Naturally draining ostium of an agger nasi cell: a case report.Abstract
We describe the case of a 61-year-old woman who underwent functional endoscopic sinus surgery functional endoscopic sinus surgery Functional endonasal endoscopic sinus surgery ENT A procedure that removes diseased nasal cavity and paranasal sinus tissue and restores mucociliary clearance Applications Chronic and/or recurrent sinusitis in Pts who fail for chronic hyperplastic rhinosinusitis. During surgery, we were able to visualize the natural ostium ostium /os·ti·um/ (os´te-um) pl. os´tia [L.] an opening or orifice.os´tial
ostium abdomina´le tu´bae uteri´nae of her left agger nasi cell. To our knowledge, such a finding has not been previously documented in the literature.
The prevalence of the agger nasi cell in the general population is not known with certainty. Jones et al found evidence of agger nasi cells on computed tomography Computed tomography (CT scan)
X rays are aimed at slices of the body (by rotating equipment) and results are assembled with a computer to give a three-dimensional picture of a structure. (CT) in 191 of 200 individuals (95.5%). (1) In their study, 100 patients (50.0%) had evidence of paranasal sinus par·a·na·sal sinus
Any of the paired cavities, designated frontal, sphenoidal, maxillary, and ethmoidal, located in the bones of the face and lined by a mucous membrane continuous with that of the nasal cavity. disease, including 95 who had CT evidence of an agger nasi cell. Of the remaining 100 patients (controls), who did not have sinus disease, 96 exhibited CT evidence of an agger nasi cell. From these findings, it appears that agger nasi cells are very common and their presence or absence is not directly associated with sinus pathology. Other studies have found a lower incidence of agger nasi cells. For example, Lang found agger nasi cells in 45 of 58 cadavers (77.6%). (2)
In this article, we describe our discovery of a naturally draining ostium of an agger nasi cell. It was exposed during functional endoscopic sinus surgery for chronic hyperplastic rhinosinusitis.
We evaluated a 61-year-old woman for nasal complaints that had persisted for more than 5 years. She reported both facial and ear fullness, a constant nasal drip of clear to yellow mucus, nasal congestion nasal congestion ENT Difficulty in nasal breathing, due to an ↑ vascular thickness of nasal mucosa. See Nasal stuffiness. , sneezing To verbally tell somebody about a new and interesting Web site. See viral marketing. , and a decreased sense of smell. A brief course of antibiotics had provided temporary relief in the past.
We prescribed a 4-week course of guaifenesin/pseudoephedrine, a topical nasal steroid, and cefuroxime, but her nasal symptoms returned following the completion of treatment. Post-treatment CT demonstrated thickening in the ethmoid ethmoid /eth·moid/ (eth´moid)
1. sievelike; cribriform.
2. the ethmoid bone; see Table of Bones. .ethmoi´dal
eth·moid or eth·moi·dal
adj. and maxillary sinuses; a single frame from this scan showed the agger nasi cell (figure 1).
[FIGURE 1 OMITTED]
The patient underwent septoplasty, left concha bullosa resection, bilateral anterior and posterior ethmoidectomies, bilateral maxillary max·il·lar·y
Of or relating to a jaw or jawbone, especially the upper one.
A maxillar; a jawbone.
adj antrostomies, and bilateral inferior turbinate turbinate /tur·bi·nate/ (-nat)
1. shaped like a top.
2. any of the nasal conchae.
tur·bi·nate or tur·bi·nat·ed
1. Shaped like a top.
2. outfracture. During endoscopic en·do·scope
An instrument for examining visually the interior of a bodily canal or a hollow organ such as the colon, bladder, or stomach.
en surgery of her left nasal cavity, we noted an ostium at the location of the left agger nasi cell (figure 2). The ostium was well developed, with smooth mucosa overlying overlying
suffocation of piglets by the sow. The piglets may be weak from illness or malnutrition, the sow may be clumsy or ill, the pen may be inadequate in size or poorly designed so that piglets cannot escape. the opening. The left agger nasi cell was opened widely with a microdebrider, and her natural ostium was sacrificed as the floor of the cell was resected.
At follow-up 2.5 years postoperatively, the patient had developed mild polypoid polypoid /pol·yp·oid/ (pol´i-poid) resembling a polyp.
Resembling a polyp.
resembling a polyp. changes and had experienced one acute exacerbation of her nasal symptoms, which required antibiotic treatment.
Believed to be a remnant of an additional concha concha /con·cha/ (kong´kah) pl. con´chae [L.] a shell-shaped structure.
concha of auricle found in lower animals, the agger nasi cell can be observed endoscopically as a bulge in the lateral nasal wall lying anterosuperior to the anterior aspect of the middle turbinate. (3,4) It represents the superior remnant of the first ethmoturbinal concha. The most anterior of the ethmoid cells, the agger nasi cell is also the first to pneumatize in the newborn, and it is quite prominent throughout childhood. Between one and seven cells are present, and they usually drain into the frontal recess. (5)
The agger nasi cell is an important surgical landmark, particularly with respect to the frontal sinus. The roof of this cell forms the floor of the frontal sinus. Therefore, a well-pneumatized agger nasi cell can narrow the frontal sinus outflow tract, which might lead to chronic frontal sinusitis sinusitis
Inflammation of the sinuses. Acute sinusitis, usually due to infections such as the common cold, causes localized pain and tenderness, nasal obstruction and discharge, and malaise. . (6) In such cases, it is often necessary to resect resect /re·sect/ (-sekt´) to excise part or all of an organ or other structure.
To perform a resection on a part of the body. the walls of some or all of these cells.
This case featured an interesting endoscopic finding--that is, a natural ostium of an agger nasi cell. Normally, the upper aspect of the uncinate process is removed in an inferior to superior direction, thus opening the agger nasi cell. The natural ostium is not typically visualized because it lies directly above the upper uncinate process, and the two structures are removed simultaneously. To our knowledge, a natural draining ostium of an agger nasi cell has not previously been documented in the literature. Because the drainage pattern of a normal agger nasi cell is not clearly understood, we could not know whether this ostium was simply an accessory ostium similar to that of a maxillary sinus or whether it represented the true natural ostium of an agger nasi cell. However, based on our understanding of sinonasal anatomy and mucociliary clearance patterns, we believe that our endoscopic examination did indeed identify the natural ostium of an agger nasi cell. Further reports will need to be compiled before we are able to elucidate the role of a naturally occurring ostium of an agger nasi cell.
(1.) Jones NS. Strobl A. Holland I. A study of the CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol 1997;22:47-51.
(2.) Lang J. Clinical Anatomy of the Nose, Nasal Cavity, and Paranasal Sinuses. New York: Thieme Medical Publishers, 1989:61.
(3.) Hollinshead WH. Anatomy for Surgeons. Vol. 1: The Head and Neck. 3rd ed. Philadelphia: Harper and Row, 1982:234.
(4.) Terrell JE. Primary sinus surgery. In: Cummings CW, ed. Otolaryngology--Head and Neck Surgery. 3rd ed. St Louis: Mosby, 1998: 1155-6.
(5.) Miller A J, Amedee RJ. Sinus anatomy and function. In: Bailey BJ, ed. Head and Neck Surgery-Otolaryngology. 2nd ed. Philadelphia: Lippincott-Raven, 1998:416.
(6.) Yanagisawa E, Joe JK. The surgical significance of the agger nasi cell. Ear Nose Throat J 1999:78:328-30.
From the School of Medicine, State University of New York (body) State University of New York - (SUNY) The public university system of New York State, USA, with campuses throughout the state. at Stony Brook (Mr. Yoo); the Department of Otolaryngology--Head and Neck Surgery, Mayo Clinic, Scottsdale, Ariz. (Dr. Kim); and the Department of Otolaryngology--Head and Neck Surgery, School of Medicine, Case Western Reserve University, Cleveland (Dr. Houser).
Reprint requests: Steven M. Houser, MD, Department of Otolaryngology--Head and Surgery, MetroHealth Medical Center, 2500 MetroHealth Dr., Cleveland, OH 44109. Phone: (216) 778-3453; fax: (216) 778-7868; e-mail: firstname.lastname@example.org
This article was prepared independent of any financial support from any external entity and was not presented at any meeting or conference.