radio-anatomie tdm des cavites nasosinusiennes
DESCRIPTION
RADIO-ANATOMIE TDM DES CAVITES NASOSINUSIENNES. E. Menif Service d’Imagerie Médicale Hôpital la Rabta Tunis - Tunisie. Processus frontal. Processus zygomatique. Face orbitaire. SM. Proc. alvéolaire. Proc. alvéolaire. OS MAXILLAIRE. Processus palatin. Processus zygomatique. - PowerPoint PPT PresentationTRANSCRIPT
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RADIO-ANATOMIE TDM
DES CAVITES
NASOSINUSIENNES E. Menif
Service d’Imagerie Médicale
Hôpital la Rabta
Tunis - Tunisie
MASTERE DE NEURORADIOLOGIE Sousse 2008
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Processus zygomatique
SM
Proc. alvéolaire
Processus palatin
Processus zygomatique
Face orbitaire
Processus frontal
Proc. alvéolaire
Canal infra orbitaire
OS MAXILLAIRE
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12- labyrinthe éthmoïdal13- lame criblée14- lame perpendiculaire15- crista galli16- lame orbitaire17- cornet suprême18- cornet supérieur19- Cornet moyen20- processus unciné29- Cornet inférieur
VUE POSTERIEURE VUE MEDIALE
ETHMOIDE
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1. Portion verticale : Sinus frontal
2. Bec nasofrontal
3. Cornet moyen
4. Cornet supérieur
5. Cornet suprême
6. Cornet inférieur
7. Sinus sphénoïdal
Portion horizontale :
1. Plancher de la fosse
crânienne antérieure
2. Toit de l’orbite
3. Toit ethmoïdal
FRONTAL
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SINUS FRONTAL
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• Deux difficultés :– Proximité d’organes « nobles »– Complexité anatomique
• Imagerie :– Diagnostic des complications des sinusites
frontales– BALISAGE ANATOMIQUE PRÉCHIRURGICAL
Plans axial, CORONAL et SAGITTAL
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1. Portion verticale : Sinus frontal
2. Bec nasofrontal
3. Cornet moyen
4. Cornet supérieur
5. Cornet suprême
6. Cornet inférieur
7. Sinus sphénoïdal
Portion horizontale :
1. Plancher de la fosse
crânienne antérieure
2. Toit de l’orbite
3. Toit ethmoïdal
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Cloison intersinusienne
INFUNDIBULUM
↓OSTIUM
Bec nasofrontal
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Le drainage se fait à travers un complexe anatomique : Tractus nasofrontal
2. Infundibulum frontal3. Ostium frontal8. Récessus frontal
1
23
8
4
9
7
5
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Le drainage se fait à travers un complexe anatomique : Tractus nasofrontal
2. Infundibulum frontal3. Ostium frontal8. Récessus frontal
1
23
8
4
9
7
5
4- Bec nasofrontal5- Agger Nasi7- Bulle ethmoïdale9- Racine cloisonnante du CM
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AN
CM
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Ostium frontal + processus unciné : son insertion supérieure est un repère anatomique important
TYPE ATYPE 1
A
TYPE 2
B
TYPE 3
C
Friedman et coll, 2004
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TYPE 4
D
TYPE 5
E
TYPE 6
F
Friedman et coll, 2004
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Récessus frontal + cellules de l’Agger Nasi :
Pneumatisation des cellules de l’AN → calibre du RF
Récessus étroit = canal frontonasal
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Bulle
Bulle frontale
Aggernasi
Cellule suprabullaire
Bulle
Aggernasi
Récessus frontal + cellules de la bulle :
Pneumatisation des cellules de la bulle → calibre du RF
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Cellules frontales : obstruction au drainage frontonasal
K1
K2
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K3
K4
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SF
SFKuhn 3
Kuhn 1
C supra orbitaireC supra orbitaire
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QUESTIONS DU CHIRURGIEN ?
• Confinement mécanique
• Risque chirurgical
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QUESTIONS DU CHIRURGIEN ?
• Confinement mécanique
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• Risque chirurgical :– Hémorragique– Lésion du nerf optique– Fuite du LCR
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→ Hémorragie : lésion artère éthmoïdale antérieure
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→ Orbite : hématome
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→ Hémorragie
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→ Atteinte du nerf optique
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Cellule d’Onodi
→ Atteinte du nerf optique
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→ Fuite de LCR : brèche osseuse
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→ Fuite de LCR : déhiscence osseuse