Variations of endonasal anatomy: relevance for the endoscopic endonasal transsphenoidal approach

Contains fulltext : 87525.pdf (publisher's version ) (Closed access)BACKGROUND: The endoscopic endonasal transsphenoidal approach (EETA) to the pituitary is performed by ear, nose, and throat (ENT) surgeons in collaboration with neurosurgeons but also by neurosurgeons alone even though neurosurgeons have not been trained in rhinological surgery. PURPOSE: To register the frequency of endonasal anatomical variations and to evaluate whether these variations hinder the progress of EETA and require extra rhinological surgical skills. METHODS: A prospective cohort study of 185 consecutive patients receiving an EETA through a binostril approach was performed. All anatomical endonasal variations were noted and the relevance for the progress of surgery evaluated. RESULTS: In 48% of patients, anatomical variations were recognized, the majority of which were spinae septi and septum deviations. In 5% of patients, the planned binostril approach had to be converted into a mononostril approach; whereas in 18% of patients with an anatomical variation, a correction had to be performed. There was no difference between the ENT surgeon and the neurosurgeon performing the approach. Complications related to the endonasal phase of the surgery occurred in 3.8%. Fluoroscopy or electromagnetic navigation has been used during 6.5% of the surgeries. CONCLUSION: Although endonasal anatomical variations are frequent, they do not pose a relevant obstacle for EETA.1 juni 201

Cervical lymphadenopathy as the only manifestation of Sarcoidosis

Sarcoidosis is a chronic multisystem disorder of unknown etiology. All parts of the body can be affected but the organ most frequently affected is the lung. Otolaryngologic manifestations occur in 20% to 40% of cases of Sarcoidosis and the spectrum of lesions that may come under the purview of Otolaryngologist is broad. In this case report a patient is presented with large cervical lymphadenopathy and without other manifestation of disorder

Anatomic Variations of the Paranasal Sinuses on CT Scan Images

Statement of Problem: Variation in paranasal sinus anatomy as shown on computed tomographic scans is of potential significance for it may pose risks during surgery or predispose to certain pathologic conditions.Purpose: The aim of this study was to assess the relative frequency and concurrence of variations in paranasal sinus anatomy in a given population and to compare the results with previous investigations conducted on different populations.Materials and Methods: All patients over 16 years of age referred to Valiasr hospital,Tehran, Iran, with paranasal sinus tomographic scans and a clinical diagnosis of chronic sinusitis were considered for this study. After excluding those with altered anatomy(iatrogenic or pathologic), scans of unaltered patients were meticulously analyzed for variations in sinus anatomy. Findings were recorded on the patient’s data sheet. The distance between the maxillary sinus floor and the alveolar ridge at the level of the 1stmolar was recorded. All findings were analyzed, and tested with Chi square, where applicable.Results: Overall 143 patients were analyzed (48.3% male and 51.7% female). The frequency of major sinus variations was: Agger nasi cell in 56.7%, Haller cell in 3.5%,Onodi cell in 7%, nasal septal deviation in 63%, Concha bullosa in 35%, and dental anomalies in 4.9% of the studied cases. The distance between the upper alveolar ridge and maxillary sinus floor was 0-30mm (mean 12.16) on the right, and 0-52mm (mean 12.20) on the left.Conclusion: The frequency of anatomic variations in sinus anatomy may be related to race and heredity. A lower number of cases in addition to the use of low yield imaging may explain the discrepancies observed between our results and other investigations.The findings of the present study were based on computed tomography