RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
SYNOPSIS FOR REGISTERATION OF SUBJECT FOR DISSERTATION
CT EVALUATION OF CONGENITAL ANATOMICAL VARIATIONS IN PARANASAL SINUSES
DR.SURESH S.KANAMADI PG IN RADIODIAGNOSIS AL-AMEEN MEDICAL COLLEGE BIJAPUR
1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
1 Name of the candidate DR.SURESH S. KANAMADI And PG IN RADIODIAGNOSIS, Address DEPARTMENT OF RADIOLOGY, (In block letters) AL-AMEEN MEDICAL COLLEGE, BIJAPUR 2. Name of the Institution AL-AMEEN MEDICAL COLLEGE, BIJAPUR, KARNATAKA. 3 Course of study and subject M.D. RADIODIAGNOSIS 4 Date of admission to course MAY 2010. 5 Title of the Topic CT EVALUATION OF CONGENITAL ANATOMICAL VARIATIONS IN PARANASAL SINUSES
6 Brief resume of the intended work: 6.1 Need for the study VIDE ANNEXURE – I 6.2 Review of literature VIDE ANNEXURE – II 6.3 Objectives of the study VIDE ANNEXURE – III 7 Material and methods 7.1 Source of data VIDE ANNEXURE – IV 7.2 Method of collection of VIDE ANNEXURE – IV data( including sampling procedure if any) 7.3 Does the study require any VIDE ANNEXURE – V investigations or interventions to be conducted on patients, humans or animals? If so please describe briefly. 7.4 Has ethical clearance been obtained from your institution VIDE ANNEXURE – VI in case of 7.3. 7.5 Patient’s Consent Form VIDE ANNEXURE – VII 8 List of References (About 4-6) VIDE ANNEXURE – VIII 9 Signature of candidate
10 Remarks of the guide TO ASSESS VARIOUS CONGENITAL ANATOMICAL VARIATIONS IN CT PARANASAL SINUSES AND THEIR SIGNIFICANCE IN NASAL PATHOLOGY
2 11 Name & Designation(In block letters) 11.1 Guide DR.ANIL GOVIND JOSHI MD. RADIODIAGNOSIS PROFESSOR, DEPARTMENT OF RADIOLOGY, AL-AMEEN MEDICAL COLLEGE, BIJAPUR
11.2 Signature
11.3 Co-Guide
11.4 Signature
11.5 Head of the Department DR.MUNEER AHMED MD. RADIODIAGNOSIS PROFESSOR AND HEAD DEPARTMENT OF RADIOLOGY, AL-AMEEN MEDICAL COLLEGE, BIJAPUR
11.6 Signature
12 12.1 Remarks of the chairman & Principal
12.2 Signature
3 ANNEXURE – I
BRIEF RESUME OF THE INTENDED WORK :-
6.1 NEED FOR THE STUDY :-
Variations in paranasal sinus anatomy are common. Some of these variations predispose to certain pathologic conditions. These variants may impair airflow by producing areas of narrowing or total obstruction or predispose to repeated attacks of sinusitis. Eventually they can lead to intraorbital or intracranial complications with advent of FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS). The CT PNS is a roadway map for preoperative assessment and surgical planning. This helps in diagnosing and to avoid the potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in preoperative evaluation.1
The paranasal CT – scan is used for examining the patients with sinusitis and its complications, because of the normal variations of Paranasal sinuses that have a constant role in etiology of the chronic and recurrent sinusitis. Also there are anatomic variations in CT-scan of patients that do not have any sinusitis clinical symptoms. The purpose of this study was to know the normal variations prevalence both generally and also considering male and female cases separately.2
Hence the present study has been under taken as a dissertation topic i.e. “CT
EVALUATION OF CONGENITAL ANATOMICAL VARIATION IN
PARANASAL SINUS” in Al-Ameen Medical College & District Hospital, Bijapur.
4 ANNEXURE – II
6.2 REVIEW OF LITERATURE:-
In a study conducted on 292 patients with the age group of 15-50years for evaluating the anatomic variations and their prevalence, they did not have any pathology in their sinuses. According to the results, the septal deviation (34.24%) was the most common and normal variation and the other cases were sequentially as follow : 1) Agger Nasi cell (36.22%), 2) Concha bullosa (15.90%), 3) Hypo plastic from sinus (6.24), 4) Aerated Septum (2.62%), 5) Haller cell (1.41%), 6) Onodi cell
(0.40%).2
Headache due to the pressure of nasal mucosa in the absence of inflammation of the nose and paranasal sinuses is a clinical entity that has gained wide acceptance.
Concha bullosa is the most commonly observed anatomical variation of the lateral nasal wall.3
Although the nasal anatomy presents many differences among individuals, certain anatomical variations are usually observed in the general population and most frequently are seen in patients presenting chronic inflammatory conditions. The relevance of a particular anatomical variation is determined by its relationship with the ostiomeatal channels and the nasal passages.4
In a CT evaluation study conducted on 200 patients for clinical suspicion of sinupathy, conclusion arrived is that the prevalence of anatomical variants in the ostiomeatal complex is high, the most frequent ones are involving the middle turbinate and the nasal septum.5
5 Congenital arhinia is an extremely rare anomaly consisting of an absence of external nasal structures and nasal passages. Fewer than 30 cases have been reported.
Patients with a familial absence of the nose have been reported, but the effects of genetic and maternal factors are unknown. Midface hypoplasia may accompany arhinia. Accompanying malformations are thought to be caused by an absent of rudimentary nose.6
In a study conducted on 143 patients over 16 years of age referred to valiasr hospital, Tehran, Iran, with paranasal sinus tomographic scans and a clinical diagnosis of chronic sinusitis, results shown that the frequency of anatomic variations in sinus anatomy may be related to race and heredity. Overall 143 patients were analyzed
(48.30% male and 51.70% female). The frequency of major sinus variations was:
Agger nasi cell in 56.70%, Haller cell in 3.50%, Onodi cell in 7%, nasal septal deviation in 63%, Concha bullosa in 35%, and dental anomalies in 4.90% of the studied cases.7
ANNEXURE-III
6.3 OBJECTIVES OF THE STUDY:
To study the congenital and anatomical variations in CT paranasal sinuses
and their significance in the development of nasal and sinus pathology.
6 7 ANNEXURE-IV
7. MATERIAL AND METHODS
7.1 SOURCE OF DATA:
The cases will be recruited from Al-Ameen Medical College Hospital, Bijapur and
Govt. District Hospital, Bijapur. Patients referred to Department of Radiology, Al-
Ameen Medical College with symptoms related to nose and paranasal sinuses (with clinical diagnosis of acute / chronic sinusitis).
INCLUSION CRITERIA.
Patients came with a history of recurrent sinus complaints and complications related to sinusitis.
EXCLUSION CRITERIA.
Known cases of Facial bone trauma and malignancies of Paranasal Sinuses.
SAMPLE SIZE:
It’s a one and half year study from January 2011 to July 2012. The total number of subjects will be those referred to Department of Radiology.
7.2 METHOD OF COLLECTION OF DATA:
1. Details of the study protocol will be explained to the subjects.
2. Informed consent will be obtained (After clearance from ethical committee).
3. The patients were subjected to Axial / Coronal sections, plain / contrast (to
assess extension of inflammation and exact extension of inflammatory lesions
into intra-orbital or intra-cranial cavities).
8 ANNEXURE-V
7.3 Does the study require any investigations or interventions to be conducted on patients, humans or animals? If so please describe briefly.
NO
9 ANNEXURE-VI
ETHICAL COMMITTEE
AL-AMEEN MEDICAL COLLEGE, BIJAPUR
The following study entitled “CT evaluation of congenital anatomical variations in paranasal sinuses” by Dr Suresh S. Kanamadi
P.G. student in Department of Radio-Diagnosis belonging to 2010- 2011 batch has been cleared from ethical committee of this institution for the purpose of dissertation work.
Chairman Ethical committee Al-Ameen Medical College, Bijapur
10 ANNEXURE-VII AL-AMEEN MEDICAL COLLEGE BIJAPUR CONSENT FORM Patient’s statement
I voluntarily accept admission to the Department of Radio-Diagnosis for the performance of the studies. The nature, demands and hazards involved in these studies have been fully explained to me. I understand that I may withdraw from these studies at any time for any reason. I confirm that I have passed my eighteenth birthday, the required minimum age necessary to take part in an adult research study.
I consent to the release of scientific data resulting from my participation in this study to the Principal Investigator for use by him/her for scientific purposes. The principal Investigator assures my anonymity. I understand that the record of this experiment becomes part of my medical record and is protected as a confidential document. I understand that this record will only be available to physicians and investigators involved with this study. Other staff may be authorized by the Head to review the record for administrative purposes or for monitoring the quality of patient care.
In the unlikely event of physical injury resulting from participation in this research, I understand that medical treatment will be available from the AMC hospital, including first aid, emergency treatment and follow–up care as needed. However, no compensation can be provided for medical care apart from the foregoing. I further understand that making such medical treatment available, or providing it, does not imply that such injury is the fault of the investigator(s). I also understand that by my participation in this study I am not waiving any of my legal rights. I understand that in the case of any problem I can contact Dr.Anil Govind Joshi, of the Dept of Radio- Diagnosis or any member of the Institutional Ethical Review Board, AMC Bijapur.
Date: ------Signature: ------Witness: ------Name: ------Physician’s Statement: I have carefully explained the nature, demands and foreseeable risks of the above studies to the patient. Date: ------Signature: ------
11 ANNEXURE – VIII
LIST OF REFERENCES :
1. Mecit Kantarci, R.Murat Karasen, Fatih Alper, et al. Remarkable
Anatomic Variations in Paranasal Sinus region and their clinical
importance. European Journal of Radiology, June 2004, Volume 50, Issue
3, 296-302.
2. Mohammad Hosein Daghighi. Amir Daryani. Evalautionof anatomic
variations of paranasal sinuses. The Internet Journal of
OtorhinolaryngologyTM ISSN:1528-8420.
3. A Peric, N Baletic, and J Sotirovic. A case of an uncommon anatomic
variation of the middle turbinate associated with headache. Acta
Otorhinolaryngol Ital. 2010 June ; 30 (3) : 156-159.
4. Ricardo Pires de Souza, Joel Pinheiro de Brito Junior, Olger de Souza
Tornin et al. Sinonasal complex : radiological anatomy. Radiol Bras
Vol.39 No.5 Sao Paulo Sept. / Oct. 2006.
5. Anna Patricia de Freitas Linhares Riello ; Edson Mendes Boasquevisque.
Anatomical variants of the ostiomeatal complex : tomographic findings in
200 patients. Radiol Bras Vol.41, No.3 Sao Paulo May / June 2008.
6. Guzin Akkuzu, Babur Akkuzu, Erdinc Aydin et al. Congenital partial
arhinia : a case report. J Med Case Reports. 2007 ; 1 : 97.
12 7. A.R. Talaiepour, AA. Sazgar, A. Bagheri. Anatomic variations of the
paranasal sinuses on CT scan images. Journal of dentistry Tehran
University of Medical Science, Tehran, Iran 2005 ; Vol: 2, No. 4.
13 PROFORMA
Case No.: IP No.:
Name: Occupation:
Age:
Address:
A. PRESENTING COMPLAINTS AND DURATION:
B. PAST HISTORY:
1. H/O similar complaints in the past
2. H/O previous surgery.
3. H/O T.B/DM/Hypertension.
C. FAMILY HISTORY:
D. CLINICAL EXAMINATION FINDINGS OF ENT:
E. INVESTIGATIONS
(a) Blood: Hb%: TC: DC:
ESR: BT: CT:
(b)Urine: Albumin : Sugar : Micro :
14 F. RADIOLOGICAL INVESTIGATIONS:
1. X-Ray Mastoid Right / Left
2. X-Ray PNS.
3. X-Ray Chest PA View.
4. CT Scan (Axial / Coronal)
G. OTHERS:
1. FESS / Operative Findings (IF DONE):
H. CLINICAL FOLLOW-UP:
15