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Radiology of Nasal Cavity and Paranasal Sinuses

Radiology of Nasal Cavity and Paranasal Sinuses. Radiology. XRAY CT MRI. Normal Anatomy. Drainage system. Lamella: 1) uncinate 2) ethmoidal bulla 3) basal lamella 4) superior turb lamella. Uncinate attachment variations. Agger Nasi. Frontal sinus outflow tract.

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Radiology of Nasal Cavity and Paranasal Sinuses

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  1. Radiology of Nasal Cavity and Paranasal Sinuses

  2. Radiology • XRAY • CT • MRI

  3. Normal Anatomy

  4. Drainage system Lamella: 1) uncinate 2) ethmoidal bulla 3) basal lamella 4) superior turb lamella

  5. Uncinate attachment variations

  6. Agger Nasi

  7. Frontal sinus outflow tract • May be narrowed by agger anteriorly or bulla posteriorly • Frontal cells (Type 1-4) • Frontal recess • Lateral: lamina papyracea • Medial: middle turbinate • Anterior: posterior wall of aggernasi • Posterior: ethmoid bulla

  8. Basal lamella B U L

  9. Keros Classification

  10. Sphenoid sinus

  11. Haller cells

  12. Other anatomic variations • Concha bullosa • Septal deviations • Paradoxic middle turbinate • convex curvature on the lateral, rather than medial side of the turbinate • Dehiscent lamina • Aerated crista galli • Optic nerve/carotid artery

  13. MRI • Helpful for evaluation of regional and intracranial complications • Detection and staging of neoplastic processes • Improved display between intraorbital and extraorbital compartments • Helpful for diagnosing fungal concretions which show low or no signal on T2 • Helps for evaluation of mucoceles and cephaloceles • Appearance varies with changing concentrations of proteins and free water protons • T2  more “watery”, higher signal • T1  more protein, higher signal • However, once protein content reaches too high signal decreases

  14. Epistaxis

  15. Epistaxis • Most common otolaryngologic emergency • Majority idiopathic • 60% of population in their lifetime • Maxillary sinus ostium serves as dividing line between “anterior” and “posterior bleeds”

  16. Vascular anatomy

  17. Endoscopic SPA ligation • Epistaxis controlled in 98% • Locate SPA at level of crista ethmoidalis • Key in surgery is to ligate all branches which can vary

  18. Embolization • Risk of complications: CVA, hemiplegia, ophthalmoplegia, facial nerve palsy, seizures, soft tissue necrosis • Effective only for ECA supply very dangerous for ICA supply due to high risk of blindness • Success rate 71-95% • Complication rate 27%

  19. Anterior ethmoid artery bleeding • Associated with nasoethmoid fractures • Bleeding rarely subsides with conservative measures • Variable position • Always seen between second and third lamellae • Most common site in the suprabullar recess (85%)

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