Progress in sinonasal imaging

Balloon Sinuplasty: Our Experience

Chronic rhino sinusitis (CRS) is a common disease. Maxillary sinusitis not cured by the medicines was addressed by the open surgical procedure namely Caldwell Luc operation. Thereafter introduction of nasal endoscopes in 1970's led to the minimally invasive surgery FESS which preserved the physiology of the nose and sinuses. In the year 2002 balloon sinuplasty was introduced in the western world and subsequently in India. Due to various logistics it was not performed and reintroduced in the year 2015 in India. It can be termed as micro minimally invasive surgery wherein anatomy as well as physiology of the nose and sinuses were preserved in cases of medically non responsive mild to moderate sinusitis. 20 cases were selected for exclusive balloon sinuplasty of maxillary sinus. Balloon sinuplasty is a relatively new procedure which can be termed as micro minimally invasive surgery addressing the CRS without the traditional forms for surgery like incision, cutting or microdebriding. The principle is causing microfractures by inflating the sinus opening and thus facilitating the drainage of the sinus contents. No immediate or late post operative complications were noted. Sinus patency 6 months later was present in 90% of the cases. Balloon sinuplasty is an excellent procedure for medically nonresponsive CRS without polyposis. The success rate is spectacular matching the FESS with almost no immediate post operative and late complication. The recurrence rate of sinusitis is low. We conclude that balloon sinuplasty is a micro invasive procedure which saves operating time, time of hospital stay of the patient and delivers excellent result with almost no complications. We hope it could be incorporated as a routine surgery for mild to moderate sinusitis not responding to medicines.

Three-dimensional linear and volumetric computed tomography analysis of the frontal sinus

The frontal sinus is one of the four paranasal sinuses in humans, and knowledge of its anatomy is important when performing surgery involving the frontal bone or sinus. Although many studies have measured the frontal sinus using radiography and computed tomography (CT), few studies have evaluated by using three-dimensional (3D) analysis. The purpose of this study was to analyze the frontal sinus using 3D reconstruction analysis and determine the differences in linear and volumetric measurements between sexes, sides, and ages. The sample comprised 281 facial CT scans: 173 and 108 from males and females, respectively. The width, height, and length of each frontal sinus and total volume were all larger in males than in females. Almost all linear and volumetric measurements were larger in young adults than in older for both sexes, but not all of the differences were statistically significant. Linear and volumetric measurements were larger for males than females regardless of age group. There were no statistically significant differences between the right and left sides except the width in males. The size of the frontal sinus was strongly influenced by sex and age. The measurements reported here might be useful for improving surgical procedures involving the frontal sinus.

The enlargement of the maxillary ostium after balloon sinuplasty evaluated by a novel measuring technique from 3D CBCT images

Our aim was to evaluate the effects of balloon sinuplasty on the size of the ostium in the maxillary sinuses in patients with chronic rhinosinusitis from cone beam computer tomography (CBCT) scans of the sinus. This is a blinded retrospective trial in patients who had undergone balloon sinuplasty of the maxillary sinus. CBCT scans were taken and SNOT-22 Quality of Life questionnaire completed before and 12 months after the operation. The size of the maxillary ostium was measured from the CBCT scans three-dimensionally. The association of changes in the SNOT-22 scores of the ostium was analysed. We discovered that the balloon sinuplasty increased the size of the maxillary ostium in all dimensions. The changes were statistically significant (p<0.05) in the axial diameter and the ostium area. The number of patent ostia increased after the intervention. The association between SNOT-22 score and ostium patency were statistically significant before the operation. Our conclusion is that the threedimensional measuring technique provides a reliable method to evaluate ostium dimensions. Balloon sinuplasty increased the size of the maxillary ostium and the result was maintained for 12 months after the operation.

Current Trends in Sinonasal Imaging

As endoscopic sinus surgery (ESS) has evolved since its introduction to the United States, so has technology for imaging the sinonasal cavities. Although imaging is most frequently performed for evaluating chronic sinusitis refractory to medical therapy, its uses have expanded beyond inflammatory sinus disease. Multidetector Computed Tomography is the current workhorse for both diagnosis and preoperative planning in prospective ESS patients, while MR imaging remains a complementary tool for evaluating suspected tumors or intracranial and orbital complications of rhinosinusitis. In this article, the authors review current trends and potential future directions in the use of these modalities for sinus imaging.

[Recommendation for Sinupret as a supplementary specimen in pharmacological treatment of rhinosinusitis]

Due to rhinosinusitis symptoms severity and relatively high treatment resistance, excipients, supplementing basic pharmacological and surgical treatment, have played a significant role in the recent years. Phytotherapy is one of the most dynamically developing studies which focuses on implementing natural active substances into the treatment. 2012 EPOS Report pinpoints the benefits of using substances of natural origin in patients with acute rhinosinusitis. Sinupret drug has been proven effective in clinical trials, as a drug for both acute and chronic rhinosinusitis, in children and adults. Sinupret is a multidirectional drug, which significantly alleviates the symptoms of rhinosinusitis.

Clinical application of virtual endoscopy as a support system for endoscopic sinus surgery

CONCLUSIONS

Computer processing of conventional CT images can provide virtual endoscopic images (VEIs). Surgeons observing these images feel as if they are observing the lesion using an endoscope. Simulation based on animated VEIs before endoscopic sinus surgery (ESS) is useful for the improvement of surgical safety and surgeons' education. Although the production of VEIs requires certain surgical experience, after the production of VEIs, surgeons can repeat simulation of a surgical procedure and have confidence in the actual operation.

OBJECTIVE

We investigated the clinical application of CT-reconstructed VEIs as a support system for ESS.

MATERIALS AND METHODS

A GE Light Speed Ultra 16 as a 16-slice CT scanner and Advantage Workstation 4.2 were used. Software called Navigator in this workstation allows the production of CT-reconstructed VEIs. We applied simulation based on VEIs to endoscopic operations for mucocele or sinusitis.

RESULTS

In nine cases of mucoceles and sinusitis, simulation based on animated VEIs was applied. According to the simulation, surgeries were performed, and the mucoceles and obstructed sinuses could be opened readily and safely. This system was more effective when there were landmarks such as polyps or irregular mucosal surfaces allowing macroscopic confirmation ahead of the viewpoint.

[Clinical evaluation of CT scans of nasal cavity and paranasal sinuses]

INTRODUCTION

Computed tomography is a basic imaging technique in nose and paranasal sinuses disease's nowadays.

AIM

The aim of the study was to outline current methodology of CT scanning of nose and paranasal sinuses.

MATERIAL AND METHODS

This study is based on the experience of Department of Otorhinolaryngology of Medical University of Lódź in evaluation by CT scanning patients with nose/paranasal sinuses problems and on the literature concerning this problem.

RESULTS

Pictures in three planes (axial, coronal, sagittal) are obtained from multi-row CT scanner. However in some cases 3D reconstructions are useful. The thickness of the single layer is 0.625 or 1 mm. In case of tumor suspicion contrast CT scanning is a routine procedure. The analysis of pictures is preceded by anamnesis and careful rhinologic examination. Coronal scans are evaluated as first and they are divided into four zones (frontal sinus, anterior ethmoid cells, posterior ethmoid cells and sphenoid sinus zones) for more systematic analysis. Then axial and sagittal scans are examined. Every single structure and its anatomical variations are named by using current terminology outlined during International Conference of Sinus Disease in Princeton in 1993 by The Anatomic Terminology Group.

CONCLUSIONS

Quality and quantity of the information from CT of nose and paranasal sinuses depends on keeping some rules concerning the stage of performing the examination and the stage of its evaluation and applying current anatomic terminology.

Multiplanar computed tomographic analysis of the frontal recess region in Chinese subjects without frontal sinus disease symptoms

The purposes of this study were to determine the prevalence of frontal-ethmoidal cells and to evaluate variation in the superior attachment of the uncinate process in Chinese subjects. 202 normal Chinese subjects (404 sides) underwent spiral computed tomography and multiplanar reconstruction images were evaluated. Agger nasi cells showed a prevalence of 94.1%. Of all the frontal cells identified in 159 sides (39.6%) of frontal recesses, the prevalence of type I, type II and type III cells was 24.4, 7.0 and 8.2%, respectively. Suprabullar, frontal bullar and interfrontal septal cells were identified in 148 sides (36.6%), 36 sides (9.0%) and 25 subjects (12.4%), respectively. 244 uncinate processes (60.4%) had 1 superior attachment and the remainder (39.6%) had 2 superior attachments. The prevalence of terminal recesses was 89.1%. Our results characterized normal frontal recess pneumatization patterns in Chinese subjects. That, together with variation in the superior attachment of the uncinate process, emphasized the role of agger nasi cells and the uncinate process in endoscopic frontal sinus surgery.