Invasive Imaging Techniques

Csf Fistula Frontobasal

In the past, several invasive cisternographic nuclear medicine and radiologic techniques have been developed to confirm and locate the site of CSF leaks. Since cisternographic techniques rely on demonstrating the passage of some marked CSF through the bone dural defect, their sensitivity strictly depends on the amount of CSF crossing the defect at the time of the examination. Nowadays they are indicated in very few cases. Among invasive techniques, radionuclide cisternography has been the first...

Wegener Granulomatosis 6511

Fungus Ball Maxillary Sinus

Wegener granulomatosis is a chronic, granulomatous vasculitis mainly affecting the respiratory tract and Fig. 6.21a-c. Acute fulminant fungal rhinosinusitis. TSE T2 axial plane a , Gd-DTPA SE T1 axial plane b , VIBE coronal plane c . Inhomogenous inflammatory material centered at the level of vertical process of maxillary bone and along medial wall of maxillary sinus. Note the absence of contrast uptake, related to ischemic necrosis invasion and obliteration of vessels . Extensive bone...

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Squamous Nasal Papilloma Septum

There are two problems to solve when assessing the extent of inverted papilloma to distinguish it from intrasinusal-retained secretions, and to define its relationship with both the orbit and the skull base Yousem et al. 1992 Savy et al. 2000 . MR can adequately answer both issues Oikawa et al. 2003 . Three relevant aspects regarding inverted pap-illoma pathways of spread have to be outlined adjacent bony structures are destroyed by mean of pressure erosion extension into adjacent sinusal...

Sarcoid And Maxillary Sinus

Maxillary Sinuses Abnormalities

Wegener granulomatosis. Plain SE T1 a and enhanced VIBE b in the axial plane. On plain SE T1, relevant thickening of the mucosa lining the right maxillary sinus is seen, combined with soft tissue signal within the pterygopalatine fossa 1 . b Marked enhancement of both the tissue in the pterygopalatine fossa and along the maxillary sinus walls is demonstrated. The fat suppressed sequence clearly shows the relevant enhancement of parapharyngeal spaces and nasopharyngeal walls 2 ....

Treatment Guidelines

Nasal Uncinate Process

The goals of medical therapy for chronic rhinosi-nusitis are control of infection, reduction of tissue edema, and improvement of ostia patency and sinus drainage. Reduction or elimination of irritating environmental factors is also important. Medical therapy is mainly based on 1 antibiotics, which help to control infection in the closed sinus cavities. A 3-week antibiotic course has been suggested as minimum treatment for chronic rhinosinusitis Wagner 1996 . Bacterial growth probably does not...

Clinical and Endoscopic Findings

Endoscopy Fungal

Patients with maxillary sinus fungus ball generally complain of symptoms similar to those of a chronic maxillary sinusitis unilateral nasal obstruction, purulent rhinorrhea, cacosmia, and facial pain , even though the disease may silently progress for a long time. When the fungus ball is located in the sphenoid sinus, vertex headache is the main complaint reported by the patient, while nasal symptoms may be less evident. Nasal endoscopy often shows nonspecific changes as medialization of the...

Unilateral Watery Rhinorrhea

Csf Meningocele Nasal Cavity

Unilateral bilateral watery persistent or intermittent rhinorrhea, a previous history of head trauma or surgery on the sinonasal tract, middle ear mastoid or skull base, and recurrent meningitis are the clinical findings which should alert the physician to the diagnosis of CSF leak. Nasal discharge usually increases or may be elicited by maneuvers elevating CSF pressure i.e., compression of the internal jugular veins, Valsalva maneuver . In case of a leak through the temporal bone, CSF reaches...

Definition Epidemiology Pathophysiology and Etiology

Rhinosinusitis is defined as an inflammation of the mucosa of the nose and paranasal sinuses. It is classified as acute, subacute, and chronic according to whether the duration of symptoms persists as long as 4 weeks, between 4 and 12 weeks, and more than 12 weeks, respectively Brook et al. 2000 . More than 2 billion is spent annually in the United States for over-the-counter medications for rhinosinusitis National Center for Health Statistics 1994 . Even though data regarding the incidence of...

Can You Get Pain At The Glabella With Sinusitus

Inferior Turbinate Meatus

Many patients with chronic rhinosinusitis present nasal obstruction as the primary complaint. Other symptoms include nasal discharge, postnasal drip, facial pain, dysosmia, chronic cough, and headache. Headache is usually dull and radiating to the top of the calvarium or bitemporal for sphenoid or posterior ethmoid disease. Pain at the glabella, inner can-thus, or between the eyes suggests anterior ethmoid or frontal rhinosinusitis. Pain over the cheeks most frequently suggests maxillary...

Imaging Findings

Ethmoid Sinus Abscess Scan

Acute rhinosinusitis does not require a radiologic study of the paranasal sinuses because the symptoms reported by the patient in association with the endoscopic examination are the only diagnostic steps required for making a correct diagnosis Phillips 1997 . When an orbital complication is suspected, generally secondary to acute ethmoiditis, CT permits differentiation between edema, phlegmon, and abscess, and precise identification of the site of the lesion, which is necessary for proper...

Mucocele Of Paranasal Sinuses

Retention Cyst Cavernous Sinus Mri

CT and MR Findings of Skull Base and Dura Mater Invasion Assessment of the deep extent of sinonasal tumors toward the dural layer is one of the issues that significantly influence the treatment planning. Like in the invasion of orbital walls, bone destruction of the skull base is better demonstrated by CT. However, here the imaging findings differ from those observed in the other bone interfaces of the sinonasal area because when the skull base is invaded, the dura mater usually shows abnormal...

Cranial Meningocele

Crista Galli

CSF Leak Associated with Persistent or Intermittent Rhinorrhea When persistent or intermittent watery rhinorrhea suggests CSF leak, endoscopy is the first line examination. An endonasal expansile lesion cephalocele glioma may be detected or endoscopy may give a negative result. In the first case, BTP test is unnecessary, as CSF leak is assumed to be related to the endonasal lesion. Additionally, having detected a nasal mass, the main clinical issue is to defining its relationship with...

Complications Of Frontal Sinus Osteoma

Pyogeni Brast

Sinonasal paragangliomas exhibit no distinctive imaging feature. On both CT and MR sinonasal para-gangliomas appear as markedly enhancing lesions bone destruction can be observed Myssiorek 2001 Fig. 8.48 . The differential diagnosis is therefore restricted to highly vascularized lesions, such as lobular capillary hemangioma, hemangiopericytoma, schwannoma, and metastases particularly from kidney, breast, and thyroid cancer . Fig. 8.48. Paraganglioma. Gd-DTPA SE T1 on sagittal plane. Brightly...

Midfacial Degloving

Lateral Rhinotomy Incision

This term includes a wide spectrum of surgical procedures, varying from partial resections of different types in relation to the site of origin of the lesion inferior maxillectomy, medial maxillectomy, subtotal maxillectomy , to the standard radical maxillectomy, to the extended radical maxillectomies, in which the operation includes clearance or resection of one or more adjacent anatomic structures orbit, premaxillary soft tissues and skin, zygomatic bone, pterygoid process, pterygomaxillary...

Antrochoanal Polyp Ct

Posterior Ethmoids

The pattern of nasal polyposis is characterized in most cases by bilateral involvement of middle meati, ethmoid infundibula often widened , and paranasal cavities. Inflammatory polyps most frequently arise in the middle meatus from the mucosa investing the middle turbinate, the ethmoid infundibu-lum, and the uncinate process. They also originate from the anterior part of ethmoid bulla or frontal recess. At CT, they appear as solid lobulated lesions filling the ethmoid, nasal fossae and sinusal...

Osteoplastic Flap Sinusotomy

Osteoplastic Flap Procedure

This operation is currently considered the gold standard whenever an external approach to the frontal sinus is required after failure of previous endonasal procedures or when the disease cannot be adequately reached transnasally. The anterior wall of the frontal sinus may be exposed through a coronal incision, which is carried out far posteriorly to be hidden by the hair line, or a butterfly or seagull incision, which is performed along the superior border of the eyebrows Fig. 5.19 . Our...

What Is Htv Disease

Retained Uncinate Process

Sphenoethmoid recess pattern is rather rare, consisting of sphenoid sinusitis and not infrequently posterior ethmoiditis, secondary to sphenoethmoid recess obstruction. Obliteration of the recess and inflammatory mucosal thickenings within sphenoid and posterior ethmoid are better depicted with axial CT Fig. 6.11 . Fig. 6.10. Ostiomeatal unit pattern. Polypoid thickening of the mucosa in the middle meatus asterisk . Retained secretions fill the maxillary sinus mucosal thickenings in the...

Maxillary Sinus Osteosarcoma

Condrosarcoma Nasal

As in several other expansile lesions of the sinonasal tract, many patients with a sarcoma may have undergone CT as the first imaging study. CT is particularly valuable in case of osteogenic sarcoma because it better defines the bony components of this malignant tumor Lee et al. 1988 . However, for most patients with soft tissue sarcomas, MR is the study of choice. It provides excellent definition of the relationship between tumor and neurovascular structures. Imaging studies should be obtained...

Nasal Septum Cocaine

Cocaine Lesions

Wegener granulomatosis is characterized by a great variety of presentations, including systemic and local manifestations. General symptoms may be weakness, arthralgia, neurologic deficits, unexplained fever, malaise, and weight loss. Otitis media and hearing loss, subglottic stenosis, and oropharyngeal lesions, such as ulcers, are common presentations in the otolaryngologic district. However, the sinonasal tract is by far the most frequently involved area, with 85 and 68 of patients suffering...

Anterior Craniofacial Resection

Anterior Craniofacial Resection

Even though anecdotal examples of operative techniques anticipating the concept of anterior craniofacial resection were published in the 1940s Dandy 1941 and 1950s Malecki 1959 , Ketcham et al. 1963 must be credited with the first results on a group of 19 patients with malignant tumors, most originating from the sinonasal tract, who had received anterior craniofacial resection. This surgical technique can be considered the major innovative procedure among the external approaches of the last...

Treatment Of Relapse Of Juvenile Angiofibroma

Sphenopalatine Artery

There are two different types of persistent lesions those left intentionally because their resection would require unacceptable neural damage, and those left due to intraoperative oversight Figs. 8.37, 8.38 . In both cases, proper management mandates a precise assessment of site, size, and extent of the lesion. Recurrences are a peculiar characteristic of juvenile angiofibroma. In fact, most authors doubt this theory and consider more likely the hypothesis of incomplete excision leaving lesion...

Fovea Ethmoidalis

Lamella Cribriform Plate

From a practical standpoint, the ethmoid bone can be divided into four structures two lateral masses, a sagittal midline lamina, and a horizontal plate Fig. 2.1 . The latter cribriform plate is the central part of the floor of the anterior cranial fossa. Several microscopic foramina perforate its thin structure, through which course the olfactory nerve filaments with their perineural investment. Fig. 2.1. The ethmoid plates and fovea ethmoidalis. A midline perpendicular plate, PP and two...

Ostiomeatal Unit

Ostiomeatal Unit Axial

Frontal bone osteomyelitis secondary to acute right frontal sinusitis due to frontal recess blockage arrows Fig. 6.5a,b. Complicated acute rhinosinusitis. Axial CT after contrast administration. a Fluid material occupies both maxillary sinuses a level is observed on the right and a left concha bullosa asterisks . The more cranial scan b shows an air-fluid collection within the anterior cranial fossa, bordered by thick and enhancing dura arrows epidural abscess. The absence of...

Platinum Based Chemotherapy With Radiation Sinonasal

Surgery with platinum-based postoperative chemotherapy should be considered the treatment of choice for sinonasal neuroendocrine carcinomas with limited local extent Perez-Ordonez et al. 1998 . According to Galera-Ruiz et al. 2001b , advanced lesions are best treated by a regimen similar to that of small cell lung cancer, which includes a combination of chemotherapy cisplatin etopo-side and radiotherapy. Differently, in the experience of Memorial Sloan Kettering Cancer Center, a good response...

Can Nasal Polyps

Scan Inverted Turbinate

Inverted papilloma arising from the maxillary sinus has to be distinguished from antrochoanal polyp, fungus ball, and from malignant neoplasms Savy et al. 2000 . The antrochoanal polyp, though exhibiting a similar pathway of extent, is usually diagnosed in adolescents, rather than in adults, and shows a homogeneous cystic content. Nevertheless, its variant - i.e., the angiomatous polyp - may be more difficult to differentiate. In fact, a strangled antrochoanal polyp passing through a...

Foramen Rotundum Ct

Infraorbital Canal

Pterygopalatine Fossa and Pterygoid Process On axial images the pterygopalatine fossa is a thin rectangular fat filled space between the pterygoid process of the sphenoid bone - posteriorly - and the perpendicular plate of the palatine bone - anteriorly, the latter being not separable on CT or MR from the posterior maxillary sinus wall, therefore appearing fused into a single bone structure Fig. 2.20 . On sagittal images the space progressively narrows downward where it connects to the...