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1. Radiology of Nasal Cavity and
Paranasal Sinuses

2. Radiology
• XRAY
• CT
• MRI

3. Normal Anatomy

4. Drainage system
Lamella:
1) uncinate
2) ethmoidal bulla
3) basal lamella
4) superior turb
lamella

6. Uncinate attachment variations

7. Agger Nasi

8. Frontal sinus outflow tract
• May be narrowed by
agger anteriorly or bulla
posteriorly
• Frontal cells (Type 1-4)
• Frontal recess
– Lateral: lamina papyracea
– Medial: middle turbinate
– Anterior: posterior wall of
agger nasi
– Posterior: ethmoid bulla

9. Basal lamella
U
B
L

10. Keros Classification

11. Sphenoid sinus

12. Haller cells

13. Other anatomic variations
• Concha bullosa
• Septal deviations
• Paradoxic middle turbinate
– convex curvature on the lateral, rather than medial side of the
turbinate
• Dehiscent lamina
• Aerated crista galli
• Optic nerve/carotid artery

14. MRI
• Helpful for evaluation of regional and intracranial complications
• Detection and staging of neoplastic processes
• Improved display between intraorbital and extraorbital compartments
• Helpful for diagnosing fungal concretions which show low or no signal on
T2
• Helps for evaluation of mucoceles and cephaloceles
• Appearance varies with changing concentrations of proteins and free
water protons
– T2  more “watery”, higher signal
– T1  more protein, higher signal
• However, once protein content reaches too high signal decreases

17. Epistaxis

18. Epistaxis
• Most common otolaryngologic emergency
• Majority idiopathic
• 60% of population in their lifetime
• Maxillary sinus ostium serves as dividing line
between “anterior” and “posterior bleeds”

19. Vascular anatomy

21. Endoscopic SPA ligation
• Epistaxis controlled in 98%
• Locate SPA at level of crista ethmoidalis
• Key in surgery is to ligate all branches which
can vary

22. Embolization
• Risk of complications: CVA, hemiplegia,
ophthalmoplegia, facial nerve palsy, seizures,
soft tissue necrosis
• Effective only for ECA supply very dangerous
for ICA supply due to high risk of blindness
• Success rate 71-95%
• Complication rate 27%

23. Anterior ethmoid artery bleeding
• Associated with nasoethmoid fractures
• Bleeding rarely subsides with conservative measures
• Variable position
– Always seen between second and third lamellae
– Most common site in the suprabullar recess (85%)