Diagnostic nasal endoscopy III pass


Dr. T. Balasubramanian M.S. D.L.O.

Synonym: DNE, Diagnostic nasal endoscopy III pass

 Third pass: Is the most important of all the three passes.  This pass studies the crucial middle turbinate area.  The middle turbinate is evaluated for its shape and size as well as its relationship to the lateral nasal wall and septum.  A bulge just above and anterior to the attachment of the middle turbinate suggests an enlarged agge nasi cells.  Sometimes the anterior tip of the middle turbinate may be triangular.  This shape has no significane unless it causes obstruction to the middle meatus.  A middle turbinate that is concave medially rather than laterally is considered paradoxical.  But paradoxical turbinate which is symptomatic needs to be treated.  If the middle turbinate is enlarged due to the presence of a large air cell inside the middle turbinate it is known as concha bullosa.   The middle turbinate is gently medialised using its plasticity.  The middle meatus comes into view.  The attachment of the uncinate process is carefully noted.  Discharge if any from this area is also recorded.  If accessory ostium is present it comes into view now.  Accessory ostium is present more posteriorly.  Normal ostium is actually not visible during diagnostic nasal endoscopy.  Accessory ostium is spherical in shape and oriented anteroposteriorly,  while the natural ostium of maxillary sinus is oval in shape and oriented transversely.



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