ABSTRACT

There has been a major advancement in managing chronic sinusitis and other sinonasal diseases. There has been a remarkable change in the surgical approach to inflammatory pathology of paranasal sinuses since the time, Messerklinger introduced endoscopic sinus surgery. In this changing scenario of indications for endoscopic sinus surgeries, detailed knowledge of sinonasal anatomy is of paramount importance. It is of utmost importance to master the relevant anatomy and its variations before one embarks upon endoscopic sinus surgery. Various cadaveric and radiological studies have been done to know about the important landmarks and anatomical variations. With increasing horizon of sinus surgery, where more of optic nerve and anterior and middle cranial fossa lesions are being dealt with endoscopically; surgeon needs to be more familiar with various variations in the anatomy of the important structures as even a small mistake can be detrimental to the vision and life of the patient.

Keywords:Anatomy, Endoscopic sinus surgery, Cadaveric dissection, Anatomical variations.

How to cite this article: Gupta AK, Bansal S, Sahini D. Anatomy and Its Variations for Endoscopic Sinus Surgery. Clin Rhinol An Int J 2012;5(2):55-62.

Source of support: Nil

Conflict of interest: None declared

Abstract
Endoscopic septoplasty is a rapidly evolving substitute to the customary “headlight” septoplasty. The primary advantage of the technique is the ability to reduce morbidity and postoperative swelling in isolated septal deviations by limiting the dissection to the area of the deviation. Other advantages include improved visualization, particularly in posterior septal deformities; improved surgical transition between septoplasty and sinus surgery and its use as an effective teaching tool. We present our experience with endoscopic septoplasty in a series of 19 patients.
Keywords: Endoscopic septoplasty, FESS, DCR.

Abstract
Surgery of the frontal sinus has gone a full circle from intranasal procedures to destructive and disfiguring external operations and now back to intranasal procedures but with endoscopes. Endoscopic surgery of the frontal sinus has always been a challenging experience because of the narrowness of the area, poor visibility, variable anatomy and encroachment by accessory cells such as agger nasi, frontal, intersinus septal cells on the drainage pathway. With the developments in optical aids such as endoscopes, which provide an angled view, better and brighter illumination, sophistication in the designs of instrumentation and development of imaging techniques, a renewed interest has been created in this area, but the knowledge of anatomy of this area is poor and does not meet the demands of the present day endoscopic surgeon. Moreover, no studies are available on Indian subjects.
   Our main interest in the present study was to study the various air cells which encroach the area of frontal recess and would need surgical removal to provide a good drainage and ventilation.
Keywords: Frontal recess, frontal recess cells, FESS, agger nasi cells, supraorbital ethmoidal cells, intersinus septal cell.

Abstract
Objectives: We present our 3 years experience with alar batten grafts, using a modified technique, for non-iatrogenic nasal valve/alar collapse.
Methods: Retrospective (Oct. 2005 to Apr. 2008) and prospective study (Apr. 2008 to Dec. 2008) of 16 consecutive patients undergoing alar batten grafts for alar collapse causing nasal obstruction. The graft was inserted through a rim incision and placed across as well as superficial to the lower lateral cartilage. The main outcome measures were subjective improvement in nasal obstruction and absence of alar collapse at examination.
Results: Alar collapse was bilateral (n = 8), right sided (n = 4) and left sided (n = 4) giving 24 operated sides (s = 24). Deviated nasal septum (n = 9), synechiae (n = 1) and drooping tip (n = 1) were also present. Donor sites for the graft were septal cartilage (n = 10), conchal cartilage (n = 4) or both septal and conchal cartilages (n = 2). The median follow-up was 4 months (range 1 month to 3 years). Subjective nasal obstruction had worsened in 0%, was unchanged in 16.6% (s = 4), had improved in 16.6% (s = 4) and 66.6% (s = 16) were completely free of obstruction. Two of the improved cases worsened at 10 and 3 years giving overall failure in 25% (s = 6). Significant alar collapse was present in all failed cases and absence of collapse was documented in improved cases (s = 13). In failed cases the graft size width was 5 to 8 mm and in successful cases it was 10 to 15 mm. Lengths of the grafts in all cases was between 18 and 24 mm. One complication of graft extrusion through skin occurred.
Conclusion: Our technique of alar batten graft insertion appears to be as effective as other techniques described in the literature. We suggest a minimum graft size of 10 mm width and 18 mm length to improve success rate.
Keywords: Rhinoplasty, nasal valve collapse, cartilage graft.

Abstract
Objectives: The purpose of this study was to propose a new staging system which would allow for an accurate preoperative tumor assessment, appropriate surgical planning and to look for any changing trends in the surgical management of JNA.
Study design and methods: Retrospective chart review of 91 patients operated between Jan.1998 to Dec. 2007 at the Postgraduate Institute of Medical Education and Research, Chandigarh. The tumor location and extent was based on preoperative imaging reports and operative notes to review the staging system and surgical approaches.
Results: All patients were initially staged according to the modified sessions staging system. The revised staging system led to the reclassification of 36 (39.6%) in stage I A, I B and II A in the old staging system to stage I according to the new staging. Before 2003, none of the patients had undergone an endoscopic excision of the JNA, whereas 32 (35%) of patients underwent an endoscopic excision in group II (after 2002) with acceptable recurrence rates.
Conclusions: The choice of the surgical approach should be based on precise tumor location and in young patients the approach should be tailored to minimize potential for facial growth retardation. We recommend endoscopic resection for tumors confined to nasopharynx, nasal cavities, sinuses and minimal extension to PMF. Excision via lateral rhinotomy and its extensions and modifications is recommended for tumors having significant involvement of pterygomaxillary fossa, infratemporal fossa, cavernous sinus or minimal intracranial extension according to the surgeon’s comfort and expertise.
Keywords: Angiofibroma, nasopharyngeal tumors, endoscopic excision, maxillofacial development.

Abstract
Purpose: The authors intend to present a case of osteosarcoma of the maxilla which presented like a mucocele, a previously unreported phenomenon.
Patients and methods: Clinical features, radiology, histopathological findings and endoscopically managed osteosarcoma of the maxilla are presented. Diagnostic difficulties and previously reported diagnostic dilemmas related to osteosarcomas of the maxillary sinus are discussed.
Results: The patient has been on regular follow-up for the past 10 months, and is free from any local or systemic disease.
Conclusion: Though osteosarcoma of the maxilla is a rare tumor about 6.5% of all osteosarcomas1, patients tend to be in the late-third to mid-fourth decades of life, a high index of suspicion and aggressive management can reduce the morbidity that goes with the management of this condition.
Keywords: Osteosarcoma, maxilla, mucocele.

Abstract
Hemangioma of maxillary sinus is a rare entity. We present a case with an inconclusive preoperative diagnosis which was treated by excision of entire tumor by medial maxillectomy through lateral rhinotomy approach. There is no recurrence after two years. The literature on the topic is reviewed.
Keywords: Hemangioma, maxillary sinus, medial maxillectomy.

Abstract
Optic nerve sheath dilatation forming a cyst containing cerebrospinal fliud (CSF) is a rare condition. It is actually an enlargement and dilation of primarily the optic nerve sheath. There is an expansion of the cerebrospinal fliud space around the optic nerve with no associated inflammation, orbital or cerebral neoplasm at the apex of the orbit. It is a very rare condition and only few cases have been reported in the literature. We describe a case of optic nerve meningocele which was successfully managed surgically through intranasal route. A brief review of the existing literature is also presented.
Keywords: optic nerve meningocele, optic nerve cyst, CSF.

ABSTRACT
Important symptoms of seasonal allergic rhinitis (SAR) are nasal congestion, rhinorrhea, nasal itch, sneezing, nighttime, eye and general symptoms. In this study, we used montelukast as anti-inflammatory agent in SAR and compared it as monotherapy vs combination therapy with levocetirizine. Results with concomitant levocetirizine and montelukast treatment are better as compared to monotherapy with levocetirizine alone in seasonal allergic rhinitis (SAR), especially pertaining to the symptoms of nasal congestion and rhinorrhea.
Keywords: Montelukast, Levocetirizine, Monotherapy, Combination therapy, Seasonal allergic rhinitis.
How to Cite:
Kaushik S, Sachan A, Awasthi RK, Vashistha S. To Evaluate the Role of Levocetirizine Monotherapy vs Levocetirizine and Montelukast Combination Therapy in Seasonal Allergic Rhinitis. Intl J Clinical Rhinology. 2011;4(3):123-126

ABSTRACT

Invasive sinus Aspergillus infection has been reported in the last decade with increased frequency, most commonly in the setting of hematologic malignancy, neutropenia, HIV infection and other states of immunosuppression. Fungal rhinosinusitis can be broadly classified into two varieties—invasive and noninvasive on the basis of tissue invasion. Invasive fungal sinusitis are acute invasive, chronic invasive (both granulomatous and nongranulomatous forms), whereas noninvasive are fungus balls and allergic fungal sinusitis. Invasive fungal sinusitis is one of the most challenging forms of sinonasal pathology to manage, most commonly presenting in immunocompromised individuals. Chronic invasive being sinus aspergillosis (CISA) is being reported in immunocompetent patients at an increasing rate while most of these cases are being reported from the India subcontinent and middle east. Invasive fungal sinusitis is on the rise worldwide and especially in north India as it is endemic in this part of the country. It is affecting immunocompetent young and middle aged population causing a great morbidity and mortality. This entity needs to be picked up early by spreading awareness among the family physicians, internists, otolaryngologists, ophthalmologists, neurosurgeons, pulmonary physicians, critical care specialists so that an early management can initiated to achieve better control over the disease. This review is an attempt to initiate an interdisciplinary approach to achieve a better outcome.

Keywords: Rhinosinusitis, Fungal sinusitis, Invasive, Nose and paranasal sinuses.

How to cite this article: Gupta AK, Bansal S, Rijuneeta, Gupta B. Invasive Fungal Sinusitis. Clin Rhinol An Int J 2012;5(2): 63-71.

Source of support: Nil

Conflict of interest: None declared