Planning and Staging the Procedure

Stage the extent of the disease and decide on the procedure. After examining the scans, stage the extent of the radiological changes. Surgical time and a strategy can then be planned and tailored to match the extent of the disease. The most popular staging system has been described by Lund and Mackay (1993) (Table 8.1).

Fig. 8.20 Sphenoid intersinus septum going to the carotid artery on both sides.

Lund Mackay Score Staging

Fig. 8.21 a An axial CT scan showing dehiscent optic nerves ies. c, d Sagittal CT scans show how in the presence of a very (arrow) in the sphenoid sinus. b Coronal CT scan showing dehis- large supraorbital cell the optic nerve (arrow) is likely to be excent optic nerves (arrow) and thin bone over both carotid arter- posed.

Fig. 8.21 a An axial CT scan showing dehiscent optic nerves ies. c, d Sagittal CT scans show how in the presence of a very (arrow) in the sphenoid sinus. b Coronal CT scan showing dehis- large supraorbital cell the optic nerve (arrow) is likely to be excent optic nerves (arrow) and thin bone over both carotid arter- posed.

Table 8.1 The radiological grading as part of the Lund and Mackay (1993) staging system, which also includes symptom, endoscopic appearance, anatomical variation, and surgical scores

Radiological grading (score 0-2)a Right Left

Maxillary

Anterior ethmoids

Posterior ethmoids

Sphenoid

Frontal

Ostiomeatal complexb

Total

a Each sinus group is graded between 0 and 2 (0 = no abnormality; 1 =

partial opacification; 2 = total opacification). b Ostiomeatal obstruction is either 0 for not obstructed or 2 for obstructed.

a Each sinus group is graded between 0 and 2 (0 = no abnormality; 1 =

partial opacification; 2 = total opacification). b Ostiomeatal obstruction is either 0 for not obstructed or 2 for obstructed.

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