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Sun K, Jin L, Zhao B, Liu G, Yuan W, Chen H, Tian Y. Radiologic Evaluation of Uncinate Processes of the Cervical Spine and the Relationship Between the Uncinate Process and Vertebral Artery: Implication in Anterior Cervical Spine Surgery. World Neurosurg 2024:S1878-8750(24)00527-8. [PMID: 38561028 DOI: 10.1016/j.wneu.2024.03.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To determine the relationship between the uncinate process (UP) and vertebral artery (VA) from a radiologic view and to confirm the surgical safety margin to minimize the risk of VA injury during anterior cervical approaches. METHODS We retrospectively reviewed computed tomography angiography of 205 patients by using a contrast-enhanced computed tomography angiography protocol of the VA. Four kinds of images were simultaneously reconstructed to measure all the parameters associated with VA and UP of cervical spine. RESULTS The shortest distance from the UP's tip to the VA's medial border (P < 0.001) was at the C-6 level (2.9 ± 0.9 mm on the left and 3.2 ± 1.3 mm on the right), and the longest distance (P < 0.001) was at the C-3 level on both sides. The distance between UP's tip and the medial border of the ipsilateral VA was statistically significantly different at each cervical level, and the right distance was larger than the left (P < 0.05). We found the height of UP gradually increased from C-3 to C5-level and then decreased from C-5 to C-7 level for both sides. The mean distance between the medial borders of left UP and left VA was on average 7.5 ± 1.4 mm. The diameter of VA was on average 3.4 ± 0.6 mm on the left side and 3.2 ± 0.7 mm on the right. The diameter of the VA was statistically significantly different on both sides, and the left side was larger than the right (P < 0.05). CONCLUSIONS Detailed radiologic anatomy of VA and UP was reviewed in this study. A deep understanding of the correlation between the UP and VA is essential to perform anterior cervical spine surgery safely and ensure adequate spinal canal decompression.
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Affiliation(s)
- Ke Sun
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lanbo Jin
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Baolian Zhao
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Gang Liu
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wen Yuan
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Huajiang Chen
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ye Tian
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China.
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Kikawada T, Araki Y, Okamoto T. Anterior ethmoid and frontal sinus drainage pathways: five patterns formed and defined by their bony walls. Eur Arch Otorhinolaryngol 2023; 280:199-206. [PMID: 35802170 DOI: 10.1007/s00405-022-07517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To perform endoscopic sinus surgery safely and effectively, surgeons need to visualize the complex anatomy of the anterior ethmoid and frontal sinus region. Because this anatomy is so variable and individualized, the foundation of understanding lies in identifying, following, and visualizing the drainage pathway patterns and anticipating possible variations. METHODS We studied 100 sides (50 cases: 22 male, 28 female, aged 12-86, average age 46.5 years, ± 19.5) using computed tomography (CT) and multiplanar reconstruction (MPR) to identify and classify the drainage pathways leading to the frontal sinus and anterior ethmoidal cells. RESULTS Analysis revealed five patterns of drainage pathways defined by their bony walls: between the uncinate process and the lamina papyracea [UP-LP]; between the uncinate process and the middle turbinate [UP-MT]; between the uncinate process and the accessory uncinate process [UP-UPa]; between the uncinate process and the basal lamella of the ethmoidal bulla [UP-BLEB]; and between the basal lamella of the ethmoidal bulla and the basal lamella of the middle turbinate [BLEB-BLMT]. In most cases, BLEB formed the posterior wall of the drainage pathway of the frontal sinus, indicating BLEB could be one of the most important landmarks for approaching the frontal sinus. CONCLUSIONS As endoscopic sinus surgery depends on an understanding of this anatomy, this study may help surgeons to identify and follow the drainage pathways more accurately and safely through the anterior ethmoid to the frontal sinus.
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Al-Abdulwahid FA, Almomen A, Alshakhs A, Al Yaeesh I, AlOmairin A, Al Yahya A, Al Suqair H, Al Omayrin F, Al Ghwainem N, AlHussain R. A Review of the Different Intraoperative Findings of Revision Endoscopic Frontal Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:1157-1162. [PMID: 36452682 PMCID: PMC9702426 DOI: 10.1007/s12070-020-02196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022] Open
Abstract
A revision endoscopic sinus surgery (rESS) is considered when the primary surgery fails to improve the symptoms or causes problems. The rESS is still a difficult surgical procedure, despite the use of imaging-guided surgical navigation systems, because the anatomical landmarks are removed or scarred. To determine the causes and indications of rESS observed radiologically or endoscopically in patients with frontal rhinosinusitis. This retrospective clinical study was conducted between 2010 and 2019 in the Ear, Nose, and Throat Department of King Fahad Specialist Hospital, Saudi Arabia. Sixty cases were indicated for revision endoscopic surgery, and all had distorted or lost anatomical landmarks. Most landmark losses were caused by undissected uncinate processes and residual agger nasi with/without ethmoid disease. The rESS surgical procedure remains difficult, despite the use of imaging-guided surgical navigation systems, because most of the anatomical landmarks are removed or scarred. An undissected uncinate process, residual agger nasi with/without ethmoid disease, extensive mucosal disease with polyps obstructing the frontal recess, and lateralized middle turbinates are the most common conditions requiring rESS.
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Affiliation(s)
| | - Ali Almomen
- Department of Rhinology & Skull Base Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | | | - Ahmed AlOmairin
- College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
| | | | - Hesham Al Suqair
- College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
| | - Fatima Al Omayrin
- Department of Biomedical Engineering, King Faisal University, AlAhsa, Saudi Arabia
| | | | - Razan AlHussain
- College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
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Choi SH, Chong EH, Jang JY. Self-traction Method for Uncinate Process Dissection During Laparoscopic Pancreaticoduodenectomy. J Gastrointest Surg 2022; 26:1547-9. [PMID: 35277798 DOI: 10.1007/s11605-021-05221-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/30/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dissection of the uncinate process is one of the most challenging procedures in laparoscopic pancreaticoduodenectomy and is also oncologically important to secure the retroperitoneal resection margin. In this study, we introduced a traction method that could provide stable lateral traction of the uncinate process to elevate it to allow better visualization of the retroperitoneal resection margin between the uncinate process and the superior mesenteric artery. METHODS The pancreatic head and duodenal unit were encircled using a 25-cm-long nylon tape and an elastic rubber band was used to tract it. The elastic power of the rubber band induces gradual automatic self-traction that allows the surgeon to proceed with the dissection without any other manipulation. With the help of this traction method, both of the operator's hands were free from the traction. RESULTS This video demonstrated the setting for the application of our self-traction method and how it can be used to achieve a proper operative field during uncinate process dissection. CONCLUSION This simple traction method could allow better exposure of the operative field and provide a stable operative environment.
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Yoganandan N, Purushothaman Y, Choi H, Jebaseelan D, Baisden J. Biomechanical effects of uncinate process excision in cervical disc arthroplasty. Clin Biomech (Bristol, Avon) 2021; 89:105451. [PMID: 34455338 DOI: 10.1016/j.clinbiomech.2021.105451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies on the role of uncinate process have been limited to responses of the intact spine and patient's outcomes, and procedures to perform the excision. The aim of this study was to determine the role of uncinate process on the biomechanical response at the index and adjacent levels in three artificial discs used in cervical disc arthroplasty. METHODS A validated finite element model of cervical spine was used. Flexion, extension, and lateral moments and follower load were applied to Bryan, Mobi-C, and Prestige LP artificial discs at C5-C6 level with and without uncinate process. Ranges of motion at index level and adjacent caudal and cranial segments, intradiscal pressures at adjacent segments, and facet loads at index level and adjacent segments were obtained. Data were normalized with respect to the preservation of uncinate process. FINDINGS Uncinate process removal increased motions up to 27% at index and decreased up to 10% at adjacent levels, decreased disc pressures up to 14% at adjacent segments, decreased facet loads at adjacent segments up to 14%, while at index level, change in loads depended on mode and arthroplasty, with Mobi-C responding with up to 51% increase and Bryan disc up to 11% decrease, while Prestige LP increased loads by 17% in extension and decreased by 9%% in lateral bending. INTERPRETATION As surgical selection is based on morphology and surgeon's experience, the present computational findings provide quantitative information for an optimal choice of the device and procedure, while further studies (in vitro/clinical) would be required.
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Affiliation(s)
- Narayan Yoganandan
- Center for NeuroTrauma Research, Department of Neurosurgery, 8701 Watertown Plank Road, Medical College of Wisconsin, Zablocki Veterans Administration Medical Center, Milwaukee, WI 53226, USA.
| | - Yuvaraj Purushothaman
- Center for NeuroTrauma Research, Department of Neurosurgery, 8701 Watertown Plank Road, Medical College of Wisconsin, Zablocki Veterans Administration Medical Center, Milwaukee, WI 53226, USA; School of Mechanical Engineering, Kelambakkam Vandalur Road, Rajan Nagar, Vellore Institute of Technology, Chennai Campus, Chennai 600127, India
| | - Hoon Choi
- Center for NeuroTrauma Research, Department of Neurosurgery, 8701 Watertown Plank Road, Medical College of Wisconsin, Zablocki Veterans Administration Medical Center, Milwaukee, WI 53226, USA
| | - Davidson Jebaseelan
- School of Mechanical Engineering, Kelambakkam Vandalur Road, Rajan Nagar, Vellore Institute of Technology, Chennai Campus, Chennai 600127, India
| | - Jamie Baisden
- Center for NeuroTrauma Research, Department of Neurosurgery, 8701 Watertown Plank Road, Medical College of Wisconsin, Zablocki Veterans Administration Medical Center, Milwaukee, WI 53226, USA
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Jiang W, Xie S, Xie Z, Tang Q, Wu B, Zhang J, Sun H, Fan R, Xiao J, Zhao S, Chen X. Endoscopic frontal recess anatomy directed by the drainage pathways using the connecting plates as landmarks. Eur Arch Otorhinolaryngol 2021; 278:3315-3323. [PMID: 33388983 DOI: 10.1007/s00405-020-06577-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the anatomical features of frontal recess (FR) drainage, and the classification of FR cells and frontal sinus (FS). METHODS Fifty sides from 30 adult cadaver heads were examined. FR cells and FS along the drainage pathways were dissected under 0° and 70° endoscopic views using unique connecting structures between the uncinate process and the ethmoid bulla as landmarks. RESULTS Connecting plates between the uncinate process and the ethmoid bulla were discovered and termed medial suprainfundibular plate (MSIP), which were observed on each cadaver head, and lateral suprainfundibular plate (LSIP) on 92% (46/50) sides. Separated by MSIP, two drainage pathways were identified and named medial pathways of the FR (MPFR) medial to the MSIP and the lateral pathways of the FR (LPFR) in the lateral side. Different drainage pathways of the FS were confirmed, in which drained into the MPFR in 37 and into the LPFR in 13 of the cadaver sides. CONCLUSIONS MSIP is the critical landmark for the recognition of MPFR, LPFR, and the classification of FR cells. The FR resection along LPFR and MPFR facilitated excellent exposure of FS.
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Affiliation(s)
- Weihong Jiang
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China.
| | - Shaobing Xie
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
| | - Zhihai Xie
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
| | - Qingping Tang
- Department of Rehabilitation, Brain Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Bei Wu
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
| | - Junyi Zhang
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
| | - Hong Sun
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
| | - Ruohao Fan
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
| | - Jianyun Xiao
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
| | - Suping Zhao
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
| | - Xiang Chen
- Department of Otolaryngology-Skull Base Surgery, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, People's Republic of China
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Zhu C, Ma L, Jia Z, Shi H, Jin J, Lou W, Qin X. Novel morphological classification of the normal pancreatic uncinate process based on computed tomography. J Int Med Res 2020; 48:300060520957453. [PMID: 32972276 PMCID: PMC7522846 DOI: 10.1177/0300060520957453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives This study aimed to assess computed tomographic (CT) features of the normal pancreatic uncinate process (UP) and to classify UP types on the basis of morphological characteristics. Methods From November 2017 to December 2018, consecutive Han Chinese adults were enrolled in this retrospective study. Morphometric evaluation of the UP was performed using CT imaging, including assessment of the maximal transverse diameter of the UP (MTDUP) and pancreas head, and assessment of the relationship between the UP and superior mesenteric vessels. Results A total of 318 participants were studied. The mean MTDUP and maximal transverse diameter of the pancreas head were 15.89 ± 4.82 mm and 46.47 ± 7.18 mm, respectively. The mean MTDUP was 10.83 ± 2.59 mm for type I UP (21.70% of participants), 13.87 ± 2.35 mm for type II (13.21%), 17.08 ± 3.43 mm for type III (56.29%), and 23.74 ± 5.02 mm for type IV (8.81%). There was a significant difference among the UP types. Conclusions Four types of normal UP can be defined on the basis of morphological CT features. The length of the UP significantly increases from types I to IV, and type III accounts for > 50%.
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Affiliation(s)
- Chunfu Zhu
- Department of Pancreas Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Le Ma
- Department of Pancreas Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jianliang Jin
- Department of Anatomy, Nanjing Medical University, Nanjing, China
| | - Wenhui Lou
- Department of Pancreatic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xihu Qin
- Department of Pancreas Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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Cui S, Nasser AE, Ma L, Su P, Su D, Liao Z. Analysis of the morphometric change in the uncinate process of the cervical spondylosis patients: A study of radiological anatomy. J Orthop Translat 2020; 24:32-8. [PMID: 32612932 DOI: 10.1016/j.jot.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 03/23/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Although there are many researches that focus on the relationship between the vertebral artery and uncinate process (UP), there were no publications concerning difference in the dimensions of the UP between the normal spine and degenerative spine, especially in Chinese patient. The purpose of this study is to determine the anatomic parameters that can be used as a guide for the procedure in intervertebral foramen decompression and for analysis of the morphometric change in the UP of the cervical spondylosis patients. Methods Forty patients from January 2016 to January 2019 were enrolled in this study. Three-dimensional computed tomography scans of the cervical spine were performed. The patients were subdivided into two groups which were nondegenerative cervical spine group (20 cases) and degenerative cervical spine group (20 cases). Six parameters concerning the height, width and angle of the UP were measured. Results In nondegenerative group, the average pedicle width was 3.63 mm–5.91 mm from C3 to C7. The average width of safe UP resection will be 3.06 mm at C3, 3.12 mm at C4, 3.28 mm at C5, 2.74 mm at C6 and 2.01 mm at C7. The average safe depth will be 6.04 mm at C3, 6.52 mm at C4, 7.61 mm at C5, 6.07 mm at C6 and 5.09 mm at C7. There are statistic difference between degenerative group and nondegenerative group, especially in the parameter minimum height of UP, maximum height of UP, medial border's distance of UP and later border's distance of UP. Conclusion In this retrospective study, our results suggest that for the Chinese patients who suffered from cervical spondylosis could be performed intervertebral foraminotomy decompression by resecting part of the UP. The safe range within the spinal canal was up to 6.73 mm of width between inferior vertebral endplate and superior vertebral endplate in the intervertebral space and up to 5.09 mm of depth from medial border of the UP to the lateral side atC3 to C7 without interfering the spinal nerve root and vertebral artery. The translational potential of this article Our study found the safe margin to perform intervertebral foramen decompression to the UP for the cervical spondylosis patients. This may help to improve safeness of the surgical procedure and provide data for future robotic surgery.
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Baran H, Elibol E, Selcuk A. Comparison of Inferior Turbinate and Uncinate Process Angulation with Normal Population in Patients with Septal Spur. Indian J Otolaryngol Head Neck Surg 2019; 71:2194-2198. [PMID: 31763319 DOI: 10.1007/s12070-019-01652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022] Open
Abstract
The presence of septal spur may cause various pathologies by affecting the development of the inferior turbinate, osteomeatal unit and uncinate process. We aimed to compare the changes of the angle with inferior turbinate and the maxillary medial wall of the uncinate process in patients with septal spur by normal population. In the study, 138 patients with septal spur and unilateral septum deviation and 83 patients without septum deviation were evaluated retrospectively. The angles of the inferior turbinate and the uncinate process with the medial wall of the maxilla were measured at the ostemaetal unit level. The changes of the inferior turbinate and the uncinate process with the maxilla medial wall compared to the opposite side of the deviated side and the normal population were compared. Angle of the inferior turbinate with the medial wall of the maxilla is significantly smaller in the side with septum deviation to the side without septum deviation and normal population and significantly large in the side without septum deviation to normal population. Angle of the uncinate process with the medial wall of the maxilla is significantly large in the side with septum deviation to the side without septum deviation and normal population and significantly smaller in the side without septum deviation to normal population. Presence of septum base crest are thought to cause structural changes at the inferior turbinate and the uncinate process. We recommend to break the inferior turbinate at the concave side in patients with basal crest.
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Affiliation(s)
- Hacer Baran
- University of Health Sciences Kartal Dr. Lütfi Kırdar Education and Research Hospital, Semsi Denizer Street. E-5 Highway Cevizli Mevkii, Kartal, Istanbul, 34860 Turkey
| | - Elif Elibol
- 2Ataturk Education and Research Hospital, Univercity Neighborhood, Bilkent Street No: 1 Cankaya, Ankara, 06800 Turkey
| | - Adin Selcuk
- Otorhinolaryngology and Head and Neck Surgery, Kocaeli Derince Education and Research Hospital, Ibnisina Neighborhood, Lojman Street, Derince, Kocaeli, 41900 Turkey
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Clifton W, Williams D, Pichelmann M. How I do it: total uncinatectomy during anterior diskectomy and fusion for cervical radiculopathy caused by uncovertebral joint hypertrophy. Acta Neurochir (Wien) 2019; 161:2229-2232. [PMID: 31402419 DOI: 10.1007/s00701-019-04033-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cervical radiculopathy from uncovertebral joint hypertrophy and foraminal stenosis is a common indication for anterior cervical diskectomy and fusion (ACDF). Often, the uncinate hypertrophy extends lateral to the foramen and impinges on the nerve close to the vertebral artery as it travels in between the transverse foramina. METHOD Using an injected cadaveric specimen to highlight the vital neurovascular and bony structures pertinent to this procedure, we demonstrate the technical details of complete uncinatectomy for cervical foraminal stenosis. CONCLUSION Total uncinatectomy is a useful adjunct during ACDF for complete foraminal decompression in cases of uncovertebral joint hypertrophy.
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Raveendranath V, Kavitha T, Umamageswari A. Morphometry of the Uncinate Process, Vertebral Body, and Lamina of the C3-7 Vertebrae Relevant to Cervical Spine Surgery. Neurospine 2019; 16:748-755. [PMID: 31284340 PMCID: PMC6944996 DOI: 10.14245/ns.1836272.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The cervical spine consists of 4 typical and 3 atypical vertebrae. The uncinate process is one of the unique features of the cervical vertebrae. Uncinectomy and uncoforaminotomy are widely used to decompress the nerve in the intervertebral foramen and to remove osteophytes from the uncinate process. Morphometric analyses of the uncinate process help spine surgeons obtain a 3-dimensional orientation for approaching the cervical spine with minimal risk to the surrounding vascular and neural structures. This study aims to analyze the morphometry of uncinate process of cervical vertebrae with relevant to cervical spine surgery.
Methods Eighty dry adult cervical vertebrae were studied, and 11 parameters were measured. Seven parameters were paired and 4 were unpaired.
Results The height of the uncinate process progressively increased from C3 to C6 and decreased at C7. The length of the uncinate process increased from C3 to C6–7. The width was greatest at C6 and smallest at C3. The vertebral body width and anteroposterior diameter gradually increased from C3 to C7. The parameters of the lamina also increased from C3 to C7.
Conclusion Precise knowledge about the cervical vertebrae is useful for diagnosing both common and uncommon causes of symptoms and for choosing an appropriate approach. Thus, it helps to increase the success rate of cervical surgery.
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Affiliation(s)
- Veeramani Raveendranath
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Thangarasu Kavitha
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Machado MAC, Surjan R, Basseres T, Makdissi F. Robotic resection of the uncinate process of the pancreas. J Robot Surg 2018; 13:699-702. [PMID: 30467703 DOI: 10.1007/s11701-018-0898-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
Since the development of the robotic platform, the number of robotic-assisted surgeries has significantly increased. Robotic surgery has gained growing acceptance in recent years, expanding to pancreatic resection. Here, we report a total robotic resection of the uncinate process of the pancreas performed in a patient with a cystic neuroendocrine tumor. To our knowledge, this is the first report of a robotic resection of the uncinate process of the pancreas. A 46-year-old man with no specific medical history was diagnosed with a neuroendocrine tumor after undergoing routine imaging. Biopsy guided by echoendoscopy revealed a well-differentiated neuroendocrine tumor. We decided to perform a robotic resection of the uncinate process of the pancreas after obtaining informed consent for the procedure. According to preoperative echoendoscopy and magnetic resonance imaging, there was a safe margin between the neoplasm and the main pancreatic duct. The technique uses five ports. The duodenum is fully mobilized, and Kocher maneuver is carefully performed. The uncinate process of the pancreas is then identified. The resection of the uncinate process begins with the division of small arterial branches from the inferior pancreaticoduodenal artery in its inferior portion, followed by control of venous tributaries to the superior mesenteric vein. Intraoperative localization of the ampulla of Vater is performed using indocyanine green enhanced fluorescence, thus defining the superior margin of the uncinate process. The pancreatic division is made about 5 mm below its upper margin for safety. Surgical specimen is then retrieved through the umbilical port inside a plastic bag. The raw pancreatic area is covered with hemostatic tissue and drained. The total operation time was 215 min. The docking time was 8 min and console time was 180 min. Blood loss was minimum, estimated at less than 50 mL. The postoperative period was uneventful, except for hyperamylasemia in the drain fluid. The patient was discharged on the 3rd postoperative day. The final pathological report confirmed well-differentiated pancreatic neuroendocrine tumor. Robotic resection of the uncinate process of the pancreas is safe and feasible, providing parenchymal conservation in a minimally invasive setting. Robotic resection should be considered for patients suffering from low-grade pancreatic neoplasms located in this part of the pancreas.
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Affiliation(s)
- Marcel Autran C Machado
- Department of Surgery, University of São Paulo, Hospital Nove de Julho, Rua Dona Adma Jafet 74 cj 102, São Paulo, 01308-050, Brazil.
| | - Rodrigo Surjan
- Department of Surgery, University of São Paulo, Hospital Nove de Julho, Rua Dona Adma Jafet 74 cj 102, São Paulo, 01308-050, Brazil
| | - Tiago Basseres
- Department of Surgery, University of São Paulo, Hospital Nove de Julho, Rua Dona Adma Jafet 74 cj 102, São Paulo, 01308-050, Brazil
| | - Fabio Makdissi
- Department of Surgery, University of São Paulo, Hospital Nove de Julho, Rua Dona Adma Jafet 74 cj 102, São Paulo, 01308-050, Brazil
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Giulianotti PC, Mangano A, Bustos RE, Gheza F, Fernandes E, Masrur MA, Gangemi A, Bianco FM. Operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique : Lessons learned since the first worldwide RPD performed in the year 2001. Surg Endosc 2018; 32:4329-4336. [PMID: 29766304 PMCID: PMC6132886 DOI: 10.1007/s00464-018-6228-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/09/2018] [Indexed: 12/21/2022]
Abstract
Background Minimally invasive pancreaticoduodenectomy (MIPD) was introduced in the attempt to improve the outcomes of the open approach. Laparoscopic pancreaticoduodenectomy (LPD) was first reported by Gagner and Pomp (Surg Endosc 8:408–410, 1994). Unfortunately, due to its complexity and technical demand, LPD never reached widespread popularity. Since it was first performed by P. C. Giulianotti in 2001, Robotic PD (RPD) has been gaining ground among surgeons. MIPD is included as a surgical option in the latest NCCN Guidelines. However, lack of surgical standardization, however, has limited the reproducibility of MIPD and made the acquisition of the technique by other surgeons difficult. We provide an accurate description of our standardized step-by-step RDP technique. Methods We took advantage of our 15-year long experience and > 150 cases performed to provide a step-by-step guidance of our RPD standardized technique. The description includes practical “tips and tricks” to facilitate the learning curve and assist with the teaching/evaluation process. Results 17 surgical steps were identified as key components of the RPD procedure. The steps reflect the subdivision of the RPD into several parts which help to understand a strategy that takes into accounts specific anatomical landmarks and the demands of the robotic platform. Conclusions Standardization is a key element of the learning curve of RPD. It can potentially provide consistent, reproducible results that can be more easily evaluated. Despite promising results, full acceptance of RPD as the ‘gold standard’ is still work in progress. Randomized-controlled trials with the application of a standardized technique are necessary to better define the role of RPD.
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Affiliation(s)
- Pier Cristoforo Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA.
| | - Roberto E Bustos
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Federico Gheza
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Eduardo Fernandes
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Mario A Masrur
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Antonio Gangemi
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Francesco M Bianco
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
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Khojastepour L, Haghnegahdar A, Khosravifard N. Role of Sinonasal Anatomic Variations in the Development of Maxillary Sinusitis: A Cone Beam CT Analysis. Open Dent J 2017; 11:367-374. [PMID: 28839485 PMCID: PMC5543612 DOI: 10.2174/1874210601711010367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/07/2016] [Accepted: 12/14/2016] [Indexed: 12/26/2022] Open
Abstract
Background: Several anatomical variations can lead to the inflammation of the paranasal sinuses; therefore, surgeons should be familiar with these variations and their impacts on the status of the paranasal sinuses. Objectives: The present study aimed to determine the prevalence of Haller cells and its association with patients’ sex and age. Furthermore, the relationships between the presence and size of Haller cells, deviation of the uncinate process and size of the maxillary sinus ostium with the occurrence of maxillary sinusitis were investigated. Materials/ Patients and Methods: 120 coronal CBCT images were retrieved and analyzed. Statistical analysis of the data was performed by means of Mann - Whitney, χ2 and T tests. Results: There were statistically significant associations between the presence and surface area of Haller cells and the occurrence of ipsilateral maxillary sinusitis. Neither the angulation of the uncinate process nor the size of the maxillary sinus ostium significantly correlates with the formation of maxillary sinusitis. Conclusion: Haller cells can interfere with the normal drainage of the maxillary sinus and result in sinusitis. In contrast, diameter of the sinus ostium and deviation of the uncinate process do not influence the inflammatory status of the maxillary sinus significantly.
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Affiliation(s)
- Leila Khojastepour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical sciences, Shiraz, Iran
| | - Abdolaziz Haghnegahdar
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical sciences, Shiraz, Iran
| | - Negar Khosravifard
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Guilan University of Medical sciences, Rasht, Iran
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15
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Cheng SY, Yang CJ, Lee CH, Liu SC, Kuo CY, Lee JC, Shih CP. The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis. Eur Arch Otorhinolaryngol 2017; 274:1905-1910. [PMID: 28116489 DOI: 10.1007/s00405-016-4441-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/21/2016] [Indexed: 11/27/2022]
Abstract
The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.
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Affiliation(s)
- Sheng-Yao Cheng
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Chenggong Road, Taipei, 114, Taiwan, ROC
| | - Chih-Jen Yang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chiao-Hua Lee
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shao-Cheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Chenggong Road, Taipei, 114, Taiwan, ROC
| | - Chao-Yin Kuo
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Chenggong Road, Taipei, 114, Taiwan, ROC
| | - Jih-Chin Lee
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Chenggong Road, Taipei, 114, Taiwan, ROC
| | - Cheng-Ping Shih
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Chenggong Road, Taipei, 114, Taiwan, ROC.
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16
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Chhadi TS, Deshpande AH, Chhadi SA, Kumbhalkar DT, Raut WK. A Solid Pseudopapillary Tumour of the Head of Pancreas: A Rare Case Report Diagnosed by Fine Needle Aspiration Cytology. J Clin Diagn Res 2016; 10:ED06-8. [PMID: 27504299 DOI: 10.7860/jcdr/2016/19456.7929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/02/2016] [Indexed: 02/06/2023]
Abstract
Solid Pseudopapillary Tumour (SPPT) is a distinctive tumour of low malignant potential with a striking and unexplained predilection for adolescent girls and young women. Hence it is important to distinguish this rare tumour from other pancreatic tumours with similar cytomorphologic features because an accurate preoperative diagnosis is highly desirable since these patients can have long survival with adequate surgery. We report a case of the rare SPPT of the pancreas in a young girl who presented with nonspecific pain in the abdomen. Radiological investigations revealed a solid cystic mass in relation to the uncinate process of pancreas and third part of duodenum. The mass was diagnosed to be a solid pseudopapillary neoplasm of pancreas on ultrasound guided FNAC. Surgical removal of the pancreatic tumour and detailed histologic study confirmed the cytologic diagnosis. We present this case because, to date, there are few case reports on the cytological diagnosis of this tumour, about 60 cases, diagnosed by Fine-Needle Aspiration Cytology (FNAC) are reported in the literature. With widespread availability of high-quality imaging systems and a better understanding of its pathology, the number of cases reported in the literature has been steadily increasing in recent years. In our case, the cytological diagnosis was done even before the detailed imaging findings were available, the cytological features of this tumour are highly characteristic and it is possible to differentiate it from other pancreatic tumours with relative ease.
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Affiliation(s)
- Tulsi Shyam Chhadi
- Assistant Professor, Department of Pathology, Government Medical College , Nagpur, India
| | | | - Shyam Atmaram Chhadi
- Associate Professor, Department of Radiology, Government Medical College , Nagpur, India
| | - Dinkar T Kumbhalkar
- Professor, Department of Pathology, Government Medical College , Nagpur, India
| | - Waman K Raut
- Head of the Department, Department of Pathology, Government Medical College , Nagpur, India
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Virgolini I, Gabriel M, Kroiss A, von Guggenberg E, Prommegger R, Warwitz B, Nilica B, Roig LG, Rodrigues M, Uprimny C. Current knowledge on the sensitivity of the (68)Ga-somatostatin receptor positron emission tomography and the SUVmax reference range for management of pancreatic neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2016; 43:2072-83. [PMID: 27174220 PMCID: PMC5007271 DOI: 10.1007/s00259-016-3395-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/11/2016] [Indexed: 02/08/2023]
Abstract
Physiologically increased pancreatic uptake at the head/uncinate process is observed in more than one-third of patients after injection of one of the three 68Ga-labelled octreotide-based peptides used for somatostatin (sst) receptor (r) imaging. There are minor differences between these 68Ga-sstr-binding peptides in the imaging setting. On 68Ga-sstr-imaging the physiological uptake can be diffuse or focal and usually remains stable over time. Differences in the maximal standardised uptake values (SUVmax) reported for the normal pancreas as well as for pancreatic neuroendocrine tumour (PNET) lesions may be related to several factors, including (a) differences in the peptide binding affinities as well as differences in sstr subtype expression of pancreatic α- and β-cells, and heterogeneity / density of tumour cells, (b) differences in scanner resolution, image reconstruction techniques and acquisition protocols, (c) mostly retrospective study designs, (d) mixed patient populations, or (e) interference with medications such as treatment with long-acting sst analogues. The major limitation in most of the studies lies in the lack of histopathological confirmation of abnormal findings. There is a significant overlap between the calculated SUVmax-values for physiological pancreas and PNET-lesions of the head/uncinate process that do not favour the use of quantitative parameters in the clinical setting. Anecdotal long-term follow-up studies have even indicated that increased uptake in the head/uncinate process still can turn out to be malignant over years of follow up. SUVmax-data for the pancreatic body and tail are limited. Therefore, any visible focal tracer uptake in the pancreas must be considered as suspicious for malignancy irrespective of quantitative parameters. In general, sstr-PET/CT has significant implications for the management of NET patients leading to a change in treatment decision in about one-third of patients. Therefore, follow-up with 68Ga-sstr-PET/CT is mandatory in the clinical setting if uptake in the head/uncinate process is observed.
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Affiliation(s)
- Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Michael Gabriel
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alexander Kroiss
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Elisabeth von Guggenberg
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Rupert Prommegger
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Boris Warwitz
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Nilica
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Llanos Geraldo Roig
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Margarida Rodrigues
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christian Uprimny
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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18
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Chung SK, Kim DW, Na Y. Numerical study on the effect of uncinectomy on airflow modification and ventilation characteristics of the maxillary sinus. Respir Physiol Neurobiol 2016; 228:47-60. [PMID: 26996072 DOI: 10.1016/j.resp.2016.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/12/2016] [Accepted: 03/15/2016] [Indexed: 11/21/2022]
Abstract
In this study, we examined the effect of uncinectomy on the alteration in local airflows and on the resulting effect on gas exchange in the maxillary sinus, by using computational fluid dynamics in two nasal cavity models: one with a preserved uncinate process, and the other with the uncinate process removed virtually. Uncinectomy distinctively changed the local flow topology by triggering the formation of counter-rotating vortices in the ostiomeatal complex, except for the instants with relatively low airflow rate when the respiration phase changed, ultimately leading to a change in the velocity field inside the ostium and maxillary sinus. Despite a significant increase in the maximum air velocity through the maxillary ostium, ventilation was found to increase only slightly when the uncinate process was removed. Furthermore, the degree of maxillary sinus ventilation by inhaled air was comparable to that by exhaled air. This was true to both models and was independent of the presence of the uncinate process.
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19
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Srivastava M, Tyagi S. Role of Anatomic variations of Uncinate Process in Frontal Sinusitis. Indian J Otolaryngol Head Neck Surg 2015; 68:441-444. [PMID: 27833869 DOI: 10.1007/s12070-015-0932-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/07/2015] [Indexed: 12/01/2022] Open
Abstract
The osteomeatal complex plays an important role in the development of Chronic rhinosinusitis. The ethmoidal infundibulum is bordered medially by the uncinate process, and the anatomic relationship between the ethmoidal infundibulum and the frontal recess may depend upon the types of attachment of the uncinate process. The osteomeatal complex is the main area targeted in chronic rhinosinusitis and within it uncinate process is the first anatomical structure encountered. The aim of this study was to evaluate the types of attachment of the uncinate process and its implications in the development of sinus inflammation. The significance of anatomical variations of uncinate process in chronic sinusitis were evaluated. A prospective CT scan study on 64 patients of chronic sinusitis (128 uncinate processes) was done. The results were tabulated and analyzed using Statistical Package for Social Science 16.0. Type I superior attachment of uncinate process into the lamina papyracea was the most common variety in all ages and both sexes and a statistically significant association between Type 1 Uncinate process and frontal sinusitis was found. (P < 0.05). The superior attachment of uncinate process alters the frontal sinus drainage and causes the frontal sinusitis.
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Affiliation(s)
- Mohit Srivastava
- Saraswathi Institute of Medical Sciences, Ghaziabad, Uttar Pradesh India
| | - Sushant Tyagi
- Saraswathi Institute of Medical Sciences, Ghaziabad, Uttar Pradesh India
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20
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Gandhi S, Sharma M, Pakhiddey R, Thakur A, Mehta V, Suri RK, Rath G. Unduly extensive uncinate process of pancreas in conjunction with pancreatico-duodenal fold. Anat Cell Biol 2015; 48:81-3. [PMID: 25806126 PMCID: PMC4371185 DOI: 10.5115/acb.2015.48.1.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 10/09/2014] [Accepted: 10/30/2014] [Indexed: 11/27/2022] Open
Abstract
Anatomical variations of pancreatic head and uncinate process are rarely encountered in clinical practice. These variations are primarily attributed to the complex development of the pancreas. An unduly enlarged uncinate process of the pancreas overlapping the third part of duodenum was discovered during dissection. This malformation of the pancreatic uncinate process was considered to be due to excessive fusion between the ventral and dorsal buds during embryonic development. On further dissection, an avascular pancreatico-duodenal fold guarding the pancreatico-duodenal recess was observed. The enlarged uncinate process can cause compression of neurovascular structures and also cause compression of adjoining viscera. The pancreatico-duodenal recess becomes a potential site for internal herniation. This case is of particular interest to the gastroenterologists and surgeons performing surgical resections. Precise knowledge of embryogenesis of such pancreatic anomalies is necessary for understanding and thus treating many diseases of the pancreas.
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Affiliation(s)
- Swati Gandhi
- Department of Anatomy, Vardhaman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Mona Sharma
- Department of Anatomy, Vardhaman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Rohini Pakhiddey
- Department of Anatomy, Vardhaman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Avinash Thakur
- Department of Anatomy, Vardhaman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Vandana Mehta
- Department of Anatomy, Vardhaman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Rajesh K Suri
- Department of Anatomy, Vardhaman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Gayatri Rath
- Department of Anatomy, Vardhaman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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21
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Demir UL, Akca ME, Ozpar R, Albayrak C, Hakyemez B. Anatomical correlation between existence of concha bullosa and maxillary sinus volume. Surg Radiol Anat 2015; 37:1093-8. [PMID: 25772518 DOI: 10.1007/s00276-015-1459-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to assess the effects of concha bullosa variation on maxillary sinus volume and uncinate angle. METHOD The study group included 169 patients (338 sides) who underwent either surgical or medical treatment with the diagnosis of chronic rhinosinusitis. The paranasal sinus computed tomography of these patients was analyzed to measure maxillary sinus volume, uncinate angle and existence of concha bullosa. Subsequently, these variables were evaluated to find out possible relationship inbetween. RESULTS Mean maxillary sinus volume and uncinate angle at right and left sides were 15.21 ± 0.47 and 15.51 ± 0.48 mm(3), 30.57 ± 0.62° and 30.20 ± 0.68°, respectively. There was no difference between patients with or without concha bullosa in regard to maxillary sinus volume and uncinate angle at both sides. Maxillary sinus volume and degree of uncinate angle did not show any significant correlation at both sides; r = -0.124, p = 0.107 and r = -0.136, p = 0.078. CONCLUSION In conclusion, concha bullosa is a common anatomical variation at nasal cavity. The existence of concha bullosa does not have any association with the volume of maxillary sinus and angle of uncinate process.
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Affiliation(s)
- Uygar Levent Demir
- Department of Otolaryngology, Uludag University Medical School, Gorukle, Nilufer, 16059, Bursa, Turkey.
| | - M E Akca
- Department of Otolaryngology, Uludag University Medical School, Gorukle, Nilufer, 16059, Bursa, Turkey
| | - R Ozpar
- Department of Radiology, University of Uludag, Bursa, Turkey
| | - C Albayrak
- Department of Otolaryngology, Uludag University Medical School, Gorukle, Nilufer, 16059, Bursa, Turkey
| | - B Hakyemez
- Department of Radiology, University of Uludag, Bursa, Turkey
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22
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Natsume T, Maruyama T, Kobayashi A, Shimizu S, Tanaka H, Matsuzaki H, Miyazaki A, Ohta T, Sato Y, Yamamoto Y, Aikawa M, Otsuka R, Yanagihara A. Ductal branch-oriented pancreatic resection for an intraductal papillary mucinous neoplasm in the uncinate process that caused recurrent acute pancreatitis: a case report of successful treatment. Clin J Gastroenterol 2013; 6:476-9. [PMID: 26182140 DOI: 10.1007/s12328-013-0428-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/09/2013] [Indexed: 02/03/2023]
Abstract
Acute pancreatitis reportedly occurs in about 15 % of cases of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs), with two-thirds of BD-IPMNs being located in the head or uncinate process of the pancreas. However, the surgical indications and optimal treatment methods for BD-IPMNs have not been established. A 59-year-old Japanese male with epigastralgia was admitted to our hospital. A multidetector row computed tomography (MDCT) scan disclosed grade I acute pancreatitis. Magnetic resonance cholangiopancreatography disclosed a 1.5-cm BD-IPMN in the uncinate process. Two months after discharge, the epigastralgia recurred, and MDCT again revealed grade I pancreatitis. Due to the repeated episodes of pancreatitis, we performed ductal branch-oriented pancreatic resection. To detect the inferior branch of the Wirsung duct and avoid the development of a pancreatic fistula, we injected indigo carmine into the tumor which confirmed ligation of the inferior branch. Histopathologically, the tumor proved to be an adenoma. The postoperative course was uneventful in both the short- and long-term follow-up and, to date, there has been no recurrence of pancreatitis, or diabetes mellitus during the 6 years since pancreatectomy. This procedure is one of the methods that can be used for the successful resection of a BD-IPMN in the uncinate process that caused recurrent acute pancreatitis.
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Affiliation(s)
- Toshiyuki Natsume
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
| | - Takashi Maruyama
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Akitoshi Kobayashi
- Department of Internal Medicine, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Shinichiro Shimizu
- Department of Pathology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Hajime Tanaka
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Hiroshi Matsuzaki
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Akinari Miyazaki
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Takumi Ohta
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Yayoi Sato
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Yuji Yamamoto
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Mizuho Aikawa
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Ryota Otsuka
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Akitoshi Yanagihara
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
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Tuli IP, Sengupta S, Munjal S, Kesari SP, Chakraborty S. Anatomical variations of uncinate process observed in chronic sinusitis. Indian J Otolaryngol Head Neck Surg 2013; 65:157-61. [PMID: 24427557 PMCID: PMC3649035 DOI: 10.1007/s12070-012-0612-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022] Open
Abstract
Chronic Sinusitis, an extremely persistent illness, is surgically best treated by Functional Endoscopic Sinus Surgery. The ostiomeatal complex is the main area targeted and within it uncinate process is the first anatomical structure encountered. The significance of anatomical variations concerning age and sex of uncinate process in chronic sinusitis were evaluated. A prospective study on 50 patients of chronic sinusitis (100 uncinate processes) was done. The results were tabulated and analyzed using Statistical Package for Social Science (SPSS) 16.0. Type I superior attachment of uncinate process (67 %) was the most common variety in all ages and both sexes and a statistically significant relationship between Type I superior attachment of uncinate process and sex was found (p < 0.05). The typical uncinate process was most common (70 %) followed by medial deviation of the uncinate (24 %). This difference in occurrence was significant with respect to both age and sex (p < 0.05). Anatomical variations of uncinate process are not responsible for causing chronic sinusitis. Mere presence of these variations of uncinate is not an indication for FESS.
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Affiliation(s)
- Isha Preet Tuli
- />Department of ENT & HNS, Sikkim Manipal Institute of Medical Sciences & Central Referral Hospital, Tadong, Gangtok, 737102 Sikkim India
| | - Subhabrata Sengupta
- />Department of ENT & HNS, Sikkim Manipal Institute of Medical Sciences & Central Referral Hospital, Tadong, Gangtok, 737102 Sikkim India
| | - Sudeep Munjal
- />Department of ENT & HNS, JCD Hospital, Sirsa, 125055 Haryana India
| | - Santosh Prasad Kesari
- />Department of ENT & HNS, Sikkim Manipal Institute of Medical Sciences & Central Referral Hospital, Tadong, Gangtok, 737102 Sikkim India
| | - Suvamoy Chakraborty
- />Department of ENT & HNS, Sikkim Manipal Institute of Medical Sciences & Central Referral Hospital, Tadong, Gangtok, 737102 Sikkim India
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Nayak DR, Balakrishnan R, Murty KD. Functional anatomy of the uncinate process and its role in endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg 2012; 53:27-31. [PMID: 23119747 DOI: 10.1007/bf02910975] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND A basic step of Functional Endoscopic sinus surgery-the most modern and revolutionary surgical treatment for chronic and recurring sinusitis, is removal of uncinate process to expose the infundibulum. The purpose of this study is to explore the functional role of uncinate process with special reference to endoscopic sinus surgery. METHODS A fixed dose of sterile methylene blue was sprayed into the nasal cavities of post endoscopic sinus surgery cases, 20 without uncinate process preservation and 20 with uncinate process preservation. The area of staining/deposition of the stain in the ethmoidal cavity and the maxillary sinuses was endoscopically observed. RESULTS Deposition of methylene blue was consistently found to be occurring in a larger area of the ethmoidal cavity including the maxillary sinus in post endoscopic sinus surgery cases without uncinate process preservation. CONCLUSION Uncinate proces probably acts as a protective wall by directing the allergen bearing and contuminated inspired air away from the sinuses and facilitating ventilation of the sinuses in the mucocilliary pretreated expiratory phase. Injudictious removal of the uncinate process especially in cases with allergic rhinosinusitis should thus expose the sinus mucosa to contaminated air.
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Affiliation(s)
- D R Nayak
- Dept. of ENT-Head & Neck Surgery, Kasturba Medical College & Hospital, 576 119 Manipal, Karnataka India
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Lee TH, Kim SJ, Chung IH. Morphometrical study of uncinate processes and vertebral body of cervical spine. J Korean Neurosurg Soc 2012; 51:247-52. [PMID: 22792419 PMCID: PMC3393857 DOI: 10.3340/jkns.2012.51.5.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/21/2012] [Accepted: 05/15/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The anatomical knowledge is the most important and has a direct link with success of operation in cervical spine surgery. The authors measured various cervical parameters in cadaveric dry bones and compared with previous reported results. METHODS We made 255 dry bones age from 19 to 72 years (mean, 42.3 years) that were obtained from 51 subjects in 100 subjects who donated their bodies. All measurements from C3-C7 levels were made using digital vernier calipers, standard goniometer, and self-made fix tool for two different cervical axes (canal and disc setting). We classified into 4 groups (uncinate process, vertebral body, lamina, and pedicle) and measured independently by two neurosurgeons for 28 parameters. RESULTS We analyzed 23970 measurements by mean value and standard deviations. In comparing with previous literatures, there are some different results. The mean values for uncinate process (UP) width ranged from 5.5 mm at C4 and 5 to 6.3 mm at C3 and C7 in men. Also, in women, the mean values for UP width ranged from 5.5 mm at C5 to 6.3 mm at C7. C7 was widest and C5 was most narrow than other levels. The antero-posterior length of UP tended to increase gradually from C3 to C6. The tip way, tip distance, and base distance of UP also showed increasing pattern from C3 to C7. CONCLUSION These measurements can provide the spinal surgeons with a starting point to address bony architectures surrounding targeted soft tissues for safeguard against unintended damages during cervical operation.
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Affiliation(s)
- Tae Hoon Lee
- Department of Neurosurgery, 21st Century Hospital, Seoul, Korea
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Nayak DR, Ramaswamy B. Endoscopic approach to middle turbinate squeeze syndrome. Indian J Otolaryngol Head Neck Surg 2012; 64:167-71. [PMID: 23730579 PMCID: PMC3392353 DOI: 10.1007/s12070-011-0245-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Accepted: 06/13/2010] [Indexed: 11/26/2022] Open
Abstract
Middle turbinate squeeze syndrome (MTSS) refers to sino-nasal headache due to intense contact between the middle turbinate and the nasal septum and/or between middle turbinate and other structures in the lateral nasal wall. This study was intended to evaluate the efficacy of precise endoscopic surgical treatment of MTSS. This is a prospective study of 126 patients with refractory cephalgia due to endoscopically confirmed MTSS who underwent functional endoscopic naso-sinus surgery (FENS) wherein the contact points and ostio-meatal complex obstruction were endoscopically relieved. 91% of cases reported improvement/resolution of headache and 95% of cases had relieved contact points as documented endoscopically. This surgery was also found to facilitate resolution of sinus disease, both radiologically (in 64% of cases) and endoscopically (in 94% of cases). Cephalgia caused by MTSS can be effectively treated by an ultra-conservative endoscopic approach.
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Affiliation(s)
- Dipak Ranjan Nayak
- Department of ENT-Head & Neck Surgery, Kasturba Medical College & Hospital, Manipal University, Manipal, 576104 Karnataka India
| | - Balakrishnan Ramaswamy
- Department of ENT-Head & Neck Surgery, Kasturba Medical College & Hospital, Manipal University, Manipal, 576104 Karnataka India
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