Download - Pns New
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Radiological Anatomy - PNS
Dr.
Asst. Prof
Medical College
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Ventral to Brain
Posterior to Facial Skeleton
Narrow Ext. Nose
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Emil Zuckerkandl
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Endoscopes & Imaging
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WHERE ARE WE NOW…?
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Introduction
Road map for endoscopic surgeon Anatomical variations Medico legal aspects
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Changing Trends…
The Gold Standard- CT Scan
CT Scan MRI
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Why Coronals…?
Plane almost identical to that approached by endoscopies
Best displays OMU UP & Bulla lie on a vertical plane
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Axial- Complementary Pterygopalatine fossa, Fossa of Rossenmuller &
optic nerve better seen Thin slice helical scanning with reformatting
Patients who cannot tolerate hyperextension
Patients with extensive dental restorations
At optic nerve & at the narrowest AP diameter of frontal recess
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Technology Advances…
Conventional CT replaced by helical or spiral CT
Shorter scan times Less motion artifact Minimisation of volume averaging artifact Permits real-time multiplanar display in OR
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Newer MDCT scanners…
Allow acquisition of 4 to 32 (64) slices with each scanner rotation
Dramatically reduces motion artifacts With 0.5mm to 0.75mm beam collimation
permits very high resolution multiplanar reformatted images
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Basic concepts…
Coronal 3mm cuts Bony & soft tissue windows Axial cuts Contrast enhanced CT Sagittal reconstruction
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Timing of CT
A/C sinusitis adequately treated C/C inflammatory diseases- maximised medical therapy
Role of CT
to define PNS anatomy
to identify regional disease in medical non-responders
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Screening CT ??
Thicker (5-10mm) axial cross section Poor diagnostic yield & eventual need for pre-
op. coronal cuts ??cost- effective
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CT Patient Positioning
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Patient preparation
A course of antibiotics, decongestants Sympathomimetic nasal spray 15mts
before CT To blow nose before CT
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At Nasion
Frontal sinus
1. Present / absent
2. No. / size
3. Intersinus septum
• pneumatization
4. Scalloping +/ -
5. Frontal cell – I -IV
6. Aggar Nasi
7. Septal deviation
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At Aggar Nasi
1. Nasl septal deviation
2. Aggar Nasi
– side , No. & size
3. Frontal cell Type- I-IV
4. Nasolacrimal duct & its relationship to aggar
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At level of OMC
1. Nasl septal deviation
2. Uncinate process +/-
- Normal / Atelectatic
- bent Medially / laterally
- Superior attachment
3. Frontal recess
- Infundibular pattern / middle meatus
4. Skull base height- Type I,II,III
5. Relation to Ant.Ethmoidal A.
6. Bulla +/-
- Hypoplastic / large / lateral sinus
7. Middle turbinate- Concha bullosa- Paradoxical MTC
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At level of
Posterior ethmoids
1. Nasal septum
-Deviations/spurs
2. Lamina papyracea dehiscence
3. Accessory ostia
4. Presence of superior/supreme turbinate
5. Onodi cells
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At level of
Sphenoid sinus
1. Onodi cells
2. Optic nerve / Internal Carotid artery prominence/dehiscence
3. Vidian nerve / Maxillary branch of trigeminal nerve dehiscence
4. Intersinus septa
-No. / attachments to ICA / Optic nerve
5. Anterior clinoid process pneumatization
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Optic foramenSOF
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BASAL LAMELLA
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Pterygoid plates
ppfPt max fissure
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Fossa of Rosenmuller
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Frontal Sinus
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Extensive Pneumatisation
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Frontal Recess
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Uncinate Process
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Terminal Recess
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Frontal Cell
I
IVIII
II
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Kero’s Classification
I IIIII
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Agger Nasi
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Pneumatisation of crista galli
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Pneumatisation of Uncinate Process
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Ostiomeatal Complex ( OMC)
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B/L CB, Lateralised UP, Narrow Infundibulum
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Elongated UP
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Uncinate Process
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Haller Cell
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Ethmoid Infundibulum
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Ethmoid Infundibulum
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Large bulla & concha bullosa narrowing infundibulum
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Infundibulum Variants
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Middle Turbinate
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Middle Turbinate Part 1
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Middle Turbinate Part 2
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Middle Turbinate Part 3
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Middle turbinate variants
paradoxical interlamellar
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Cocha Bullosa
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Bulla Ethmoidalis Variants
Absent bulla Bulla with multiple cells
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Sinus Lateralis
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Sinus Lateralis = Suprabullar recess and retrobullar recess
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Maxillary Sinus
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Height of Skullbase at Post.Ethmoid
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Sphenoethmoidal Cell
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Sphenoid Sinus
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Sphenoid variations
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Pneumatisation
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Anterior Clinoid Process Pneumatisn
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Dehiscent Optic Nerve & ICA
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Be careful…
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Allergic Fungal Rhinosinusitis
MRI: Central hypointensity on T1, central signal void on T2; increased peripheral enhancement
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Thank You
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Haller cells
multiple Large & flat
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UP blocking EI