Synonyms: 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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