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Figure 7. Variations in the Osteomeatal Complex (4) Different configurations of the maxillary ostium (Figure 5). (a) Vertical 28 (56%) Co) Horizontal 13 (26%) • ) (c) Oblique 9 (18%) / ]' :/, _!_ / (5) Variation in the location of the maxillary / , ostium in relation to the infundibulum (Figure 6): anterior 4 (8%) a. Uncinate processis moderatelytall and middle third 22 (44%) hiatusis moderatelywide 26 (52%) posteriorthird 24 (48%) b. Extremedevelopmentof the uncinateprocess 9 (18%) (6) Variation in the osteomeatal complex (Figure 7). c. Hiatusis narrow 4 (8%) d. Uncinateprocessand infundibulumare rudimentary 2 (4%) DISCUSSION e. Bulla overhangsthe uncinate,process 8 (16%) In orderto testour hypothesisthat basicanatomy textbook values basedon cadaver dissectionon f. The uncinate process and bulla Caucasians need not reflect those of Filipinos, a are in contact 1 (2%) comparison of values obtained in this study and published date data was done. There was no significant variation between the --_ right and left lateral nasal walls (p
This study presents variations with regard to contemplates designing a cannula specifically for measurements of anatomical structures in the lateral Filipinos. nasal wall among Caucasians and Filipinos. Consid- Myerson (1931) stated that the maxillary ostium eration of this observation must be borne in mind in occupies a vertical, horizontal, or oblique position in doing nasal surgery as well as in designing instruments the infundibulum. He was able to cannulate successfor use in Filipino patients, fully 138 of 170 maxillary ostia (82%). Ninety-eight A discussion of the antomic variations found in (71%) were verticall placed, 34 (25%) horizontal, and the study will be presen_ted. 6 (4%) were obliquely placed. Comparing these with the results of this study, 28 (56%) were vertically A. Absence of the supreme turbinate placed, 13 (26%) horizontal and 9 (18%) were obliquely Schaeffer (1916) cited the presence of the supreme placed. This variation in position among Filipinos turbinat.e either unilaterally or,bilaterally in 60% of should be borne in mind in any attempt to catheterize individuals. It is definitely the most rudimentary of the ostium such that unnecessary bruising and trauma the turbinates and may present only as a slight fold in this area are avoided. in the lateral nasal wall which makes identification Another important variation is the position of the quite difficult. There was no supreme turbinate found maxillary ostium in relation to the length of the inin any of the cadavers dissected in this study. To our fundibulum. Variation in the position of the ostium knowletlge, there has been no published material whether in the anterior, middle or posterior third of D regarding the specific clinical significance of the the ethmoidal infundibulum was cited by Van Alyea supreme turbinate. (Figure 3). In his analysis,of 163 specimens, 9 (5.5%) were anteriorly located in the uncinate groove, 18 (11%) B. Nasolaerimal ostium in the middle third and 117 (71.8%) were in the posterior • The inferior meatus, with the most important third. However, he found 19 ostia with opening into stru6ture therein, the nasolacrimal ostium, was ob- the posterior tip ofthe groove, unhiddenbytheuncinate served to be similar in this study and that of the process. In this study, 4 (8%)were anteriorly located, published data. The nasolacrimal ostium is generally 22 (44%) in the.middle third and 24 (48%) were in found at the highest part of the meatus in its anterior the posterior third. In no case was the ostium found portion approximately 28 mm from the nares. Similar to open beyond the posterior edge of the uncinate to previous observations, there is a wider diameter of process. The greater percentage of ostia placed in the the ostium when placed just below the attached border middle third in Filipino cadavers suggests better of the interior turbinate. When located lower in the accessibility of the maxillary ostium for cannulation lateral wall of the inferior meatus, it is silt-like, col- as compared to Caucasians. lapsed and guarded by a fold of mucous membrane Variations in the configuration of the infundibucalled the plica lacrimalis or valve of Hasner. The lum as well as the relation between the ethmoidal bulla latter was observed in one of the cadavers (Figure 4g) and the uncinate process have also been cited by Van although the nasolacrimal ostium was most commonly Alyea. Figure 2 shows the different observations Van found just below the bend of the attached inferior Alyea noted. He reported a 25% incidence of pattern turbinate anteriorly. C where the hiatus was quite narrow. In this study, Costen pointed out that accessory openings into the most common observation was pattern A where the antrum through the inferior meatus should be made there is a moderately tall uncinate process with a as far back as possible in order to avoid scarfing or moderately wide hiatus in 26 (52%) of eases. There destruction of the nasolacrimal ostium. The sugges- is extreme development of the uncinate process in 9 tion of Ritter to do an antrostomy at the upper central (18%),a narrow hia_s in 4 (8%) as well as a prominent part of the meatus because of the thin bone in this and overchanging ethmoidal bulla in 8 (16%) of cases. area may prove a safe and practical as it avoids injury The ethmoidal buUa was in actual contact with.the to the nasolacrimal ostium, uncinate process in 1 cadaver (2%). It is clear from these figures that in about 44% of cases, probing the C. Ostium of the maxillary siun ostium would be very difficult if not almost impossible In conformity with the classic description of the in the living. The accessibility of the maxillary ostium • maxillary ostium, it was found in this study to be round is of utmost clinical ihaortance. A successful catheterior oval, approximately 4 mm in diameter. The smallest zation and lavage of the maxillary sinus through the diameter was 1.59 ram. This is important when one natural ostium not only depends on the skill of the ! 110
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Iq4LIPl:qut=S TABLE OF CONTENTS NEC
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HEAD AND NECK SURGERY - TO ADD OR N
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PRESIDENT'S PAGE The years 1989-90
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RIZAL MEDICAL CENTER DEPARTMENT OF
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muscles. Again it is likely possibl
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area measuring 4.8 x 3.7 cm extendi
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tend to recur locally, even after p
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UNIVERSITY OF THE PHILIPPINES PHILI
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The majority of patients with hyper
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mass wa uttrasonograImy. Neck explo
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Figure 2 : Parathyroid Adcnoma vs.
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E.wa_ileMassonLe_Maxilla "salt& pep
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of some clinical features as well a
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MCU HOSPITAL DEPARTMENT OF OTOLARYN
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JOSE REYES MEMORIAL MEDICAL CENTER
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nonetheless stated: "We have the im
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to the diagnostic know-how of the c
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PATIENTS & METHODS: These signs and
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Most patients in group 1 complained
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DISCUSSION: and septal deviation mi
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OSPITAL NG MAYNILA DEPARTMENT OF OT
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..temporary relief. According to Ha
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CASE REPORT phonuclear cells. The r
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TITLE:Cleft Lip Surgeryfor Rural Fi
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After intubation and the endoctrach
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BIBLIOGRAPHY Converse, J.M., Recons
Page 61 and 62: UNIVERSITY PHILIPPINE DEPARTMENT OF
Page 63 and 64: Table 3. Distribution of Organism b
Page 65 and 66: J BIBLIOGRAPHY Y MACKOWIAK, P.A., J
Page 67 and 68: Figure 3. SENSITIVITY PATTERN OF Pr
Page 69 and 70: Figure 3. Percent SENSITIVITY PATTE
Page 71 and 72: loradatine 10 mg/tabletgiven once a
Page 73 and 74: 1. Severity of Symptoms 3. Comparis
Page 75 and 76: -J;r,ceiving 40 mg of loratadine da
Page 79 and 80: : ' : _ : ::::::: : : i : ::
Page 81 and 82: These patients are new patients see
Page 83 and 84: - Table Vl Baseline Signs and Sympt
Page 85 and 86: The following Table VII will show t
Page 87 and 88: • 14.Drowsiness: None 30 2 4 10 2
Page 89 and 90: Actifed's side effect of drowsiness
Page 91 and 92: " to be packed with one type of pac
Page 93 and 94: With regard to microbiology of nasa
Page 95 and 96: TABLE 6: MANNER OF CONTROL OF REBLE
Page 97 and 98: APPENDIX C MICROBIALGROWTH POTENTIA
Page 99 and 100: EAST AVENUE MEDICAL CENTER DEPARTME
Page 101 and 102: type (20%-30% of cases) varies from
Page 103 and 104: TABLE Ii HistologicalClassification
Page 105 and 106: THE LATERAL NASAL WALL IN FILIPINOS
Page 107 and 108: MIDDLE MEATUS: Diameter of ostium:
Page 109 and 110: .;4".,..:'.-" ............. '---.",
Page 111: Figure 4. Variation in the location
Page 115: ACKNOWLEDGMENT The authors would li
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