This document summarizes a study that analyzed anatomical variations of the paranasal sinuses visible on coronal CT scans. 100 patients undergoing CT scans for complaints related to the paranasal sinuses were included. The scans were analyzed for variations in structures like the septum, agger nasi cells, ethmoid bulla, uncinate process, turbinates, and sinuses. Statistical analysis was performed on the results. Common variations found included septal deviations, pneumatized agger nasi cells, concha bullosa, haller cells, Onodi cells and variations in sinus anatomy and pneumatization. The study concluded that the paranasal sinus region commonly has congenital anomalies and normal anatomical variations that
This document summarizes important anatomical variations of the paranasal sinuses that are relevant for sinusitis. It describes variations that can occur in structures like the agger nasi cells, uncinate process, middle turbinate, cribriform plate, and maxillary ostia. These variations include pneumatization of cells or bony structures as well as anatomical abnormalities that can obstruct drainage of the sinuses. Understanding these variations is important for evaluating patients with recurrent sinusitis as certain variations may contribute to obstruction and recurrence.
PNS (Para-nasal-sinuses) anatomy and variantsDr. Mohit Goel
This document describes the anatomy seen on different types of sinus CT scans, including coronal, axial, and sagittal views. It discusses key structures like the frontal sinus, ethmoid air cells, sphenoid sinus, and osteomeatal complex. It also describes common anatomical variations such as septal deviations, agger nasi cells, variations in the uncinate process, and pneumatized middle turbinates (concha bullosa). The goal is to understand normal sinus anatomy and common anatomic variations that can affect sinus drainage and development of disease.
This document provides an overview of the anatomy of the temporal bone as visualized on HRCT scans. It describes the 3 main planes of scanning and their utility. It then details the individual bones that make up the temporal bone and the external, middle, and inner ear structures. Numerous axial, coronal, and sagittal HRCT images are presented to illustrate key anatomic landmarks and relationships. Structures like the ossicles, facial nerve canal, internal auditory canal, labyrinthine and cochlear anatomy are specifically called out.
This document discusses the importance of CT scans for identifying anatomy, operative planning, risk assessment, and informed consent in ENT procedures. It outlines key structures visible on axial, coronal, and sagittal CT scan planes of the temporal bone including the semicircular canals, vestibular aqueduct, internal auditory canal, ossicles, cochlea, facial nerve, and direction of scan slices. The document is intended to educate on interpreting temporal bone CT scans for ENT procedures.
This document describes various approaches to the infratemporal fossa (ITF) for tumors. It discusses anterior approaches like transoral, transantral, and transmaxillary which provide access to the anteromedial ITF. Lateral approaches like transzygomatic access the lateral ITF. Inferior approaches like transmandibular reach the ITF from below. The document outlines the pioneers who developed different ITF approaches and describes in detail the postauricular infratemporal fossa approach developed by Fisch, involving types A, B, and C. It discusses the advantages, disadvantages, and variations of different ITF approaches.
Ct anatomy of paranasal sinuses( PNS) pk.pdf pptDr pradeep Kumar
This presentation includes cross sectional anatomy like axial,saggital and coronal images of paranasal sinuses and most important variation of paranasal sinus.This help alot. Must read topic for radiology resident. Thanks
This document summarizes important anatomical variations of the paranasal sinuses that are relevant for sinusitis. It describes variations that can occur in structures like the agger nasi cells, uncinate process, middle turbinate, cribriform plate, and maxillary ostia. These variations include pneumatization of cells or bony structures as well as anatomical abnormalities that can obstruct drainage of the sinuses. Understanding these variations is important for evaluating patients with recurrent sinusitis as certain variations may contribute to obstruction and recurrence.
PNS (Para-nasal-sinuses) anatomy and variantsDr. Mohit Goel
This document describes the anatomy seen on different types of sinus CT scans, including coronal, axial, and sagittal views. It discusses key structures like the frontal sinus, ethmoid air cells, sphenoid sinus, and osteomeatal complex. It also describes common anatomical variations such as septal deviations, agger nasi cells, variations in the uncinate process, and pneumatized middle turbinates (concha bullosa). The goal is to understand normal sinus anatomy and common anatomic variations that can affect sinus drainage and development of disease.
This document provides an overview of the anatomy of the temporal bone as visualized on HRCT scans. It describes the 3 main planes of scanning and their utility. It then details the individual bones that make up the temporal bone and the external, middle, and inner ear structures. Numerous axial, coronal, and sagittal HRCT images are presented to illustrate key anatomic landmarks and relationships. Structures like the ossicles, facial nerve canal, internal auditory canal, labyrinthine and cochlear anatomy are specifically called out.
This document discusses the importance of CT scans for identifying anatomy, operative planning, risk assessment, and informed consent in ENT procedures. It outlines key structures visible on axial, coronal, and sagittal CT scan planes of the temporal bone including the semicircular canals, vestibular aqueduct, internal auditory canal, ossicles, cochlea, facial nerve, and direction of scan slices. The document is intended to educate on interpreting temporal bone CT scans for ENT procedures.
This document describes various approaches to the infratemporal fossa (ITF) for tumors. It discusses anterior approaches like transoral, transantral, and transmaxillary which provide access to the anteromedial ITF. Lateral approaches like transzygomatic access the lateral ITF. Inferior approaches like transmandibular reach the ITF from below. The document outlines the pioneers who developed different ITF approaches and describes in detail the postauricular infratemporal fossa approach developed by Fisch, involving types A, B, and C. It discusses the advantages, disadvantages, and variations of different ITF approaches.
Ct anatomy of paranasal sinuses( PNS) pk.pdf pptDr pradeep Kumar
This presentation includes cross sectional anatomy like axial,saggital and coronal images of paranasal sinuses and most important variation of paranasal sinus.This help alot. Must read topic for radiology resident. Thanks
The document describes the anatomical structures of the temporal bone, including its four parts - squamous, mastoid, petrous, and tympanic. It details the locations and structures of the mastoid process, styloid process, zygomatic process, external acoustic meatus, middle ear cavity, mastoid antrum, ossicles, inner ear, internal auditory canal, carotid canal, jugular foramen and fossa, and course of the facial nerve. CT and MRI are described as the main imaging techniques used to evaluate the temporal bone, with CT excellent for osseous structures and MRI better for soft tissues.
The document discusses the anatomy and imaging of the paranasal sinuses. It begins with the embryology of the sinuses, noting that the maxillary, ethmoid, and frontal sinuses develop from invaginations of the nasal cavity into bones. The anatomy sections describe each of the four major sinuses - maxillary, ethmoid, sphenoid, and frontal - as well as other structures like the osteomeatal complex and nasal passages. Variations in anatomy are also covered. Imaging modalities for evaluating the sinuses include conventional radiography, CT, and MRI, with CT considered the gold standard.
The temporal bone contains 5 portions and has a complex anatomy. It houses the external ear, middle ear, and inner ear structures. The middle ear contains 3 ossicles that transmit sound from the tympanic membrane to the inner ear. Key structures include the mastoid air cells, epitympanum, mesotympanum, hypotympanum, tegmen, and boundaries between the middle ear and inner ear. CT effectively demonstrates the normal anatomy and variations of the temporal bone.
This document discusses the radiological anatomy of the paranasal sinuses and provides guidance on using CT scans to evaluate the anatomy. It outlines key anatomical structures visible on coronal and axial CT scans such as the frontal sinus, uncinate process, ethmoid bulla, sphenoid sinus, and their common variations. It also discusses technology advances in CT scanning and basic concepts for evaluating and positioning patients for sinus CT scans.
This document discusses the anatomy seen on CT scans of the temporal bone in different planes. It provides details on key structures visible in the axial, coronal, and sagittal planes, including the semicircular canals, cochlea, facial nerve canal, ossicles, and mastoid air cells. Different anatomical compartments of the middle ear are also described based on coronal imaging. The purpose is to identify relevant anatomy, assess disease extension and surgical planning for ear procedures.
This document summarizes CSF leaks, their causes, presentations, diagnostic testing, imaging, and treatment options. CSF leaks can be caused by trauma, inflammation, or congenital defects and present with symptoms like ear drainage, hearing loss, or meningitis. Diagnosis involves tests of drainage fluid and imaging modalities like CT, MRI, and radionuclide scans. Treatment depends on the location and cause but may include conservative measures, antibiotics, or surgical repair through various approaches to close defects.
1. The petrous apex is a pyramid-shaped structure within the temporal bone that contains several vascular and neural channels.
2. Cholesterol granulomas are the most common petrous apex lesions, appearing hyperintense on T1- and T2-weighted MRI. Other developmental lesions include cholesteatomas, mucoceles, and cephaloceles.
3. Inflammatory, neoplastic, vascular, and osseous dysplasia lesions can also involve the petrous apex. Large or cranial nerve-compressing lesions may cause symptoms like hearing loss, facial weakness, or trigeminal nerve dysfunction.
Endoscopic anatomy of Retrotympanum; Middle earPrasanna Datta
1. The retrotympanum is a complex anatomical region in the middle ear that houses important structures.
2. Recent studies using endoscopy have provided improved visualization of the retrotympanum, allowing for a better understanding of its anatomy and variations.
3. Key structures in the retrotympanum include the sinus tympani, subpyramidal space, and inferior retrotympanum. Understanding their anatomy can help surgeons completely remove diseases like cholesteatoma.
The document discusses different types of skull base surgical approaches - Type A, B, and C. Type A involves radical mastoidectomy and exposes the jugular bulb, carotid artery, and posterior fossa. Type B explores the petrous apex, clivus, and superior infratemporal fossa. Type C allows exposure of structures like the nasopharynx and parasellar area. The infratemporal fossa approach has allowed advances in lateral skull base surgery for tumors like glomus jugular tumors.
this prsentation incluses HRCT temportal bone cross sectional anatomy images axial saggital and coronal with labelled diagram. This presentation help alot for radiology resident. Thanks.
1. The document provides detailed anatomical descriptions of key structures relevant to endoscopic sinus surgery, including the nasal septum, middle turbinate, ground lamella, uncinate process, osteomeatal complex, frontal sinus drainage pathway, and anterior skull base.
2. Important anatomical variations that can impact surgery such as concha bullosa, paradoxical middle turbinate, and Onodi cells are described.
3. Radiographic features of the paranasal sinuses and adjacent structures on CT that influence surgical planning are outlined, including pneumatization extent, dehiscences, and bony abnormalities.
Cross Sectional Anatomy of Paranasal sinus Sarbesh Tiwari
The document summarizes the anatomy and variations of the paranasal sinuses. It describes the locations and openings of the different sinus groups. Key anatomical structures involved in sinus drainage like the osteomeatal complex are also explained. Common anatomic variations seen on imaging that can affect sinus drainage are discussed. These variations include concha bullosa, Haller cells, Onodi cells and pneumatization of surrounding bones.
This document provides information on canal wall down (CWD) mastoidectomy surgery. It defines CWD mastoidectomy as the removal of the posterior and superior bony walls of the external ear canal and excision of all mastoid air cells, converting the mastoid cavity, middle ear, and ear canal into a single cavity exteriorized through the ear canal. It discusses indications for CWD mastoidectomy such as cholesteatoma, tumors, and anatomical factors like a low-lying tegmen. The document outlines the surgical technique and considerations like facial ridge lowering. It also addresses outcomes, complications, and the challenges of long-term management after CWD mastoidectomy.
New microsoft office power point presentationhumra shamim
The document discusses radiology of the mastoid bone. It describes the five compartments of temporal bone pneumatization including the mastoid. It lists the functions of temporal bone air cells. It describes the three types of mastoid pneumatization: sclerotic, diploic, and pneumatic. It discusses x-ray views used to image the mastoid including Law's view, Schuller's view, Towne's view, and Stenver's view. It provides guidance on reading x-rays and examples of findings and diagnoses.
The document describes the anatomy of neck spaces. It discusses that the neck can be divided into suprahyoid and infrahyoid spaces based on the hyoid bone. Specific spaces described include the sublingual, submandibular, buccal, masticator, parotid, pharyngeal mucosal, parapharyngeal, visceral, anterior cervical, posterior cervical, carotid, retropharyngeal, prevertebral, and danger spaces. The spaces are delineated by layers of cervical fascia including the superficial, middle, and deep layers. Understanding these neck spaces is important for diagnosing conditions and limiting the spread of infections and tumors.
A 16-year-old male presented with recurrent nasal bleeding. Imaging revealed a large mass along the left nasal fossa with lobulated contours and extension into multiple compartments including the nasal cavity, sinuses, and intracranial space. The mass showed intermediate signal intensity on T2-weighted imaging with a macrocyst along the periphery of the intracranial component. These features are characteristic of an olfactory neuroblastoma, also known as esthesioneuroblastoma, which arises from the olfactory epithelium and commonly involves multiple nasal compartments with cyst formation along the intracranial periphery.
The document discusses the anatomy of the sinus tympani, a cavity located in the posterior region of the tympanic cavity. It describes how the sinus tympani was first named and discussed in 1820. It defines the two portions of the retrotympanum based on the position of the facial nerve. It outlines different shapes that the sinus tympani can take, including classical, confluent, partitioned, and restricted, and different types - A, B, and C - based on its extension in relation to the facial nerve. The shapes and types of the sinus tympani can influence the surgical approach used for cholesteatoma surgery.
Endoscopic ear surgery (EES) has emerged as a valuable technique for visualizing and operating in the ear. The document discusses the history and evolution of EES from its early uses in the 1960s to becoming an accepted approach. It provides rationales for using EES, such as obtaining a wider field of view within the ear canal. The document outlines instrumentation, setup, techniques, and indications for EES. It emphasizes that EES is not meant to replace the microscope but can be useful as an adjunct or alternative approach in select cases.
Coblation is a non-thermal tissue ablation technique that uses radiofrequency energy and saline to generate a precise plasma field. This plasma field breaks down tissue molecules with minimal damage to surrounding structures. Coblation was developed in the 1990s and is commonly used in ENT procedures like tonsillectomy, adenoid removal, and turbinate reduction due to benefits like bloodless dissection, precision, and reduced pain. The coblation system includes a wand, RF generator, foot pedal, and saline irrigation. The wand's electrodes and saline generate a localized plasma field for tissue removal in ablation mode or hemostasis in coagulation mode.
Imaging of paranasal sinuses (including anatomy and varaints)pk1 pdf pptDr pradeep Kumar
This is very good powerpoint presentation of imaging anatomy and variants of paranasal sinuses and imaging pathology as well as multiple pathological imaging findings and images.it will helps for radiologist and radiology resident and even ent resident. our references is CT and mri whole body by Haaga and various internet sources. THANKS.
The document discusses Functional Endoscopic Sinus Surgery (FESS). FESS is a minimally invasive procedure that uses an endoscope to access and treat the paranasal sinuses. It aims to restore sinus function by re-establishing ventilation and mucociliary clearance. Key steps in FESS include uncinectomy to remove the uncinate process, maxillary antrostomy to access the maxillary sinus, and ethmoidectomy to access the ethmoid sinuses. Proper identification of anatomical landmarks like the middle turbinate, uncinate process, and bulla ethmoidalis is important for successful FESS.
The document describes the anatomical structures of the temporal bone, including its four parts - squamous, mastoid, petrous, and tympanic. It details the locations and structures of the mastoid process, styloid process, zygomatic process, external acoustic meatus, middle ear cavity, mastoid antrum, ossicles, inner ear, internal auditory canal, carotid canal, jugular foramen and fossa, and course of the facial nerve. CT and MRI are described as the main imaging techniques used to evaluate the temporal bone, with CT excellent for osseous structures and MRI better for soft tissues.
The document discusses the anatomy and imaging of the paranasal sinuses. It begins with the embryology of the sinuses, noting that the maxillary, ethmoid, and frontal sinuses develop from invaginations of the nasal cavity into bones. The anatomy sections describe each of the four major sinuses - maxillary, ethmoid, sphenoid, and frontal - as well as other structures like the osteomeatal complex and nasal passages. Variations in anatomy are also covered. Imaging modalities for evaluating the sinuses include conventional radiography, CT, and MRI, with CT considered the gold standard.
The temporal bone contains 5 portions and has a complex anatomy. It houses the external ear, middle ear, and inner ear structures. The middle ear contains 3 ossicles that transmit sound from the tympanic membrane to the inner ear. Key structures include the mastoid air cells, epitympanum, mesotympanum, hypotympanum, tegmen, and boundaries between the middle ear and inner ear. CT effectively demonstrates the normal anatomy and variations of the temporal bone.
This document discusses the radiological anatomy of the paranasal sinuses and provides guidance on using CT scans to evaluate the anatomy. It outlines key anatomical structures visible on coronal and axial CT scans such as the frontal sinus, uncinate process, ethmoid bulla, sphenoid sinus, and their common variations. It also discusses technology advances in CT scanning and basic concepts for evaluating and positioning patients for sinus CT scans.
This document discusses the anatomy seen on CT scans of the temporal bone in different planes. It provides details on key structures visible in the axial, coronal, and sagittal planes, including the semicircular canals, cochlea, facial nerve canal, ossicles, and mastoid air cells. Different anatomical compartments of the middle ear are also described based on coronal imaging. The purpose is to identify relevant anatomy, assess disease extension and surgical planning for ear procedures.
This document summarizes CSF leaks, their causes, presentations, diagnostic testing, imaging, and treatment options. CSF leaks can be caused by trauma, inflammation, or congenital defects and present with symptoms like ear drainage, hearing loss, or meningitis. Diagnosis involves tests of drainage fluid and imaging modalities like CT, MRI, and radionuclide scans. Treatment depends on the location and cause but may include conservative measures, antibiotics, or surgical repair through various approaches to close defects.
1. The petrous apex is a pyramid-shaped structure within the temporal bone that contains several vascular and neural channels.
2. Cholesterol granulomas are the most common petrous apex lesions, appearing hyperintense on T1- and T2-weighted MRI. Other developmental lesions include cholesteatomas, mucoceles, and cephaloceles.
3. Inflammatory, neoplastic, vascular, and osseous dysplasia lesions can also involve the petrous apex. Large or cranial nerve-compressing lesions may cause symptoms like hearing loss, facial weakness, or trigeminal nerve dysfunction.
Endoscopic anatomy of Retrotympanum; Middle earPrasanna Datta
1. The retrotympanum is a complex anatomical region in the middle ear that houses important structures.
2. Recent studies using endoscopy have provided improved visualization of the retrotympanum, allowing for a better understanding of its anatomy and variations.
3. Key structures in the retrotympanum include the sinus tympani, subpyramidal space, and inferior retrotympanum. Understanding their anatomy can help surgeons completely remove diseases like cholesteatoma.
The document discusses different types of skull base surgical approaches - Type A, B, and C. Type A involves radical mastoidectomy and exposes the jugular bulb, carotid artery, and posterior fossa. Type B explores the petrous apex, clivus, and superior infratemporal fossa. Type C allows exposure of structures like the nasopharynx and parasellar area. The infratemporal fossa approach has allowed advances in lateral skull base surgery for tumors like glomus jugular tumors.
this prsentation incluses HRCT temportal bone cross sectional anatomy images axial saggital and coronal with labelled diagram. This presentation help alot for radiology resident. Thanks.
1. The document provides detailed anatomical descriptions of key structures relevant to endoscopic sinus surgery, including the nasal septum, middle turbinate, ground lamella, uncinate process, osteomeatal complex, frontal sinus drainage pathway, and anterior skull base.
2. Important anatomical variations that can impact surgery such as concha bullosa, paradoxical middle turbinate, and Onodi cells are described.
3. Radiographic features of the paranasal sinuses and adjacent structures on CT that influence surgical planning are outlined, including pneumatization extent, dehiscences, and bony abnormalities.
Cross Sectional Anatomy of Paranasal sinus Sarbesh Tiwari
The document summarizes the anatomy and variations of the paranasal sinuses. It describes the locations and openings of the different sinus groups. Key anatomical structures involved in sinus drainage like the osteomeatal complex are also explained. Common anatomic variations seen on imaging that can affect sinus drainage are discussed. These variations include concha bullosa, Haller cells, Onodi cells and pneumatization of surrounding bones.
This document provides information on canal wall down (CWD) mastoidectomy surgery. It defines CWD mastoidectomy as the removal of the posterior and superior bony walls of the external ear canal and excision of all mastoid air cells, converting the mastoid cavity, middle ear, and ear canal into a single cavity exteriorized through the ear canal. It discusses indications for CWD mastoidectomy such as cholesteatoma, tumors, and anatomical factors like a low-lying tegmen. The document outlines the surgical technique and considerations like facial ridge lowering. It also addresses outcomes, complications, and the challenges of long-term management after CWD mastoidectomy.
New microsoft office power point presentationhumra shamim
The document discusses radiology of the mastoid bone. It describes the five compartments of temporal bone pneumatization including the mastoid. It lists the functions of temporal bone air cells. It describes the three types of mastoid pneumatization: sclerotic, diploic, and pneumatic. It discusses x-ray views used to image the mastoid including Law's view, Schuller's view, Towne's view, and Stenver's view. It provides guidance on reading x-rays and examples of findings and diagnoses.
The document describes the anatomy of neck spaces. It discusses that the neck can be divided into suprahyoid and infrahyoid spaces based on the hyoid bone. Specific spaces described include the sublingual, submandibular, buccal, masticator, parotid, pharyngeal mucosal, parapharyngeal, visceral, anterior cervical, posterior cervical, carotid, retropharyngeal, prevertebral, and danger spaces. The spaces are delineated by layers of cervical fascia including the superficial, middle, and deep layers. Understanding these neck spaces is important for diagnosing conditions and limiting the spread of infections and tumors.
A 16-year-old male presented with recurrent nasal bleeding. Imaging revealed a large mass along the left nasal fossa with lobulated contours and extension into multiple compartments including the nasal cavity, sinuses, and intracranial space. The mass showed intermediate signal intensity on T2-weighted imaging with a macrocyst along the periphery of the intracranial component. These features are characteristic of an olfactory neuroblastoma, also known as esthesioneuroblastoma, which arises from the olfactory epithelium and commonly involves multiple nasal compartments with cyst formation along the intracranial periphery.
The document discusses the anatomy of the sinus tympani, a cavity located in the posterior region of the tympanic cavity. It describes how the sinus tympani was first named and discussed in 1820. It defines the two portions of the retrotympanum based on the position of the facial nerve. It outlines different shapes that the sinus tympani can take, including classical, confluent, partitioned, and restricted, and different types - A, B, and C - based on its extension in relation to the facial nerve. The shapes and types of the sinus tympani can influence the surgical approach used for cholesteatoma surgery.
Endoscopic ear surgery (EES) has emerged as a valuable technique for visualizing and operating in the ear. The document discusses the history and evolution of EES from its early uses in the 1960s to becoming an accepted approach. It provides rationales for using EES, such as obtaining a wider field of view within the ear canal. The document outlines instrumentation, setup, techniques, and indications for EES. It emphasizes that EES is not meant to replace the microscope but can be useful as an adjunct or alternative approach in select cases.
Coblation is a non-thermal tissue ablation technique that uses radiofrequency energy and saline to generate a precise plasma field. This plasma field breaks down tissue molecules with minimal damage to surrounding structures. Coblation was developed in the 1990s and is commonly used in ENT procedures like tonsillectomy, adenoid removal, and turbinate reduction due to benefits like bloodless dissection, precision, and reduced pain. The coblation system includes a wand, RF generator, foot pedal, and saline irrigation. The wand's electrodes and saline generate a localized plasma field for tissue removal in ablation mode or hemostasis in coagulation mode.
Imaging of paranasal sinuses (including anatomy and varaints)pk1 pdf pptDr pradeep Kumar
This is very good powerpoint presentation of imaging anatomy and variants of paranasal sinuses and imaging pathology as well as multiple pathological imaging findings and images.it will helps for radiologist and radiology resident and even ent resident. our references is CT and mri whole body by Haaga and various internet sources. THANKS.
The document discusses Functional Endoscopic Sinus Surgery (FESS). FESS is a minimally invasive procedure that uses an endoscope to access and treat the paranasal sinuses. It aims to restore sinus function by re-establishing ventilation and mucociliary clearance. Key steps in FESS include uncinectomy to remove the uncinate process, maxillary antrostomy to access the maxillary sinus, and ethmoidectomy to access the ethmoid sinuses. Proper identification of anatomical landmarks like the middle turbinate, uncinate process, and bulla ethmoidalis is important for successful FESS.
The document discusses the anatomy and physiology of the pituitary gland and sphenoid sinus. It then covers pituitary adenomas including classification, clinical features, investigations and approaches to transsphenoid hypophysectomy surgery. Specific surgical steps are outlined including opening the sphenoid sinus, removing the bony walls, and dissecting the dura, capsule and gland tissue to remove an adenoma. Potential complications of the surgery are also mentioned.
surgical anatomy of nose is a humble attempt to make the anatomy of nose simpler and easy for medical students and fellow physicians. at the end of the presentation the students will be able to identify all the structures.
Endoscopic anatomy of nose ,paranasal sinus and anterior skull baseRajat Jain
This document provides an overview of nasal endoscopic anatomy and the endoscopic examination technique. It describes the three passes used in endoscopy to examine the different anatomical structures of the nose and paranasal sinuses. The first pass examines the nasal septum, inferior turbinate, and posterior choana. The second pass examines the superior turbinate, sphenoethmoidal recess, and sphenoid ostium. The third pass examines the middle meatus, uncinate process, bulla ethmoidalis, and maxillary ostium. It also describes important anatomical structures like the turbinates, sinuses, arteries and variations that can be observed during nasal endoscopy.
This document provides an overview of functional endoscopic sinus surgery (FESS). It discusses the history and principles of FESS, including reestablishing ventilation and mucociliary clearance while preserving normal tissue. Messerklinger's 5 lamella approach is described. Indications for primary sinonasal surgery include chronic and acute rhinosinusitis, polyps, and fungal infections. Anatomical landmarks visualized during endoscopic examination of the nasal cavity and paranasal sinuses are outlined, along with key features seen on coronal and axial CT scans.
The lateral wall of the nasal cavity is formed by several bones including the nasal, maxilla, lacrimal, ethmoid, palatine and sphenoid bones. It contains three bony projections called turbinates. Several anatomical structures are located within the lateral wall including the agger nasi cell, ethmoid bulla, uncinate process and ostiomeatal complex. The document describes the bones, turbinates, sinuses and various anatomical variations that can be present within the lateral wall of the nasal cavity.
Middle ear ventilatory pathway and Mucosal folds.pptxSaneeshDamodaran
The document discusses the anatomy and physiology of the middle ear ventilation pathways. It describes the mucosal folds in the middle ear which develop during fetal development from sacs and pouches. Important folds include the tensor tympani fold, malleal folds, and incudal folds. These folds orient the spread of middle ear pathology. The tympanic isthmus and its blockage are also discussed, which can lead to attic dysventilation even with a normally functioning Eustachian tube. Preserving the tensor tympani fold during surgery is important to ensure ventilation of the attic region. A well-aerated mastoid and functioning Eustachian tube also help in maintaining proper middle ear ventilation
Middle ear ventilatory pathway and Mucosal folds.pptxSaneeshDamodaran
The document discusses the anatomy and physiology of the middle ear ventilation pathways. It describes the mucosal folds in the middle ear which develop during fetal development from sacs and pouches. Important folds include the tensor tympani fold, malleal folds, and incudal folds. These folds orient the spread of middle ear pathology. The tympanic isthmus and its ventilation are also discussed. Blockage of these pathways can cause attic dysventilation and retraction, even with a normally functioning Eustachian tube. The Eustachian tube, mastoid cells, and transmucosal gas exchange also help control middle ear ventilation and pressure.
This document provides an overview of imaging modalities used in evaluating the ear, nose, and paranasal sinuses. It discusses plain radiography views including lateral, Caldwell, Waters, and submentovertex views. CT imaging of the nose and paranasal sinuses is described as the gold standard, with details on interpreting coronal and axial cuts. Key anatomical structures like the frontal sinus, ethmoid air cells, and sphenoid sinus are identified on various imaging views.
The nose has important anatomical structures that allow it to carry out its key physiological functions. Externally, the nose is made up of bone and cartilage, including the nasal bones and lateral cartilages. Internally, the nasal cavity contains three turbinates that divide it into air passages. The osteomeatal complex includes structures like the agger nasi and ethmoid bulla that are involved in drainage and ventilation of the paranasal sinuses. Physiologically, the nose conditions inhaled air by warming, humidifying and filtering it. It also plays a role in respiration and protects the lower airways through mucociliary clearance.
This document discusses the anatomy and imaging of the paranasal sinuses. It describes the drainage pathways of each sinus and the structures that make up the osteomeatal complex. It also covers anatomical variations that can occur like concha bullosa, Haller cells, and Onodi cells. Imaging modalities for evaluating the sinuses are described, with CT identified as the gold standard due to its ability to depict bone, soft tissues, and air. Scanning techniques for CT include coronal sections performed with the patient in a prone position and their head hyperextended.
1. The document discusses the surgical and functional anatomy of the lateral nasal wall and paranasal sinuses, including key anatomical structures and landmarks.
2. It also covers preoperative considerations for endoscopic sinus surgery, such as patient assessment, radiographic evaluation, preoperative medical therapy, and choices for anesthesia.
3. Intraoperative techniques are described, including the use of image-guided navigation systems, total intravenous anesthesia to improve surgical field visualization, and topical anesthesia administration.
This document provides an overview of sinus surgery and CT scan imaging for sinus procedures. It discusses:
1. CT scan is the preferred imaging modality for sinus surgery as it can accurately demonstrate bone anatomy and the extent of disease.
2. When reading CT scans, it is important to view the coronal, axial, and sagittal planes and identify key anatomical structures like the nasal septum and skull base.
3. Contrast can help identify complications like abscesses or tumors. Systematic evaluation of anatomy, variations, pathology and risk to nearby structures is important.
middle ear spaces an important topic otorhinolaryngologyDrsiyaMedfriend
This document discusses the detailed anatomy of the various spaces within the middle ear. It begins with the embryology of the middle ear and then describes each individual space in detail, including their boundaries, contents, and surgical importance. The main spaces discussed are the epitympanum/attic, hypotympanum, mesotympanum, protympanum, retrotympanum, and their subdivisions. For each space, the document outlines their anatomical boundaries, relationships to surrounding structures, and clinical relevance for ear surgeries.
The middle ear cavity lies between the external ear canal and inner ear. It contains the auditory ossicles (malleus, incus, stapes) and has three parts - mesotympanum, epitympanum (attic), and hypotympanum. The mesotympanum contains the ossicles and is lined by epithelium. The hypotympanum is below the eardrum and lined by ciliated epithelium. The epitympanum (attic) is above the eardrum and divided into medial and lateral parts by the ossicles. It provides communication between the middle ear cavity and mastoid air cells.
The document discusses the anatomy and variants of the paranasal sinuses relevant to functional endoscopic sinus surgery (FESS). It describes the four paired sinuses and their drainage pathways. Key anatomical structures for drainage include the osteomeatal complex and frontal recess. Common anatomic variants are described such as concha bullosa, Haller cells, and Onodi cells which can impact sinus drainage. Radiologists should evaluate pre-operative scans for variants that may obstruct drainage or pose surgical hazards. A systematic checklist is recommended to identify issues important for surgical planning.
1. The document discusses the development of mucosal folds in the middle ear from the 3rd to 7th month of fetal development as mesenchymal tissue is absorbed and pouches called sacci develop and enlarge.
2. It describes the two types of mucosal folds - composite folds containing ligaments and mucosa, and duplicate folds formed from the fusion of expanding air sac walls. Important folds like the anterior malleal fold are also outlined.
3. The mucosal folds carry structures like ligaments and blood vessels to the ossicles and orient the progression of middle ear diseases, though they are not true barriers. Selective dysventilation of spaces like Prussak's space can lead
This document provides an overview of the anatomy of the sella and suprasellar region. It describes the sella turcica as a saddle-shaped depression in the sphenoid bone that houses the pituitary gland. The nasal cavity and sphenoid bone form the boundaries around the sella. The pituitary gland sits within the sella and has anterior and posterior lobes that serve different endocrine functions. Several cranial nerves pass through the suprasellar region above the sella, including the optic nerves and oculomotor nerve. Major vascular structures like the carotid arteries also have relationships within the sella and suprasellar anatomy.
Sexually transmitted diseases are transmitted through sexual contact via mucous membranes or bodily fluids. They include chlamydia, gonorrhea, herpes, syphilis, and human papillomavirus. Symptoms vary but can include discharge, sores, rashes, or pain. Prevention requires abstinence or correct and consistent condom use. Anyone experiencing symptoms should see a doctor for testing and treatment to prevent further spread.
Graves disease and Thyroid eye disease with orbital decompressionLiju Rajan
This document discusses Graves disease and thyroid associated ophthalmopathy. Graves disease is an autoimmune disease that commonly presents as a triad of thyroid disorder, eye changes, and skin changes. It is caused by antibodies that stimulate the thyroid gland and cause hyperthyroidism. Treatment options include antithyroid medications, radioactive iodine therapy, or surgery. Thyroid eye disease is an inflammatory disorder of the eye muscles and fatty tissue behind the eyes that is associated with Graves disease. The pathogenesis involves infiltration of tissues by immune cells that causes swelling.
OAE and BERA ( otoacoustic emissions and brainstem evoked response audiometry)Liju Rajan
Otoacoustic emissions (OAEs) are sounds produced by the inner ear that can be measured in the ear canal. There are different types of OAEs including spontaneous, stimulus frequency, transient evoked, and distortion product OAEs. OAEs are believed to be generated by outer hair cells in the cochlea and are reduced or absent when outer hair cell function is impaired. Brainstem auditory evoked response (BERA) testing objectively measures electrical activity in the auditory pathway generated in response to auditory stimuli. BERA waveforms provide information about auditory nerve and brainstem function. Abnormalities in BERA wave latencies, amplitudes, and morphology can indicate lesions
Recent Advances in Management of Laryngeal Cancer
The document discusses the anatomy, embryology, risk factors, diagnosis and staging of laryngeal cancer. It provides details on the different subsites of laryngeal cancer including glottic, supraglottic and subglottic cancers. Treatment options including radiation therapy and various surgical procedures are summarized depending on the stage and site of the tumor. Early stage cancers can often be managed with endoscopic resection while more advanced stages may require open partial laryngectomy or chemoradiation. Ongoing research focuses on optical imaging techniques to detect early cancers.
This document provides an overview of sialendoscopy procedures. It begins with the anatomy of the parotid and submandibular salivary glands. It then discusses sialolithiasis (salivary gland stones), the indications for sialendoscopy including removal of stones and treatment of strictures, and the technique of sialendoscopy including identification of ducts, instrumentation, and methods for removing stones such as grasping, lithotripsy, and extracorporeal shockwave lithotripsy. Complications are also briefly mentioned.
Carcinomatongue 150622043025-lva1-app6891Liju Rajan
The document discusses carcinoma of the tongue. It begins by describing the anatomy of the oral cavity and structures included. It then discusses the tongue's muscles and functions. Risk factors for oral cancer include tobacco, alcohol, poor oral hygiene, and HPV infection. Premalignant lesions of the tongue include leukoplakia and erythroplakia. Treatment options depend on the stage and size of the tumor and include surgery, radiation therapy, chemotherapy, and neck dissection. Prognosis depends on stage, with earlier stages having better survival rates.
The document summarizes the physiology of swallowing. It describes the three main phases - oral, pharyngeal, and esophageal. Key points include that swallowing requires coordinated muscle activity in the head and neck and involves passing food from the mouth to stomach. The oral phase prepares food for swallowing through chewing and tongue movement. In the pharyngeal phase, the airway is protected as food is pushed over the epiglottis. Swallowing is controlled by neural pathways from the cortex to brainstem and medulla. Respiration is suspended during swallowing to prevent aspiration.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
1. Anatomical Variations of
Paranasal Sinuses on Coronal
CT-Scan in Subjects with
Complaints Pertaining to PNS
(concentrated on coronal CT)
Presented by
Dr. Liju Rajan,
2nd year postgraduate
Moderator
Dr. CP DAS
Dr. D Mohanty
2. The CT scan is the gold standard investigation in Functional Endoscopic Sinus
Surgery preoperative cases and cannot be replaced by the MRI because it
gives detailed bony anatomy of the area and serves as a “road map” for the
operating surgeon
A very basic paranasal sinus study would include bony and soft tissue windows
of 3 mm cuts taken anterior to posterior in the coronal plane
3. Timing of CT
Acute sinusitis adequately treated ( 3 weeks after course of antibiotics and NSAIDS)
Chronic inflammatory diseases- maximised medical therapy
It is advisable to use topical nasal decongestant before CT, or atleast blow the nose and
clear secretions
Role of CT
to define PNS anatomy
to identify regional disease in medical non-responders
4. Coronal Scan
Most of the anatomical details can be seen well in coronal sections.
Because this plane is almost identical to that approached by endoscopes
Best displays Osteo-Meatal Unit
Uncinate Process & Ethmoidal Bulla lie on a vertical plane
12. 1st cell appearing in scan. Agger
nasi cell
Well developed frontal septum
with intact floor
Middle turbinate starts come into
the view
Nasolacrimal system comes into
view
13. Floor of frontal sinus is missing.
Frontal recess
Aggar Nasi cell not seen. Frontal recess present
posterior to aggar nasi cells
First part of middle turbinate in saggital plain getting
attached to the roof
Concha
17. Ant ethmoidal artery
Another land mark for starting of
posterior ethmoidal cells and basal
lamella
Loss of sharpness of triangular
shape of maxillary sinus
18. Ground lamella – transcission 2nd part
Superior turbinate
Posterior frontanalle
19. Changes while going from ant ethmoid to
post ethmoid
Orbit – more smaller and squire
Maxillary sinus- from triangular to oval
Larger and fewer air cells
Flatter and thicker skull base
Past Ground lamella
Past ant ethmoidal.a
Presence of sup turbinate
22. Differentiate between posterior
ethmoids and sphenoids
Posterior ethmoids
Ccomplete septum will be seen
Clear view of inferior and middle
turbnate
Sphenoid
Inter sphenoidal septum
Turbinates not clear
23. Choana
Sphenoid sinus
Greater wing of sphenoid
Vidian cannal
Foramen rotendum
Ptregoid process
Medial and latral ptregoid plates
Optic nerve
Buldge of carotid artery
Medial ptregoid plates forming
lateral wall of choana
24.
25. Septal Deviations
There may be gross septal deviations as well as mild
Bony deviations can be clearly seen and studied
Sometimes may be associated with concha bullosa , ITH or a pneumatised septum or may be
associated with osteomeatal unit
26. Agger Nasi Cell
1 to 3 in number and may vary
Some times these cells may be hypoplastic
Some times prominent which causes
changes in superior attachment of uncinate
and also bulge in middle turbinate
27. Uncinate Process
The uncinate process may be hypoplastic or laterally bent. In this case the
infundibulum is a narrow space, which may be difficult to enter
Sometimes will be well developed and resemble anterior wall of bulla.
Sometimes more medially rotated and present like a duplication of middle
turbinate
Upper attachment of uncinate process
33. Middle Turbinate
Concha bullosa the
pneumatisation of middle
turbinate
pneumatized from either the
frontal recess,
the agger nasi cell,
anterior ethmoid cells or the
middle meatus
Or a isolated cell
Large concha may impair drainage
of PNS
35. Middle turbinate shows a latral
bent instead of medial bent
Can block infundibulum
36. A normally curved middle turbinate
may curl upon itself to produce a
concavity within it. This concavity
is called the turbinate sinus
37. Ethmoidal Bulla
The ethmoidal bulla is usually the largest and most constantly pneumatized
anterior ethmoid cell
hypoplastic or rarely even a solid non-pneumatized
Some cases very prominent and may push uncinate or middle meatus
compromising infundibulum or middle meatus
38. Usually bulla extend upto skull base if not
the space present is suprabullar recess
In some cases bulla will not extend up to
ground lamella the space is called
retrobullar recess
Suprabullar recess and retro bullar resess
togother form sinus latralis grunwald
It drains into a semilunar space hiatus
semilunaris superioralis
39. Ethmoidal air cells
Infraorbital cell or haller cell
Compromise the maxillary sinus
drainage
40. The anterior ethmoid cells may migrate into the frontal recess area where they are then named
the frontal cells. These are of four types
— Type I: A single cell above the agger nasi cell.
— Type II: Two or more cells above the agger nasi cell.
— Type III: (Frontal bulla) A cell which extends well into the frontal sinus. Single massive cell
pneumatizing cephalad into frontal sinus
— Type IV: An isolated “loner cell” within the frontal sinus.
41.
42.
43.
44.
45. Ground Lamella
The ground lamella of the middle turbinate, which separates the anterior and
posterior ethmoid cells, is not always in a coronal plane
May bulge into anterior ethmoid or posterior ethmoid and have convexity vise
versa
It may show dehiscences or be partially deficient in which case infection can
pass from anterior to posterior ethmoids
46. Some times may get pneumatised
to form multiple septae
47. Some cases the 2nd part of middle
turbinate directly get attached to
medial wall of maxillary sinus.
Thus maxillary sinus behaves as 2
one part as posterior ethmoids and
other as maxillary sinus in terms of
drainage and disease
52. Sphenoid sinus
It may be present as a small pit in
a predominantly non-pneumatized
sphenoid bone-conchal type.
It may extend upto the anterior
wall of the sella turcica—Presellar
type
It may pneumatize the entire
sphenoid body below and behind
the sella turcica, so that the
pituitary forms a distinct bulge in
its posterosuperior wall—Sellar
type
53. Inter sphenoidal may not divide
sphenoid equally
Septum may get attached to vital
structures like Optic Nerve and
Carotid artery
54. The sphenoid sinus may show
extensive pneumatization laterally
into the pterygoid processes and
the greater wing of sphenoid.
The maxillary and vidian nerves
can then be seen prominently
within these lateral recesses of the
sphenoid
55. Maxillary Sinus
The maxillary sinus is fairly constant in its pattern of pneumatization and
drainage. Occasionally it may be hypoplastic or asymmetric.
Rarely it may be completely absent
Accessory ostia may be present in the anterior and posterior fontanelle in 25
percent of the cases
May get pneumatised extensively and encroach on alveolar process of teeth
Infra orbital nerve is dehesent and lie submucosally
56. Anatomical Variations of
Paranasal Sinuses on
Coronal CT-Scan in
Subjects with Complaints
Pertaining to PNS
Journal Proper
IJARS - Intrenational journal of anatomy radiology and surgery
57. MATERIALs AND METHODS
This prospective study was performed in the Department of Radiodiagnosis,
Mysore Medical College and Research Institute (KR Hospital) Mysore
Total 100 patients who were referred form ENT OPD and wards from
December 2013- July 2015 (1/12/2013 to 31/7/2015) with complaints
pertaining to PNS were included in the study
Patients were subjected to Coronal CT-scans of PNS using GE SYSTEMS-Hi
Speed Dual-Slice CT. For CT examination patient was positioned in prone
position with neck extended and angulation was perpendicular to hard palate.
58. Imaging was done from posterior margin of sphenoid sinus to anterior margin
of frontal sinus. Thickness was 5mm slices with 3mm retro reconstruction.
59. The images were reviewed using bone and soft tissue windows and the details were analyzed:
1. Septum Deviation
2. Agger nasi pneumatized
3. Bulla Ethmoidalis
4. Uncinate process
5. Middle turbinate: pneumatisation
6. Maxillary sinus septation
7. Pneumatized superior turbinate
8. Supraorbital cell
9. Haller cell
10. Onodi cell
11. Frontal sinus
12. Cribriform Plate
13. Extramural sphenoid pneumatization
14. Other findings: Inflammatory sinus disease acute, chronic or allergic. If present, in which sinus?
60. Statistical Analysis
Results were cross tabulated.
Frequencies descriptive statistics were the statistical methods used. Level of
significance of findings was assessed by Chi-square test
61.
62.
63.
64.
65.
66.
67. DISCUSSION
Nasal cavity and para nasal sinuses together form a single anatomical and
functional unit.
Congenital anomalies and normal anatomical variations in this region are a
rule rather than exception. Conventional X-rays don’t provide adequate
information because of structural superimposition. There has been
tremendous advances in the surgical treatment of sinusitis in recent years,
particularly in Functional Endonasal Endoscopic Surgery (FESS), which requires
the clinician to have a precise knowledge of nasal sinus anatomy and
anatomical variants, many of which are detectable only by the use of CT.
68. Deviated Nasal Septum
In a study of 110 subjects by Perez-Pinas J Sabate et al., [1], 80 subjects
showed DNS. Most were non traumatic deviations of the septum (64 cases,
72%); the numbers of left and rightward deviations were similar, with a slight
predominance of the former
In our study 62% of patients showed deviated nasal septum and also showed
slight predominance to the left side (29%) as compared to right side (23%). On
statistical basis p values were also significant (p<0.001).
71. The optic nerve is in close relation with Onodi cells when
present, accurate delineation of optic nerve is important
in preoperative planning. The presence of Onodi cells is
the most important factor limiting posterior extent of
endoscopic clearance.
72. Septations in PNS
According to John Earwaker , maxillary sinus showed septations in about 19
cases out of 800 patients studied. According to Abdullah BJ et al., out of 70
patients studied 68.9% showed septations in the sphenoid sinus
In our study frontal sinus showed septations in about 31%.Maxillary sinus
showed septations in about 19%. Sphenoid sinus showed septations in about
49%.
73. Frequency of Variations of Middle
Turbinate
In our study 43% of the cases
showed concha bullosa [Table/Fig-
14,15] out of which bilateral is the
maximum of about 41% followed by
right side of about 32% and least is
on the left side of about 25%.
Presence of a concha bullosa does
not suggest a pathological finding.
However, in the setting of chronic
sinus disease, resection of the
concha bullosa should be
considered to improve paranasal
sinus access
74. Orientation of the Uncinate Process
Earwaker observed horizontal orientation of the uncinate process, unilaterally
or bilaterally in 19% of cases, the variant was associated with an enlarged
ethmoidal bulla and, in some cases, with contralateral septal deviation.
Vertical orientation of the process which appeared enlarged or deformed was
observed in 32% of patients
In our study 43% of cases showed horizontal orientation [Table/Fig-18] of the
uncinate process (with 82% of the cases associated with enlarged ethmoidal
bulla) and 57% cases showed vertical orientation of the uncinate process(with
8.7% of the cases associated with enlarged ethmoidal bulla
75. Cribriform Plate
Soraia Ale Souza et al.,[20] study showed Keros type II as the most common
variant (73.3%) followed by type I in 26.3% and type III in 0.5% of cases.
However, in our study Type I is commonest. The type of cribriform plate is
important in predicting the intra operative complications during FESS
76. CONCLUSION
Direct coronal CT is the imaging modality of choice for the evaluation of the
anatomical variations in paranasal sinuses
Coronal CT-scan provides more detailed information of the posterior sinus
variations.
Among the special cells, Aggernasi cell is the most common type
Septations in paranasal sinuses is most common in sphenoid sinus
Vertical orientation of uncinate process is the most common variety
Type I variety of the cribriform plate is the most common type.