DISTRIBUTION OF ANATOMIC VARIATIONS OF THE NOSE AND PARANASAL SINUSES IN KASHMIRI POPULATION BY COMPUTED TOMOGRAPHY SCAN ANALYSIS.

Background: Knowledge of anatomy constitutes an integral part of the total management of patients with sinonasal diseases. The aim of this study was to obtain the prevalence of sinonasal anatomic variations in the Kashmiri population and to understand their importance and impact on the disease process, as well as their influence on surgical management and outcome. Materials and Methods: This study is a prospective review of retrospectively performed normal computed tomography (CT) scans of the nose and paranasal sinuses in the adult Kashmiri population at SMHS Hospital. The scans were reviewed by two independent observers. Results: The most common anatomic variation after excluding agger nasi cells were pneumatized Crista Galli, which was seen in 69% of the scans. However, the least common variation seen in this series was Pneumatized inferior turbinate, which was encountered in 1.1 % of the cases. Conclusion: A wide range of regional differences in the prevalence of each anatomic variation exists. Understanding the preoperative CT scan is substantially important because it is the roadmap for the sinus surgeon. Detection of anatomic variations is vital for surgical planning and the prevention of complications.

Malignant tumors of the nose and paranasal sinuses: a retrospective review of a Portuguese cancer center’s experience

Introduction. Although uncommon from a population-based perspective, there is considerable morbidity and mortality associated with malignant tumors of the nose and paranasal sinuses.The objective of this study was to characterize the presentation, risk factors, management and survival of patients with these tumors treated at a single institution.Materials and methods. We retrospectively reviewed the clinical records of patients with malignancies of the nose and paranasal sinuses diagnosed between January 2010 and December 2014 at a tertiary cancer center. Univariate and multivariate analysis were performed.Results. Ninety patients were included in the study. Mean age at diagnosis was 62.8 years (range, 2–95 years) and mean follow-up was 44.5 months (range, 2–113 months). The maxillary sinus (33.3 %) and the nasal cavity (32.2 %) were the most frequent sites of origin. Squamous cell carcinoma (36.7 %), mucosal melanoma (15.6 %) and adenoid cystic carcinoma (10 %) were the most common histologic subtypes. Surgery was the primary treatment for 86.7 % of patients. Recurrence occurred in 45 patients (50 %). The overall 5‑year survival was 39.3 % and disease free-survival was 45.9 %. Survival was significantly decreased in non-smokers (p = 0.022), T3–4 tumors (p = 0.007), positive lymph nodes (p <0.001), nonepithelial tumors (p = 0.036) and positive margins (p = 0.032). Survival was not affected by surgical approach between endoscopic, open and combined approaches (p = 0.088).Conclusion. Prognosis is poor, with high recurrences and low survival, but clearly histology, location and stage-dependent. Sound oncologic principles, with complete resections and negative margins, result in a better outcome.

The Importance of Light Diagnosis in Joint Injuries of the Walls of the Upper Jaw Cavity

The article discusses the possibilities of computed tomography and magnetic resonance imaging when examining patients in an ENT clinic. The authors' materials cover complex observations of diseases of the nose and paranasal sinuses. The patients were operated on, which made it possible to compare the data of radiation studies with operational findings and cytological material. CT scan in coronal projection allows to clarify the diagnosis, determine the possible causes of recurrent sinusitis and identify the individual structural features of the nasal cavity and PNS that contribute to the development of intraoperative complications. When analyzing CT data, special attention should be paid to identifying and correctly interpreting the intranasal anatomy. It is necessary to indicate in detail the location of the cyst of the maxillary sinus, which allows the surgeon to correctly choose the optimal surgical access.

The Importance of Light Diagnosis in Joint Injuries of the Walls of the Upper Jaw Cavity

The article discusses the possibilities of computed tomography and magnetic resonance imaging when examining patients in an ENT clinic. The authors’ materials cover complex observations of diseases of the nose and paranasal sinuses. The patients were operated on, which made it possible to compare the data of radiation studies with operational findings and cytological material. CT scan in coronal projection allows to clarify the diagnosis, determine the possible causes of recurrent sinusitis and identify the individual structural features of the nasal cavity and PNS that contribute to the development of intraoperative complications. When analyzing CT data, special attention should be paid to identifying and correctly interpreting the intranasal anatomy. It is necessary to indicate in detail the location of the cyst of the maxillary sinus, which allows the surgeon to correctly choose the optimal surgical access.

Correlation Between the Opacification Degree of Paranasal Sinuses on CT, Clinical Symptoms and Anatomical Variations of the Nose and Paranasal Sinuses in Patients with Chronic Rhinosinusitis

Objectives: This study aimed to evaluate the correlation between the opacification degree of the paranasal sinuses on computed tomography (CT) with clinical symptoms, and anatomical variations of the nose and paranasal sinuses in patients with chronic rhinosinusitis (CRS). Materials and Methods: This descriptive prospective study evaluated 100 patients (60 males and 40 females), who were diagnosed with CRS by ENT specialists according to the clinical findings, and were scheduled for a CT scan. The patients were requested to express the severity of their symptoms using a visual analog scale. The CT scans of the paranasal sinuses were assessed for the presence of anatomical variations and scored using the modified Lund-Mackay scoring system for the opacification degree of each sinus. The correlations between the anatomical variations and sinusitis, and also between the severity of symptoms/disease severity and CT scores were statistically analyzed. P<0.05 was considered statistically significant. Results: The most common symptoms were purulent (discolored) nasal drainage and nasal obstruction. Septal deviation was the most common anatomical variation. The maxillary and anterior ethmoid sinuses were the most commonly involved areas. The Spearman’s correlation coefficient showed a significant correlation between the sinus involvement and some of the evaluated symptoms, as well as certain types of anatomical variations (P<0.05). Conclusion: Some specific anatomical variations of the paranasal sinuses may predispose them to sinusitis. The CT scan score can predict the severity of many symptoms such as purulent (discolored) nasal drainage, nasal obstruction, hyposmia/anosmia, halitosis, cough, and fatigue, among the other symptoms of CRS.

The nose and paranasal sinuses

The external nose is pyramidal and consists of a bony cartilaginous framework. The root/radix is continuous with the forehead an inferiorly terminates at the nasal tip. The dorsum of the nose is formed by two lateral surfaces that converge in the midline. The cartilaginous structure of the nose is formed by paired upper (lateral) cartilages that contribute to the internal nasal valve with the nasal bones, and lower lateral cartilages, combined with additional minor nasal cartilages that surround the ala. The nasal septum relies upon anastomoses from five vessels: two from the ophthalmic, two from the maxillary and one from the facial. Collectively, they form Kieselbach’s plexus. The paranasal sinuses are the frontal, sphenoidal, ethmoidal and maxillary – located within the bones of the same name. They are paired structures lined with mucosa that is continuous with the lateral nasal side wall into which they drain, facilitating clearance of mucus by way of the mucociliary escalator.

Facial Ulcer: A Harbinger of Post-COVID-19 Mucormycosis, a Case Report

: Facial ulcers may be the manifestation of a wide variety of disorders with infective, inflammatory, granulomatous, or malignant etiopathogenesis, leading to challenges in differential diagnosis and management. Mucormycosis is an angio-invasive, rapidly spreading, and potentially fatal fungal infection beginning from the nose and paranasal sinuses after the inhalation of fungal spores, manifesting with cutaneous necrotic eschar. The rhinomaxillary region is the commonest site involved, particularly in immunocompromised individuals. Mucormycosis incidence in people with coronavirus disease 2019 (COVID-19) is on the rise, especially in India during the second wave. Diabetes mellitus is an independent risk factor for severe COVID-19 infection, as well as for mucormycosis. We report an elderly gentleman with uncontrolled diabetes, treated for the COVID-19 infection, who presented with an ulcer over the left nasal ala. This case report highlights the importance of high-index suspicion and prompt and aggressive multidisciplinary management of mucormycosis, as a life-saving measure.

Pneumosinus dilatans associated with infantile cerebral palsy and nasal polyposis: Case report

Pneumosinus dilatans is a rare disease characterized by air-filled expansion of a paranasal sinus. Approximately 134 cases are reported in the literature, but not only one associated with infantile cerebral palsy (ICP) and nasal polyposis. We herein present this case report aimed to further characterize this uncommon condition: a 28-year-old female diagnosed with infantile cerebral palsy and nasal polyposis, in whom the cranio-facial CT scan revealed the association of a pneumosinus dilatans involving the frontal sinus. The patient is currently undergoing a protocol for endoscopic surgery of the nose and paranasal sinuses.

Overview of the Presentation and Updated Management of Sinusitis

Acute and chronic sinusitis are common primary care presentations. They are caused by mucosal inflammation, which inhibits mucociliary function of the nose and paranasal sinuses. Because it affects the mucous membranes that line both the nose and the sinuses, the complete medical word for sinusitis is "rhinosinusitis". Sinusitis is usually caused by a viral upper respiratory tract infection, with bacterial sinusitis occurring in about 2% of cases, yet in most cases overall antibiotics are being used and prescribed which is in most part are not needed, and cases often resolves without antibiotics need, most general practitioners rely on clinical findings to make the diagnosis. Watchful waiting and symptom treatment with nasal oxymetazoline, pseudoephedrine, and saline nasal irrigation are recommended. In this paper, we overview the presentation and management of sinusitis.

Clinicopathologic profile of sinonasal diseases in a tertiary hospital in Port Harcourt

Background: In a typical ear nose and throat clinic, disease conditions involving the nose and paranasal sinuses are not uncommon. The aim of this study is to determine the clinicopathologic profile of these diseases as it occurs in university of Port Harcourt teaching hospital. Methodology: A retrospective descriptive analysis of all patients with diagnosis of sinonasal disease that presented in the ear nose and throat surgery department of university of Port Harcourt teaching hospital within the period of 5years (from 2016 – 2020). Data retrieved were biodata, clinical features, diagnosis and treatment, these were all collated and analysed. Patients without complete records were excluded. The patients recruited had clinical diagnosis which was aided by radiological investigations and confirmed by histology. Result: A total of 68 patients were studied within the 5year period. There were 35males and 33 females. The mean age was 33.96+/_17.9 years. The age groups 11-20 and 41-50 were more affected. Rhinosinusitis was the commonest condition seen while inflammatory polyp was the commonest histologic diagnosis. Polypectomy with bilateral antrostomy was the commonly done surgery in 26.4% age. Conclusion: Disease of the nose and paranasal sinuses are commonly seen in ENT practice and rhinosinusitis is the commonest entity encountered with inflammatory polyp as the commonest histopathologic finding. Squamous cell carcinoma was the commonest malignant lesion seen occurring more in males. Age distribution of the diseases was statistically significant.