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Lee S, Fernandez J, Mirjalili SA, Kirkpatrick J. Pediatric Paranasal Sinuses- Development, Growth, Pathology & Functional Endoscopic Sinus Surgery. Clin Anat 2022; 35:745-761. [PMID: 35437820 PMCID: PMC9544638 DOI: 10.1002/ca.23888] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 11/27/2022]
Abstract
The paranasal sinuses (maxillary, frontal, ethmoid, and sphenoid sinuses) are complex anatomical structures. The development and growth of these have been investigated utilizing a number of different methods ranging from cadaveric analysis to modern cross sectional imaging with 3D modeling. An understanding of normal pediatric paranasal sinus embryology and development enables us to better determine when pathology may be affecting the normal developmental process. Cystic fibrosis, chronic sinusitis, deviated nasal septum and cleft lip and palate are some of the conditions which have been shown to effect paranasal sinus development to varying degrees. Functional endoscopic sinus surgery (FESS) is becoming increasingly common and an understanding of sinus anatomy together with when periods of rapid growth occur during childhood is important clinically. Although concerns have been raised regarding the impact of FESS on facial growth, there is limited evidence of this in regards to either changes in anthropomorphic measurements or clinical assessments of symmetry post operatively.
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Affiliation(s)
- Sophie Lee
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joshua Kirkpatrick
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Maggiore G, Pietragalla M, De Amicis C, Nardi C, Bruno C, Gallo O, Bonasera L, Perrone A, Cavallo A, Colagrande S, Taccetti G, Locatello LG. The Risks of Complications During Endoscopic Sinus Surgery in Cystic Fibrosis Patients: An Anatomical and Endoscopic Study. Laryngoscope 2021; 131:E2481-E2489. [PMID: 33464574 DOI: 10.1002/lary.29404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE/HYPOTHESIS An increasing proportion of adult cystic fibrosis (CF) patients is being referred to endoscopic sinus surgery (ESS) in order to relieve the symptoms of chronic rhinosinusitis (CRS). Given that CFTR mutations profoundly alter sinonasal development, we want to explore the relationship between their peculiar surgical anatomy and the risk of postoperative complications. STUDY DESIGN Retrospective case-control study. METHODS Paranasal sinuses CT scans of 103 CF adult patients with CRS were compared to those belonging to a cohort of 100 non-CF adult patients to explore their anatomical differences. Secondly, CF and non-CF patients who received primary/revision ESS were analyzed in order to assess their preoperative CT scan in terms of surgically relevant variants, and according to the CLOSE checklist. Surgical outcomes were statistically compared in order to explore the differences between groups. RESULTS CF group presented more frequently with smaller and less pneumatized paranasal sinuses and a higher Lund-Mckay score compared with controls. No anatomical differences emerged in terms of genotype stratification. Non-CF CRS patients undergoing ESS showed a significantly deeper olfactory fossa and a more frequent supraorbital pneumatization compared to CF patients (P < .001 and P = .031, respectively). Whereas this latter group underwent more often aggressive surgical procedures (P = .001), no difference in terms of postoperative adverse events was found (P = .620). CONCLUSIONS Despite receiving more often aggressive ESS procedures, adult CF patients do not show an increased risk of postoperative complication and this may be linked to a different proportion of anatomical and surgically-relevant variants. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2481-E2489, 2021.
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Affiliation(s)
| | - Michele Pietragalla
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Christian De Amicis
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Cosimo Nardi
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Luigi Bonasera
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Anna Perrone
- Department of Radiology, Anna Meyer Children's University Hospital, Florence, Italy
| | - Annalisa Cavallo
- Department of Infectious and Tropical Diseases, Careggi University Hospital, Florence, Italy
| | - Stefano Colagrande
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Giovanni Taccetti
- Cystic Fibrosis Center, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
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Lee S, Fernandez JW, Mahadevan M, Tarr G, Mirjalili A. Using 3D-reconstruction to analyse typical growth trends of the maxillary sinus in children. Int J Pediatr Otorhinolaryngol 2020; 138:110334. [PMID: 32919161 DOI: 10.1016/j.ijporl.2020.110334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES There remains a lack of consistent evidence surrounding the developmental anatomy of the maxillary sinus (MS), despite its clinical significance in radiological interpretation and surgical intervention. Our aim was to analyse the typical growth trends of the MS throughout development, to better understand its morphological transformation from birth until late adolescence. METHODS Computed Tomography (CT) scans of individuals aged 0-18 years within the Auckland District Health Board region in New Zealand were examined retrospectively. Sixty-five patients were selected for the study after careful review of criteria. Manual 3D-reconstruction was utilised to replicate the MS from CT images and the mean changes in size, volume and shape with increasing age were analysed. Principal component analysis (PCA) was performed to statistically calculate the mean 3D shapes of the MS in each age group and analyse the independent modes of variation evident in sinus morphology between individuals of each age category. RESULTS At 0-1 years of age, mean MS size was 1.03 × 1.82 × 1.27 cm (width, length, height) with a mean volume of 0.81 cm3. By 16-18 years, mean size increased to 3.39 × 4.30 × 4.63 cm and mean volume became 21.63 cm3. Growth increased linearly but most rapid expansion occurred in the first 4-5 years of life. No significant differences were observed between males and females or right and left sides. Sinus morphology gradually progressed throughout the course of growth from an ellipsoidal structure at its rudimentary phase to a pyramidal shape when fully matured. PCA revealed that within younger age groups significant variation was observed in MS size, while older age groups had relatively less size variation but increased variability in 3D shape. CONCLUSIONS The results of this study can be used as a reference for typical MS growth in healthy children and as a basis to study how disease or surgical intervention may influence sinus development in children.
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Affiliation(s)
- Sophie Lee
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - Murali Mahadevan
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gregory Tarr
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Ali Mirjalili
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
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Hervochon R, Teissier N, Blondeau JR, Remus N, Bassinet L, Canoui-Poitrine F, Van Den Abbeele T, Prulière-Escabasse V. Computed Tomography Description of the Uncinate Process Angulation in Patients With Cystic Fibrosis and Comparison With Primary Ciliary Dyskinesia, Nasal Polyposis, and Controls. EAR, NOSE & THROAT JOURNAL 2019; 98:89-93. [PMID: 30884997 DOI: 10.1177/0145561319828645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: There is a medial bulging of the lateral nasal wall in patients with cystic fibrosis (CF). AIMS: Uncinate process (UP) angulation measurements in patients and controls to objectify this bulging. MATERIALS AND METHODS: Thirty CF, 17 primary ciliary dyskinesia (PCD), 13 chronic rhinosinusitis with polyps (CRSwp), and 30 controls were included. Angles were measured bilaterally on computed tomography (CT) scans: A, B, C on coronal sections, D and E on axial sections. Angle A was between the UP and the orbit inner wall, whereas the others were between UP and midline. RESULTS: There was no significant difference between controls, PCD, and CRSwp. However, CF had 3 statistically different angles with controls, 5 with CRSwp, and 4 with PCD. Angle A average value was 126° (±16°) in patients with CF, 138° (±19°) in controls ( P = .007), 145° (±15°) in PCD ( P = .001), and 138° (±14°) in CRSwp ( P = .001). Angle E average value was 35° (±10°) in patients with CF, 20° (±6°) in controls ( P < .001), 21° (±4°) in PCD ( P < .001), and 22° (±6°) in CRSwp ( P < .001). CONCLUSION: Uncinate process's anatomy is only modified in CF: Angle between UP and inner wall of orbit is closed, and angles between UP and midline are opened. SIGNIFICANCE: These measures quantify the medial bulging of lateral nasal wall and support nasofibroscopic observations.
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Affiliation(s)
- Rémi Hervochon
- 1 Ear Nose and Throat Department and Cystic Fibrosis Centre, Intercommunal Hospital of Créteil, Paris, France
| | - Natacha Teissier
- 2 Pediatric Ear Nose and Throat Department, Robert Debré Pediatric Hospital, APHP, Paris, France
| | | | - Natacha Remus
- 4 Pediatric Department and Cystic Fibrosis Centre, Intercommunal Hospital of Créteil, Paris, France
| | - Laurence Bassinet
- 5 Pneumology Department and Cystic Fibrosis Centre, Intercommunal Hospital of Créteil, Paris, France
| | - Florence Canoui-Poitrine
- 6 Biostatistics Department, Henri Mondor Hospital, APHP, Créteil, France.,7 University Paris Est Créteil, UPEC 94000 Créteil, France.,8 DHU Ageing Thorax Vessel Blood, Créteil, France
| | - Thierry Van Den Abbeele
- 2 Pediatric Ear Nose and Throat Department, Robert Debré Pediatric Hospital, APHP, Paris, France
| | - Virginie Prulière-Escabasse
- 1 Ear Nose and Throat Department and Cystic Fibrosis Centre, Intercommunal Hospital of Créteil, Paris, France.,7 University Paris Est Créteil, UPEC 94000 Créteil, France.,8 DHU Ageing Thorax Vessel Blood, Créteil, France
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Woodworth BA, Ahn C, Flume PA, Schlosser RJ. The Delta F508 Mutation in Cystic Fibrosis and Impact on Sinus Development. ACTA ACUST UNITED AC 2018; 21:122-7. [PMID: 17283574 DOI: 10.2500/ajr.2007.21.2905] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Cystic fibrosis (CF) patients often have widespread inflammatory paranasal sinus disease with an increased incidence of frontal, maxillary, and sphenoid hypoplasia. The most common genetic defect in CF is the delta F508 mutation. The effect of specific CF genotypes on phenotypic sinus development and infections is not well understood. The purpose of this study was to determine whether the homozygous delta F508 mutation is associated with an increased incidence of sinus hypoplasia when compared with other mutations. Methods This study is a retrospective review of all adult patients seen at our CF center from 1996 to 2005. Patients ≥18 years old with a CF diagnosis using genetic and sweat chloride testing and sinus CT scans were included. Frontal sinus aplasia/hypoplasia and maxillary and sphenoid sinus hypoplasia were documented using published criteria. Data collected included patient demographics, genetic mutations, and prior sinus surgeries. Results Forty-five patients were identified with an average age of 32 years (range, 18–48 years). Thirty-one patients had prior sinus surgeries. Delta F508 homozygotes (n = 25) had a significantly increased frequency of underdeveloped frontal (98%), maxillary (70%), and sphenoid (100%) sinuses (p < 0.001) when compared with other mutations (69, 8, and 50%, respectively). Conclusion CF patients homozygous for the delta F508 mutation have a greater incidence of hypoplastic or underdeveloped sinuses. Whether this is secondary to an increased frequency of sinus infections or a phenotypic expression of the genetic mutation itself remains an area for further investigation.
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Affiliation(s)
- Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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Calton JB, Koripella PC, Willis AL, Le CH, Chiu AG, Chang EH. Paranasal sinus size is decreased inCFTRheterozygotes with chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 7:256-260. [DOI: 10.1002/alr.21874] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | | | | | - Eugene H. Chang
- Department of Otolaryngology; University of Arizona; Tucson AZ
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CT-abnormalities, bacteriology and symptoms of sinonasal disease in children with Cystic Fibrosis. J Cyst Fibros 2016; 15:816-824. [PMID: 27049043 DOI: 10.1016/j.jcf.2016.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Sinonasal pathology in adults with Cystic Fibrosis (CF) is common but the extent of CT-abnormalities and symptoms of sinonasal disease in children with CF and the age of onset are less frequently studied. METHODS In this observational, cross-sectional study 58 children with CF from two CF centres were included. All subjects completed a questionnaire regarding sinonasal symptoms, underwent a CT scan of the paranasal sinuses, and in each subject a culture of the upper airways was performed. Subjects were divided in 6 age cohorts (0-2, 3-5, 6-8, 9-11, 12-14 and 15-17years) and were divided into severe and mild CF based on their CFTR mutation. Opacification of the sinonasal system of the subjects was compared with opacification on MRI-scans of an age-matched control group without CF. RESULTS Most frequently reported symptoms were nasal obstruction and posterior/anterior nasal discharge. Opacification was abundant in every age cohort of the study group and was significantly more compared to the control group. In patients with severe CF the opacification was higher than subjects with mild CF. Upper airway cultures showed predominantly Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa. CONCLUSION CT-abnormalities indicating sinonasal disease and symptoms are present from shortly after birth which may argue for a thorough examination of the upper airways in children with CF.
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The role of septated concha bullosa on sinonasal pathologies. Eur Arch Otorhinolaryngol 2014; 272:1417-21. [PMID: 25091322 DOI: 10.1007/s00405-014-3216-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to retrospectively determine the possible role of septated concha bullosa on sinonasal pathologies. Paranasal sinus computerized tomography scans of patients with symptoms of headache, postnasal drip, nasal obstruction and smell disorders were retrospectively evaluated. Twenty-eight subjects with unilateral septated concha bullosa and 13 subjects with unilateral concha bullosa without septation were selected as the study and control groups, respectively. Both groups were compared according to the presence of septal deviation and sinus pathology. There were no statistically significant differences in baseline characteristics (age and gender) between the groups. Sinus involvement was found in 20 patients (71.4 %) in the study group and in 10 patients (76.9 %) in the control group. The most common pathology accompanying septated concha bullosa was maxillary sinusitis (65 %), and ethmoid sinus was the second most involved sinus (25 %). Similar results in terms of sinus involvement were also seen in the control group. Septal deviation was seen in 18 patients in the study group (64.2 %) and in 12 patients in the control group (92.3 %). Eventually, there was no statistically significant difference between septated and non-septated concha bullosa groups according to the accompanying sinonasal pathologies.
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Kang SH, Piltcher OB, Dalcin PDTR. Sinonasal alterations in computed tomography scans in cystic fibrosis: a literature review of observational studies. Int Forum Allergy Rhinol 2014; 4:223-31. [PMID: 24415497 DOI: 10.1002/alr.21266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/14/2013] [Accepted: 11/19/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Almost all cystic fibrosis (CF) patients reveal upper airway involvement in computed tomography (CT) scans. Sinonasal pathology has become a challenging issue because there are few studies to guide appropriate management. The objective of this study was to provide information about paranasal sinus CT manifestations in CF patients, mainly in adulthood. METHODS We performed a literature review of descriptive studies about CT sinonasal findings in CF patients using the following databases: MEDLINE, EMBASE, Web of Science, LILACS, Scielo, and Cochrane. RESULTS Eighteen articles were included in this review. There was a high variability in methodological aspects for most of the studies. The most prevalent findings reported were opacification of sinuses, presence of frontal and sphenoidal aplasia or hypoplasia, underdevelopment of paranasal sinuses, and medial bulging of the lateral nasal wall in CT scans. CONCLUSION There are few studies in the CF adult population regarding sinonasal CT alterations. Many studies report specific pathological features in CF upper airways that could help in the diagnosis of doubtful cases.
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Affiliation(s)
- Suzie Hyeona Kang
- Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Chaaban MR, Kejner A, Rowe SM, Woodworth BA. Cystic fibrosis chronic rhinosinusitis: a comprehensive review. Am J Rhinol Allergy 2013; 27:387-95. [PMID: 24119602 PMCID: PMC3899543 DOI: 10.2500/ajra.2013.27.3919] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Advances in the care of patients with cystic fibrosis (CF) have improved pulmonary outcomes and survival. In addition, rapid developments regarding the underlying genetic and molecular basis of the disease have led to numerous novel targets for treatment. However, clinical and basic scientific research focusing on therapeutic strategies for CF-associated chronic rhinosinusitis (CRS) lags behind the evidence-based approaches currently used for pulmonary disease. METHODS This review evaluates the available literature and provides an update concerning the pathophysiology, current treatment approaches, and future pharmaceutical tactics in the management of CRS in patients with CF. RESULTS Optimal medical and surgical strategies for CF CRS are lacking because of a dearth of well-performed clinical trials. Medical and surgical interventions are supported primarily by level 2 or 3 evidence and are aimed at improving clearance of mucus, infection, and inflammation. A number of novel therapeutics that target the basic defect in the cystic fibrosis transmembrane conductance regulator channel are currently under investigation. Ivacaftor, a corrector of the G551D mutation, was recently approved by the Food and Drug Administration. However, sinonasal outcomes using this and other novel drugs are pending. CONCLUSION CRS is a lifelong disease in CF patients that can lead to substantial morbidity and decreased quality of life. A multidisciplinary approach will be necessary to develop consistent and evidence-based treatment paradigms.
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Affiliation(s)
| | | | - Steven M. Rowe
- Medicine, and
- the Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bradford A. Woodworth
- From the Departments of Surgery/Division of Otolaryngology and
- the Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
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Orlandi RR, Wiggins RH. Radiological sinonasal findings in adults with cystic fibrosis. Am J Rhinol Allergy 2009; 23:307-11. [PMID: 19490807 DOI: 10.2500/ajra.2009.23.3324] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Care of cystic fibrosis (CF) patients has extended the expected survival far into adulthood. The morphological changes of adult CF patients' paranasal sinuses have not been thoroughly addressed. METHODS A retrospective review was performed of computed tomography imaging of adult CF patients at an academic medical center. Developmental changes, bone sclerosis, mucoceles, and degree of inflammation (using a modified Lund-Mackay scoring system) were assessed. RESULTS Forty-five patients were included in the study. The majority of frontal and sphenoid sinuses were either aplastic or hypoplastic. Maxillary hypoplasia was less commonly seen. Seven patients had mucoceles. Sclerosis of the sinuses was a common finding, affecting 84.4% of patients. Inflammation of the sinuses was also common, with a median modified Lund-Mackay score of 15.0 (out of a median 20 possible). CONCLUSION Poor development of the sinuses seen in pediatric CF patients persists into adulthood. Inflammation of the sinuses is a common finding. Bone sclerosis, likely caused by chronic inflammation, affects a large majority of these patients.
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Affiliation(s)
- Richard R Orlandi
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah 84132, USA.
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McMurphy AB, Morriss C, Roberts DB, Friedman EM. The usefulness of computed tomography scans in cystic fibrosis patients with chronic sinusitis. ACTA ACUST UNITED AC 2008; 21:706-10. [PMID: 18201451 DOI: 10.2500/ajr.2007.21.3104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study was performed to evaluate the usefulness of computed tomography (CT) scans of the sinuses in children with cystic fibrosis (CF) as an outcomes measurement for medical and surgically treated chronic rhinosinusitis. METHODS Patients with CF who had sinus scans performed at the study institution from January 1999 to September 2003 were identified. The scans and any available prior scans were scored according to the Lund-MacKay system. A retrospective chart review determined if hospitalization with i.v. antibiotic therapy or operative intervention had occurred between scans and if the scans showed improvement secondary to the intervention. RESULTS One hundred thirty-four patients were identified who met inclusion criteria. A total of 290 scans were reviewed, with the average number of CT scans per patient of 2.24 (range, 1-10). The average Lund-MacKay score for scans closest in time to the first sinus surgery was 14.5. (range, 7-24), and for the first postoperative scans, the score was 14.7 (8-24). There was no significant difference between the preoperative and postoperative Lund-MacKay score after initial surgery (p = 0.99) or in subsequent scans despite medical or surgical interventions (p = 0.90). CONCLUSION CT scanning of the sinuses does not appear to be useful in determining outcomes of intervention in CF patients.
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