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Increased Inflammatory Markers Detected in Nasal Lavage Correlate with Paranasal Sinus Abnormalities at MRI in Adolescent Patients with Cystic Fibrosis. Antioxidants (Basel) 2021; 10:antiox10091412. [PMID: 34573044 PMCID: PMC8465538 DOI: 10.3390/antiox10091412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a characteristic feature of cystic fibrosis (CF) multiorgan disease and develops early in the life of patients with CF. The study aimed to correlate the inflammatory markers and the presence of structural abnormalities detected by MRI in the paranasal sinuses of patients with CF. Methods: Nasal lavage and MRI of the paranasal sinuses was performed in a cohort of 30 CF patients (median age 14 y; range 7–20 y). Morphological abnormalities characteristic of CF were evaluated with a dedicated CRS MRI scoring system and correlated with different inflammation parameters measured in nasal lavage. Inflammation of the paranasal sinuses was positively associated with structural abnormalities in MRI. The concentration of the pro-inflammatory markers neutrophil elastase (NE) and the neutrophil elastase/alpha1-antitrypsin (NE/A1AT) complex correlated significantly with CRS-MRI sum score (p < 0.05, r = 0.416 and p < 0.05, r = 0.366, respectively). S. aureus infection was associated with the increased pro-inflammatory cytokine activity of IL-6 and IL-8, and increased levels of NE/A1AT complex in our patients (p < 0.05, respectively). CRS-MRI sum score and individual sinus MRI scores were positively associated with inflammatory activity as a sign of CRS pathology present in CF.
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Krajewska J, Zub K, Słowikowski A, Zatoński T. Chronic rhinosinusitis in cystic fibrosis: a review of therapeutic options. Eur Arch Otorhinolaryngol 2021; 279:1-24. [PMID: 34296343 PMCID: PMC8739462 DOI: 10.1007/s00405-021-06875-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
Purpose Chronic rhinosinusitis (CRS) is observed in almost 100% of patients with cystic fibrosis (CF). CF-related CRS treatment is extremely challenging because of the underlying genetic defect leading to its development. CRS in CF is often refractory to standard therapy, while recurrences after surgical treatment are inevitable in the majority of patients. This study provides a precise review of the current knowledge regarding possible therapeutic options for CF-related CRS. Methods The Medline and Web of Science databases were searched without a time limit using the terms “cystic fibrosis” in conjunction with “otorhinolaryngological manifestation”, “rhinology” and “sinusitis”. Results Precise guidelines for CF-induced CRS therapy are lacking due to the lack of large cohort randomized controlled trials. None of the existing therapeutic agents has already been recommended for CRS in CF. Therapy targeting the underlying genetic defect, intranasal dornase alfa administration, and topical delivery of colistin and tobramycin showed promising results in CF-related CRS therapy. Besides the potential effectiveness of nasal steroids, strong recommendations for their usage in CF have not been provided yet. Systemic corticosteroid usage is controversial due to its potential negative influence on pulmonary disease. Ibuprofen revealed some positive effects on CF-related CRS in molecular and small cohort studies. Intranasal irrigation with saline solutions could relieve sinonasal symptoms. Nasal decongestants are not recommended. Endoscopic sinus surgery is the first-line surgical option for refractory CRS. Extensive surgical approaches should be considered as they could improve long-term outcomes in CRS. Conclusion Further studies are warranted to establish consensus for CF-related CRS therapy.
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Affiliation(s)
- Joanna Krajewska
- Department of Otolaryngology Head and Neck Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Krzysztof Zub
- Department of Otolaryngology Head and Neck Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Adam Słowikowski
- Department of Pediatric Pulmonology, Medical Center Karpacz, Karpacz, Poland
| | - Tomasz Zatoński
- Department of Otolaryngology Head and Neck Surgery, Wroclaw Medical University, Wrocław, Poland.
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3
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Friedrich RE, Scheuer HT, Kersten JF, Scheuer HA. Sphenoid Bone Pneumatisation on Lateral Cephalograms of Patients With Neurofibromatosis Type 1. In Vivo 2021; 35:349-361. [PMID: 33402484 DOI: 10.21873/invivo.12266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disease that causes tumors and many developmental disorders, e.g., cranial dysplasia. The purpose of this retrospective study was to analyse the pneumatisation of the sphenoid bone in NF1. PATIENTS AND METHODS The anonymised lateral cephalograms of 166 NF1 patients and 166 age- and sex-matched controls were examined for anterior-posterior sphenoid pneumatisation. The patient group analysis considered whether the patients had been affected by a facial plexiform neurofibroma (FPNF). RESULTS Sphenoid pneumatisation was significantly lower in NF1 patients than in controls [odds ratio (OR)=0.184; 95%CI=0.11-0.32; p<0.001]. A FPNF statistically significantly reduced sinus formation in patients (OR=0.38; p=0.002). CONCLUSION The condition 'NF1' has an effect on sphenoid pneumatisation. The findings are relevant for planning surgical procedures in this region and confirm current concepts to evaluate NF1 as a histogenesis control gene. The examination technique and basis of calculation presented here are easy-to-use and low-irradiation exposure instruments for screening for differences in sphenoid bone pneumatisation in defined populations.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany; .,Neurofibromatosis Laboratory, Hamburg, Germany
| | - Hannah T Scheuer
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany.,Neurofibromatosis Laboratory, Hamburg, Germany
| | - Jan F Kersten
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna A Scheuer
- Orthodontic Practice, Hamburg-Lokstedt, Hamburg, Germany.,Department of Orthodontics, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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4
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Magnetic Resonance Imaging Detects Chronic Rhinosinusitis in Infants and Preschool Children with Cystic Fibrosis. Ann Am Thorac Soc 2021; 17:714-723. [PMID: 32142375 DOI: 10.1513/annalsats.201910-777oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Chronic rhinosinusitis (CRS) contributes to disease burden of patients with cystic fibrosis (CF). However, its onset and progression in infants and preschool children with CF remain poorly understood.Objectives: To determine the prevalence and extent of CRS in young children with CF using magnetic resonance imaging (MRI).Methods: MRI was performed in sedation in 67 infants and preschool children with CF (mean age 2.3 ± 2.1 yr; range 0-6 yr) and 30 non-CF control subjects (3.5 ± 2.0 yr; range 0-6 yr). Paranasal sinus dimensions and structural abnormalities, including mucosal swelling; mucopyoceles; and nasal polyps of the maxillary, frontal, sphenoid, and ethmoid sinuses; and, in addition, medial maxillary sinus wall deformation, were assessed using a dedicated CRS MRI scoring system.Results: Pneumatization and dimensions of paranasal sinuses did not differ between the two groups. MRI detected an increased prevalence of mucosal swelling (83% vs. 17%; P < 0.001), mucopyoceles (75% vs. 2%; P < 0.001), polyps (26% vs. 7%; P < 0.001), and maxillary sinus wall deformation (68% vs. 2%; P < 0.001) in infants and preschool children with CF compared with age-matched control subjects. Furthermore, the extent of these abnormalities was also increased with a MRI sum score of 22.9 ± 10.9 in CF compared with 4.5 ± 7.6 in non-CF control subjects (P < 0.001).Conclusions: MRI detected normal dimensions of paranasal sinuses, and a high prevalence and severity of paranasal sinus abnormalities due to CRS in infants and preschool children with CF without radiation exposure. Our results support the development of MRI for sensitive noninvasive diagnosis and monitoring of CRS in young children with CF, and as outcome measures for clinical trials.Clinical trial registered with www.clinicaltrials.gov (NCT00760071).
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Pappa AK, Sullivan KM, Lopez EM, Adams KN, Zanation AM, Ebert CS, Thorp BD, Senior BA, Leigh MW, Knowles MR, Kimple AJ. Sinus Development and Pneumatization in a Primary Ciliary Dyskinesia Cohort. Am J Rhinol Allergy 2020; 35:72-76. [PMID: 32551925 PMCID: PMC7750665 DOI: 10.1177/1945892420933175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Primary ciliary dyskinesia (PCD) is a genetically diverse disease which
causes impaired mucociliary clearance, and results in pulmonary, otologic,
and rhinologic disease in affected patients. Genetic mutations in multiple
genes impair the ability of patients to clear mucous from the lungs, middle
ear, and sinonasal cavity and lead to chronic pulmonary and sinonasal
symptoms. Methods We identified 17 PCD patients who had available CT scans. Volumes for
bilateral maxillary, sphenoid, and frontal sinuses were calculated. A
control population of patients who had preoperative CT scans for endoscopic
endonasal resection of skull base pathology without sinonasal cavity
involvement was also identified. Results The mean age of PCD was 33 and ranged from 13 to 54 years. Patients were age-
and gender-matched to a control group that underwent resection of anterior
skull-base tumors and had a mean age of 35 that ranged between 17–53 years
old. The volumes for all thee sinus cavities were significantly smaller
(p < 0.007) compared to the control population. The average Lund-Mackay
score was 10.6 in the PCD cohort (range 6–16) in comparison to an average of
0.7 in the control cohort (range 0–2). Conclusions Overall sinus volumes were smaller in patients with PCD compared to our
control population. Future studies will be aimed at understanding defects in
sinus development as a function of specific genetic mutations in PCD
patients. Ultimately, a better understanding of the underlying
pathophysiology of PCD will allow us to identify the optimal treatment
practices for this unique patient group.
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Affiliation(s)
- Andrew K Pappa
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelli M Sullivan
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin M Lopez
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine N Adams
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Margaret W Leigh
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mike R Knowles
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Uzun L, Sagun OF, Seferoglu B, Etlik O, Mahmutyazicioglu K. The Significance of Magnetic Resonance Imaging and Computed Tomography Findings in Sphenoid Sinus Agenesis. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556131409300207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lokman Uzun
- From the Department of ORL-Head and Neck Surgery,
Goztepe Teaching and Training Hospital, Istanbul Medeniyet University, Istanbul,
Turkey
| | | | | | - Omer Etlik
- Department of Radiology, Sema Teaching and Training
Hospital, Fatih University, Istanbul
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Halderman AA, Lee S, London NR, Day A, Jain R, Moore JA, Lin SY. Impact of high- versus low-risk genotype on sinonasal radiographic disease in cystic fibrosis. Laryngoscope 2018; 129:788-793. [PMID: 30549259 DOI: 10.1002/lary.27595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Understanding of how specific mutations impact the cystic fibrosis transmembrane conductance regulator (CFTR) protein has given rise to the classification of CF patients into low-risk and high-risk genotypes. Few prior studies have investigated differences in sinonasal disease between low-risk and high-risk CF genotypes. This multi-institutional review aimed to evaluate radiographic sinus disease severity based on genotype. METHODS A review was conducted on adult patients with CF evaluated between 2005 to 2017 at three academic institutions. Data including age, gender, CFTR mutation, and presence of a maxillofacial/sinus computed tomography scan was collected. A modified Lund-Mackay score (MLMS) was assigned to each scan, and the presence of sinus aplasia or hypoplasia was determined. Patients were further grouped depending on genotype into low- or high-risk for comparison. RESULTS A total of 126 patients were included with 99 patients in the high-risk and 21 in the low-risk groups. The high-risk group had significantly higher MLMS than the low-risk group (mean 13.88 vs. 8.06, P < 0.0001, 95% CI -8.196 to -3.462) The rate of frontal (P < 0.01), maxillary (P = 0.04), and sphenoid (P < 0.001) hypoplasia/aplasia was significantly higher in high-risk patients compared to low-risk. CONCLUSION This is one of the largest studies to date evaluating the impact of CF genotype on paranasal sinus development and disease. Genotype appears to impact sinonasal disease severity and also potentially paranasal sinus cavity development to a degree, although the exact mechanism is unknown. LEVEL OF EVIDENCE 4 Laryngoscope, 129:788-793, 2019.
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Affiliation(s)
| | - Stella Lee
- Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nyall R London
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Andrew Day
- Department of Otolaryngology Head and Neck Surgery, Dallas, Texas
| | - Raksha Jain
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern, Dallas, Texas
| | - John A Moore
- Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandra Y Lin
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
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8
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Woodworth BA, Ahn C, Flume PA, Schlosser RJ. The Delta F508 Mutation in Cystic Fibrosis and Impact on Sinus Development. ACTA ACUST UNITED AC 2018; 21:122-7. [PMID: 17283574 DOI: 10.2500/ajr.2007.21.2905] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Cystic fibrosis (CF) patients often have widespread inflammatory paranasal sinus disease with an increased incidence of frontal, maxillary, and sphenoid hypoplasia. The most common genetic defect in CF is the delta F508 mutation. The effect of specific CF genotypes on phenotypic sinus development and infections is not well understood. The purpose of this study was to determine whether the homozygous delta F508 mutation is associated with an increased incidence of sinus hypoplasia when compared with other mutations. Methods This study is a retrospective review of all adult patients seen at our CF center from 1996 to 2005. Patients ≥18 years old with a CF diagnosis using genetic and sweat chloride testing and sinus CT scans were included. Frontal sinus aplasia/hypoplasia and maxillary and sphenoid sinus hypoplasia were documented using published criteria. Data collected included patient demographics, genetic mutations, and prior sinus surgeries. Results Forty-five patients were identified with an average age of 32 years (range, 18–48 years). Thirty-one patients had prior sinus surgeries. Delta F508 homozygotes (n = 25) had a significantly increased frequency of underdeveloped frontal (98%), maxillary (70%), and sphenoid (100%) sinuses (p < 0.001) when compared with other mutations (69, 8, and 50%, respectively). Conclusion CF patients homozygous for the delta F508 mutation have a greater incidence of hypoplastic or underdeveloped sinuses. Whether this is secondary to an increased frequency of sinus infections or a phenotypic expression of the genetic mutation itself remains an area for further investigation.
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Affiliation(s)
- Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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9
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Andersen TN, Darvann TA, Murakami S, Larsen P, Senda Y, Bilde A, Buchwald CV, Kreiborg S. Accuracy and precision of manual segmentation of the maxillary sinus in MR images-a method study. Br J Radiol 2018; 91:20170663. [PMID: 29419324 DOI: 10.1259/bjr.20170663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the accuracy and precision of segmentation of the maxillary sinus in MR images to evaluate the potential usefulness of this modality in longitudinal studies of sinus development. METHODS A total of 15 healthy subjects who had been both craniofacial CT and MR scanned were included and the 30 maxillary sinus volumes were evaluated using segmentation. Two of the authors did segmentation of MRI and one of these authors did double segmentation. Agreement in results between CT and MRI as well as inter- and intraexaminer errors were evaluated by statistical and three-dimensional analysis. RESULTS The intraclass correlation coefficient for volume measurements for both method error, inter- and intraexaminer agreement were > 0.9 [maximal 95% confidence interval of 0.989-0.997, p < 0.001] and the limit of agreement for all parameters were < 5.1%. Segmentation errors were quantified in terms of overlap [Dice Coefficient (DICE) > 0.9 = excellent agreement] and border distance [95% percentile Hausdorff Distance (HD) < 2 mm = acceptable agreement]. The results were replicable and not influenced by systematic errors. CONCLUSION We found a high accuracy and precision of manual segmentation of the maxillary sinus in MR images. The largest mean errors were found close to the orbit and the teeth. Advances in knowledge: MRI can be used for 3D models of the paranasal sinuses with equally good results as CT and allows longitudinal follow-up of sinus development.
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Affiliation(s)
- Tobias N Andersen
- 1 Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.,2 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet; and DTU Compute, Technical University of Copenhagen) , Copenhagen , Denmark
| | - Tron A Darvann
- 2 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet; and DTU Compute, Technical University of Copenhagen) , Copenhagen , Denmark.,3 Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Shumei Murakami
- 2 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet; and DTU Compute, Technical University of Copenhagen) , Copenhagen , Denmark.,4 Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry , Osaka , Japan
| | - Per Larsen
- 2 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet; and DTU Compute, Technical University of Copenhagen) , Copenhagen , Denmark.,4 Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry , Osaka , Japan
| | | | - Anders Bilde
- 1 Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Christian V Buchwald
- 1 Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Sven Kreiborg
- 2 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet; and DTU Compute, Technical University of Copenhagen) , Copenhagen , Denmark.,4 Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry , Osaka , Japan.,5 Department of Pediatric Dentistry and Clinical Genetics, School of Dentistry, University of Copenhagen , Copenhagen , Denmark
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10
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Malone A, Bruni M, Wong R, Tabor M, Boyev KP. Pneumatization Patterns of the Petrous Apex and Lateral Sphenoid Recess. J Neurol Surg B Skull Base 2017; 78:441-446. [PMID: 29134161 DOI: 10.1055/s-0037-1603972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/12/2017] [Indexed: 12/23/2022] Open
Abstract
Introduction The petrous apex poses a challenge for surgical intervention due to poor access. As intraoperative image guidance and surgical instrumentation improve, newer endoscopic approaches are increasingly favored. This study aims to provide normative data on the anatomy of the lateral sphenoid sinus recess and petrous apex. These normative data could assist in determining the efficacy of a transnasal transsphenoidal approach to lesions of the anteroinferior petrous apex. Methods This is a retrospective study investigating normative data on all maxillofacial computed tomography (CT) scans performed at a level I trauma center over a 6-month period. All appropriate images had the pneumatization pattern of the petrous apex and lateral recess of the sphenoid sinus reviewed by a single otologist and graded bilaterally. These were then analyzed in SPSS; Pearson correlation analyses and χ 2 test were used. Results A total of 481 patients were identified, yielding a total of 962 temporal bones and sphenoid sinuses for analysis. Eighty-eight percent of sides analyzed had a nonpneumatized lateral recess. The petrous apex was nonpneumatized in 54% of sides analyzed. There was a correlation noted between the degree of pneumatization of the petrous apex and pneumatization of the lateral recess of the sphenoid. Conclusion This study is the first to provide normative data comparing pneumatization of the petrous apex and sphenoid sinus. These data may support future work evaluating the utility of an endonasal approach to the petrous apex.
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Affiliation(s)
- Alexander Malone
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Margherita Bruni
- Department of Otolaryngology, New York Head & Neck Institute-Northwell Health, New York, New York, United States
| | - Robert Wong
- Department of Otolaryngology, Bronx Lebanon Hospital Center, Bronx, New York, United States
| | - Mark Tabor
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - K Paul Boyev
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
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11
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Nasal endoscopy and paranasal sinus computerised tomography (CT) findings in an Irish cystic fibrosis adult patient group. Eur Arch Otorhinolaryngol 2014; 272:3353-9. [DOI: 10.1007/s00405-014-3446-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
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12
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Rivas Caldas R, Boisramé S. Upper aero-digestive contamination by Pseudomonas aeruginosa and implications in Cystic Fibrosis. J Cyst Fibros 2014; 14:6-15. [PMID: 24933711 DOI: 10.1016/j.jcf.2014.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cystic Fibrosis (CF) is a severe genetic disorder that is common among the Caucasian population. Bacterial respiratory infections are the main cause of morbidity and mortality in CF patients. Pseudomonas aeruginosa is the main pathogen of lower airways (LAW) decline. METHOD To understand chronic broncho-pulmonary colonization, a systematic review is conducted. The aim of our article is to identify the pathways of contamination in the upper aero-digestive tract. RESULTS A large number of articles report that P. aeruginosa is established first at nasopharyngeal sites. The vast majority of authors agree that the upper aero-digestive tract is the first location of colonization by P. aeruginosa and its presence appears to be predictive of subsequent broncho-pulmonary colonization. CONCLUSION This review supports the possible involvement of the nasal and paranasal sinuses and oral cavity as means of contamination.
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Affiliation(s)
- R Rivas Caldas
- Laboratoire Universitaire de Biodiversité et d'Ecologie Microbienne (LUBEM-EA 3882), Université de Bretagne Occidentale, Université Européenne de Bretagne (UBO-UEB), 22 avenue C. Desmoulins, 29238 Brest Cedex, France.
| | - S Boisramé
- Département de Chirurgie Orale, Pôle Organes des Sens, Centre Hospitalier Régional Universitaire (CHRU), 5 Av. Foch, 29609 Brest Cedex, France; Laboratoire Universitaire de Biodiversité et d'Ecologie Microbienne (LUBEM-EA 3882), (UBO-UEB), 22 avenue C. Desmoulins, 29238 Brest Cedex, France; CRCM, centre de Perharidy, Route de Perharidy, 29680 Roscoff, France.
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13
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Kang SH, Piltcher OB, Dalcin PDTR. Sinonasal alterations in computed tomography scans in cystic fibrosis: a literature review of observational studies. Int Forum Allergy Rhinol 2014; 4:223-31. [PMID: 24415497 DOI: 10.1002/alr.21266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/14/2013] [Accepted: 11/19/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Almost all cystic fibrosis (CF) patients reveal upper airway involvement in computed tomography (CT) scans. Sinonasal pathology has become a challenging issue because there are few studies to guide appropriate management. The objective of this study was to provide information about paranasal sinus CT manifestations in CF patients, mainly in adulthood. METHODS We performed a literature review of descriptive studies about CT sinonasal findings in CF patients using the following databases: MEDLINE, EMBASE, Web of Science, LILACS, Scielo, and Cochrane. RESULTS Eighteen articles were included in this review. There was a high variability in methodological aspects for most of the studies. The most prevalent findings reported were opacification of sinuses, presence of frontal and sphenoidal aplasia or hypoplasia, underdevelopment of paranasal sinuses, and medial bulging of the lateral nasal wall in CT scans. CONCLUSION There are few studies in the CF adult population regarding sinonasal CT alterations. Many studies report specific pathological features in CF upper airways that could help in the diagnosis of doubtful cases.
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Affiliation(s)
- Suzie Hyeona Kang
- Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Orlandi RR, Wiggins RH. Radiological sinonasal findings in adults with cystic fibrosis. Am J Rhinol Allergy 2009; 23:307-11. [PMID: 19490807 DOI: 10.2500/ajra.2009.23.3324] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Care of cystic fibrosis (CF) patients has extended the expected survival far into adulthood. The morphological changes of adult CF patients' paranasal sinuses have not been thoroughly addressed. METHODS A retrospective review was performed of computed tomography imaging of adult CF patients at an academic medical center. Developmental changes, bone sclerosis, mucoceles, and degree of inflammation (using a modified Lund-Mackay scoring system) were assessed. RESULTS Forty-five patients were included in the study. The majority of frontal and sphenoid sinuses were either aplastic or hypoplastic. Maxillary hypoplasia was less commonly seen. Seven patients had mucoceles. Sclerosis of the sinuses was a common finding, affecting 84.4% of patients. Inflammation of the sinuses was also common, with a median modified Lund-Mackay score of 15.0 (out of a median 20 possible). CONCLUSION Poor development of the sinuses seen in pediatric CF patients persists into adulthood. Inflammation of the sinuses is a common finding. Bone sclerosis, likely caused by chronic inflammation, affects a large majority of these patients.
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Affiliation(s)
- Richard R Orlandi
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah 84132, USA.
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15
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Eggesbø HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol 2006; 16:872-88. [PMID: 16391905 DOI: 10.1007/s00330-005-0068-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 10/09/2005] [Accepted: 10/14/2005] [Indexed: 10/25/2022]
Abstract
Paranasal sinus development and pneumatisation variants are described, and rhinosinusitis and different patterns of inflammatory sinonasal diseases are reviewed. Other inflammatory sinonasal diseases, e.g., fungal sinusitis, mucocele, pyocele and sinonasal manifestations in systemic diseases, are briefly described. Computed tomography (CT) is the primary modality in diagnosing and mapping suspected inflammatory sinonasal disease. Magnetic resonance (MR) imaging is complementary to CT if fungal sinusitis, pyocele or malignancy are suspected.
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Affiliation(s)
- H B Eggesbø
- Department of Radiology, Aker University Hospital, Oslo, Norway.
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16
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Degirmenci B, Haktanir A, Acar M, Albayrak R, Yücel A. Agenesis of sphenoid sinus: three cases. Surg Radiol Anat 2005; 27:351-3. [PMID: 16200385 DOI: 10.1007/s00276-005-0336-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 04/11/2005] [Indexed: 10/25/2022]
Abstract
Paranasal sinus agenesis is an unusual clinical condition. The frontal sinus agenesis is more frequently seen, whereas agenesis of the sphenoid sinus is extremely rare. This report presents three new cases of sphenoid sinus agenesis. The absence of the sphenoid sinus was demonstrated by computed tomography (CT) in all cases.
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Affiliation(s)
- Bumin Degirmenci
- Department of Radiology, Faculty of Medicine, University of Kocatepe, Afyon, Turkey.
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17
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Abstract
A 22-year-old female patient presented to our hospital complaining of a headache. Evaluation with magnetic resonance imaging (MRI) demonstrated the absence of sphenoid sinus. Agenesis of sphenoid sinus is a rare entity; it usually occurs with syndromes. A case of sphenoid sinus agenesis without any anomaly or syndrome is reported.
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Affiliation(s)
- Ihsan Anik
- University of Kocaeli, School of Medicine, Department of Neurosurgery, Kocaeli, Turkey.
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18
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Eggesbø HB, Søvik S, Dølvik S, Eiklid K, Kolmannskog F. Proposal of a CT scoring system of the paranasal sinuses in diagnosing cystic fibrosis. Eur Radiol 2003; 13:1451-60. [PMID: 12682781 DOI: 10.1007/s00330-003-1825-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2002] [Revised: 12/03/2002] [Accepted: 12/23/2002] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to develop a paranasal sinus CT scoring system that could be used as a diagnostic tool to discriminate cystic fibrosis (CF) patients from control patients examined for sinonasal disease. The model should include as few and easily applicable criteria as possible, supported by statistical analyses and clinical judgement. We used data from 116 CF and 136 control patients. The CF patients were grouped according to the number of confirmed CF mutations: genetically verified (CF-2), or based on sweat testing and clinical findings alone (CF-1, CF-0). Nine paranasal sinus CT criteria, including development, pneumatisation variants and inflammatory patterns, were evaluated. The final model included three criteria: (a) frontal and (b) sphenoid sinus development, and (c) absence of three pneumatisation variants. This model discriminated CF-2 from controls with overlap of summed scores in only 8 of 206 patients. When this model was applied in the CF-1 and CF-0 groups, two populations seemed to exist. A larger group with summed scores overlapping that of the CF-2 group and a smaller group with summed scores overlapping that of the control group. We conclude that this CT scoring system may support, as well as exclude, a CF diagnosis in cases of diagnostic uncertainty.
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Affiliation(s)
- H B Eggesbø
- Department of Radiology, Aker University Hospital, 0514, Oslo, Norway.
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