Rao K. Computed Tomography of Paranasal Sinus Pathologies with Functional Endoscopic Sinus Surgery/Nasal Endoscopy Correlation. Clin Rhinol An Int J 2016;9(1):1-5.

A 25-year-old male patient came with a history of nasal obstruction on the left side. He was also concerned about his nasal framework deformities, such as gross deviation of the nose to left, hump over the nose, asymmetrical nostril, and overall bulky nose.

Detailed history was taken and examination done to rule out contraindication to septorhinoplasty. Expectations, requirements, and postoperative results of the patient were understood. Open approach reduction rhinoplasty was carried out. Unique techniques, such as intermediate and transverse osteotomies were done to achieve the required results.

Bulky deviated nose was reduced to an esthetically good-looking nose by humpectomy, four types of osteotomies, extended spreader grafts, columellar strut, and Tipplasty.

Surgical steps must be undertaken in order to achieve good esthetic results. Surgeries, such as humpectomy must be done before osteotomies, intermediate osteotomies must be done before lateral osteotomies, and Tipplasty must be done after osteotomies.

Sagar NJ, Devasamudra CR. Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty. Clin Rhinol An Int J 2016;9(1):6-12.

Chronic rhinosinusitis (CRS) refers to a group of disorders characterized by inflammation of the mucosa of the paranasal sinuses. Nasal endoscopy and computed tomography (CT) scans are successfully used as diagnostic modalities of nose and paranasal sinus diseases. There have been many studies regarding the anatomic variations leading to pathogenesis of paranasal sinus diseases. Considerable progress has been made in the medical and surgical control of these conditions; however, a large number of questions relating to the diagnosis, evaluation, and treatment of the diseases remain unanswered.

The study included 82 clinically diagnosed cases of CRS who underwent CT scan and were advised to undergo diagnostic endoscopy. The anatomical findings of the nose were compared to see correlation between nasal endoscopy and CT scan.

The mean age (±standard error of the mean) of presentation was 34.11 (±1.42) years, while most patients were from the age group of 18 to 30 years. Males were predominating the study group with 62.2%, while 37.8% were females. The most common anatomic variation was deviated nasal septum with 92.68% CT reported patients. This was followed by inferior turbinate hypertrophy, septal spur, concha bullosa, and agger nasi cells.

Computed tomography scan is considered the gold standard for sinonasal imaging. Diagnostic endoscopy and CT scan are a must prior to any functional endoscopic sinus surgery. They help in assessing the extent of sinus disease and to know the variations and vital relations of the paranasal sinuses. Computed tomography scan assists the surgeon as a “road map” during endoscopic sinus surgery.

Chakraborty P, Jain RK, Joshi P, Kumari R, Pradhan S. Anatomic Variations of the Nose in Chronic Rhinosinusitis: Correlation between Nasal Endoscopic and Computerized Tomography Scan Findings and a Review of Literature. Clin Rhinol An Int J 2016;9(1):13-17.

M oran N, D as D . E pistaxis—Incidence, Etiology, and Management: A Hospital-based Study. Clin Rhinol An Int J 2016;9(1):18-20.

The superior attachment of the uncinate process and the agger nasi cell are important landmarks in frontal sinus surgery and are in close relation with each other. The aim of this study is to investigate the relationship between the two.

A retrospective radiological study.

A total of 50 patients with features of chronic sinusitis were evaluated radiographically, i.e., by computed tomography. Hundred sides, i.e., 50 scans, were evaluated for superior attachment of the uncinate process and the presence of agger nasi. Chi-square test was used as a statistical tool for eliciting the relationship between the two.

The agger nasi cell was found in 68 (68%) of 100 sides. The prevalence of agger nasi cell according to the superior attachment of uncinate process types was 64.1% for lamina papyracea, 79.41% for skull base, and 53.84% for middle turbinate. The presence of agger nasi cell according to the superior attachment types of uncinate process was not statistically significant (X² = 3.5925, p = 0.16592).

The agger nasi cell was found in 68 sides (68%), and there was no statistical significance between the superior attachment of the uncinate process and the presence of agger nasi cell.

Shivaraj R, Dsouza C, Pinto G. Influence of Superior Attachment of the Uncinate Process on the Presence of Agger Nasi. Clin Rhinol An Int J 2016;9(1):21-23.

The nose is the most prominent feature on the face, giving it an exaggerated importance than other facial features. Many people have some complaints about the shapes of their noses. There is increasing interest in cosmetic rhinoplasty in recent times, but reports of anthropometric measurements of the Indian population are limited.

The objective of this survey was to provide anthropometric data for reconstructive and cosmetic surgery, and medical esthetics.

A random sample of medical students of both the sexes between the ages of 18 and 25 years from our medical college was obtained for this study. We measured the nasal height, nasal width, and anatomical nasal index. We also inquired about the degree of satisfaction and, in case of dissatisfaction, what an individual wants with his/her nose. The data were analyzed statistically.

Nasal indices were leptorrhine type and showed sexual dimorphism (female vs male: 60.44 vs 67.79). Most of the individuals were satisfied with their nose. Those unsatisfied had larger nasal indices and wanted smaller noses.

This study can help in understanding the need of those who want a more “shapely” nose and can contribute to satisfactory results of cosmetic and reconstructive nasal surgery, anthropology, and forensic medicine.

Agarwal J, Sharma R, Kumar V. Morphometric Analysis and Degree of Satisfaction of Nasal Profiles in Young Medical Students in Northern India. Clin Rhinol An Int J 2016;9(1):24-27.

To study the anatomical variations of osteomeatal complex and the importance of preoperative computed tomography (CT) in patients with chronic sinusitis undergoing functional endoscopic sinus surgery. We studied the different variations and their frequency of occurrence.

A total of 100 patients undergoing endoscopic sinus surgery were studied by nasal endoscopy, CT scanning, and at the time of definitive surgery, variations were recorded.

The frequency of occurrence of sinonasal anatomical variations was septal deviation in 76%, agger nasi cells in 71%, concha bullosa in 61%, medialized uncinate process in 48%, prominent bulla ethmoidalis in 41%, paradoxical middle turbinate in 33%, accessory maxillary ostium in 28%, frontal cell in 22%, intumescentia septi nasi anterior in 21%, lateralized uncinate in 15%, pneumatized uncinate process in 4%, Haller cells in 12%, and Onodi cells in 8%.

The high incidence of variations emphasizes the need for proper preoperative assessment for safe and effective endoscopic sinus surgery.

Narendrakumar V, Subramanian V. Anatomical Variations in Osteomeatal Complex among Patients undergoing Functional Endoscopic Sinus Surgery. Clin Rhinol An Int J 2016;9(1):28-32.

Although the association between obesity and bronchial asthma (BA) has been gaining more attention, few studies have been conducted concerning the relationship between body mass index (BMI) and other allergic diseases. The purpose of this study is to determine the relationship between allergic rhinitis (AR) and BMI.

This was a retrospective study. Two hundred and ten patients of AR (138 males and 72 females) and 424 healthy controls were included in the study. The BMI of patients and controls were calculated and correlated.

The percentage of AR patients with a low BMI was 9.5%, whereas 57.6% had a normal BMI; 21% were preobese and 9.5% were obese. In the control group, 48.6% subjects had normal BMI range followed by preobese 21.2%, underweight 20.3%, and obese 9.9%. Among the overweight (preobese+ obese) category, the maximum number of subjects belonged to cases, i.e., 32.8% with an odds ratio (OR) of 0.95 (95% confidence interval (CI) 0.91-1.07). Thus, AR was not associated with high BMI. Among the underweight, the maximum number of subjects belonged to the control group, i.e., 20.3% with an OR of 2.13 (95% CI 1.24-3.68). Thus, AR had no relationship with lower BMI also. It was also observed that more of the female patients (18, 29.1, and 12.5% were underweight, preobese, and obese respectively) had deranged BMI than male patients (5.3, 20.2, and 7.9% were underweight, preobese, and obese respectively). A relative risk of 1.124 (95% CI 1.01-1.23) and 1.04 (95% CI 0.95-1.13) was present in female patients with low and high BMI respectively, which is statistically significant (p = 0.0008).

It was concluded that BMI was not associated with increased prevalence of AR. Among the underweight and overweight, AR was more common in females than in males. Thus, BMI had a significant association with AR among female patients. Overall, BMI had no significant association with AR.

Kala H, Bhagat S, Varshney S, Bist SS. A Clinical Study of Relationship of Body Mass Index with Allergic Rhinitis. Clin Rhinol An Int J 2016;9(1):33-36.

Yadav J, Ranga RK, Goel AK, Gupta KB. Mucociliary Clearance in Bronchiectasis. Clin Rhinol An Int J 2016;9(1):37-39.

Dash AK, Patro S, Patro SK, Gupta AK, Biswal RN. Amphotericin B Emulsion in Rhino-orbital Mucormycosis: Is It Most Effective? Clin Rhinol An Int J 2016;9(1): 40-42.

Bhargava A, Khanduri S, Shakeel M, Srivastava S, Varshney P. Maxillary Sinus Hypoplasia-A Not-so-uncommon Clinical Entity: A Review. Clin Rhinol An Int J 2016;9(1):43-45.

Mucormycosis is a rare opportunistic invasive fungal infection. The most commonly reported form of the disease is rhinocerebral mucormycosis. Early diagnosis of the disease and aggressive medical and surgical intervention prevent the high morbidity and mortality associated with mucormycosis.

A 54-year-old diabetic and hypertensive male presented with severe frontal headache and retro-orbital pain of 4 days duration with high-grade fever. On examination, the patient was conscious and oriented with a blood pressure of 210/100 mm Hg. The pupils were anisocoric. Frontal sinus tenderness was present. Anterior rhinoscopy showed deviation of nasal septum to left without edema and nasal mucosal congestion. Eye examination revealed normal vision without any periorbital swelling and normal fundus. Plain axial computed tomography showed soft-tissue density material in sphenoid sinus with focal hyperdense component anteriorly. Cerebrospinal fluid study was negative for meningitis with a normal cerebrospinal fluid pressure. Axial T1-weighted image showed T1 intermediate to high signal soft tissue occluding the sphenoid sinus. Axial T2-weighted image showed T2 high signal soft tissue occluding the sphenoid sinus. Similar signal tissue was seen in the middle and posterior ethmoid air cells on both sides. Axial and coronal postcontrast T1-weighted fat-saturated images showed heterogeneously enhancing soft tissue in sphenoid and ethmoid sinuses. The patient underwent functional endoscopic sinus surgery and tissue sampling, following which antifungal therapy with posaconazole was initiated since biopsy from sinus mucosa was consistent with mucormycosis. The patient responded well to functional endoscopic sinus surgical evacuation of the fungal debris and posaconazole and is doing well on follow-up.

This report highlights the possibility of occurrence of this rapidly fatal condition even with normal-looking nasal mucosa. High index of suspicion is required to prevent the complications as the course of the disease is very rapid. This case report emphasizes the fact that posaconazole is the only available oral antifungal that can be used as a first-line agent in the management of mucormycosis, even in immunocompromised individuals.

Jalal MJA, Fernandez SJ, Thomas RM, Kandathil JC, Menon MK, Kuruttukulam G. Posaconazole: An Only Oral First-line Antifungal for Rhinocerebral Mucormycosis. Clin Rhinol An Int J 2016;9(1):46-49.

Tandon S, Meher R, Chauhan A. Extramedullary Plasmacytoma of Nasal Cavity. Clin Rhinol An Int J 2016;9(1):50-52.

To present two rare cases of ectodermal dysplasia presenting with maggot infestation due to atrophic rhinitis.

Case report.

A tertiary care referral hospital.

Two male children aged about 5 and 8 years presented to the ear, nose, and throat emergency with a history of maggot infestation of the nose.

Clinical examination was suggestive of ectodermal dysplasia. Intranasal examination was suggestive of atrophic rhinitis. Maggots were removed in the conventional manner. Following a conservative treatment, skin biopsy and nasal mucosal biopsy were done, which confirmed the diagnosis of ectodermal dysplasia.

Any ectodermal dysplasia patient should be suspected of having atrophic rhinitis and intranasal conservative therapy should be initiated at the earliest to prevent complications like maggots in the nose.

Pati S, Pal S, Saha S, Biswas S. Ectodermal Dysplasia presenting with Atrophic Rhinitis: A Report of Two Cases and a Review of the Literature. Clin Rhinol An Int J 2016;9(1):53-55.

Verma H, Dass A, Singhal SK, Gupta N, Arun TM, Kaur A. Changing Trends in Endoscopic Endonasal Medial Maxillectomy. Clin Rhinol An Int J 2016;9(1):56-58.