The ostiomeatal unit and endoscopic surgery: anatomy, variations, and imaging findings in inflammatory diseases.

To correlate symptoms of deviated nasal septum (DNS) and chronic rhinosinusitis with the findings of nasal endoscopy and computed tomographic (CT) imaging. To evaluate the influence of degree of septal angle deviation on the severity of lateral nasal wall abnormalities. A prospective study was conducted on 67 patients with clinical evidence of DNS and chronic sinusitis attending ENT OPD between January 2012 and September 2013. All these patients underwent nasal endoscopy and CT scan PNS coronal sections. Direction and degree of DNS was recorded. Range of sinus mucosal thickening on CT scan films was also recorded. Chronic sinusitis is common in the age group between 21 and 40 years (50.74 %) with male preponderance (55.22 %), chief symptoms being nasal obstruction (86.56 %), headache (73.13 %) and nasal discharge (52.23 %). Left sided DNS is more common (64.17 %). Most of the patients have moderate DNS, i.e. 6°-10°(56.7 %), followed by severe (22.4 %) and then mild (20.9 %). DNS results in compensatory structural changes in the turbinates and/or lateral nasal wall which causes ostiomeatal complex (OMC) obstruction resulting in sinusitis. Contralateral concha bullosa and ethmoid bulla prominence was noted. Maxillary sinus is most commonly affected sinus (73.13 %). Patients with increasing septal angles were associated with a higher incidence of maxillary sinus mucosal changes (p \ 0.05). Present study reemphasized the concept that septal deviation causes obstruction at OMC which results in an increased incidence and severity of bilateral chronic sinus disease.

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“…The exact prevalence is not known [6,10]. In present study authors observed enlarged ethmoidal bulla in 28.35 % of the cases, on CT Scanning.…”

Section: Discussionmentioning

confidence: 47%

Endoscopic and Computed Tomographic Evaluation of Influence of Nasal Septal Deviation on Lateral Wall of Nose and Its Relation to Sinus Diseases

Poorey

Gupta

2014

Indian J Otolaryngol Head Neck Surg

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“…Advanced septal deviation may lead to a narrow or blocked meatus, pushing the middle concha towards the lateral wall. This situation also increases the risk of secondary infl ammation and infection (23).…”

Section: Nasal Septal Variationmentioning

confidence: 99%

Evaluation of the anatomical variation in the nasal cavity and paranasal sinuses of patients with cleft lip and palate using cone beam computed tomography

Dedeoğlu¹,

Altun²,

Küçük³

et al. 2017

BLL

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OBJECTIVE: The aim of this study was to evaluate the frequency of anatomical variation in nasal cavity and paranasal sinuses by comparing a unilateral cleft lip and palate (UCLP) group with a non-syndromic control group using cone beam computed tomography (CBCT). SUBJECTS AND METHODS: This study included 24 UCLP patients in the UCLP group and 24 non-syndromic patients in the control group. Coronal CBCT images were taken in all patients and were evaluated for anatomical variation. The measurements obtained in this study were analysed using chi-square and Fisher's exact tests to compare the two groups statistically. RESULTS: In the UCLP group, there were statistically lower frequencies of pterygoid process pneumatisation (p <0.05), higher wing pneumatisation (p < 0.05), and sphenoid sinus over pneumatisation (p < 0.05), and statistically higher frequencies of anterior nasal septal deviation (p < 0.05) compared to the control group. CONCLUSION: A higher incidence of anterior nasal septal deviation was found in UCLP patients compared to the patients in the control group. It is likely that for this reason, UCLP patients might be predisposed to sinusitis. In UCLP patients, the incidence of neurovascular structures in the sphenoid sinus was lower than that in non-syndromic control patients (Tab. 1, Fig. 6, Ref. 33). Text in PDF www.elis.sk.

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“…Haller cell is a type of extramural ethmoidal cells that extend into the inferomedial orbital floor. The involvement of these variations has been investigated in chronic sinusitis but not in sinus fungus ball (Bolger et al 1991;Laine and Smoker 1992;Sivasli et al 2003;Caughey et al 2005;Al-Qudah 2008;Orlandi 2010). Bacteria and fungi have different sizes and structures, and provoke different reactions in the human body.…”

Section: Introductionmentioning

confidence: 99%

Septal Deviation Is Associated with Maxillary Sinus Fungus Ball in Male Patients

Oshima

Nomura

Sugawara

et al. 2014

Tohoku J. Exp. Med.

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Fungus is one of the causes of chronic rhinosinusitis. If the fungus occupies the sinus but does not invade the sinonasal mucosa, this is called sinus fungus ball. Any association between anatomical variations and fungus ball remains unclear. Sinus fungus ball is defined as non-invasive chronic fungal rhinosinusitis occurring in immunocompetent patients, and the maxillary sinus is the most commonly affected. The etiology of maxillary sinus fungus ball remains unclear. This study assessed the potential contribution of anatomical variations, such as deviated nasal septum, concha bullosa, and Haller cell to the development of fungus ball in the maxillary sinus. Concha bullosa and Haller cell are structural variations that narrow the nasal airflow passage and contribute to chronic rhinosinusitis. The involvement of these variations has been investigated in chronic sinusitis but not in sinus fungus ball. Preoperative computed tomography findings of 103 patients with maxillary sinus fungus ball were evaluated retrospectively. Septal deviation and Haller cell were not correlated with the side of maxillary sinus fungus ball. Concha bullosa was more common on the unaffected side (p = 0.099). When we analyzed males and females separately, maxillary sinus fungus ball was more common on the concave side of the deviated septum in only male patients (p = 0.006). The high incidence of maxillary fungus ball in the concave side may reflect the consequences of the traumatic effects caused by wall shear stress of the high-velocity airflow and the increased chance of inhaling fungus spores.

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The ostiomeatal unit and endoscopic surgery: anatomy, variations, and imaging findings in inflammatory diseases.

Cited by 132 publications

References 26 publications

Endoscopic and Computed Tomographic Evaluation of Influence of Nasal Septal Deviation on Lateral Wall of Nose and Its Relation to Sinus Diseases

Endoscopic and Computed Tomographic Evaluation of Influence of Nasal Septal Deviation on Lateral Wall of Nose and Its Relation to Sinus Diseases

Evaluation of the anatomical variation in the nasal cavity and paranasal sinuses of patients with cleft lip and palate using cone beam computed tomography

Septal Deviation Is Associated with Maxillary Sinus Fungus Ball in Male Patients

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