Size of Bulla Ethmoidalis and Sinonasal Mucosa: Does it Matters in Osteomeatal Complex Obstruction?

Introduction: Bulla ethmoidalis is derived from the Latin word where bulla means a hollow, thin-walled, bony prominence. It is formed by pneumatisation of the bulla lamella or second ethmoid basal lamella. An extensively pneumatised bulla may expand anteriorly coming into intimate contact with the posterior free margin of the uncinate process, thereby narrowing or partially blocking the hiatus semilunaris. Material and Methods: 40 bisected halves of the formalin fixed adult human head and neck specimens were procured from the Department of Anatomy. Retrospectively, we procured 20 CT films both in coronal and axial views of paranasal sinus from the Department of Radiology. Anatomical variations and mucosal abnormalities are analysed. Results: In the present study of the position of nasal septum in 20 PNS CTs, 6 (30%) CTs showed centralized nasal septum, 5 (25%) showed left side deviation and 9 (45%) had right side deviation of the nasal septum. Bulla measuring 10x3 mm to 12x6 mm were present in 19(47.5%) specimens, 13x4 to 16x6 mm present in 12 (30%) and 18x4 to 21x9 mm seen in 9 (22.5%) cases. CT evaluation of Mucosal thickening was observed in maxillary sinus 27 (67.5%) cases, followed by ethmoidal sinus 13 (32.5%). Conclusion: The CT scan should not be used exclusively to diagnose chronic sinusitis or to determine the need for surgery. Rather, it should be used to provide supplementary clinical data to the history and endoscopic exam and assist in directing surgical treatment to the affected areas.