RAJIV GANDHI UNIVERSITY OF HEALTH

SCIENCES, KARNATAKA

BANGALORE

SRI DEVARAJ URS MEDICAL COLLEGE

TAMAKA, KOLAR.

SYNOPSIS FOR DISSERTATION

CT EVALUATION OF

ANATOMICAL VARIATIONS OF PARANASAL SINUS REGION

AND THEIR CLINICAL IMPORTANCE

DR. JAIGER.C

P.G. IN RADIO-DIAGNOSIS

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE-II
REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the candidate & address DR. JAIGER.C.

PG IN RADIO-DIAGNOSIS

DEPARTMENT OF RADIO-DIAGNOSIS

SRI DEVARAJ URS MEDICAL COLLEGE

TAMAKA, KOLAR – PIN: 563101

2. Name of the institution SRI DEVARAJ URS MEDICAL COLLEGE

TAMAKA, KOLAR –PIN: 563101

3. Course of study and subject M.D. (RADIO-DIAGNOSIS)

4. Date and admission of course MAY – 2007

5. Title of the Topic CT evaluation of Anatomical variations

of paranasal sinus region and their

clinical importance.

6. BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for the study:

Anatomical variations studied on CT scan are found to block the osteomeatal complex (OMC) and cause chronic sinusitis. The detection of these variants to prevent potential hazards is essential for the use of current endoscopic surgery on the sinuses.

A precise knowledge of the anatomy of the paranasal sinuses is essential for the clinician. With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed toward paranasal region anatomy. Conventional radiology does not permit a detailed study of the nasal cavity and paranasal sinuses, and has now largely been replaced by computerized tomographic (CT) imaging. Currently, CT scanning is the standard imaging in the evaluation of the paranasal sinuses. This gives an applied anatomical view of the region and the anatomical variants that are very often found.

6.2 Review of literature:

In a study done in 110 subjects, paranasal region shows high percentage (67%) of anatomical variability, the variations most often observed were, in order, deviation of the nasal septum, the presence of a concha bullosa, bony spurs of the nasal septum and Onodi air cells .1

It was postulated that variations in the anatomy of the nasal cavity result in obstruction and mucous stasis that can lead to infection. Other authors have also proposed these concepts to explain how anatomical variants such as concha bullosa and pneumatized superior turbinate might produce similar symptoms. 2,3,4

Congenital anomalies and normal anatomical variations in this region, though rare, are important as they may have pathological consequence or may be the source of difficulty during surgery. CT scan of paranasal sinuses acts as a preoperative road map to accurately define the relevant anatomy of osteomeatal complex. It also shows the extent of mucosal disease deep in the osteomeatal complex. It is mandatory to have this study before the patient is to undergo a surgical procedure. 5,6

The radiologist must pay close attention to anatomical variants in the preoperative evaluation. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery .5

Two complications dominate the thoughts of any surgeon undertaking functional endoscopic sinus surgery (FESS), namely damage to orbital structures and fractures of the fovea ethmoidalis. To avoid these complications, a detailed knowledge of the paranasal sinus anatomy of the patient is essential. This is usually assessed using preoperative CT scans of the paranasal sinuses. 7

6.3 Objectives of study:

To evaluate the anatomical variations of paranasal sinus region by CT and to assess their clinical importance.

7. MATERIALS AND METHODS:

7.1 Source of data:

Cases for the above-proposed study will be collected from R.L. Jalappa

Hospital and Research Center, Kolar.

7.2 Method of collection of data:

1.  All patients who are diagnosed clinically and/or radiologically as having chronic sinusitis and refractory to medical therapy in R.L. Jalappa Hospital and Research Center are included in this study. The consent of the patients has been taken prior to the investigation.

2.  The proposed prospective study include evaluation of cases over a period

of one and half year i.e. from Dec 2007 –May 2009.

3.  The investigation will be performed by using SIEMENS CT, using un

enhanced CT in the coronal plane, complemented by axial views in selected

cases.

Inclusion criteria:

1.  All patients who are diagnosed clinically and/or radiologically as having chronic sinusitis.

2.  Patients refractory to medical therapy.

Exclusion criteria:

1. Patient with history of RTA.

2.  Patients with sinonasal malignancy.

3. Pediatric age group where paranasal sinuses are still not well pnuemotized.

4. Pregnant women and patients with past h/o surgery in the paranasal region.

The data collected from these patients will be analyzed using descriptive tools like proportions.

7.3 Does the study require any investigations or interventions to be conducted on

patients or humans or animals? if so, please describe briefly

Yes. Computerized Tomography is a widely accepted imaging modality used to

evaluate paranasal sinus region. No contrast will be used in this study.

7.4 Has ethical clearance being obtained from institution in case of 7.3

The proposed study has been cleared by the ethical committee of the

Institution.

8. LIST OF REFERENCES:

1. Pérez-Piñas I, Sabate J, Carmona A, Catalina H C J, Jimenez C J. Anatomical

variations in the human paranasal sinus region studied by CT . Journal of Anatomy

2000; 197(2): 221–227.

2. Kopp W, Stammberger H, Fotter R. Special radiologic image of the paranasal

sinuses. European Journal of Radiology 1998; 8:152-156.

3. Blaugrund SM. Nasal septum and concha bullosa. Otolaryngol Clinics of North

America 1989; 22:291-306.

4. Clerico DM. Pneumatized superior turbinate as a cause of referred migraine

headache. Laryngoscope 1996;106:874-879.

5. Maru Y K, Gupta V. Anatomic variations of the bone in sinnasal CT. Indian J of

Otolaryngology and Head and Neck Surgery 2001; 53(2):123-128.

6. Mecit K, Mural K, Fatih A, Omer O, Adnan O, Adem K. Remarkable anatomic

variations in paranasal sinus region and their clinical importance. European

Journal of Radiology 2004; 50(3):296- 303.

7. Jones T M, Almahdi J M D, Bhalla R K , Lewis-Jones H, Swift A C.The radiological

anatomy of the anterior skull base. Clinical Otolaryngology 2002;27(2):101-105.

9. Signature of the candidate :

10. Remarks of the guide : CT coronal study of paranasal region is a part of

routine workup. These cases will be included in

proposed study.

Name and Designation of :

11. 11.1) Guide : Dr. PURNIMA HEGDE., MD(RD)

PROFESSOR OF RADIOLOGY

11.2) Signature :

11.3) Head of Department : Dr. UMESH KRISHNA MURTHY, MD (RD)

PROFESSOR & HOD OF RADIOLOGY

12.

12.1) Remarks of Chairman & Principal:

12..2) Signature :