Severe Hypoplasia of Paranasal Sinuses and Turbinates.

This case report describes a patient in their 40s with a history of bronchiectasis, azoospermia, and epididymal cysts who presented with bilateral nasal obstruction.

Rhinogenic and sinus headache - Literature review.

BACKGROUND: Headache is a common, yet challenging symptom to evaluate given its wide range of clinical presentations and different etiologies. For centuries, conceptual understanding of headache causation has been attributed to anatomic abnormalities of the nose and paranasal sinuses. METHODS: Structured literature review. RESULTS: The number of cases, categorized as migraines or other primary headaches, misdiagnosed as a "sinus headache" is high in the literature, ranging from 50 to 80%. The potential mechanisms for rhinogenic headaches were classically described as pain secondary to prolonged mucosal contact points, hypoxia in the paranasal sinuses secondary to poor ventilation, or pressure caused by the growth of nasal polyps. Additionally, other mechanisms were described and are still being studied. Corrective surgery for mucosal contact points in the nasal cavity is deemed necessary for relieving the headache, although patient outcomes are variable. CONCLUSION: Delay in proper diagnosis and treatment negatively impact patient quality of life. Most cases of "sinus headache" or "rhinogenic headache" seen in clinical practice are in fact misdiagnosed as either primary headaches or migraines. Because of increased misdiagnoses, Otolaryngologists should establish a direct and precise diagnosis congruent with a chief complaint being a headache. Vital information such as a good clinical history, well-performed nasal endoscopy, and occasional CT scan may decrease misdiagnosis probability.

Morphological, anatomical, radiological and clinical features of Mladina type 6 nasal septum deformations in humans.

PURPOSE: The objective of this study was to prove the higher frequency of the type 6 deformations overall compared to the results obtained by conventional diagnostic methods, such as computed tomography images and clinical examination. METHODS: The study was performed at the Institute of Anatomy, where a total of 114 randomly selected skulls were examined. The skulls were then scanned in a fixed position using the cone-beam technique (CBCT). The literature epidemiological data of the clinical incidence of type 6 in studies that also used Mladina classification were obtained. RESULTS: There was a statistically significant difference (p < 0.0001) in the frequency of type 6 deformation as diagnosed by visual inspection (22.8%) and computed tomography (7.9%). The frequency obtained by CT imaging amounted 7.9% and was almost the same as the results obtained by a clinical examination which varied between 9 and 11%. CONCLUSIONS: The frequency of type 6 nasal septal deformation is higher by visual inspection of the skulls than by computed tomography imaging at a level of significance of 0.05. The incidence of type 6 findings on coronal CT images of paranasal sinuses is approximately the same as that found with anterior rhinoscopy. Type 6, visible or concealed; probably have one-fourth to one-fifth people in population, so the number of clinically overlooked and/or unrecognized types 6 is much greater than we thought it to be.

A 16-Year Study on Incidence and Progression of Diseased Sphenoethmoidal (Onodi) Cell.

Traumatic operative injury of the optic nerve in an endoscopic sinus surgery may cause immediate or delayed blindness. It should be cautioned when operating in a sphenoethmoidal cell, or known as Onodi cell, with contact or bulge of the optic canal. It remains unclear how frequent progression to visual loss occurs and how long it progresses to visual loss because of a diseased sphenoethmoidal cell. Research to discuss these questions is expected to help decision making to treat diseased sphenoethmoidal cells. From July 2001 to June 2017, 216 patients received conservative endoscopic sinus surgery without opening a diseased sphenoethmoidal cell. We used their computed tomography images of paranasal sinuses to identify diseased sphenoethmoidal cells that could be associated with progression to visual loss. Among the 216 patients, 52.3% had at least one sphenoethmoidal cell, and 14.8% developed at least one diseased sphenoethmoidal cell. One patient developed acute visual loss 4412 days after the first computed tomography. Our results show that over half of the patients have a sphenoethmoidal cell but suggest a rare incidence of a diseased sphenoethmoidal cell progressing to visual loss during the follow-up period.

Magnetic Resonance Imaging Detects Chronic Rhinosinusitis in Infants and Preschool Children with Cystic Fibrosis.

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).

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique.

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients' files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6-9 months of healing time. Mean follow-up was 17.5 months, range 12-36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

Radiological and endoscopic findings in patients undergoing revision endoscopic sinus surgery.

Over the last three decades, functional endoscopic sinus surgery (FESS) has become one of the most common surgical techniques, with significant data supporting its efficacy in treating chronic rhinosinusitis (CRS). However, despite this initial published success rate, approximately 10-15% of them will require a subsequent revision surgery. The severity of the disease, the comorbidities and the anatomical variation that are not addressed adequately in the primary surgery, are considered the main factors that cause the failure of the primary surgery. Our objective is to report anatomical findings that may contribute to recurrent disease to improve the success rate in the primary surgery. PATIENTS AND METHODS: A prospective cross sectional study was conducted for 24 patients presenting for revision functional endoscopic sinus surgery (FESS). Lund-kennedy and Lund-Mackay score systems, pre and intraoperative CT scan and endoscopic assessments utilized, respectively, to delineate the causes of the primary surgery's failure. The most common finding was persistent frontoethmoidal cell, anterior and posterior ethmoid cell: 81.2%, 72.9%, 70.8%, respectively. Bony osteitis and scarred frontal recess were visible in 66.7%. Recirculation phenomena, resected concha bullosa and persistent Onodi cell, were the least noticeable findings: 6.25%, 8.3%, 8.30% consecutively CONCLUSIONS: The recurrence of the CRS that needs revision FESS is multifactorial in etiology ranging from sever mucosal disease to anatomical variations that is not addressed precisely in primary surgery. Trials of studies with a larger number of patient series comparing the anatomical variations that impact on recurrence of CRS with and without polyp are required.

Sternoclavicular sinus: Case series and literature review of a rare head and neck lesion.

OBJECTIVE: The objective of this study is to describe the clinical and pathologic features of a rare congenital neck anomaly, a sternoclavicular sinus, and review the literature on this topic. STUDY DESIGN: This study is a retrospective case series of four subjects diagnosed with a sternoclavicular sinus. METHODS: Patients with a congenital neck anomaly, distinct from common branchial cleft anomalies, were identified through a 10-year retrospective chart review of a tertiary care pediatric otolaryngology practice. RESULTS: We describe four patients with a congenital neck anomaly with common features of a sternoclavicular anomaly. All patients presented with a superficial neck anomaly adjacent to the sternoclavicular joint. Surgical excision through an external approach was successfully performed in three out of the four patients with subsequent resolution of symptoms. The literature review compiles all the cases presented. Theories on embryologic origin include incomplete fusion of sternum and clavicle or unusual remnant of a fourth branchial cleft. Commonalities include left sided predominance, squamous epithelium lined sinus tract ending at the sternoclavicular junction, and successful surgical excision in almost all cases. CONCLUSION: A sternoclavicular sinus is a rarely described congenital neck abnormality. Presentation and management is similar to branchial cleft anomaly but with a distinct anatomical pathway that is important for surgeons to recognize. LEVEL OF EVIDENCE: This manuscript presents a case series. The level of evidence proposed is Level 4.

The incidence of sinus crista galli in children and adults: a computerized tomography study / La incidencia del sinus crista galli en niños y adultos: un estudio de tomografía computarizada

The pneumatization area in the crista galli region of the ethmoid bone can be called Sinus Crista Galli (SCG). The authors would like to recommend the terminology as sinus crista galli for pneumatized crista galli. Our aims in this study are to determine SCG on three dimensional Computerized Tomography (CT) images, to investigate its frequency, dimension and to emphasize their clinical significance in children and adults. A total of 360 adult images (160 female, 200 male) and 68(43 female, 25 male) pediatric images were examined. The presence SCG was recorded with axial and coronal paranasal sinus CT images. The height, width, anterposterior diameter of the sinus was measured. All the data we obtained from this study were analyzed using the SPSS 18.0 program. Descriptive statistics are shown as mean ± Sdt. Sinus crista galli was found in 17 examined images of the 360 (4.72 %) in adult group. Chronic pansinusitis was detected in 7 of 17 cases. Frontal sinusitis findings were detected in 7 cases. Sinusitis was not observed in 3 cases. The incidence of SCG was found in 4 pediatric images out of 68 (5.88 %). In 1 out of 4 cases, infection was detected in SCG. We did not observe SCG in the pediatric group with 0-7 years of age. Sinus crista galli was found at low rates in adult and pediatric age group. However; relationship was found between these variation and chronic rhinosinusitis. Additionally, detection of SCG in paranasal sinus CT can be provided better results and reduce complications in anterior cranial fossa surgery.

El área de neumatización en la crista galli del etmoides se puede denominar sinus crista galli (SCG). Los autores recomiendan incluir en la terminología anatómica el término sinus crista galli para la crista galli neumatizada. Los objetivos del estudio fueron determinar la SCG en imágenes tridimensionales de tomografía computarizada (TC), investigar su frecuencia, dimensión y enfatizar su importancia clínica en niños y adultos. Se examinaron un total de 360 imágenes de adultos (160 mujeres, 200 hombres) y 68 (43 mujeres, 25 hombres) en imágenes pediátricas. La presencia de SCG se registró con imágenes de tomografía axial y axial del seno paranasal. Se midió la altura, anchura y diámetro anteroposterior del seno del proceso crista galli. Todos los datos obtenidos se analizaron mediante el programa SPSS 18.0. Las estadísticas descriptivas se muestran como media ± DS. El seno crista galli se encontró en 17/360 (4,72 %) de las imágenes examinadas en el grupo de adultos. Se detectó pansinusitis crónica en 7 de 17 casos. Se detectaron hallazgos de sinusitis frontal en 7 casos. Sinusitis no se observó en 3 casos. La incidencia de SCG se encontró en 4 imágenes pediátricas de 68 (5,88 %). En 1 de cada 4 casos, se detectó infección en SCG. No observamos SCG en el grupo pediátrico con 0-7 años de edad. El seno crista galli se encontró en bajas tasas en adultos y en niños. Sin embargo, se encontró relación entre estas variaciones y la rinosinusitis crónica. Además, la detección de SCG en la tomografía computarizada del seno paranasal puede proporcionar mejores resultados y reducir las complicaciones en la cirugía de la fosa craneal anterior.

Evaluation and treatment of pulsatile tinnitus associated with sigmoid sinus wall anomalies.

OBJECTIVE: Describe clinical and radiographic features of sigmoid sinus wall anomalies (SSWA) associated with pulsatile tinnitus (PT) and determine factors predictive of response to surgery. METHODS: Preoperative diagnostic imaging and treatment response were reviewed after surgical repair of 40 ears among 38 consecutive patients presenting with PT associated with SSWA who underwent transtemporal sinus wall reconstruction. RESULTS: Twenty-three ears had isolated sigmoid sinus dehiscence, and 17 had diverticulum. The rates of transverse sinus stenosis (TSS) and empty sella, 66% and 32% respectively, were significantly higher than in historical controls (P = 0.02 and 0.001). Thirty-six out of 40 subjects (90%) had complete resolution of their PT following surgery, including all those with a diverticulum. For subjects with dehiscence alone without diverticulum, a favorable response to surgery was strongly associated with the presence of TSS (P = 0.01) and empty sella (P = 0.02). CONCLUSION: Sigmoid sinus diverticulum and dehiscence are a clinically important cause of PT. Women of childbearing age with an elevated body mass index (BMI) are commonly affected, and there is a high rate of associated TSS and empty sella. Transtemporal sinus wall reconstruction has a high rate of success in appropriately selected patients. Patients with isolated sinus wall dehiscence without diverticulum, TSS, or empty sella are less likely to respond to transtemporal sinus wall reconstruction. These data imply a multifactorial cause of PT in at least some patients with SSWA. LEVEL OF EVIDENCE: 4 Laryngoscope, 128:S1-S13, 2018.

Paediatric orbital cellulitis and the relationship to underlying sinonasal anatomy on computed tomography.

OBJECTIVE: To assess if there is an association between sinonasal anatomical variants and the risk of developing orbital cellulitis and associated complications, in children. METHODS: A retrospective case-control series was conducted, examining computed tomography confirmed sinonasal anatomical variants of septal deviation and concha bullosa in children who presented with periorbital cellulitis who went on to develop orbital cellulitis and abscesses. RESULTS: Thirty children had a Chandler score of 2 or greater on computed tomography. Mean age was seven years and there was relatively equal sex distribution. There was no association between presence of concha bullosa and side of disease (odds ratio = 1), and no statistically significant difference between septal deviation and ipsilateral orbital infection (p = 0.125). CONCLUSION: There was no statistical correlation between any sinonasal bony or cartilaginous anatomical variants on computed tomography and orbital complications of acute rhinosinusitis in our paediatric cohort. The findings do not support the theory that these anatomical variants predispose to orbital cellulitis occurring in these children, nor complications thereof.

The prevalence of the Onodi cell - Most suitable method of CT evaluation in its detection.

BACKGROUND: The Onodi cell (sphenoethmoidal air cell) is an anatomic variant of the most posterior ethmoid cell that pneumatised superiorly and laterally to the sphenoid sinus, and is in close relation to the optic nerve. The proper identification of the Onodi cell is essential during a pre-operative computer tomography (CT) examination, as the presence of that ethmoid cell variant makes sphenoid sinus surgery more risky. The bulging of the optic nerve to the ethmoid cell wall is well visualized during endoscopic examination, but there are no clearly defined criteria for a potentially dangerous Onodi cell type in CT examinations. OBJECTIVE: To determine the prevalence and types of Onodi cell in CT examination and find the most suitable CT scanning planes to identify it. MATERIAL AND METHODS: Three plane (axial, coronal and sagittal) reconstructions of 196 paranasal sinuses were analyzed. The most posterior ethmoid cell was classified into four types, according to its position in relation to the sphenoid sinus and the optic nerve canal bulging into the lumen of the sphenoethmoid cell. RESULTS: The Onodi cell was detected in 39.8% of cases, although in 55.6% of cases a direct contact between the most posterior ethmoid cell and the optic nerve was present. Bulging of the optic nerve canal was seen in 25% of cases. In two cases two posterior ethmoid cells were in direct contact with the optic nerve canal. CONCLUSION: The prevalence of the Onodi cell was higher than previously reported. Pre-operative paranasal sinuses CT examination should be evaluated in all three planes (axial, coronal and sagittal) to avoid missing or over-detection of the Onodi cell. Axial and sagittal planes are preferable for the detection of the Onodi cell.

Investigation of diagnosis and surgical treatment of mucosal contact point headache.

We aimed to investigate the differences in incidence of nasal anatomic abnormalities between patients with and without headache and the outcome of surgical treatment for the headache patients with mucosal contact points. We conducted the observational study and recruited 107 subjects without headache (nonheadache group) and 78 patients with recurrent headache for more than 2 years (headache group). Study participants underwent high-resolution sinus computed tomography scans, and the incidence of nasal anatomic abnormalities was calculated in both groups. An additional 25 patients with recurrent headache underwent endoscopic surgical treatment. Mucosal contact points were observed in 85.9% of patients with recurrent headache and also in 80.4% of participants without headache. The most common mucosal contact point was between a deviated nasal septum and lateral nasal wall (41.1%). The incidence of deviated nasal septum contacting with lateral nasal wall was significantly different between the headache group (55.1%) and the nonheadache group (40.2%) (p < 0.05). The postoperative pain scores of the additional 25 headache patients with recurrent headache and mucosal contact point who were treated with endoscopic surgery decreased significantly compared with their preoperative measurements (p < 0.001), but only 44% of patients had recovered from headache 7 days postoperatively. We conclude that some patients with recurrent headache may not have a mucosal contact point, and some patients with mucosal contact points may not meet the diagnostic criteria of mucosal contact point headache since pain was not resolved within 7 days after surgical treatment. The diagnostic criteria of mucosal contact point headache before surgery should be reevaluated.

Pneumatization of crista galli in pre-adult and adult stages / Neumatización de la crista galli en etapas pre adultas y adultas

The sinonasal region in humans is one of the regions that commonly shows anatomical variations. These variations can be easily diagnosed by paranasal CT evaluation. One of these variations is Crista galli pneumatization. In recent years, there have been opinions supporting the hypothesis that pneumatization originates from the frontal sinus. In this study, we planned to evaluate whether the presence of Crista galli pneumatization varied in pre-adult and adult periods. In this retrospectively designed study, 218 coronal paranasal CT images collected between 2012 and 2013 were evaluated. Patients were divided into two groups according to age under or over 18 years. In the group under the age of 18 (97 cases), pneumatization was detected in 2.1 % of samples, while in the group over the age of 18 (121 cases), crista galli pneumatization was observed in 15.7 % of samples. According to these results, crista galli pneumatization was found to increase in adulthood. Considering that the frontal sinus is in a rudimentary state at birth, it is radiographically detected first at 6 years of age, and reaches its main size in puberty, this increase in pneumatization runs parallel to the development of the frontal sinus. Consequently, this supports the opinion that crista galli pneumatization originates from the frontal sinus.

La región nasosinusal en los seres humanos con frecuencia muestran variaciones anatómicas. Estas variaciones se pueden diagnosticar fácilmente mediante la evaluación por tomografía computadorizada (TC) de los senos paranasales. Una de estas variaciones es la neumatización de la Crista galli. En los últimos años, se ha apoyado la hipótesis de que ésta neumatización se origina en el seno frontal. En este estudio fue evaluada la presencia de neumatización de la Crista galli y su posible variación en los períodos pre-adultos y adultos. Se realizó un estudio retrospectivo donde se evaluaron 218 imágenes de TC coronal de senos paranasales, recogidas entre 2012 y 2013. Los pacientes fueron divididos en dos grupos según la edad, menores o mayores de 18 años. En el grupo de menores de 18 años (97 casos), se detectó neumatización en el 2,1 % de las muestras, mientras que en el grupo de mayores de 18 (121 casos), se observó neumatización de la Crista galli en el 15,7 % de las muestras. De acuerdo con estos resultados, la neumatización de la Crista galli aumenta en la edad adulta. Teniendo en cuenta que el seno frontal se encuentra en un estado rudimentario en el nacimiento, se detecta radiográficamente a los 6 años de edad alcanzando su tamaño principal en la pubertad; este aumento de la neumatización es paralelo al desarrollo del seno frontal. En consecuencia, esto apoya la opinión de que la neumatización de la Crista galli se origina en el seno frontal.

Analysis of sinonasal anatomical variations associated with maxillary sinus fungal balls.

OBJECTIVE: The pathogenesis of MSFB development remains unclear, but it has been suggested that poor sinus ventilation is associated with disease development; such a ventilation is influenced by anatomical variation of the paranasal sinuses. Thus, we sought to determine whether sinonasal anatomical variations were associated with MSFB development. METHODS: Thirty-one patients with MSFB and 28 gender-matched control patients were included in the present study. The presence or absence of Haller cells and a concha bullosa were scored, and the angle of septal deviation and the minimal and maximal lengths of the infundibulum were measured on preoperative computed tomography images. RESULTS: In the MSFB group, both a concha bullosa (61.3% vs. 28.6%, p=0.006) and Haller cells (41.9% vs. 30.4%) were present at higher frequencies than in the control group, although the between-group difference in Haller cell occurrence was not statistically significant (p=0.348). In addition, MSFB patients had a significantly lower mean infundibular width (3.23±0.69mm vs. 3.99±1.17mm, p<0.001) and a longer infundibular length (9.71±1.43mm vs. 8.23±1.72mm, p<0.001) than controls. CONCLUSIONS: Sinonasal anatomical variations, especially the presence of a concha bullosa, and/or a narrow and long infundibulum, may play roles in the development of maxillary sinus fungal balls (MSFBs).

Normal Anatomy and Anatomic Variants of the Paranasal Sinuses on Computed Tomography.

It is imperative for all imaging specialists to be familiar with detailed multiplanar CT anatomy of the paranasal sinuses and adjacent structures. This article reviews the radiologically relevant embryology of this complex region and discusses the region-specific CT anatomy of the paranasal sinuses and surrounding structures. Radiologists also need to know the clinical implications of identifying preoperatively the numerous anatomic variations encountered in this region and prepare a structured report according to the expectations of the referring clinician.

CT of Anatomic Variants of the Paranasal Sinuses and Nasal Cavity: Poor Correlation With Radiologically Significant Rhinosinusitis but Importance in Surgical Planning.

OBJECTIVE: The purpose of this study was to determine the incidence of sinonasal anatomic variants and to assess their relation to sinonasal mucosal disease. MATERIALS AND METHODS: A retrospective evaluation of 192 sinus CT examinations of patients with a clinical history of rhinosinusitis was conducted. The CT scans were evaluated for the presence of several anatomic variants of the sinonasal cavities, and the prevalence of each variant was calculated. Prevalences of all sinonasal anatomic variants were compared between patients who had minimal to no apparent imaging evidence of rhinosinusitis and those who had radiologic evidence of clinically significant rhinosinusitis. RESULTS: The most common normal variants were nasal septal deviation, Agger nasi cells, and extension of the sphenoid sinuses into the posterior nasal septum. We found no statistically significant difference in the prevalence of any of the studied anatomic variants between patients with minimal and those with clinically significant paranasal sinus or nasal cavity disease. CONCLUSION: Analysis of every routine CT scan of the paranasal sinuses obtained for sinusitis or rhinitis for the presence of different anatomic variants is of questionable value unless surgery is planned.

[Maxillary sinus malformations (double wall bone) lead to chronic sinusitis in a case].

Chronic rhinosinusitis is a common otorhinolaryngological disease, although the incidence of chronic sinusitis is the result of many factors, the local anatomic abnormalities is one of the most important reasons. When maxillary sinus dysplasia that sinus cavity becomes small. These was some sinus cavity partial or complete bony septum malformation used to be reported occasionally, according to reports in the literature of this malformation rate is below 2%, bony divides sinus cavity is divided into 2 to 3 independent lacunar deformity are very rare, next we will introduce a case of sinus cavity that been divided into double deck by bone wall.

Comparison of radiographic and clinical characteristics of low-risk and high-risk cystic fibrosis genotypes.

BACKGROUND: Patients with cystic fibrosis (CF) exhibit a wide range of disease severity, and can be broadly stratified into high-risk and low-risk groups based on cystic fibrosis transmembrane conductance regulator (CFTR) mutation class. Patients with a low-risk genotype are often diagnosed as adults, with milder disease and lower sweat chloride values. The aim of the current study was to better understand radiographic and clinical characteristics of sinus disease in adult CF patients within this risk category. METHODS: Adult CF patients were retrospectively compared to a control group of patients with chronic rhinosinusitis. CF diagnostic testing and pulmonary characteristics were compared between high-risk and low-risk CF groups, and sinus CT findings were compared among all 3 groups. RESULTS: When comparing CF cohorts (n = 25 and 30, respectively), earlier age at diagnosis (p < 0.001), higher sweat chloride values (p < 0.001), lower forced expiratory volume in 1 second (FEV1 ) values (p < 0.001), and a higher prevalence of pulmonary infection with Pseudomonas aeruginosa (p = 0.001) were found in the high-risk genotype group. A significantly increased incidence of sinus hypoplasia/aplasia and bony sclerosis was seen when comparing both CF groups to the control cohort (n = 30), as well as when comparing the high-risk and low-risk CF genotype cohorts. CONCLUSION: The current study describes clinicopathologic findings of sinus disease in adult CF patients in the context of genotype severity. Our data demonstrate that while patients within a low-risk genotype cohort have generally milder lung disease, they retain classic radiographic findings of CF sinus disease that can help raise the index of suspicion for undiagnosed CF.