Cone beam computed tomography is an imaging technique that can be used for the paranasal sinuses. This study assessed how widely it is used and the impact it has on chronic rhinosinusitis management in the ENT department of one hospital.

A nationwide survey was conducted to assess the use of cone beam computed tomography throughout ENT UK members. A retrospective analysis of four-year rhinology clinic data for patients presenting with chronic rhinosinusitis symptoms was subsequently performed to assess how many scans were achieved the same day and the subsequent patient management.

The survey results indicated that a majority of staff do not use cone beam computed tomography to image sinuses (86.5 per cent), and this was largely because of lack of access (92 per cent). This study assessed 355 cone beam computed tomography requests. Overall, 306 cases had a cone beam computed tomography scan on the same day as their clinic appointment with the majority seen back in clinic during the same hospital attendance for the results. Overall, 97 patients were discharged on the same day.

This study suggested a lack of awareness and understanding of cone beam computed tomography in managing rhinosinusitis. The ‘one-stop’ rhinology clinic model offers benefits including reduced patient hospital attendance.

This prospective, epidemiological British Ophthalmological Surveillance Unit study into ophthalmic complications of functional endoscopic sinus surgery aimed to determine the minimum incidence, presenting features and management throughout the UK.

Cases of ophthalmic complications of functional endoscopic sinus surgery, between February 2016 and February 2018, were identified through the British Ophthalmological Surveillance Unit reporting card system. Reporting ophthalmic consultants were sent an initial questionnaire, followed by a second questionnaire at six months.

Twenty-six cases of ophthalmic complications of functional endoscopic sinus surgery were reported. The majority (16 cases (62 per cent)) had limitations of ocular motility at presentation. The most common final diagnosis was rectus muscle (33 per cent) and nasolacrimal duct trauma (27 per cent). Using national data, this study reports a minimum incidence of ophthalmic complications of functional endoscopic sinus surgery in the UK of 0.2 per cent over two years.

In terms of ophthalmic complications, functional endoscopic sinus surgery is shown to be safe. Ophthalmic complications are rare, but when they do occur, they commonly result in rectus muscle trauma, often requiring surgical intervention.

This study assessed the utility of current sialendoscopes in the paranasal sinuses in a cadaveric model and evaluated novel uses for sialendoscopes.

Currently available sialendoscopes were used for visualisation and performing interventions in the paranasal sinuses. Ten cadaver heads were studied before and after dissection. Outcomes included ostia identification, sinus cannulation, success of mucosal biopsy collection and image clarity.

Marchal and Erlangen sialendoscopes were found to be effective for both visualising and cannulating the sphenoid sinuses before and after dissection. Both types demonstrated poor maxillary ostia visualisation without dissection, but did allow treatment after antrostomy. Larger diameter sialendoscopes were associated with the lowest image distortion during maxillary ostia assessment. Mucosal biopsy collection within the sphenoid sinus, but not in the maxillary sinus, was possible before dissection.

Sialendoscopes can be used for visualisation and performing interventions in the sinonasal cavity, but their utility is mainly limited to the sphenoid sinus. They may be considered a minimally invasive method for drug delivery and/or biopsy collection in the post-operative setting for all sinuses. Design improvements are suggested.

Concha bullosa is the pneumatisation of intranasal conchae (usually the middle turbinate, and rarely the inferior or superior turbinate); however, the term is generally used to describe aeration of the middle concha. Superior concha bullosa is a rare finding, and only a few cases of inferior concha bullosa have been reported in the medical literature. When symptomatic, concha bullosa may cause various problems including nasal congestion, headache, postnasal drip, anosmia and, sometimes, epiphora.

Computed tomography, following history-taking and physical examination, is a valuable tool in diagnosing turbinate pneumatisation. This article presents a very rare case with bilateral triple conchae pneumatisations.

The symptomatology, diagnosis and treatment options for cases of multiple concha bullosa are discussed. The surgical interventions performed in the presented case are briefly described.

The presented patient had pneumatisation of all six turbinates. In such cases, we propose that this condition be termed ‘conchae bullosis’ rather than ‘conchae bullosa’, in a similar fashion to the use of nasal polyposis as the plural form of nasal polyp.

We present two cases of dental implant migration into the maxillary sinus, with subsequent removal via image-guided, transnasal endoscopy.

Presentation of clinical cases, together with a literature review of alternative surgical techniques, the theories behind implant migration, and the benefits of an image-guided, endoscopic approach.

One patient was asymptomatic, and the other had begun to experience sinogenic symptoms after implant displacement. Both patients presented to the ENT clinic, and both underwent the BrainLab protocol to generate computed tomography images for navigational reconstruction. Transnasal endoscopy was carried out with this guidance, and the implants were removed successfully in both cases. Previously used surgical techniques such as the Caldwell-Luc procedure or extraction through the tooth socket have higher rates of conversion to open procedures, more damage to the nasal sinuses and higher post-operative complication rates compared with the transnasal endoscopic approach.

Both patients underwent successful removal of their migrated dental implants with no complications, and neither required any follow-up intervention.