The Functional State Of The Mucous Membrane Of The Nasal Cavity And Paranasal Sinuses After Radical And Minimally Invasive Surgical Interventions

Improving the effectiveness of treatment of chronic rhinosinusitis (CRS) is a priority task of modern otorhinolaryngology, not only domestic, but also foreign. This interest in the problem is due to the widespread prevalence of this pathology. In different countries, the criteria for accounting for the incidence, algorithms for the diagnosis and treatment of rhinosinusitis differ significantly, and for CRS these differences are more pronounced than for acute. A retrospective analysis of the structure and prevalence of ENT diseases according to inpatient observations for 5 years showed that chronic diseases of the nose and paranasal sinuses (SNP) occupied a priority place among hospitalized patients (45.8 ± 0.9% and 55.5 ± 1,0%). In the structure of the main diseases of SNP, the largest share in the adult population is occupied by inflammation of the maxillary sinus (HPP), in which there is an annual increase in the incidence of 1-1.5%, the second most frequent is inflammation of the ethmoid labyrinth cells, then the frontal and sphenoid sinuses.

Ethmoid labyrinth osteoma: case report

Osteomas are common benign slowly growing neoplasms that make up a group of osteogenic tumors, occurring mainly in the lower jaw and the sinonasal region with the involvement of the frontal sinuses in 80–96%, an ethmoid labyrinth in 2–15%, maxillary in 2–5% of cases, and extremely rarely – sphenoid sinuses. Among all benign tumors of the paranasal sinuses, osteomas occur in 3–10% of patients. The tumor can have a different density, as well as grow both on a pedicle and on a broad base, which makes it difficult to extract, especially when located in the frontal sinus. There is also a risk of developing liquorrhea when the osteoma adheres to the base of the skull. Patients and methods: Patient G., 67 years old, with complaints of impaired nasal breathing, postnasal leakage of mucous discharge into the pharynx, and recurrent headache localized in the frontal region, was admitted for planned surgical treatment to the otorhinolaryngological department of the Clinical Medical Center of the Evdokimov Moscow State Medical University. The listed symptoms have been noted over the past year. A computed tomogram of the head revealed a picture of an osteoma of the ethmoid sinus on the right, adjacent to the base of the skull in the area of the lateral lamella of the middle turbinate. Results: A transnasal endoscopic approach to the roof of the ethmoid labyrinth was performed by removing the middle turbinate, resecting the ethmoid bulla. After removal of the tumor, a naked area of the dura mater and pinpoint liquorrhea were visualized. Plastic surgery of the skull base defect was performed using several layers of biodegradable hemostatic material. Conclusion: Osteoma of the paranasal sinuses is a well-visualized tumor on a computed tomography, which usually does not require histological confirmation. At the same time, surgical treatment of this type of tumor may be accompanied by difficulties in their extraction, when located in the frontal sinus, as well as the risk of liquorrhea, when adhering to the base of the skull, which requires the surgeon to have skills in closing defects of the skull base and knowledge of the features of postoperative management.

Anatomical nomenclature of the frontal ethmoidal region: state-of-the-art

Endoscopic operations on the frontal sinus and anterior ethmoid labyrinth are among the most technically difficult in rhinosurgery. This results from the wide variability of the anatomical relationships of the elements involved in the formation of the ventilation pathway and sinus outflow. In addition, problems arise regarding the definition of suprastructural components that play a key role in the pathogenesis of diseases of the frontal sinuses: frontal recess, ostium, and drainage pathway of the frontal sinus. The article aims to review the nomenclature of the anatomical elements of the anterior ethmoid labyrinth and suprastructural components that are presented as contradictory in various literature sources. The authors pay special attention to the process of rhinological nomenclature developing in the historical aspect, determine its place in general anatomical terminology, call attention to the applied aspects of its use and development prospects. In the author’s opinion, a clear and orderly nomenclature allows to some extent simplifying the understanding of rather confusing anatomy of the anterior ethmoid labyrinth, which is critically important both in practice and in scientific research.

The utilization of paranasal sinus coronal tomography scans as a predictor for the anterior ethmoidal artery course.

Background. This study aims to identify radiological features on paranasal sinus coronal tomography images that can guide the surgeon to localize and determine the course of the anterior ethmoidal artery (AEA). These features include the visualization of anterior ethmoidal foramen (AEF) and anterior ethmoidal sulcus (AES) as well as the supraorbital pneumatization (SOP). Methods. This retrospective study includes 182 of the paranasal sinuses coronal tomography (CT) for patients who attended the clinic from January 2019 to August 2019 in King Abdullah University Hospital. We excluded the following images from our study: patients younger than twelve years old, patients with a sinus surgery record or trauma, patients with sinus malignancies, congenital anomalies of the face, images with fibro-osseous lesions that impaired the visualization of ethmoid roof, and images with opacified frontal recess region and/or the ethmoidal cells.Results. Both AEF and AES are prominent features on the coronal CT scan that are used to localize the AEA canal and predict its course in the ethmoid labyrinth. It was found that both radiological landmarks are presented in 100% and 93.4 % of our cases; respectively. Moreover, the presence of SOP is significant with the existence of AEA canal on coronal CT scan images.Conclusion. The preoperative evaluation of a coronal CT scan to localize the AEA can be precisely determined by visualization of both the AEF and AES. On the other hand, the presence of SOP is considered a significant sign on the CT scan were AEA can be identified.

Computed-tomography volumetric study of the ethmoid labyrinth

Morphological variability of paranasal sinuses is well known for endoscopic surgeons and anatomists alike. The ethmoid sinus is the most complex and variable of all paranasal sinuses, due to the fact that its development is not yet well known and is influenced by many factors. Volumetric studies of the sinuses have been made using dried skulls, cadaver heads and imaging studies, but there are still not sufficient data in order to name a standard value for each sinus. Few data can be found especially regarding the ethmoid sinus. In this paper, we measured the volumes of ethmoid lateral masses, and for anterior and posterior groups of cells, using imaging studies and a volumetric feature of our imaging studies. Results showed an average volume between 7.34 cm3 and 8.39 cm3for the ethmoid lateral mass, between 4.33 cm3and 4.92 cm3 for the anterior ethmoid and between 3.01 cm3and 3.47 cm3for the posterior ethmoid groups. We also found that the average volume of the anterior ethmoid occupies between 58-59% of the whole volume, while the posterior ethmoid occupies only 41-42% of this volume.