Faculty Bibliography

BACKGROUND: Anatomic and mucosal obstruction of the frontal sinus outflow tract (FSOT) can result in frontal sinusitis often associated with frontal headache. Thorough evaluation of symptomatic patients requires axial and coronal computerized tomographic (CT) scans of the paranasal sinuses (PNS). With the advent of multichannel multidetector CT scanning, the availability of high-quality sagittal images has become increasingly widespread. However, the utility of these images in the assessment of FSOT patency has not yet been established. METHODS: A retrospective review of coronal and sagittal images from 25 PNS CT scans (50 sides) were randomized, blinded, and independently evaluated by two neuroradiologists. FSOT obstruction by agger nasi cells, the ethmoid bulla, and mucosal disease was assessed. A degree of confidence was rendered for each of these findings. The results were then compared against a consensus diagnosis, which was rendered based upon simultaneous reading of the coronal and sagittal images. Generalized estimating equations were used to assess the difference between sagittal and coronal images in terms of reader confidence and diagnostic concordance with the consensus. RESULTS: Review of sagittal images had a higher degree of concordance with the consensus than did coronal images, and was highest for mucosal disease. Both readers were more confident in rendering a diagnosis based upon the sagittal images. CONCLUSION: Sagittal reformatted CT images of the PNS are helpful in the radiologic evaluation of the FSOT. Experienced neuroradiologists had a higher degree of confidence in the diagnosis of the obstruction of the FSOT using sagittal reformatted images

BACKGROUND: The relationship between nasal airway function and sleep-disordered breathing (SDB) remains unclear. Although correction of nasal obstruction can significantly improve nighttime breathing in some patients, nasal obstruction may not play a role in all cases of SDB. An effective method of stratifying these patients is needed. Acoustic rhinometry (AR) is a reliable, noninvasive method of measuring the dimensions of the nasal airway. METHODS: In 44 patients, we performed acoustic rhinometric measurements of nasal airway cross-sectional area, followed by hospital-based polysomnography and nasal continuous positive airway pressure (nCPAP) level titration. We compared anatomic nasal obstruction to perceived nasal obstruction, as well as respiratory distress index and nCPAP titration level, using the Pearson correlation and multiple linear regression analysis within body mass index groups. RESULTS: Perceived nasal obstruction correlated significantly with objective anatomic obstruction as measured by AR (r = 0.45, p < 0.01). For certain subgroup analyses in patients with a body mass index below 25, AR measurements correlated significantly with both nCPAP titration pressure (r = 0.85, p < 0.01) and respiratory distress index (r = 0.67, p = 0,03). CONCLUSION: Nasal airway function may be a significant component of SDB in some patients, perhaps playing a larger role in patients who are not overweight. The best responders to nasal surgery for SDB may be nonoverweight patients with nasal obstruction. AR along with nasal examination may be helpful in the evaluation and treatment of the SDB patient

The use of an intracoperative navigation device improves surgical accuracy, helps identify anatomic landmarks, and minimizes the risk of complications during surgery of the paranasal sinuses and skull base. Despite the benefits of image guidance, its use is limited by the headset, which precludes external surgical access. We report the successful use of a cranial pin placed into the outer table of the calvarium during surgery. This pin eliminates the need for a headset and permits unencumbered external surgical access. We describe a case that used a combined endoscopic and osteoplastic flap approach to the frontal sinus with this cranial pin system. There were no complications associated with placing the pin. The patient reported only minimal postoperative discomfort related to the temporal scalp incision. The cranial pin combines the benefits of surgical navigation with external surgical access to the paranasal sinuses and skull base. (C) 2004 Elsevier Inc. All rights reserved

The plasma cell dyscrasias and amyloidosis are distinct clinical entities that may co-exist. Both disease processes may present with manifestations in the head and neck, making familiarity with these conditions by otolaryngologists essential. Prompt diagnosis and evaluation for systemic disease are crucial in proper treatment planning

Anatomically, the sphenoid sinus is more complicated than the other paranasal sinuses as a result of its close proximity to surrounding vital structures. It is directly related to the anterior cranial fossa, hypophysis, brain stem, optic nerves, carotid artery, as well as the cavernous sinuses and its contents. Additionally, of the three single cavity paranasal sinuses (ie, frontal, maxillary, sphenoid), it is the sinus with the most anatomic variability. This complexity creates the need for a comprehensive understanding of the anatomy before surgery in and around the sinus. This article reviews the embryology, physiology, and anatomy of the sphenoid sinus