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Anatomic Variations of the Nose and Paranasal Sinuses in Saudi Population
234 Original article Anatomic variations of the nose and paranasal sinuses in saudi population: computed tomography scan analysis Nada Alshaikha, Amirah Aldhuraisb aDepartment of Otolaryngology Head & Neck Background Surgery, Rhinology Unit, Dammam Medical Knowledge of the anatomy constitutes an integral part in the total management of Complex (DMC), bDepartment of ENT, King Fahad Specialist Hospital (KFSH), Dammam, patients with sinonasal diseases. The aim of this study was to obtain the prevalence Saudi Arabia of sinonasal anatomic variations in Saudi population and to understand their importance and impact on the disease process, as well as their influence on Correspondence to Nada Alshaikh, MD, Department of Otorhinolaryngology Head and surgical management and outcome. Neck Surgery, Dammam Medical Complex, Materials and methods Dammam - 31414, Saudi Arabia This study is prospective review of retrospectively performed normal computed e-mail: [email protected] tomography (CT) scans of the nose and paranasal sinuses in adult Saudi Received 13 November 2016 population at Dammam Medical Complex. The scans were reviewed by two Accepted 23 December 2016 independent observers. The Egyptian Journal of Otolaryngology Results 2018, 34:234–241 Of all CT scans that were reviewed, 48.4% were of female patients and 51.6% were of male patients. The mean age of the study sample was 38.5±26.5 years. The most common anatomic variation after excluding agger nasi cell was pneumatized crista galli, which was seen in 73% of the scans. However, the least common variation seen in this series was hypoplasia of the maxillary sinus, which was encountered in 5% of the cases. We did not detect a single pneumatized inferior turbinate among the studied scans. -
Surgical Management of Nasal Airway Obstruction
Surgical Management of Nasal Airway Obstruction John F. Teichgraeber, MDa, Ronald P. Gruber, MDb, Neil Tanna, MD, MBAc,* KEYWORDS Nasal obstruction Nasal breathing Septal deviation Nasal valve narrowing Turbinate hypertrophy KEY POINTS The management and diagnosis of nasal airway obstruction requires an understanding of the form and function of the nose. Nasal airway obstruction can be structural, physiologic, or a combination of both. Anatomic causes of airway obstruction include septal deviation, internal nasal valve narrowing, external nasal valve collapse, and inferior turbinate hypertrophy. Thus, the management of nasal air obstruction must be selective and carefully considered. The goal of surgery is to address the deformity and not just enlarge the nasal cavity. INTRODUCTION vomer, and maxillary crest. The narrowest portion of the nose is the internal nasal valve (10–15), The management and diagnosis of nasal airway which is formed by the septum, the inferior turbi- obstruction requires an understanding of the nate, and the upper lateral cartilage. Short nasal form and function of the nose. Nasal airway bones, a narrow midnasal fold, and malposition obstruction can be structural, physiologic, or a of the alar cartilages all predispose patients to in- combination of both. Thus, the management of ternal valve incompetence. nasal airway obstruction must be selective and The lateral wall of the nose contains 3 to 4 turbi- often involves medical management. The goal of nates (inferior, middle, superior, supreme) and the surgery is to address the deformity and not just corresponding meatuses that drain the paranasal enlarge the nasal cavity. This article reviews airway sinuses. The nasolacrimal duct drains through obstruction and its treatment. -
Macroscopic Anatomy of the Nasal Cavity and Paranasal Sinuses of the Domestic Pig (Sus Scrofa Domestica) Daniel John Hillmann Iowa State University
Iowa State University Capstones, Theses and Retrospective Theses and Dissertations Dissertations 1971 Macroscopic anatomy of the nasal cavity and paranasal sinuses of the domestic pig (Sus scrofa domestica) Daniel John Hillmann Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the Animal Structures Commons, and the Veterinary Anatomy Commons Recommended Citation Hillmann, Daniel John, "Macroscopic anatomy of the nasal cavity and paranasal sinuses of the domestic pig (Sus scrofa domestica)" (1971). Retrospective Theses and Dissertations. 4460. https://lib.dr.iastate.edu/rtd/4460 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Retrospective Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. 72-5208 HILLMANN, Daniel John, 1938- MACROSCOPIC ANATOMY OF THE NASAL CAVITY AND PARANASAL SINUSES OF THE DOMESTIC PIG (SUS SCROFA DOMESTICA). Iowa State University, Ph.D., 1971 Anatomy I University Microfilms, A XEROX Company, Ann Arbor. Michigan I , THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED Macroscopic anatomy of the nasal cavity and paranasal sinuses of the domestic pig (Sus scrofa domestica) by Daniel John Hillmann A Dissertation Submitted to the Graduate Faculty in Partial Fulfillment of The Requirements for the Degree of DOCTOR OF PHILOSOPHY Major Subject: Veterinary Anatomy Approved: Signature was redacted for privacy. h Charge of -^lajoï^ Wor Signature was redacted for privacy. For/the Major Department For the Graduate College Iowa State University Ames/ Iowa 19 71 PLEASE NOTE: Some Pages have indistinct print. -
Anatomy, Physiology, and General Concepts in Nasal Reconstruction
Anatomy, Physiology, and General Concepts in Nasal Reconstruction Jason D. Bloom, MDa, Marcelo B. Antunes, MDb, Daniel G. Becker, MDb,* KEYWORDS Nasal reconstruction Nasal anatomy Skin physiology Wound healing Facial lines ANATOMY, PHYSIOLOGY, AND GENERAL originally determined the nasal subunits when CONCEPTS IN NASAL RECONSTRUCTION described by Gonzalez-Ulloa and colleagues.2 The thickest area is the caudal portion of the nose, Nasal reconstruction has made great strides in the on the nasal tip and ala, with its skin rich in seba- last 50 years. Nasal reconstructive surgeons have ceous glands. This nasal skin progressively gets gotten away from the idea of “filling the hole” and thinner until it reaches the rhinion, where it is the now have multiple options, which enable them to thinnest,3 and again as it transitions from the tip to achieve an aesthetically pleasing nose and good the columella and the alar rim.4,5 functional results.1 As the central and often the most noticeable feature of the face, the nose is Soft-tissue envelope also one of the most difficult to reconstruct. Nasal The soft-tissue envelope is composed of 4 layers: reconstruction requires a thorough understanding the superficial fatty layer, the fibromuscular of this complex, 3-dimensional structural and layer, the deep fatty layer, and the perichondrial/ topographic anatomy. Also, key to this type of periosteal layer.4 The superficial fatty layer is inti- surgery is the relationship of the nose to the mately connected to the dermis. Immediately surrounding tissues of the face and how these deep to this layer is the fibromuscular layer. -
Anatomy, Histology, and Embryology
ANATOMY, HISTOLOGY, 1 AND EMBRYOLOGY An understanding of the anatomic divisions composed of the vomer. This bone extends from of the head and neck, as well as their associ- the region of the sphenoid sinus posteriorly and ated normal histologic features, is of consider- superiorly, to the anterior edge of the hard pal- able importance when approaching head and ate. Superior to the vomer, the septum is formed neck pathology. The large number of disease by the perpendicular plate of the ethmoid processes that involve the head and neck area bone. The most anterior portion of the septum is a reflection of the many specialized tissues is septal cartilage, which articulates with both that are present and at risk for specific diseases. the vomer and the ethmoidal plate. Many neoplasms show a sharp predilection for The supporting structure of the lateral border this specific anatomic location, almost never of the nasal cavity is complex. Portions of the occurring elsewhere. An understanding of the nasal, ethmoid, and sphenoid bones contrib- location of normal olfactory mucosa allows ute to its formation. The lateral nasal wall is visualization of the sites of olfactory neuro- distinguished from the smooth surface of the blastoma; the boundaries of the nasopharynx nasal septum by its “scroll-shaped” superior, and its distinction from the nasal cavity mark middle, and inferior turbinates. The small su- the interface of endodermally and ectodermally perior turbinate and larger middle turbinate are derived tissues, a critical watershed in neoplasm distribution. Angiofibromas and so-called lym- phoepitheliomas, for example, almost exclu- sively arise on the nasopharyngeal side of this line, whereas schneiderian papillomas, lobular capillary hemangiomas, and sinonasal intesti- nal-type adenocarcinomas almost entirely arise anterior to the line, in the nasal cavity. -
Surgical Interventions for Inferior Turbinate Hypertrophy: a Comprehensive Review of Current Techniques and Technologies
International Journal of Environmental Research and Public Health Review Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and Technologies Baharudin Abdullah * and Sharanjeet Singh Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; [email protected] * Correspondence: [email protected] Abstract: Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of the inferior turbinate is to relieve the obstruction while preserving the function of the turbinate. There have been a variety of surgical techniques described and performed over the years. Irrespective of the techniques and technologies employed, the surgical techniques are classified into two types, the mucosal-sparing and non-mucosal-sparing, based on the preservation of the medial mucosa of the inferior turbinates. Although effective in relieving nasal block, the non-mucosal-sparing techniques have been associated with postoperative complications such as excessive bleeding, crusting, pain, and prolonged recovery period. These complications are avoided in the mucosal-sparing approach, rendering it the preferred option. Although widely performed, there is significant confusion and detachment between current practices and their basic objectives. This conflict may be explained by misperception over the myriad Citation: Abdullah, B.; Singh, S. Surgical Interventions for Inferior of available surgical techniques and misconception of the rationale in performing the turbinate Turbinate Hypertrophy: A reduction. A comprehensive review of each surgical intervention is crucial to better define each Comprehensive Review of Current procedure and improve understanding of the principle and mechanism involved. -
Radiographic Evaluation of the Nasal Cavity, Paranasal Sinuses and Nasopharynx for Sleep-Disordered Breathing
RADIOGRAPHIC EVALUATION OF THE NASAL CAVITY, PARANASAL SINUSES AND NASOPHARYNX FOR SLEEP-DISORDERED BREATHING Dania Tamimi, BDS, DMSc Diplomate, American Board of Oral and Maxillofacial Radiology ROLE OF CBCT • To discover the anatomic truth DISCOVER FACTORS THAT • Lead to Abnormal Upper Airway Anatomy • Increase Resistance • Cause Turbulent or Laminar Air Flow • Increase Collapsibility • Airway lumen • Soft tissue component • Osseous component CHECKLIST – EVALUATE FOR • Nasal obstruction • Sinus pathology • Nasopharynx pathology • Oropharyngeal morphologic predisposing factors and pathology • Maxillary and mandible morphologic predisposing factors • TMJs • Hyoid bone position • Evaluate for Head position (false positive or negative) • C-spine for pathology • Cranial base CHECKLIST – EVALUATE FOR • Nasal obstruction • Sinus pathology • Nasopharynx pathology • Oropharyngeal morphologic predisposing factors and pathology • Maxillary and mandible morphologic predisposing factors • TMJs • Hyoid bone position • Evaluate for Head position (false positive or negative) • C-spine for pathology • Cranial base NASAL CAVITY AND SINUSES • Patency of external and internal nasal valves • Morphology of nasal septum • Morphology and symmetry of turbinates • Patency of sinus drainage pathways • Presence of sinonasal pathology THE NOSE HAS THREE MAJOR FUNCTIONS 1. Breathing 2. Olfaction 3. Conditioning the air THE NASAL VALVE • Turbulence distributes the air in the nasal fossa for conditioning and olfaction. • When there is stenosis of the nasal valve, -
Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: a Clinicopathologic and Immunophenotypic Study of 86 Cases
Head and Neck Pathol DOI 10.1007/s12105-013-0487-3 ORIGINAL RESEARCH Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: A Clinicopathologic and Immunophenotypic Study of 86 Cases Lester D. R. Thompson • Carla Penner • Ngoc J. Ho • Robert D. Foss • Markku Miettinen • Jacqueline A. Wieneke • Christopher A. Moskaluk • Edward B. Stelow Received: 14 July 2013 / Accepted: 23 August 2013 Ó Springer Science+Business Media New York (outside the USA) 2013 Abstract ‘Primary sinonasal tract and nasopharyngeal (n = 44), with a mean size of 3.7 cm. Patients presented adenoid cystic carcinomas (STACC) are uncommon equally between low and high stage disease: stage I and II tumors that are frequently misclassified, resulting in inap- (n = 42) or stage III and IV (n = 44) disease. Histologi- propriate clinical management. Eighty-six cases of STACC cally, the tumors were invasive (bone: n = 66; neural: included 45 females and 41 males, aged 12–91 years (mean n = 47; lymphovascular: n = 33), composed of a variety 54.4 years). Patients presented most frequently with of growth patterns, including cribriform (n = 33), tubular obstructive symptoms (n = 54), followed by epistaxis (n = 16), and solid (n = 9), although frequently a com- (n = 23), auditory symptoms (n = 12), nerve symptoms bination of these patterns was seen within a single tumor. (n = 11), nasal discharge (n = 11), and/or visual symp- Pleomorphism was mild with an intermediate N:C ratio in toms (n = 10), present for a mean of 18.2 months. The cells containing hyperchromatic nuclei. Reduplicated tumors involved the nasal cavity alone (n = 25), naso- basement membrane and glycosaminoglycan material was pharynx alone (n = 13), maxillary sinus alone (n = 4), or commonly seen. -
Anatomy and Physiology of the Nose and Paranasal Sinuses
Anatomy and Physiology of the Nose and Paranasal Sinuses PD Dr. med. Basile N. Landis Unité de Rhinologie-Olfactologie Service d’Oto-Rhino-Laryngologie et de Chirurgie cervico- faciale, Hôpitaux Universitaires de Genève, Suisse Anatomy External Nose Large Nose Thin Nose Huizing, de Groot, Functional reconstructive nasal surgery, 2003, Georg Thieme Verlag Anatomy External Nose Numerous anatomical variations! Huizing, de Groot, Functional reconstructive nasal surgery, 2003, Georg Thieme Verlag Anatomy External Nose 3 Parts: Huizing, de Groot, Functional reconstructive nasal surgery, 2003, Georg Thieme Verlag Anatomy External Nose Anatomy External Nose Anatomy External Nose Innervation V1 V1 GG V2 V2 V3 V3 Trigeminal nerve Anatomy External Nose Blood Supply Prometheus, Springer Verlag Anatomy Blood Supply – Anastomoses ! Prometheus, Springer Verlag Furuncle of the nose Cause: • Skin infection of the nasal vestibule / tip of the nose. Usually due to hair follicle Symptoms: • Swelling, Pain, Redness Danger: • Septic emboli via the angular vein / cavernous sinus drainage. Risk of cavernous sinus thrombosis Treatement: • Antibiotics i.v.; Rest; Incision-Drainage Cavernous sinus thrombosis Diagnostics: • MRI Cause: • Infection of region drained by the venous Treatement: system reaching the cavernous sinus. • Surgery of the infectious focus • Propagation of an infection by contiguity • AB i.v. (sphenoid sinus) • Steroids (controversy) Symptoms: • Anticoagulation • Fever, Headache, Neurological deficits VERY HIGH morbidity and mortality !!! Anatomy -
The Nasal Cycle: a Comprehensive Review*
REVIEW The nasal cycle: a comprehensive review* 1 2 1 Alfonso Luca Pendolino , Valerie J. Lund , Ennio Nardello , Rhinology Online, Vol 1: 67-76, 2018 1 Giancarlo Ottaviano http://doi.org/10.4193/RHINOL/18.021 1 Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy *Received for publication: 2 Ear Institute, University College London, London, United Kingdom May 7, 2018 Accepted: June 5, 2018 Abstract Background: The nasal cycle is the spontaneous, reciprocal congestion and decongestion of the nasal mucosa during the day and it is present in almost 70-80% of healthy adults. The German physician Richard Kayser first described it in 1895. Since then, the number of papers focused on this fascinating issue has continued to flourish. Main body: Even though there are a high number of publications on this topic, the understanding of nasal cycle is still very poor. The present review tries to offer a comprehensive analysis of this issue investigating all the physiologic and pathologic conditions able to modify the nasal cycle. A section of methods used for its evaluation has been also included in this review. Conclusion: The influence of the nasal cycle on nasal airflow must be considered during any rhinologic evaluation, especially if investigating the need for septal/turbinates surgery, rather than nasal medical therapy alone. The nasal cycle is a normal pheno- menon and must be recognized in order to differentiate it from the pathologic causes of nasal obstruction. Key words: nasal cycle, nasal patency, nasal airflow, nasal mucosa, pattern, congestion, decongestion Introduction characteristics is not fulfilled(7). This paper presents a review of The nasal cycle (NC) is the spontaneous congestion and decon- the literature with the aim to offer an organized presentation gestion of the nasal mucosa during the day, where congestion issue. -
Functional Results in Airflow Improvement Using A
Braz J Otorhinolaryngol. 2018;84(2):166---172 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE Functional results in airflow improvement using a ଝ ‘‘flip-flap’’ alar technique: our experience a,∗ b Arianna Di Stadio , Carlo Macro a University La Sapienza, Rome, Italy b Ospedale San Camillo-Forlanini, Dipartimento Chirurgia Maxillo-Facciale, Rome, Italy Received 24 November 2016; accepted 17 January 2017 Available online 21 February 2017 KEYWORDS Abstract Introduction: Pinched nasal point can be arising as congenital malformation or as results of Alar cartilage; unsuccessfully surgery. The nasal valve alteration due to this problem is not only an esthetic Nose point; Surgery; problem but also a functional one because can modify the nasal airflow. Several surgical tech- Rhinomanometry; niques were proposed in literature, we proposed our. Objective: The purpose of the study is the evaluation of nose airway flow using our flip-flap Functional esthetic technique for correction of pinched nasal tip. Methods: This is a retrospective study conducted on twelve patients. Tip cartilages were remod- eled by means of autologous alar cartilage grafting. The patients underwent a rhinomanometry pre and post-surgery to evaluate the results, and they performed a self-survey to evaluate their degree of satisfaction in term of airflow sensation improvement. Results: Rhinomanometry showed improved nasal air flow (range from 25% to 75%) in all patients. No significant differences were showed between unilateral and bilateral alar mal- formation (p = 0.49). Patient’s satisfaction reached the 87.5%. Conclusion: Our analysis on the combined results (rhinomanometry and surveys) showed that this technique leads to improvement of nasal flow in patients affected by pinched nasal tip in all cases. -
Surgical Anatomy of the Paranasal Sinus M
13674_C01.qxd 7/28/04 2:14 PM Page 1 1 Surgical Anatomy of the Paranasal Sinus M. PAIS CLEMENTE The paranasal sinus region is one of the most complex This chapter is divided into three sections: develop- areas of the human body and is consequently very diffi- mental anatomy, macroscopic anatomy, and endoscopic cult to study. The surgical anatomy of the nose and anatomy. A basic understanding of the embryogenesis of paranasal sinuses is published with great detail in most the nose and the paranasal sinuses facilitates compre- standard textbooks, but it is the purpose of this chapter hension of the complex and variable adult anatomy. In to describe those structures in a very clear and systematic addition, this comprehension is quite useful for an accu- presentation focused for the endoscopic sinus surgeon. rate evaluation of the various potential pathologies and A thorough knowledge of all anatomical structures their managements. Macroscopic description of the and variations combined with cadaveric dissections using nose and paranasal sinuses is presented through a dis- paranasal blocks is of utmost importance to perform cussion of the important structures of this complicated proper sinus surgery and to avoid complications. The region. A correlation with intricate endoscopic topo- complications seen with this surgery are commonly due graphical anatomy is discussed for a clear understanding to nonfamiliarity with the anatomical landmarks of the of the nasal cavity and its relationship to adjoining si- paranasal sinus during surgical dissection, which is con- nuses and danger areas. A three-dimensional anatomy is sequently performed beyond the safe limits of the sinus.