CT scan of nose and PNS
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This document provides an overview of sinus surgery and CT scan imaging for sinus procedures. It discusses: 1. CT scan is the preferred imaging modality for sinus surgery as it can accurately demonstrate bone anatomy and the extent of disease. 2. When reading CT scans, it is important to view the coronal, axial, and sagittal planes and identify key anatomical structures like the nasal septum and skull base. 3. Contrast can help identify complications like abscesses or tumors. Systematic evaluation of anatomy, variations, pathology and risk to nearby structures is important.
CT scan of nose and PNS
- 1. Road Map To Sinus Surgery By Dr.Muhammad A.Sherwani
- 2. Knowledge is Power Reda Kamel Professor of Rhinology
- 3. Imaging modalities CT Scan is choice of Imaging PLAIN X-RAY CT Scan MRI Ability to accurate demonstration of fine bone anatomy of O.M.C & extent of the disease in & around the P.N.S .
- 4. Reading CT Films Planes :Coronal / Axial /sagittal Mark: R/L sides properly Bone 1000-3000 (HU) or soft tissue window 400-800 (HU). Read from Nasion to Sphenoid sinus (4-5)mm,extensive disease and revision surgery (3mm)coronal cut and axial cut should advised Study following in all Sections Nasal Septum Lamina Papyracea Skull Base Native or contrast
- 5. Using contrast in CT-scan Complicated sinusitis: • Subperiosteal abscess! • Cavernous sinus thrombosis! • Epi / subdural abscess! Tumours: • Malignant • Angiofibroma
- 6. systematic way of reading the CT film anatomy anatomical variations pathology structures which may be at risk skull base orbit optic nerve internal carotid artery
- 7. •Preparation and position of the patient: 1.not to be fasting 2.blow the nose to clear out any secretions 3.hyper extended neck software found reconstruct the coronal and sagittal plane from axial plane Post op. CT-scan: 1.Not recommended as routine. 2.Done after 6months of ESS
- 9. Agger nasi: is one of the air cells of the anterior ethmoid
- 10. Agger nasi with well pnumatized cell
- 11. Importance : Agger Nasi Cells Agger causing disease Large Agger Nasi cell
- 12. Frontal cells: are Ant.ethmoidal cell that pneumatize the frontal recess above the agger nasi cell
- 13. Kuhn cell: K1 single small cell above the Agger nasi
- 14. K2: multiple small cells two or more cells above the Agger cell
- 15. K3: single large cell extend to frontal sinus
- 16. K4: single small cell inside the frontal sinus
- 17. Frontal bulla cell: superior extension of BE into frontal sinus
- 18. Supra orbital cell: posterior to frontal sinus ostium
- 19. Uncinate process attachments attached to the L.P. 70%
- 20. Attached to skull base 30%
- 21. Attached to Middle Turbinate 30%
- 27. Middle turbinate : important surgical landmark attachments Part I Part II Part III Horizontal Oblique Vertical
- 29. Middle turbinate: paradoxically bent (C shape)
- 30. Bulla Ethmodalis: is part of the air cells of the anterior ethmoid pnumatized
- 32. Haller cell: Its an ethmoidal air cells that project inferiorly into the floor of the orbit in the region of the maxillary sinus ostium
- 33. Maxillary sinus: Accessory ostium anterior
- 34. Maxillary sinus: Accessory ostuim posterior
- 35. Maxillary sinus: hypoplastic /aplastic maxilla
- 36. Roof of Ethmoid: 1.fovea ethmodalis 2.lateral lamella
- 37. : Anterior Skull Base
- 38. Ethmoid Roof :Anterior skull base keros 1(1-3mm)shallow olfactory fossa
- 39. Ethmoid Roof :Anterior skull base keros 2(4-7mm)average olfactory fossa
- 40. Ethmoid Roof :Anterior skull base keros 3(8-16mm) deep olfactory fossa
- 41. Anterior Ethmoidal Artery: AEA is orbital branch of ophthalmic artery
- 44. Posterior Ethmoidal cells: are larger in size and fewer in number
- 45. Posterior Ethmoid cell: Vertical height
- 46. SKULL BASE: Height Low skull base height Normal skull base height
- 48. Post ethmoid cell: sphenoethmoidal cell( Onodi cell) is a lateral and superior extension of the post. ethmoids
- 50. Sphenoid sinus : Size of the sinus normal sphenoid sinus excessive pnumatiztion
- 51. Sphenoid Sinus Absent Septa Multiple Septa
- 52. Asymmetrical situated septum of sphenoid sinus
- 53. Variations : Sphenoid Sinus Septa ending on Optic Septa ending on Carotid
- 54. Variations : Sphenoid Sinus Dehiscent Optic Nerve Dehiscent Int. Carotid.a 22% 6%
- 55. FAQ
- 56. Axial view: Nasopharynx Post. wall of the frontal sinus Orbital content Optic nerve Internal carotid artery
- 57. Axial section at level of frontal sinus
- 58. Axial section at level of optic nerve
- 60. Thank for all
- 61. Axial section at level maxillary sinus
- 62. CT in Pathology
- 63. Pathology is 1. Homogenous/heterogenous 2. Densities (hypodense /isodense /hyperdense) 3. Calcification 4. Bone erosion around opacified area 5. Start on affected side Ant. To Post. 6. Look at opposite site Ant. To Post. 7. Look to the integrity of the vital structures.
- 64. Acute Sinusitis Air Fluid level Mucosal thickening Complete opacification of the sinus
- 65. Chronic Sinusitis Ethmoid sinus is commonly involved Mucosal thickening Bone remodeling due to osteitis Polyposis
- 66. fungal sinusitis Complete opacification of multiple sinuses Sinus expansion & erosion of sinus wall Focal area of increased attenuation that is created within a diseased sinus
- 67. fungal sinusitis When you suspect the fungal infection you should ask for soft tissue window
- 68. Benign polyp Homogenous, well circumscribed hypodense / isodense mass
- 69. AC Polyp
- 70. Mucocoele Hypodense, non-enhancing mass that fills and expands the sinus cavity
- 71. benign tumors: Antrochoanal polyp Angiofibroma Inverting papilloma
- 72. Malignant tumor