Search

Computed tomography (CT) is the gold standard for diagnosing sinusitis and anatomical variations and a guide for paranasal sinus (PNS) surgeries. High doses of radiation lead to increased risk of head and neck malignancies, radiation-induced cataracts, hypothyroidism, and hyperthyroidism. The purpose of this study was to assess the effectiveness of low-dose CT as compared to standard-dose CT in the identification of anatomical variants of paranasal sinus and rhinosinusitis. This was a prospective cross-sectional study consisting of 72 patients who were divided equally into cases (underwent low-dose CT for PNS) and controls (underwent CT for PNS using standard dose protocols). Prevalence of anatomical variants and sinusitis were compared. Image quality was assessed using volume CT dose index (CTDIvol), dose length product (DLP), scan length, and noise. Subjective assessment was done by two radiologists, and scores were given. The comparison and analysis of the quantitative and qualitative variables were done. Anatomical variants were comparable among cases and controls, with post-sellar sphenoid being most common and paradoxical middle turbinate being least common surgically important variant. The difference in mean SD of CTDIvol (mGy), DLP (mGy-cm), effective dose (mSv), globe, and air noise between low and standard doses was statistically significant. A moderate agreement (with kappa 0.50) in cases and substantial agreement (with kappa 0.69) in controls was observed between both observers. Low-dose CT PNS and standard-dose CT PNS are comparable in delineating the paranasal sinus anatomy, with a 3.53× reduction of effective radiation dose to patients. [ABSTRACT FROM AUTHOR]

Malignant tumors of sinonasal region are rare and affect less than 1 in 100,000 people per year. They are histologically diverse group and potentially pose significant management problems due to their proximity to the orbit and intracranial cavity. Although squamous cell carcinoma (SCC) is most common malignant tumor of paranasal cavity, tumors like adenocarcinoma, olfactory neuroblastoma, malignant melanoma, adenoid cystic carcinoma, sarcomas, haemoproliferative tumors, e.g. lymphoma may also occur. Retrospectively study was done in a tertiary care institute from January 2008 to December 2018 in India. Inclusion criteria—all biopsy proven PNS malignancy patients operated by endoscopic approach, irrespective of age and gender. Exclusion criteria- patients diagnosed with nasopharyngeal carcinoma, skin involvement, gross orbital involvement (muscle invasion), metastasis, operated by open approaches. 46 patients who underwent endoscopic tumor removal were reviewed. 36 (78.2%) were males and 10 (4.6%) females. Most common tumor in our study was adenoid cystic carcinoma. Recurrence was seen in 6 patients. Palliative therapy was given to all patients with recurrence. Management of malignant PNS tumor involving anterior skull base is multidisciplinary. R0 resection should be main goal in all malignant PNS malignancy. Tumors invading unresectable areas like cavernous sinus, brain parenchyma, carotids can be left in these places followed by palliation except in cases of squamous cell carcinoma. If R0 cannot be achieved surgically in SCC than patient should be considered inoperable and send for palliation. T1–T3 PNS malignant tumors can be managed by endoscopic approach followed by adjuvant therapy after a period of 6 weeks. Endoscopic excision should be converted to endoscopic assisted open approach in case of T4 tumors. We have tried to give a management protocol for management of malignant PNS tumors. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Paranasal sinus mucoceles are the most common expansile lesion of the paranasal sinuses. Hereby we present a comprehensive retroprospective study on the paranasal sinus mucoceles in our geographic area which is very significantly lacking till now which we hope would immensely help comparative analysis and management in near future. [ABSTRACT FROM AUTHOR]

Background: Mucormycosis of the nose and paranasal sinuses has emerged as an epidemic following COVID-19 pandemic. The management involves surgical debridement, the extent of which depends on the bulk of the disease. Extension to the orbit and palate depends on the involvement of specific sites in the nose and paranasal sinuses. This study intended to identify those sites., Materials and Methods: This was a single-center case-control study. There were 3 groups according to the region involved (Palate, orbit and both). The fourth group with neither involvement was the control. Scoring system was used to estimate the bulk of disease according to the site involved in MRI scan. Odds ratio and chi-square tests were used to study risk and association respectively. ROC curve was obtained for the MRI scores of the cases and controls., Results: 214 patients were studied in all; 44.39% and 61.68% had palate and orbit involvement, respectively. Maxillary sinus roof had significant association and the highest risk for spread of disease into the palate. The risk for the orbit to be involved was increased when there was disease in the cavernous and sphenoid sinus. For the orbit, the site with the significant association was the ethmoid sinus, infratemporal fossa and roof of the maxillary sinus., Conclusion: Due attention should be given for clearance during surgical debridement to the high-risk sites to prevent recurrences and reduce morbidity and mortality. MRI scores were most helpful to identify the bulk of disease when both palate and orbit were involved., (Copyright © 2021 Elsevier Inc. All rights reserved.)