Rajiv gandhi university of health sciences, karnataka bangalore



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION



1

Name of the Candidate Dr. ANINDITA ROY
Address (in block letters) FLAT NO. 24, 30, BELVEDERE ROAD P.O. ALIPORE,

KOLKATA -27 PIN : 700027



2

Name of the Institution KVG MEDICAL COLLEGE, SULLIA

3

Course of study and subject MD RADIO-DIAGNOSIS AND IMAGING

4

Date of admission to course 28/05/2010

5

Title of the topic : ANATOMICAL VARIATION CT OF PARANASAL SINUSES AND
THEIR ASSOCIATION WITH INFECTION .


6. BRIEF RESUME OF THE INTENDED WORK

6.1Need for the study
Recent advances in the understanding of mucocilliary activity and the pathophysiology of the nasal cavity and paranasal sinuses (PNS) have revolutionized the surgical management of sinusitis .The endoscopic surgical procedures have reduced patient morbidity dramatically. To effectively implement the surgical procedures detailed anatomical knowledge of the microanatomic locales and variations is required. In this study detailed anatomical study of the variations of paranasal sinuses and their bearing on the sinus infections is evaluated.


6.2 Review of Literature
The advent of relatively less invasive techniques of functional endoscopic sinus surgery has provided an important role for coronal CT (computed tomography) of the PNS, both as a diagnostic tool and as an important part of preoperative planning.1

The importance of anatomic variations as a predisposing cause for sinus disease, particularly in relation to the osteomeatal complex, has been stressed by several authors.2


These variations compromise already narrow drainage pathways and produce significant obstruction .3
The prevalence of anatomic variations has been variously described, ranging from pure anatomic descriptions to descriptions based on CT examinations.4

The revolutionary changes in the surgical treatment of sinusitis in recent years, particularly in endonasal endoscopic surgery, require the clinician to have a precise knowledge of nasal sinus anatomy and of the large no. of anatomical variants in the region, many of which are detectable only by the use of CT.5




CT examination of PNS will provide an anatomic road map of the PNS to identify the presence of significant anatomic abnormalities, the location and severity of the disease and exact location of the obstruction.6
Computerized tomography offers the gold standard in terms of imaging the extent of disease and the fine detailed anatomy. Neither plain radiograms (x-rays) nor MRI(magnetic resonance imaging) offer optimal information in this respect.7

CT scanning has allowed the radiologist to image PNS disease with accuracy and detail never before attainable. The information has made the image an important member of the physician team that evaluates the operability and treatment planning of these patients.8


Paradoxical curvature of the middle turbinate was found in 26.1% of patients. Haller’s cells in 45.1%pneumatization of uncinate process in 2.5% and lamellar cell of the middle turbinate was seen in 46.2% of the cases. In 31.2% pneumatization was noted in the bulbous part of turbinate and ‘true’ concha bullosa in 15.7% of the patients. The agger nasi cell was present in 98.5% of patients, crista galli pneumatization in 83.7%, bulla galli in5.4% and DNS (Deviated nasal septum) 18.8%.9
Unique development of PNS explains for their enormous amount of anatomical variations. They further stated that CT is an excellent means of providing anatomical information of this region and also assist in endoscopic evaluation.10
Remarkable anatomic variations of PNS and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinonasal surgery.11

6.3 Objectives of the study:
+
1. To study the frequency of occurrence of anatomical variations in computed tomography of paranasal sinuses.
2. To study the anatomical variations that are present and their association with disease.

7. Materials and methods
All the patients who are referred for computed tomography of the PNS from 1st december2010-30th November 2012 for evaluation of inflammatory infectious disorders of the PNS were studied. CT scan of the patients were taken and evaluated in mucosal window and bone window in all the cases and the details of the anatomical variations were recorded as per the proforma enclosed. The data analysed statistically to assess the implications of anatomical variations on the patients disease.

Inclusion criteria:
All patients who are reffered for computed tomographic scan of paranasal sinuses and above 12 years of age.


Exclusion criteria:
1. Sinonasal anatomy alteration or obscuration due to inflammatory diseases (When bony detail was obscured by polypoid mucosal disease).
2. previous sinonasal surgery (excluding nasoantral window antrostomy).
3. Facial trauma.
4. Paranasal sinus neoplasm.
5. Younger age of the patients (<12 years).

Follow-up: Not required

7.3 Does the study require any investigation/intervention to be conducted on patients/humans/animals? If so please describe briefly.

Yes


*CT paranasal sinuses required as part of routine clinical evaluation of paranasal disease.

7.4 Has ethical clearance been obtained from your institution?
Yes.

8. REFERENCES:

1. Zeinreich S J, Kennedy D W, Rosenbaum AE. Paranasal sinuses: CT imaging requirements for endoscopic surgery. Radiology 1987; 163:769-775


2.Babbel R, Harnsberger HR, Welson B, et al. Optimization of techniques in screening CT of the sinuses. AJR (American journal of radiology) 1991; 157:1093-1098
3. Bolger WE, Butzin CA, Parsons DS. paranasal sinus bony anatomic variations and mucosal abnormalities; CT analysis for endoscopic sinus surgery. Laryngoscope 1991; 101:56-64
4. Mafee MF, Endoscopic sinus surgery: role of the radiologist. Ame. J Neuroradiology 1991; 12; 885-860
5. G Marmolya, EJ Wiesen, R Yagan, CD Haria and AC Shah. Paranasal sinuses: Low-Dose CT, Radiology December 1991:181; 689-691
6. Anne G, Osborn and Robert E Anderson.Direct Saggital and tomographic scans of the face and paranasal sinuses.Radiology, october1978:129; 81-87
7. John R, Hasselink, Alfred L Weber, Paul F.Evaluation of Mucoceles of the paranasal sinuses with computed tomography, Radiology, november1979:133; 397-400
8.White PS,Cowan IA, Robertson MS.Limited CT scanning techniques of the paranasal sinuses, The journal of laryngology and otologyJan 1991;105:20-23
9. Bilaniuk LT and Zimmerman RA.Computed tomography in evaluation of the paranasal sinuses. Radiology clinics Nor Am March 1982; 20(1):51-66
10.Jing BS,Goepfert H,Close LG. Computerized tomography of paranasal sinus neoplasms .Laryngoscope 1978;88:1485-1503
11. Lund VJ, Scadding GK The.computed tomography of the paranasal sinuses and functional endoscopic surgery; The journal of laryngology and otology March 1991; 105; 181-185

PROFORMA
Name: Age: Sex:

MRD No:


Address:


  • Present History

  • Nasal discharge (Rhinorrhoea)

* Watery/mucoid/Purulent

- Nasal obstruction: Present/Absent

- Headache/Facial pain: Present/Absent

- Post nasal discharge: Present/Absent

- History of Epistaxis: Present/Absent

- History of sneezing: Present/Absent

* Past History

* Personal History

* Family History

* General physical examination


* Systemic examination

- Respiratory system

- Cardio- vascular system

- Per abdomen

- Central Nervous system

*ENT examination

- Rhinoscopy

* Anterior * Posterior

INVESTIGATIONS


  • Blood –

  1. Haemoglobin :

  2. ESR:

  3. Total WBC Count:

  4. Different WBC Count :

  • Urine

CT findings will be recorded according to the Following proforma

  1. Septum

  • Deviated to right /left / double curves

  1. Palate

  • Shifted to right /left

  1. Nasal Turbinates

  • Inferior , Middle, superior

  • Small/large/pneumatized/paradoxical curve

  • With septal deviation /without septal deviation

  • Pneumatization : with distortion/ without distortion

  1. Osteomeatal complex

  1. Uncinate process

-Vertical /horizontal

b. Ethmoid bulla

- Enlarged/Normal/absent or hypoplastic.

5. Osteomeatal complex with horizontal uncinate process and septal deviation to

- Contralateral side /Ipsilateral side

6. Osteomeatal complex with vertical uncinate process and septal deviation (also turbinate)

- Unilateral septal deviation / Unilateral large turbinate / Bilateral septal deviation/Bilateral large turbinate.

7. Bilateral abnormal osteomeatal complex and septal deviation

- With septal deviation / without septal deviation

8. Unilateral choanal atresia

- Present / absent.

9. Maxillary sinus

Size: Normal/average/enlarged

Aplasia: Present/absent

Septae: Present /absent

Over pneumatization: Present/ absent

Sphenomaxillary plate: Unilateral/ Bilateral

Haller’s cells (infraorbital ethmoidal cells): Present/absent

Duplication: Present/absent

Maxillary sinus extensions



  • Infraorbital recesses – Present /absent

  • Alveolar recesses- Present/absent

  • Zygomatic recesses- present/absent

10. Frontal sinus

Size: Normal/Average/Enlarged

Aplasia: Yes/No

Hypoplasia: Yes/No

Frontal sinus extensions:



  • Extensions into orbital plate : Present/absent

  • Extensions into crista galli : Present/absent

  • Extensions into anterior ethmoids : Present/absent

11. Ethmoid sinus complex

Intra mural cells: Present/absent

Extra mural cells:


  1. Extra mural agger nasi cells : Present/absent

  2. Extra mural supra orbital cells : Present/absent

  3. Extramural middle turbinate cells (conche bullosa) : Present/absent

  4. Extramural uncinate process cells : Present/absent

  5. Extra mural superior turbinal cells : Present/absent

  6. Cells of orbital plate of the maxilla (Haller cells): Present/absent

  7. Extramural sphenoidal cells (onodi cell) : Present/absent

12. Sphenoid sinus

Size: Normal /Average /Enlarged

Absence: Yes/No

Septae: Present/absent

Sphenoid sinus extensions:


  • Lateral recess (i) lesser wing - Present/absent

(ii) Greater wing - Present/absent

(iii) Pterygoid - Present/absent




  • Midline recess (i) Rostral - Present/absent

(ii) Septal vomeral - Present/absent

(iii) Inferior clival - Present/absent

(iv) Superior olival - Present/absent
Dehiscences of optic nerve and internal carotid artery: Present/absent

13. Other anatomic variation:

- Maxillary sinus septa: Present/absent

- Accessory ostia: Present/absent


14. Sinuses

Mass/Mucosal thickening / fluid level/soft tissue extensions/wall of sinus/ polyposis)



ETHICAL COMMITTEE CLEARENCE


1

TITLE OF DISSERTATION

ANATOMICAL VARIATION CT OF PARANASAL SINUSES AND THEIR ASSOCIATION WITH INFECTION .

2

NAME OF THE CANDIDATE

Dr. ANINDITA ROY

3

NAME OF THE GUIDE

Dr. GANGE GOWDA K.

4

APPROVED / NOT APPROVED

APPROVED




Sri. KRISHNAMURTHY, Chairperson

Dr. SUBBANNAYYA KOTIGADDE, Secretary

Dr. S. GOPAL RAO, Member

Dr. C.S. MOHANRAJ, Member

Dr. H.R. SHIVAKUMAR, Basic Scientist

Law Expert : Sri KRISHNAMURTHY, Advocate




PRINCIPAL

K.V.G MEDICAL COLLEGE AND HOSPITAL, SULLIA

INFORMED CONSENT
I, Dr. ANINDITA ROY, Post graduate student in Department of Radiology conducting a dissertation work for award of MD degree in Radio-diagnosis & imaging.

The topic for the study is Anatomical Variation CT of Paranasal Sinuses And Their Association With Infection.

1. To study the frequency of occurrence of anatomical variations in computed tomography of paranasal sinuses.
2. To study the anatomical variations that are present and their association with disease.
I have been told in a language that I understand ( ) about the study. I have been told that this is for a dissertation procedure, that my participation is voluntary and he / she reserve the full right to withdraw from the study at my own initiate at any time, without having to give any reason, and that refresh to participate or withdraw from the study at any stage will nor prejudice my/his/her, rights and welfare. Confidentially will be maintained and only be shared for academic purposes.

I hereby give consent to participate in the above study. I am also aware that I can withdraw this consent at any later date, if I wish to. This consent form being signed voluntarily indicates agreement to participate in the study, until I decide otherwise. I understand that I will receive a signed and dated copy of this form.

I have signed this consent form, before my participation in this study.

Signature of the Parent / Guardian :

Date :

Place :


Signature of the Witness :

Date :


Place

I hereby state that the study procedures were explained in detail and all questions were fully and clearly answered to the above mentioned participant / his/her relative



Date :

Contact address :


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