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Imaging for Endoscopic Sinus Surgery

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

Karnataka ENT Hospital & Research Center,Chitradurga, Karnataka.


Imaging v/s Endoscopy

V/S


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 Sinus



Variations : Frontal Cells

Type I

Type III

Type II

Type IV


Variations : Agger Nasi Cells


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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