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Mishra S, Thakur V, Kapila S, Moudgil S, Mishra S. Comparison of Low-Dose Non-contrast CT in Detecting Anatomical and Surgically Important Variants of Paranasal Sinuses to Standard Dose Non-contrast CT: Experience from a Tertiary Care Hospital in Sub-Himalayan Region of Northern India. Indian J Otolaryngol Head Neck Surg 2024; 76:64-72. [PMID: 38440524 PMCID: PMC10908968 DOI: 10.1007/s12070-023-04081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/13/2023] [Indexed: 03/06/2024] Open
Abstract
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.
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Affiliation(s)
- Swastika Mishra
- Department of Radiodiagnosis, IGMC, Shimla, Himachal Pradesh 171001 India
| | - Vijay Thakur
- Department of Radiodiagnosis, IGMC, Shimla, Himachal Pradesh 171001 India
| | - Sumala Kapila
- Department of Radiodiagnosis, IGMC, Shimla, Himachal Pradesh 171001 India
| | - Sandeep Moudgil
- Department of Intervention Radiology, NIMS University, Jaipur, Rajasthan 303121 India
| | - Sanat Mishra
- Department of Gastroenterology, GMC-SSH, Nagpur, Maharashtra 440003 India
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Hsu LF, Ratanasereeprasert N, Wang SK, Chen JT, Chen YJ, Yeh TH, Sung HH, Yao CCJ. Craniofacial and olfactory sensory changes after long-term unilateral nasal obstruction-an animal study using MMP-3-LUC transgenic rats. Sci Rep 2024; 14:2616. [PMID: 38297007 PMCID: PMC10830476 DOI: 10.1038/s41598-024-51544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024] Open
Abstract
Nasal obstruction exerts considerable physiological effects on the respiratory system and craniofacial morphology during the developmental stage. This study used MMP-3-LUC transgenic rats for in vivo tracking of long-term expression in the rat nasal region after unilateral nasal obstruction. Skeletal changes of the craniofacial, nasal, and sinus regions were measured through micro-computed tomography examination and analysis with 3D image processing and calculation. Matrix metalloproteinase-3 and olfactory marker protein expression were also investigated through immunohistochemistry (IHC). Unilateral nasal obstruction significantly reduced the MMP-3 signal in the nasal region of MMP-3-LUC transgenic rats, which was mainly expressed in the respiratory epithelium. Long-term obstruction also caused morphological changes of the craniofacial hard tissue, such as nasal septal deviation, longer inter-jaw distance, and increased maxillary molar dental height. It also caused compensatory growth in olfactory nerve bundles and the olfactory epithelium, as confirmed by IHC. In our study, long-term unilateral nasal obstruction caused nasal septal deviation toward the unobstructed side, hyper divergent facial development including longer molar dental height, and reduced MMP-3 production. However, further investigation is necessary to explore the mechanism in depth.
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Affiliation(s)
- Li-Fang Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Nutthakarn Ratanasereeprasert
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Shih-Kai Wang
- Department of Dentistry, National Taiwan University School of Dentistry, Taipei, Taiwan
| | - Jung-Tsu Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan
| | - Yi-Jane Chen
- Department of Dentistry, National Taiwan University School of Dentistry, Taipei, Taiwan
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Hsuan Sung
- National Laboratory Animal Center, National Applied Research Laboratories, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 1, Chang-Te Street, Taipei, 10048, Taiwan.
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan.
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Muacevic A, Adler JR, Alsurayhi AS, Alshibely AY, Alkaabi TH, Alqurashi LM, Alahdal AA, Saber AA, Almansouri OS. Nasal Septal Deviation: A Comprehensive Narrative Review. Cureus 2022; 14:e31317. [PMID: 36514566 PMCID: PMC9736816 DOI: 10.7759/cureus.31317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
The nasal septum is an osteocartilaginous wall that divides the nose into two nasal cavities. Asymptomatic minor deviation of the septum is considered a normal developmental variation found in the majority of the population. The reported global prevalence rates had great variation due to the extent of deviation considered in the reporting studies. Previous classification systems have been proposed to classify the nasal septal deviation according to the characteristics of the nasal septum seen horizontally and vertically. For some patients, the degree of the deviation may affect the nasal airflow causing obstruction or impairing the olfactory function. Headache, rhinosinusitis, high blood pressure, obstructive sleep apnea, and breathing sounds are also among the clinical presentations of nasal septal deviation. Clinical assessment is sufficient to make the diagnosis while imaging techniques are required for decision-making. Radiological imaging techniques such as computed tomography (CT) are used to classify and assess the severity of the deviated septum. Surgical correction is the treatment option for nasal septal deviation. Septoplasty is the most common procedure used for nasal correction with high satisfaction levels and low complication rates. In this review, we present a comprehensive summary of the concept, presentation, diagnosis, management options, and quality of life of patients with nasal septal deviation.
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Baddam P, Young D, Dunsmore G, Nie C, Eaton F, Elahi S, Jovel J, Adesida AB, Dufour A, Graf D. Nasal Septum Deviation as the Consequence of BMP-Controlled Changes to Cartilage Properties. Front Cell Dev Biol 2021; 9:696545. [PMID: 34249945 PMCID: PMC8265824 DOI: 10.3389/fcell.2021.696545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
The nasal septum cartilage is a specialized hyaline cartilage important for normal midfacial growth. Abnormal midfacial growth is associated with midfacial hypoplasia and nasal septum deviation (NSD). However, the underlying genetics and associated functional consequences of these two anomalies are poorly understood. We have previously shown that loss of Bone Morphogenetic Protein 7 (BMP7) from neural crest (BMP7 ncko ) leads to midfacial hypoplasia and subsequent septum deviation. In this study we elucidate the cellular and molecular abnormalities underlying NSD using comparative gene expression, quantitative proteomics, and immunofluorescence analysis. We show that reduced cartilage growth and septum deviation are associated with acquisition of elastic cartilage markers and share similarities with osteoarthritis (OA) of the knee. The genetic reduction of BMP2 in BMP7 ncko mice was sufficient to rescue NSD and suppress elastic cartilage markers. To our knowledge this investigation provides the first genetic example of an in vivo cartilage fate switch showing that this is controlled by the relative balance of BMP2 and BMP7. Cellular and molecular changes similar between NSD and knee OA suggest a related etiology underlying these cartilage abnormalities.
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Affiliation(s)
- Pranidhi Baddam
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Daniel Young
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Garett Dunsmore
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - Chunpeng Nie
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Farah Eaton
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shokrollah Elahi
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Juan Jovel
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Antoine Dufour
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Daniel Graf
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
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Galluzzi F, Garavello W, Dalfino G, Castelnuovo P, Turri-Zanoni M. Congenital bony nasal cavity stenosis: A review of current trends in diagnosis and treatment. Int J Pediatr Otorhinolaryngol 2021; 144:110670. [PMID: 33706014 DOI: 10.1016/j.ijporl.2021.110670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
Congenital bony nasal cavity stenosis is caused by alterations of the normal embryological development of the nasal cavity. Depending on the site of the obstruction, the most important types of stenosis are: choanal atresia and stenosis, congenital nasal pyriform aperture stenosis, congenital midnasal stenosis, arhinia and nasal septum deviation. Although they are uncommon, they could be potentially life-threatening conditions that require early diagnosis and proper treatment. In case of neonatal nasal obstruction, appropriate differential diagnosis with other causes, such as rhinitis and sinonasal masses, are performed by nasal endoscopy and radiological exams. Treatment strategy consisting of medical nasal therapies and endoscopic or open nasal surgery should be tailored according to the types and the degree of the stenosis. When indicated, endoscopic endonasal approach is considered the most effective technique in neonates warranting minimal surgical invasiveness and maximum effect. In order to promote the management of these rare yet clinically relevant neonatal nasal breath disorders, we review the current trends in diagnosis and treatment of congenital bony nasal cavity stenosis.
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Affiliation(s)
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Abstract
Congenital nasal deformities can cause nasal obstruction with early respiratory distress. Choanal atresia is characterized by no communication between the nasal cavity and nasopharynx. Pyriform aperture stenosis involves more anterior nasal obstruction with limited intranasal space. Nasal masses such as encephaloceles, gliomas, and dermoids are thought to be related through a skull base defect in utero. Imaging with computed tomography and MRI are helpful in distinguishing lesions and identifying intracranial communication. Nasolacrimal duct cysts can get infected and cause obstruction. Nasal septal deviation can be corrected at bedside if detected early. Evaluation and treatment are discussed with all these entities.
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Affiliation(s)
- Roy Rajan
- Department of Surgery, Lehigh Valley Health Network, 1210 South Cedar Crest Boulevard, Suite 1100, Allentown, PA 18103, USA.
| | - David Eric Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 6161B, Baltimore, MD 21287, USA
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Lawlor CM, Grant M, Levy J, Ananth A, Guarisco JL. Neonatal nasal septal deviation: Two cases of successful early surgical intervention. EAR, NOSE & THROAT JOURNAL 2018; 96:E20-E23. [PMID: 28846795 DOI: 10.1177/014556131709600806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Neonatal nasal septal deviations can occur as a result of trauma in utero or during birth. They are associated with significant clinical implications, including respiratory distress and failure to thrive. The incidence and classification of these deformities are varied in the otolaryngology literature. Some authors advocate conservative observation, but no consensus on management has been reached. We present 2 cases of neonatal septal deviation that occurred during difficult deliveries. We repaired the defects with closed reduction in the operating room within the first 2 weeks of life to good effect.
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Affiliation(s)
- Claire M Lawlor
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, 1430 Tulane Ave., SL-59, New Orleans, LA 70112-2699, USA.
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Macari AT, Haddad RV. The case for environmental etiology of malocclusion in modern civilizations—Airway morphology and facial growth. Semin Orthod 2016. [DOI: 10.1053/j.sodo.2016.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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