Imaging for Endoscopic Sinus Surgery

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www.kenthospitals.com

Dr. Prahlada N.B M.S (PGIMER, Chandigarh)

Karnataka ENT Hospital & Research Center,Chitradurga, Karnataka.

Imaging v/s Endoscopy

Surgery done without imaging

Imaging modalities

CT Scan is choice of Imaging

Plain X-Ray CT Scan MRI

Patient Preparation

• Course of Antibiotics & Decongestants

• Sympathomimetic Nasal Spray 15 min before CT procedure

• Patient to blow the nose just before procedure

Reading CT Films

• Coronal Images

• Mark R/L sides properly

• Read from Nasion to Sphenoid sinus

• Study following in all Sections- Nasal Septum- Lamina Papyracea- Skull Base

Normal Anatomy

Coronal Section : At Nasion

Coronal Section : At Agger Nasi

Frontal Recess

Sagittal Section Coronal Section

Lacrimal Apparatus

Coronal Section : At OMC

Anterior Skull Base

Ethmoid Infundibulum

Axial Section Coronal Section

Middle turbinate attachements

I Part II Part III Part

Vertical Oblique Horizontal

Lateral Recess

Coronal Section Sagittal Section

Coronal Section : At Post. Ethmoid

Posterior Ethmoid Cells (Onodi)

Coronal Section : At Sphenoid

Axial Section : At Frontal

Axial Section : At Optic nerve

Axial Section : At Maxillary sinus

Anatomical Variations

Variations : Frontal Sinus

Coronal Section Axial Section

Variations : Frontal Cells

Type I

Type III

Type II

Type IV

Variations : Agger Nasi Cells

Agger causing disease Large Agger Nasi cell

Variations : Frontal Recess

Variations : Anterior Skull Base

Type I Type II Type III

1 - 3 mm 4 - 7 mm 8 - 16 mm

Variations : Uncinate process

Medially bent Pneumatized

Variations : Bulla Ethmoidalis

Absent Bulla

Variations : Ethmoid Sinus

Variations : Haller’s Cells

Variations : Middle turbinate

Concha Paradoxic MT Interlamellar

Rostrum of the Sphenoid

Sphenoid Pneumatization types

Conchal

Presellar

Sellar

Variations : Sphenoid Sinus

Extensive pneumatization

Pterygoidpenumatization

Dehiscent nerves ACP penumatization

Dehiscent Optic Nerve Dehiscent Int. Carotid.a

Absent Septa Multiple Septae

Septa ending on Optic Septa ending on Carotid

CT in Pathology

Acute Sinusitis• Air Fluid level

• Mucosal thickening

• Complete opacification of the sinus

Chronic Sinusitis

• Ethmoid sinus is commonly involved

• Mucosal thickening

• Bone remodeling due to osteitis

• Polyposis

Fungal Sinusitis• Allergic fungal sinusitis

• Sinus mycetoma

• Acute invasive fungal sinusitis

• Chronic invasive fungal sinusitis

• Chronic granulomatous fungal sinusitis

Allergic fungal sinusitis

• Complete opacification of multiple sinuses

• Sinus expansion & erosion of sinus wall

• High attenuation areas due to metals

Sinus Mycetoma

• Focal area of increased attenuation that is created within a deseased sinus

Acute invasive fungal sinusitis

• Aggressive bone erosion

• Extension of disease into adjacent soft tissues

• Intrasinus high attenuation may not be present

Bening polyp

• Homogenous, well circumscribed hypodense/isodense mass

AC Polyp

Mucocoele

• Hypodense, non-enhancing mass that fills and expands the sinus cavity

Mucocoele

Frontal Sphenoid

Complications of FESS

Complication : NLD injury

Complication : ACF injury

Complication : CSF Leak

Complication : Orbital Haemorrhage

Complication : Medical rectus injury

Complication :Pneumo-encephaloceole

Complication : Optic Nerve injury

Complication : Haemorrhage

Thank you

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Imaging for Endoscopic Sinus Surgery

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