Professional Documents
Culture Documents
CT Sinus
CT Sinus
Dr.K.PRASANNA
Radiology Resident
RMMCH
NOSE AND NASAL FOSSA
OSTEOMEATAL COMPLEX
ANATOMICAL VARIATIONS
IMAGING MODALITIES
CONCLUSION
NOSE AND NASAL FOSSA
Bony part & cartilaginous part covered by muscle & skin
Cartilaginous part – upper & lower lateral cartilages, lesser alar
cartilages & septal cartilage
Nasal skin
Internal nose divided into the
Right and left by the nasal
septum
NASAL CAVITY PROPER
Roof – Nasal bone,
sphenoid & ethmoid bone
Floor - Palatine process of
the maxilla & Palatine bone
Medial wall
Lateral wall
Mainly by both Internal &
external carotid, both on the
septum & lateral walls
Inferior conchae
Cartilage – In external nose,
the lateral wall of cavity is
supported by cartilage
(lateral process of septal
cartilage & major, minor
alar cartilage)
Marked by three bony projections, they extend medially across the
nasal cavity separating the nasal cavity into for air channels – the
turbinates or conchae
Superior ,middle & inferior tubinates or conchae. The conchae do not
extend forwards into the external nose
The air space below and lateral to each turbinate is called as meatus
Superior, middle & inferior meatus & sphenoethmoidal
recess
Middle Meatus – much significant
Superior Meatus – Limited only to posterior one third of lateral
wall. Posterior ethmoidal sinus opens into it.
Middle Meatus
Inferior Meatus – Runs along the whole length of lateral wall.
Nasolacrimal duct opens in its anterior part. Largest of all meatus
Posterior – Post
Ethmoidal,
Sphenoid
Significance
Lighten the skull & facial bones
trauma
EPITHELIUM
They are lined by mucosa similar to that of the nasal cavity – pseudo
stratified ciliated columnar epithelium
Epithelium contains – Mucinous & serous glands
Mucoperiosteum
Sinuses Status at First Reaches
Birth Radiological Adult size
evidence by
Maxillary sinus Present at birth 4-5 months after 15 years
birth
On average,
it has capacity
of 14.75 ml (14-15)
• Facial surface of maxilla and cheek
Ant wall
• Infra temporal & pterygopalatine
Post wall fossa
• Floor of orbits
Roof
• Alveolar part of maxilla
Floor
DRAINAGE – OSTIUM
Seen high up in the medial wall
Does not open directly into the nasal cavity, but opens into post.
part of ethmoidal infundibulum, via hiatus semilunaris into middle
meatus.
Present at birth
Reaches adult size by 12 years
First radiological evidence seen at 1
year
Relations
Roof – formed by the anterior cranial fossa
Lateral wall - orbit
Medial wall – nasal cavity
Thin paper like bony part of the ethmoid separating the air cells
from the orbit, called lamina papyracea, can be easily destroyed
leading to spread of ethmoidal infections into the orbit
Optic nerve forms a close relationship with the posterior ethmoidal
cells & is at risk during ethmoidal surgery
OSTEOMEATAL COMPLEX
The osteomeatal complex is the key anatomic area addressed
by endoscopic sinus surgeons. Blockage of the osteomeatal
complex prevents effective mucociliary clearance, thus leading
to a stagnation of secretions and therefore leading to recurrent
or chronic sinusitis.
The OMC is bounded
ethmoid bulla
frontal recess
uncinate process
infundibulum
hiatus semilunaris
middle meatus.
ANATOMICAL
VARIANTS
Paradoxic Curvature
Normally, the convexity of the middle
turbinate bone is directed medially, toward
the nasal septum.
When paradoxically curved, the convexity
of the bone is directed laterally toward the
lateral sinus wall.
The inferior edge of the middle turbinate
may assume various shapes, which may
narrow and/or obstruct the nasal cavity,
infundibulum, and middle meatus.
Concha Bullosa
It is an aerated turbinate, most often the middle
turbinate.
Less frequently, superior & inferior turbinate
aeration can occur.
When the pneumatization involves the bulbous
segment of the middle turbinate, the term
concha bullosa applies.
If only the attachment portion of the middle
turbinate is pneumatized, and the
pneumatization does not extend into the
bulbous segment, it is known as a lamellar
concha.
Other Variations
Additional variations of the middle turbinate can occur, including
medial & lateral displacement, lateral bending, L shape, and sagittal
transverse clefts
Medial displacement – due to other middle meatal structures (i.e.,
polypoid disease, pneumatized uncinate process) encroaching upon
the middle turbinate.
Lateral displacement - due to the compression of the turbinate
toward the lateral nasal wall by a septal spur or septal deviation.
The nasal septum deviation may
compress the middle turbinate
laterally, narrowing the middle
meatus and the presence of
associated bony spurs may
further compromise the OMU.
Obstruction, secondary
inflammation, swollen
membranes, and infection can
occur
DEVIATION
The course of the free edge of the uncinate process may either
extend slightly obliquely toward the nasal septum, with the
free edge surrounding the inferoanterior surface of the ethmoid
bulla, or it extends more medially to the medial surface of the
ethmoid bulla. If the free edge of the uncinate is deviated in a
more lateral direction, it may cause narrowing or obstruction of
the hiatus semilunaris and infundibulum.
Attachment
Attachment to the lamina papyracea, the lateral surface of the
middle turbinate, or the fovea ethmoidalis in the floor of the
anterior cranial fossa may occur.
If the uncinate process attaches to the ethmoidal roof or middle
turbinate, during uncinatectomy, traction could inadvertently
damage the ethmoid roof and result in CSF rhinorrhea or other
intracranial complications.
Sometimes the free edge of
the uncinate process
adheres to the orbital floor,
or inferior aspect of the
lamina papyracea. This is
referred to as an atelectatic
uncinate process
Pneumatization
The pneumatization of the uncinate
process is believed to be due to
extension of the agger nasi cell within
the anterosuperior portion of the
uncinate process.
Functionally, the pneumatized
uncinate process resembles a concha
bullosa or an enlarged ethmoid bulla.
Infraorbital ethmoid cells are
pneumatized ethmoid air cells
that project along the medial
roof of the maxillary sinus and
the most inferior portion of the
lamina papyracea, below the
ethmoid bulla and lateral to
the uncinate process
Two definitions of Onodi cells.
The first defines them as the most
posterior ethmoid cells, being
superolateral to the sphenoid sinus and
closely associated with the optic nerve.
Another, more general description
defines Onodi cells as posterior ethmoid
cells extending into the sphenoid bone,
situated either adjacent to or impinging
upon the optic nerve
Its appearance varies considerably, based on the extent of
pneumatization.
Extensive pneumatization may obstruct the ostiomeatal
complex.
Elongated ethmoid bullae are usually in a superior to inferior
direction rather than in an anterior to posterior direction.
So, Relatively unlikely to obstruct the ostiomeatal complex.
Encountered rarely
extends into the lesser wing
and the anterior and
posterior clinoid processes
Can lead to distortion of
optic cannal configuration
May be either congenital or the
result of prior facial trauma.
It occur most often at the site of
the insertion of the basal
lamella into the lamina
papyracea, thus rendering this
portion of the lamina papyracea
most delicate
Orbit at risk
When aeration of the normally bony crista galli occurs the
aerated cells may communicate with the frontal recess, and
obstruction of this ostium.
CT
MRI
X ray – Water’s view & caldwell view