Introduction:The anatomical variations of the lateral wall of nose may create technical difficulties during surgery and increase predisposition for chronic rhinosinusitis (CRS). Various cadaveric and radiological studies have been carried out to identify the variations of critical landmarks in sinonasal anatomy. However, studies analyzing the nasal endoscopic examination of living patients are scarce.Objective: The aim of the study was to compare the anatomical variations in the middle meatus of patients having CRS with that of normal population. Materials and methods:This was a prospective clinical study, where 700 subjects (1,400 middle meatus) were subjected to diagnostic nasal endoscopy, over a period of 2 years. A total of 350 subjects each with CRS and normal population were included in the case and control group, respectively. Endoscopic examination of nasal cavity was done to observe the middle meatus configuration. Results:The anatomical variations in the case group were significantly higher that of control. The most common atypical anatomical presentation in both the case and control group were atypical agger nasi (14 vs 7%, p-value = 0.0001), concha bullosa in middle turbinate (12 vs 9%, p-value = 0.0809), medially projected uncinate process (10 vs 4%, p-value = 0.0001), and sausage shaped ethmoid bulla (18 vs 10%, p-value = 0.0001). Interestingly, opening of ethmoid bulla was also observed in both the groups. Conclusion:The prevalence of anatomic variations is significantly higher in the case group. However, the detection of a single anatomical variant itself does not establish the genesis of pathophysiology of CRS. Familiarity with such anatomy is important to optimize surgical treatment of sinus disease, while avoiding complications.

Primary parapharyngeal space (PPS) tumors are rare, representing only 0.5% of all head and neck neoplasms. About 80% of tumors of this space are benign, and 20% are malignant. They often pose therapeutic and diagnostic problems due to variable non-specific symptoms and the complex anatomy of this space. Pleomorphic adenoma is the most common benign tumor of this space. It presents as an asymptomatic mass causing mild bulging in the soft palate or tonsillar region, or fullness near the angle of the mandible in the neck. We report the case of a 60-year-old male admitted to the emergency department with breathing difficulty and acute stridor. He was unable to maintain oxygen saturation, and an emergency tracheostomy was performed. Radiological and cytological evaluation were performed, and the patient was diagnosed as having primary PPS pleomorphic adenoma. The tumor was excised via the transcervical approach. The rarity of tumor in this space and unusual life-threatening presentation prompted the authors to report this case. To our knowledge, this is the third case reported worldwide of a pleomorphic adenoma causing upper airway obstruction and acute respiratory failure.

Ossifying fibroma is a rare, benign fibro-osseous lesion composed of lamellar bone and fi brous tissue. It occurs as an osseous lesion in the craniofacial skeleton. Clinically, lesions are usually asymptomatic, slow-growing and well-circumscribed. However, in very few cases, particularly in younger patients these tumors have demonstrated an aggressive course of development. Surgical management via a wide local excision is a necessity since it is notorious for recurrence, especially paranasal sinuses lesions. Here, we describe a case of a 9-yearold male child who had left forehead swelling with painless, progressive proptosis and downward lateral displacement of the globe for approximately 8 months. Computed tomography showed a massive expansile lesion involving the left frontal bone. The mass was excised surgically via a Lynch Howarth approach and proved histopathologically to be a juvenile ossifying fi broma. The radiological interpretation will be discussed which is helpful for diagnosis and selecting appropriate surgical approach in growing child.

Introduction: Chronic rhinosinusitis (CRS) is a global health problem affecting approximately 14% of the population of all age groups. CRS has a significant adverse impact on quality of life of the patients.Objective: The aim of this study was to compare the quality of life of patients suffering from CRS with that of normal population and to assess the association between objective nasal endoscopic score, self-rated symptom score and quality of life (QoL) score. Methodology:This was a prospective study conducted over a period of 12 months. A total of 110 cases of CRS and 50 normal subjects taken as controls were recruited from out patients department. Patients diagnosed as a case CRS were subjected to rhinosinusitis disability index (RSDI), subjective QoL questionnaires and self-rated symptom score in their vernacular language followed by diagnostic nasal endoscopy, using 0º rigid endoscope (4 mm).Results: This study revealed that the mean ± SD total QoL score in the patients was 50.2 ± 14.9 (15-94) which was significantly affected as compared to control group where it was only 18.2 ± 9.15 (3-47). The mean ± SD of the functional, emotional and physical domains were 17.6 ± 5.46 (4-34), 16.5 ± 8.29 (5-88) and 16.5 ± 5.84 (2-35) respectively. There was no correlation between endoscopic score and the patient's self-rated symptom score or RSDI score. The correlation between the self-rated symptom score and total QoL score was significant (p = 0.02). Conclusion:On comparing the QoL in the patients of CRS with the controls, it was observed that QoL was affected more in the patients of CRS in the physical, functional and emotional domain of their life. CRS has considerable adverse impact on QoL of patients and RSDI is a valuable tool in assessing the QoL in patients of CRS.