RESUMEN
BACKGROUND: Accidental injury of lamina papyracea (LP) remains one of the most common complications reported in endoscopic sinus surgery (ESS) even in most recent studies. The purpose of this study was to categorize the LP position radiologically and from an endoscopic perspective. METHODS: A total of 207 computed tomography (CT) scans (414 sides) including both diseased and control groups were retrospectively reviewed by 2 examiners. Inferior turbinate attachment to the lateral nasal wall and the inferior margin of the planned middle meatal antrostomy (MMA) were identified anteriorly. Position of LP in relation to the vertical line passing through MMA inferior margin was reported. LP was categorized to lie either within 2 mm on either side of the MMA inferior margin (type I), more than 2 mm medial to the MMA line (type IIa: 2 to 4 mm; type IIb: >4 mm), or more than 2 mm lateral to the MMA line (type IIIa: 2 to 4 mm; type IIIb: >4 mm). RESULTS: Of the 221 sides in the control group, 69.7% were classified as type I, 24.9% as type II, and 5.5% as type III. Among the 193 diseased operated sides examined, 60.1% were classified as type I, 20.2% as type II, and 13.5% as type III. Weighted kappa coefficient showed good interexaminer reliability. Five sides (2.6%) in the case group had accidental LP penetration intraoperatively, 4 of them were type II and type III LP. CONCLUSION: This study improves surgeons' awareness of LP variations in the endoscopic field and can be of help for residents in training.
Asunto(s)
Endoscopía , Hueso Etmoides/anatomía & histología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Hueso Etmoides/diagnóstico por imagen , Hueso Etmoides/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
PURPOSE: To determine the anatomic variations that can lead to optic nerve damage during the sugical treatment of posterior paranasal sinus lesions MATERIALS AND METHODS: two hundred optic nerves of 100 persons were examined using ostiomeatal unit CT (OMU CT). The anatomical features of this nerve and posterior paranasal sinuses were classified into four types : the optic nerve adjacent to the sphenoid sinus without indentation of the sinus wall (type 1); the optic nerve adjacent to the sphenoid sinus, causing indentation of the sinus wall (type 2); the optic nerve passing through the sphenoid sinus (type 3); and the optic nerve adjacent to the sphenoid sinus and posterior ethmoid sinus (type 4). Bony dehiscence around the optic nerve and pneumatization of the anterior clinoid process were also evaluated. RESULTS: The anatomical classification of the optic nerve and posterior paranasal sinuses was as follows : type 1, 1326 (66%); type 2, 60 (30%); type 3, 6 (3%), and type 4, 2 (1%). Bony dehiscence around the optic nerve had developed in 58 cases (29%) and pneumatization of the anterior clinoid process in 13 (6.5%). These conditions were most common in type 3 optic nerve, and second most common in type 2. CONCLUSION: The 2 and 3 optic nerve, bony dehiscence around the optic nerve and pneumatization of the anterior clinoid process are the anatomic variations that can lead to optic nerve damage during the surgical treatment of posterior paranasal sinus lesions. To prevent optic nerve damage, these factors should be carefully evaluated by OMU CT.
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Humanos , Clasificación , Senos Etmoidales , Nervio Óptico , Senos Paranasales , Seno EsfenoidalRESUMEN
PURPOSE: To evaluate incidentally observed thickened mucosa of paranasal sinuses on brain MRI of patients without evidence of sinusitis. MATERIALS AND METHODS: We reviewed brain MRI of 82 adults aged over 20 ; 45 were males and 37 were females. Brain axial MRI was obtained from the hard palate with 8mm thickness and 2mm gap. The mucosal thickness of incidentally observed paranasal sinuses seen on brain MRI was measured at the mostly thickened portion by T2- and T1-weighted images. RESULTS: The mean mucosal thickness at the most thickened portion of paranasal sinuses, regardless of their location was 3.5mm with S.D. of 1.5mm. The mucosal thickening was observed more commonly in maxillary (79 patients, mean 3.0mm, S.D. 1.4mm) and ethmoid sinuses (80 patients,mean 2.7mm, S.D. 1.1mm) than in sphenoid (39 patients, mean 1.6mm, S.D. 1.4mm) or frontal sinuses (38 patients, mean 1.9mm, S.D. 1.4mm). CONCLUSION: Mucosal thickening of up to 6.5mm was a common finding on brain MRI of patients without evidence of sinusitis ; accuracy was 95%.
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Adulto , Femenino , Humanos , Masculino , Encéfalo , Senos Etmoidales , Seno Frontal , Imagen por Resonancia Magnética , Membrana Mucosa , Paladar Duro , Senos Paranasales , Valores de Referencia , SinusitisRESUMEN
PURPOSE: To evaluate the dynamic patency of the frontonasal duct(FND) on PNS CT scan after administration ofan iso-osmolar contrast agent (lsovist) into the nasal cavity. MATERIALS AND METHODS: Coronal PNS CT scans from ten normal and 30 patients with symptoms of chronic sinusitis were obtained after administration of lsovist intothe nasal cavity, followed by Valsalva maneuver for the even distribution of the agent into the FND and sinuses. Atotal of 80 FNDs were evaluated for dynamic patency by examining the presence of the contrast agent in ducts. RESULTS: The contrast agent was visualized in 34/37 FNDs(91.9%) without ipsilateral frontal sinus it is and was visualized in 18/43 FNDs(41.9%) in cases of ipsilateral frontal sinusitis. In addition, the contrast agent within the ipsilateral frontal sinus was visualized in 8/18 FNDs(44.4%). The major causes of ductal obstruction were mucoperiosteal thickening and polypoid lesions secondary to inflammation. CONCLUSION: PNS CT scan together with the administration of lsovist, which caused minimal irritation, was useful for the evaluation of the relationship between the dynamic patency of the FND and frontal sinusitis, In addition, this study can provide the rhinologist with accurate anatomical and pathological information concerning the FND before a choice is made between endoscopic sinus surgery or medical treatment.