Pallanch, John F.

BackgroundWe aimed to test the hypothesis that three‐dimensional (3D) volume‐based scoring of computed tomography (CT) images of the paranasal sinuses was superior to Lund‐Mackay CT scoring of disease severity in chronic rhinosinusitis (CRS). We determined correlation between changes in CT scores (using each scoring system) with changes in other measures of disease severity (symptoms, endoscopic scoring, and quality of life) in patients with CRS treated with triamcinolone.MethodsThe study group comprised 48 adult subjects with CRS. Baseline symptoms and quality of life were assessed. Endoscopy and CT scans were performed. Patients received a single systemic dose of intramuscular triamcinolone and were reevaluated 1 month later. Strengths of the correlations between changes in CT scores and changes in CRS signs and symptoms and quality of life were determined.ResultsWe observed some variability in degree of improvement for the different symptom, endoscopic, and quality‐of‐life parameters after treatment. Improvement of parameters was significantly correlated with improvement in CT disease score using both CT scoring methods. However, volumetric CT scoring had greater correlation with these parameters than Lund‐Mackay scoring.ConclusionVolumetric scoring exhibited higher degree of correlation than Lund‐Mackay scoring when comparing improvement in CT score with improvement in score for symptoms, endoscopic exam, and quality of life in this group of patients who received beneficial medical treatment for CRS.

Background Safe and efficient endoscopic frontal sinus surgery requires a thorough knowledge of the location of the frontal sinus outflow tract. This study was designed to describe the prevalence of the different frontal recess cells and 3D analysis by virtual endoscopy of their ostial orientation in relation to the frontal ostium. Methods Fifty high-resolution CT scans (100 sides) of disease-free paranasal sinuses were reviewed using triplanar and virtual 3D analysis. The prevalence and ostial locations of the frontal recess cells and the relationship of the various ostia to the frontal sinus ostium were mapped and analyzed. Results The cell type, prevalence, and most common relationship of the cell's ostium to the frontal ostium were intersinus septal cells, 7% medial and anterior; Kuhn type 1 cells, 28%, lateral and anterior; Kuhn type 2 cells, 6%, anterior and lateral; Kuhn type 3 cells, 11%, medial or lateral; supraorbital ethmoid cells, 11%, posterior; suprabullar cells, 68%, posterior; and frontal bullar cells, 16%, posterior or lateral. In 35% of the sides, none of the aforementioned cell types were found. There were many blind recesses that were seen in all locations except anterolateral to the frontal ostium. Openings of adjacent pneumatized middle turbinates were often posteromedial to the frontal ostium. Agger nasi cells were present in at least 86%, opening lateral to frontal ostium. Conclusion Frontal outflow tract mapping by virtual endoscopy and knowledge of the ostial configurations will help surgeons perform more efficient and accurate surgery particularly for minimally invasive approaches including balloon dilation.