Frontal Sinusitis Management: Intact Ethmoidal Bulla Technique Vs Ethmoidal Bullectomy

Introduction Conventional functional endoscopic sinus surgery (FESS) for frontal sinusitis treatment involves ethmoidal bullectomy, that is associated with damage to the surrounding structures. These complications can be overcome by minimally invasive FESS anterior to the ethmoidal bulla that allows ease in locating the sinus ostium, eliminating risk of injury to anterior skull base and nearby structures. This study aims to compare the efficacy of ethmoidal bullectomy versus intact ethmoidal bulla technique as an adjunct to FESS in frontal sinusitis management. Materials and Methods Forty patients, clinically and radiologically diagnosed with frontal sinusitis, were randomly divided into 2 groups: Group A (n=20; treated with FESS keeping the ethmoidal bulla intact) and Group B (n=20; treated using FESS with ethmoidal bullectomy). After detailed history and clinico-radiological examinations, diagnostic nasal endoscopy was performed, followed by FESS. Pre- and post-operative endoscopic and clinical assessment was done using Modified Lund-Kennedy Endoscopy (MLKE) Score and Sino-Nasal Outcome Test-22 (SNOT-22) Questionnaire, respectively. Data was analyzed using software R version 3.6.3. Results Significant reductions in SNOT-22 (clinical improvement) and MLKE scores (endoscopic improvement) were seen within the groups from baseline to each follow-up visit and between the successive recall visits (p<0.001). The SNOT-22 and MLKE scores were insignificant at any visit between the groups, along with age distribution, gender and intra-operative complications (p>0.05). Complications were seen only in Group B. Conclusion Both, ethmoidal bullectomy and intact ethmoidal bulla technique, when used as adjuncts to FESS, showed similar improvements in frontal sinusitis patients. However, bullectomy was associated with greater risk of intra-operative complications.

Three-dimensional structure of the basal lamella of the middle turbinate

The middle turbinate’s basal lamella (3BL) is a variable landmark which needs to be understood in endoscopic transnasal skull base surgery. It comprises an anterior frontal and a posterior horizontal part and appears in its simplest depiction to be “L”-shaped, when viewed laterally. In this study we analyzed its 3D morphology and variations focusing on a precise and systematic description of the anatomy. CBCTs of 25 adults, 19 cadavers and 6 skulls (total: 100 sides) were investigated with the 3DSlicer software, creating 3D models of the 3BL. We introduced a novel geometrical classification of the 3BL’s shape, based on segments. We analyzed their parameters and relationship to neighboring structures. When viewed laterally, there was no consistent “L”-shaped appearance of the 3BL, as it is frequently quoted. A classification of 9 segment types was used to describe the 3BL. The 3BLs had in average of 2.95 ± 0.70 segments (median: 3), the most frequent was the horizontal plate (23.05% of all segments), next a concave/convex plate (22.71%), then a sigma plate (22.37%). Further types were rare. We identified a horizontal plate in 68% of all lateral views whilst 32% of the 3BLs were vertical. A sigma–concave/convex–horizontal trisegmental 3BL was the most common phenotype (27%). Globally, the sigma–concave/convex pattern was present in 42%. The 3BL adhered the ethmoidal bulla in 87%. The segmenting method is eligible to describe the 3BL’s sophisticated morphology.

Nasal endoscopic evaluation of patients presenting with frontal headache

<p class="abstract"><strong>Background:</strong> Headache is a universal symptom affecting most people at some point in their lifetime. The most common cause of headache in ENT is acute sinusitis or an acute exacerbation of chronic sinusitis. Anatomic variations like a massive concha bullosa, enlarged ethmoidal bulla, laterally rotated uncinate can interfere with mucociliary clearance. Thus, a thorough nasal endoscopic evaluation will help us to detect any anatomic abnormality which may predispose to sinogenic headache.</p><p class="abstract"><strong>Methods:</strong> 100 patients with frontal headache underwent diagnostic nasal endoscopy and all anatomic variations and pathological abnormalities were noted</p><p class="abstract"><strong>Results:</strong> 83% cases had a diagnosis of deviated nasal septum or rhinosinusitis, and the rest 17% had non sinonasal cause for headache</p><p class="abstract"><strong>Conclusions:</strong> Anatomic abnormalities like middle turbinate anomaly, spur, enlarged bulla, hyperplastic uncinate and pathological abnormality like mucopurulent discharge, polypi can be diagnostic of sinogenic cause for frontal headache.</p>

Ethmoid silent sinus syndrome causing inward displacement of the orbit: case report

Objective:We describe a previously unreported case of ethmoid silent sinus syndrome.Method:Case report and review of the world literature regarding silent sinus syndrome.Results:A 33-year-old woman developed medial displacement of the left orbital contents in the absence of trauma, surgery or other significant pathology. Imaging showed opacification of the left ethmoid sinus and implosion of the medial orbital wall. Previously reported cases of silent sinus syndrome have all involved the maxillary sinus, with subsequent implosion of the orbital floor. Computed tomography scans of our patient showed wide, flat ethmoidal bulla and surrounding cells, with few horizontal bony septae reinforcing the area of collapse.Conclusion:This case represents the first report of ethmoid silent sinus syndrome. We argue that, in anatomically susceptible individuals, the silent sinus syndrome can present due to chronic ethmoidal sinusitis.