Preoperative evaluation of chronic rhinosinusitis patients by conventional radiographies, computed tomography and nasal endoscopy

Yıl 2009, Cilt: 19 Sayı: 4, 184 - 191, 18.08.2009

Fikret Kasapoğlu Selçuk Onart Oğuz Basut

Öz

Objectives: The aim of this study was to compare the efficacy of conventional radiography CR , computed tomography CT and nasal endoscopy for the preoperative evaluation of chronic rhinosinusitis in patients with persistent complaints despite appropriate medical therapy. Patients and Methods: Forty-three patients 26 males, 17 females; mean age 43 years; range 15 to 73 years were prospectively evaluated. All patients underwent detailed physical examination, CR and coronal high resolution CT of paranasal sinuses. Thirty of them were evaluated with detailed nasal rigid and/or flexible endoscopy as well. The anatomic variations and mucosal changes in paranasal sinuses were noted. The specificity and sensitivity of CR was calculated using CT findings as a reference point. Surgery was performed on two of the other three patients because of obstructive symptoms of middle turbinate. Paradoxal middle turbinate surgery was performed on one patient due to a headache of rhinogenic origin. Results: In our study 40 93% of all patients showed mucosal abnormalities on CT. Computed tomography scanning of the patients revealed anatomic variations in 74.4% of the cases. Mucosal pathology was most frequently observed in the anterior ethmoid region middle meatus . While we found mucosal anomalies in 47.4% of all sinuses using CR, 42.2% of these cases were confirmed with CT. Also, 19.5% of all sinuses evaluated as normal with CR presented pathologic findings on CT. An overall correlation of 75.3% was observed between CR and CT, while diagnostic nasal endoscopy and CT findings were correlated at a rate of 87%. Conclusion: i While no ipsilateral maxillary or frontal sinus disease was detected when no abnormality in the anterior ethmoid region and infundibulum was observed endoscopically in the presence of mucosal abnormalities similar abnormalities were seen at the same side for maxillary or frontal sinuses. ii Anatomic variations of nasal and paranasal sinuses may be considered as etiologic and predisposing factors of chronic rhinosinusitis. iii Conventional radiography should not be used as a single diagnostic tool in pre-operative evaluation; however, due to its high sensitivity, CR technique may be used alone in the diagnosis and follow-up of maxillary sinus disease. iv Nasal endoscopy may reduce unnecessary diagnostic CT scanning procedures.

Anahtar Kelimeler

Conventional radiography, endoscopic sinus surgery, paranasal computed tomography

Kronik rinosinüzitli hastaların konvansiyonel radyografi, bilgisayarlı tomografi ve nazal endoskopi ile ameliyat öncesi değerlendirilmesi

Öz

Amaç: Bu çalışmada uygun medikal tedaviye rağmen semptomları devam eden, kronik rinosinüzitli hastaların ameliyat öncesi değerlendirilmesinde düz radyografiler, paranazal sinüs bilgisayarlı tomografisi BT kullanıldı ve nazal endoskopinin etkinliği karşılaştırıldı.Hastalar ve Yöntemler: Kırk üç hasta 26 erkek, 17 kadın; ort. yaş 43 yıl; dağılım 15-73 yıl ileriye dönük olarak değerlendirildi. Bütün hastalara ayrıntılı fizik muayene, konvansiyonel radyografi ve koronal planda yüksek çözünürlüklü paranazal sinüs BT uygulandı. Otuz hasta ayrıca rijit ve/veya fleksibl nazal endoskopi ile değerlendirildi. Paranazal sinüslerdeki anatomik varyasyonlar ve mukozal değişiklikler kaydedildi. Bilgisayarlı tomografi referans alınarak düz radyografilerin duyarlılık ve özgüllükleri araştırıldı. Diğer üç hastadan ikisine obstrüktif semptomlar nedeniyle konka bulloza cerrahisi, bir hastaya da rinojenik kaynaklı baş ağrısı nedeniyle paradoksal orta konka cerrahisi uygulandı. Bulgular: Olguların 40’ında %93 BT’de mukozal anormallikler bulundu. Bilgisayarlı tomografi görüntülemelerinde hastaların %74.4’ünde anatomik varyasyonlar saptandı. Patolojinin en sık görüldüğü alan anterior etmoid bölge orta mea idi. Konvansiyonel radyografilerde bütün sinüslerin %47.4’ünde mukozal değişiklik bulunurken, BT’de bunların %42.2’si doğrulandı. Aynı zamanda konvansiyonel radyografilerle tamamen normal olarak değerlendirilen sinüslerin BT incelemesinde %19.5’inde patolojik bulgu saptandı. Toplamda konvansiyonel radyografiler ile BT uyumu %75.3 bulundu. Tanısal nazal endoskopi ve BT bulguları arasında %87 ilişki bulundu.Sonuç: i Anterior etmoid bölge veya infundibulumda endoskopik bir anomali olmadığında aynı tarafta maksiller ya da frontal sinüs hastalığı görülmedi; anomali varlığında ise aynı taraf maksiller veya frontal sinüste benzer anormallikler bulundu. ii Nazal ve paranazal sinüslerin anatomik varyasyonları kronik rinosinüzitli hastalarda etyolojik ve predispozan faktör olarak kabul edilebilir. iii Düz radyografiler cerrahi öncesi değerlendirmede yalnız başlarına kullanılmamalıdır. ancak yüksek duyarlılıkları nedeniyle düz radyografiler sadece maksiller sinüs hastalığının tanı ve takibinde tek başlarına kullanılabilir. iv Nazal endoskopi, gereksiz tanısal BT çekimlerini azaltabilir

Anahtar Kelimeler

Konvansiyonel radyografi, endoskopik sinüs cerrahisi, paranazal bilgisayarlı tomografi

Kaynakça

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