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2014 | September-December | Volume 7 | Issue 3

RESEARCH ARTICLE

Editorial

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/aijcr-7-3-v  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Tulika Gupta, Suhalika S Sahni, Ruchi Goyal

Surgical Anatomy of Nasolacrimal Duct and Sac in Human Cadavers

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:91 - 95]

Keywords: Nasolacrimal duct,Nasolacrimal sac,Surgical anatomy,Cadavers

PDF  |  DOI: 10.5005/jp-journals-10013-1205  |  Open Access |  How to cite  | 

Abstract

Background

Surgical importance of the nasolacrimal duct (NLD) for both otolaryngologists and ophthalmologists cannot be overemphasized. Injury to this structure can lead to iatrogenic epiphora, synechiae formation and need for secondary lacrimal diversion procedures.

Materials and methods

The present study was conducted on 27 mid-sagittal sections of head and neck of formalin fixed adult cadavers. The inferior opening of the NLD was identified and exposed. The duct and the lacrimal sac were dissected. Pertinent distances of the inferior opening of the NLD from the easily identifiable surgical landmarks were recorded, so as to accurately locate the inferior opening of the duct using a digital vernier calliper (accuracy 0.02 mm, Mitutoya, Japan). Various dimensions and angulation of the duct and lacrimal sac were measured.

Results

The average length of NLD was 11.42 ± 2.45 mm and it was making an angle of 20° with the vertical plane. The duct was narrowest in caliber in its upper 1/3rd in majority (82%) of the cases. The average diameter of the inferior opening of the NLD was 3.14 mm. In two cases (7.4%), the opening was only 1.8 mm wide. The mean distance of the inferior opening of the duct was 20.7 mm from the columella, 25.5 mm below the skull base and 16.5 mm above the hard palate. The average distance between the inferior opening of the NLD and anterior end of the inferior turbinate was 14.8 mm. The mean A-P diameter of superior opening of NLD was about 3 mm. The average length and width of nasolacrimal sac at its center was 6.95 and 3.24 mm respectively.

Conclusion

Detailed anatomical knowledge of the NLD is of great importance for safe and successful endonasal surgery. The present study attempts to provide useful surgical guidelines by using anatomic and positional relationships between the NLD and the major surrounding landmarks.

How to cite this article

Sahni SS, Goyal R, Gupta T, Gupta AK. Surgical Anatomy of Nasolacrimal Duct and Sac in Human Cadavers. Clin Rhinol An Int J 2014;7(3):91-95.

RESEARCH ARTICLE

SS Bist, Sarita Mishra, Vinish Agrawal, Priyanka Gairola

Assessment of Quality of Life in Patients of Chronic Rhinosinusitis

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:4] [Pages No:96 - 99]

Keywords: Rhinosinusitis,Quality of life,Sinus surgery

PDF  |  DOI: 10.5005/jp-journals-10013-1206  |  Open Access |  How to cite  | 

Abstract

Introduction

Chronic rhinosinusitis (CRS) is a global health problem affecting approximately 14% of the population of all age groups. CRS has a significant adverse impact on quality of life of the patients.

Objective

The aim of this study was to compare the quality of life of patients suffering from CRS with that of normal population and to assess the association between objective nasal endoscopic score, self-rated symptom score and quality of life (QoL) score.

Methodology

This was a prospective study conducted over a period of 12 months. A total of 110 cases of CRS and 50 normal subjects taken as controls were recruited from out patients department. Patients diagnosed as a case CRS were subjected to rhinosinusitis disability index (RSDI), subjective QoL questionnaires and self-rated symptom score in their vernacular language followed by diagnostic nasal endoscopy, using 0° rigid endoscope (4 mm).

Results

This study revealed that the mean ± SD total QoL score in the patients was 50.2 ± 14.9 (15-94) which was significantly affected as compared to control group where it was only 18.2 ± 9.15 (3-47). The mean ± SD of the functional, emotional and physical domains were 17.6 ± 5.46 (4-34), 16.5 ± 8.29 (5-88) and 16.5 ± 5.84 (2-35) respectively. There was no correlation between endoscopic score and the patient's self-rated symptom score or RSDI score. The correlation between the self-rated symptom score and total QoL score was significant (p = 0.02).

Conclusion

On comparing the QoL in the patients of CRS with the controls, it was observed that QoL was affected more in the patients of CRS in the physical, functional and emotional domain of their life. CRS has considerable adverse impact on QoL of patients and RSDI is a valuable tool in assessing the QoL in patients of CRS.

How to cite this article

Gairola P, Bist SS, Mishra S, Agrawal V. Assessment of Quality of Life in Patients of Chronic Rhinosinusitis. Clin Rhinol An Int J 2014;7(3):96-99.

RESEARCH ARTICLE

Anilkumar Suryadev Harugop, Ramesh Mudhol, Amit Nargund, Shailaja Hugar, Amrit Kapoor, Rohan Shetty

Efficacy of Mitomycin-C for Prevention of Adhesion Formation after Functional Endoscopic Sinus Surgery in Cases of Chronic Rhinosinusitis: A Prospective Cross-sectional Study

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:100 - 104]

Keywords: Chronic rhinosinusitis,Synechiae,Adhesions,FESS/ESS,Topical mitomycin-C,SNOT score

PDF  |  DOI: 10.5005/jp-journals-10013-1207  |  Open Access |  How to cite  | 

Abstract

Objective

To determine whether topical application of mitomycin- C at the conclusion of FESS decreases the incidence of postoperative adhesion formation.

Study design

Prospective cross-sectional study.

Materials and methods

Between June 2011 and June 2013, 42 patients (65 sides) aged between 16 and 66 years diagnosed to have chronic rhinosinusitis (CRS) underwent FESS. At the conclusion of the ESS, cotton ribbon wick soaked with 1 ml mitomycin-C (0.4 mg/ml) was placed in right/left/ both middle meati, near the widened sinus ostia for a period of 4 minutes. Following application, nasal cavity was irrigated with sterile normal saline. Patients were examined weekly for 1 month after surgery. Additional examinations were done at the end of 2nd and 3rd months postoperatively. At the end of 3 months follow-up, the outcome was assessed subjectively by symptoms and objectively by endoscopic findings.

Results

At the end of 3 months follow-up, a significant decrease (80%) in symptom scores was observed (6.64 ± 1.80, p < 0.001). Similarly in sinonasal outcome test (SNOT) score we observed a significant reduction (71%) in scores (17.76 ± 8.17, p < 0.001) and 3.1% cases showed adhesions.

Conclusion

CRS patients have remarkable improvement in their symptoms after FESS. Topical application of mitomycin-C at the conclusion of FESS/ESS has a role in prevention of adhesion formation.

How to cite this article

Harugop AS, Mudhol R, Nargund A, Hugar S, Kapoor A, Shetty R. Efficacy of Mitomycin-C for Prevention of Adhesion Formation after Functional Endoscopic Sinus Surgery in Cases of Chronic Rhinosinusitis: A Prospective Cross-sectional Study. Clin Rhinol An Int J 2014;7(3):100-104.

RESEARCH ARTICLE

Mohan Kameswaran, S Raghunandhan, John K Thomas

A Prospective Double-Blinded Randomized Controlled Study Comparing the Efficacy of a Novel Biodegradable Synthetic Polyurethane Foam (Nasopore) vs Standard Polyvinyl Acetate Sponge (Merocel) as Packing Material after Functional Endoscopic Sinus Surgery: The First Indian Experience

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:7] [Pages No:105 - 111]

Keywords: Chronic rhinosinusitis,Functional endoscopic sinus surgery,Nasal packing,Merocel,Nasopore

PDF  |  DOI: 10.5005/jp-journals-10013-1208  |  Open Access |  How to cite  | 

Abstract

Background

In Indian clinical practice, conventional nasal packing for hemostasis after routine rhinological surgery is usually performed with Vaseline (paraffin) gauze, and rarely with glove-finger packs or tamponade balloons. These materials are tedious to pack and cause discomfort to the patient on removal. Newer nasal packs which have recently emerged in the Indian scenario are found to be more user-friendly, equally effective for hemostasis and less traumatic to the operated nasal mucosa. Most rhinologists today, prefer to use polyvinyl acetate sponge packs (Merocel/Ivalon) for tamponade after nasal surgery. These packs are very effective but non-absorbable and need to be removed which does not augur well with many patients postoperatively. The recent entry of a biodegradable synthetic polyurethane foam (Nasopore) as an alternative nasal packing material, has evoked new interest, which initiated this study.

Study method

This prospective randomized double-blinded controlled study was aimed to compare the clinical efficacy and patient comfort level, while using Merocel and Nasopore as packing material after functional endoscopic sinus surgery (FESS). This study included thirty adults who were diagnosed with moderate to severe bilaterally comparable chronic rhinosinusitis, who underwent FESS under general anesthesia and received size-matched nasal packs randomly - Merocel on one side and Nasopore on the other. The assessment of clinical efficacy of both packs with regards to ease of packing, hemostasis, pressure effects, infections and adhesions was done with a Diagnostic Nasal Endoscopy at first postoperative day, first week and fourth week after surgery. All Merocel packs were removed on the first postoperative day. Patient comfort levels for both packs were recorded with a standard symptom questionnaire marked on a visual analogue scale of ten and the results were statistically compared between the two groups.

Results

Comparable outcomes were found while using Merocel or Nasopore with regards to ease of nasal packing and control of postoperative bleeding. There was a statistical difference in the hemostatic property between the two materials in the immediate postoperative period. Five out of 30 patients developed reactionary bleeds with Nasopore, which required repacking with same material within the first 24 hours, but no further bleeds were noted. Two out of these five patients on the first postoperative day had migration of Nasopore toward the choana and had to be repacked with additional Nasopore. Sequential postoperative nasal endoscopy revealed that Nasopore is more mucosal friendly with lesser incidence of adhesions, synechiae, infection and edema, with better biocompatibility and safety. The major success with Nasopore was found to be, the fact that no pack removal was necessary, which immensely improved patient satisfaction and willingness to use the material when compared to Merocel. This was proved by the patient's symptom questionnaire which showed significant benefits of Nasopore over Merocel with regards to compliance and comfort levels.

Conclusion

Nasopore is a novel biodegradable synthetic material which is clinically as efficacious and patient-friendly as Merocel and is suitable for postoperative nasal packing after functional endoscopic sinus surgery. The clinical benefits of Nasopore and its outcomes among patients as recorded in our study, stands proof to support Nasopore as a successful packing material in rhinological surgery.

How to cite this article

Raghunandhan S, Kameswaran M, Thomas JK. A Prospective Double-Blinded Randomized Controlled Study Comparing the Efficacy of a Novel Biodegradable Synthetic Polyurethane Foam (Nasopore) vs Standard Polyvinyl Acetate Sponge (Merocel) as Packing Material after Functional Endoscopic Sinus Surgery: The First Indian Experience. Clin Rhinol An Int J 2014;7(3):105-111.

RESEARCH ARTICLE

Anil Jain, Pankaj Shah, Datt Modh, Bhaskar Thakkar, Ashish Katarkar, Krupal Joshi

Deficiency of Vitamin D in Allergic Rhinitis: A Possible Factor in Multifactorial Disease

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:112 - 116]

Keywords: Allergic rhinitis,Vitamin D deficiency,Calcitriol

PDF  |  DOI: 10.5005/jp-journals-10013-1209  |  Open Access |  How to cite  | 

Abstract

Aims and objectives

To establish the correlation between vitamin D3 serum levels and allergic rhinitis.

Materials and methods

Vitamin D levels were assessed in 23 patients with allergic rhinitis diagnosed clinically by allergic rhinitis and its impact on asthma 2008 criteria and results were compared with vitamin D status in the normal population of same region.

Results

The levels of serum vitamin D levels were significantly low in the patients of allergic rhinitis.

Conclusion

Measuring of serum levels of vitamin D could be considered in the routine assessment of patients with allergic rhinitis.

How to cite this article

Thakkar B, Katarkar A, Modh D, Jain A, Shah P, Joshi K. Deficiency of Vitamin D in Allergic Rhinitis: A Possible Factor in Multifactorial Disease. Clin Rhinol An Int J 2014;7(3):112-116.

RESEARCH ARTICLE

Bhanu Bhanu Bhardwaj, Jaskaran Singh Gill, Tanya Singh

The Role of CT Scan and Histopathology in Diagnosis of Allergic Fungal Sinusitis

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:4] [Pages No:117 - 120]

Keywords: AFS,Preoperative diagnosis,Role,CT scan

PDF  |  DOI: 10.5005/jp-journals-10013-1210  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Bhardwaj BB, Gill JS, Singh T. The Role of CT Scan and Histopathology in Diagnosis of Allergic Fungal Sinusitis. Clin Rhinol An Int J 2014;7(3):117-120.

CASE REPORT

Vivek Sasindran, Antony Joseph, Sabah Moosankutty, Amol Gautam

A Case of Acute Fronto-Ethmoido-Orbital Mucocele

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:4] [Pages No:121 - 124]

Keywords: Frontoethmoidal mucocele,Proptosis,Orbital decompression

PDF  |  DOI: 10.5005/jp-journals-10013-1211  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Sasindran V, Joseph A, Moosankutty S, Gautam A. A Case of Acute Fronto-Ethmoido-Orbital Mucocele. Clin Rhinol An Int J 2014;7(3):121-124.

CASE REPORT

Sourabha K Patro, Varun Nabh

Frontal Meningoencephalocele: Changing Trends

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:125 - 129]

Keywords: Meningoencephalocele,Frontal,Repair,Endoscopic

PDF  |  DOI: 10.5005/jp-journals-10013-1212  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Gupta AK, Patro SK, Nabh V. Frontal Meningoencephalocele: Changing Trends. Clin Rhinol An Int J 2014;7(3):125-129.

CASE REPORT

Ankit Gulati, Priya Malik, Shehbaaz Singh Virk

Foreign Body Ethmoid: An Unusual Presentation

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:2] [Pages No:130 - 131]

Keywords: Foreign body,Ethmoid,Unusual,Removal

PDF  |  DOI: 10.5005/jp-journals-10013-1213  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Kakkar V, Virk SS, Sharma C, Malik P, Bishnoi S, Gulati A. Foreign Body Ethmoid: An Unusual Presentation. Clin Rhinol An Int J 2014;7(3):130-131.

CASE REPORT

Antony Joseph, Amol Gautam, Vivek Sasindran, Shobin Suja Abraham

Fungal Mass in the Concha Bullosa: A Rare Entity

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:3] [Pages No:132 - 134]

Keywords: Concha bullosa,Fungal ball,Aspergillus infections

PDF  |  DOI: 10.5005/jp-journals-10013-1214  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Sasindran V, Joseph A, Abraham SS, Gautam A. Fungal Mass in the Concha Bullosa: A Rare Entity. Clin Rhinol An Int J 2014;7(3):132-134.

CASE REPORT

Kamble J Harsha, K Parameswaran, Akash K George, Anu Thomas

Unusually Deep Intracranial Extension of Instrument with Internal Carotid Artery Injury during Functional Endoscopic Sinus Surgery

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:4] [Pages No:135 - 138]

Keywords: Functional endoscopic sinus surgery,Internal carotid artery dissection,Stroke

PDF  |  DOI: 10.5005/jp-journals-10013-1215  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Harsha KJ, Parameswaran K, George AK, Thomas A. Unusually Deep Intracranial Extension of Instrument with Internal Carotid Artery Injury during Functional Endoscopic Sinus Surgery. Clin Rhinol An Int J 2014;7(3):135-138.

CASE REPORT

Uma Nahar Saikia, Balwinder Kaur

Congenital Lateral Nasal Proboscis with Orbital Mass

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:3] [Pages No:139 - 141]

Keywords: Proboscis lateralis,Orbital mass,Congenital

PDF  |  DOI: 10.5005/jp-journals-10013-1216  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Kaur B, Bansal S, Saikia UN, Gupta P. Congenital Lateral Nasal Proboscis with Orbital Mass. Clin Rhinol An Int J 2014;7(3):139-141.

CASE REPORT

Sathiya Murali, Mohan Kameswaran, Kiran Natarajan, Amarnath Devarasetty, A Senthilvadivu, Sudhamaheswari

Sinonasal Rosai-Dorfman Disease

[Year:2014] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:142 - 146]

Keywords: Sinonasal Rosai-Dorfman disease,Emperipolesis,S100 protein

PDF  |  DOI: 10.5005/jp-journals-10013-1217  |  Open Access |  How to cite  | 

Abstract

Aim

Rosai-dorfman disease (RDD) is a rare histiocytic proliferative disorder characterized by painless massive lymphadenopathy. Extranodal manifestations may occur in the head and neck area. This is a case report of a patient with sinonasal RDD and its management.

Materials and methods

This is a case report of a 36-year-old patient with sinonasal RDD. The clinical features, imaging and histological features are described. The patient underwent endoscopic surgery. Recurrence (8 months later) was managed by laserization of the nasal mass with KTP/532 laser followed by oral corticosteroid therapy.

Results

A 36-year-old lady presented with complaints of left sided nasal obstruction, nasal discharge and left facial discomfort of 6 months duration. There was history of occasional blood stained nasal discharge. Diagnostic nasal endoscopy revealed a polypoidal mass in the left nasal cavity. CT scans revealed soft tissue opacity in the left maxillary antrum, left ostiomeatal complex and extending into the left orbit. There was erosion of the posterolateral wall of the left maxilla. The patient underwent endoscopic surgery and had an uneventful postoperative recovery. Biopsy was reported as Rosai-Dorfman disease. Subsequently, 8 months later, the patient reported with a complaint of nasal obstruction and discharge. A recurrent lesion was noted in the left nasal cavity and maxillary antrum. The mass was managed by laserization followed by oral corticosteroid therapy. One year later, the patient is free from disease and has been advised regarding the necessity of periodic follow-ups.

Conclusion

RDD is a rare disease encountered by the otolaryngologist. The manifestation of extranodal Rosai-Dorfman disease is most commonly seen in the nasal cavity and paranasal sinuses. The clinical findings and imaging characteristics are variable and the diagnosis can be easily missed. Otolaryngologists and pathologists must be aware of the clinical presentation, imaging characteristics and histologic features of Rosai-Dorfman disease.

How to cite this article

Natarajan K, Devarasetty A, Murali S, Senthilvadivu A, Sudhamaheswari, Kameswaran M. Sinonasal Rosai-Dorfman Disease. Clin Rhinol An Int J 2014;7(3):142-146.

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