulsory for the radiologist to be aware of the anatomical variants of nasal cavity and PNS especially if the subject is considered for surgical intervention.
