EEE eee te fia e a sd Best CT view fl ety ave wee stan ROMY Ph te rarage me Hoa pemay die toed Sorel ; z PCat pomee o peearesaty Sape yen : . re single eal! above the agger nasi cet ve wes worm eee " rer of cols above the 29ger nasi cet ysl ie -trontal cll that prewnatizes ito te tanta Fi yo Sansa sumta 20" Hora Ca SAFC) a ental a sracrataes pe rons i A Mp extends by more oftne veticd heght Rerer nave a scent moss mentee te— Figure 99-5 In the coronal CT scans <2 (FB), ager nasi cell (dotted arrow) 2 2nd (ty, Seen (). Preumatization of the orbitals peg oe the supraorbital ethmoids (SOE), mae of a cant jmina’ effect of the orbital roof. The ces 3 gh one i (solid arro anterior ete at 1w) is seen traversing the s ‘axial image identifying the type 3 c: nena i Within these, frontay tg, i wrt T nding superior! y into the fro; 3 7 1¢ frontal si ype 3.cell/T al sinus, ah M 5 Duy extel this a cell (d). It is throu «ol geet r Ss Se 4 cel usually pneumauize from ene can be extensive (Figure 99.6) and cause ia obstruction of the outflow tract or be i In most instances, it is NOT possible to ar sth, CY re these cells via a standard frontal sinus appro, . extended procedure such as see and a: mi juired. In approximately 65% of Caucasian patiens, orbital plate of the frontal bone can be extensively : marized, resulting in supraorbital ethmoid cells ‘Ott (Figure 99.5c)- ‘An cthnic variation docs exist with th incidence being much lower in east Asi 13§0 aber of surgical challeng ase a y to mistake the opening of the supraorbital cells as that of the frontal sinus. d laterally. d eS former tends to open more posteriorly an Cells can pneumatize . Larg s within the frontal sinus 2 fev ae"- 5, (8) CT image shows cells within MruVvouVPpy a coll i ee grontal ke cells are present in the frontal recess «= Although anteri 9.7 m, THE ‘age (b). The parasagittal view accepted gold s i, reins ( the skull base pred 2 mon, apple eumatisation of the bulla (¢). Note the hewn be nt snc : 1 mon A frontal sinus drainage pathway ante- ow it ns ‘tt gnicken a cells (A). emiler opécs ost antal DU , (Ae 10 potiexs ne rr . variable fronte dal cells as they are 7? from frontal ethmoi , aie with the frontal process of the maxilla or i oo ak Instead they hug the skull base and are i vifedl on the axial and parasagittal CT sections dent! ate for mispects js the name Indicates, fronta aise (rom the frontal sinus septum. These tend to push Imaain the drainage pathway laterally and ultimately drain into a the frontal recess on that side (Figure 99.8). According — Plam sme n the most recent classification proposed by the EPOS — and mans eee paper) group, an intersinus septal cell wr prowe a medial frontoethmoidal cell." ering, an Di vIEW Eo lagnosis Ultras A cay the para Cully i he para : Panicuh, ken clinical history is indispensible, This osteony larly ; YOmportant with frontal sinus svmmtoms — the ext6 soction 3 ninologY .giSTED TOMO! 1 endoscopy 4081 | compuTen AS y and nasal se with frontal imagine erative plan seal dite 10 GRAPHY (CT) are essential #7 ns hut this cine symoprom 1 Sie pig the first choice ind is essential . coronal Ihetter corre Y indings daring surkery Musared that parasapitta mifying the com 2 Thave lemon ny not only wey ey ans ae ie withon the ron Me should be avaitable in aa Meas tal nl ‘noe, Although Zinreich 1 ang rocol for CT rman of The SINUSES: ea pave developed their own preferred ae lose apival ane mutter ecror cr ture images quickly and reformat Howerets views ae ex eel paths Coronal, asia feat propos frost wnstAtTIOTS echnique. Corre pecan oo Paranal and para ital pane Sat images inte corona pies 7 ainfjrect coronal images is no longer Newt aN} ro acquire direct Coron Bes _— lose of paranas la ehest raiogeaph.™ Advantages oicimproved patient comfort during oars ei See teas] ect ts. Furthermore, Seanming and avoidane al . Rarthermarts amine om thin section axial scanning cam be ata from timmpurer assisted navigation, if available, ere jail can be achieved with contiguous axial cuts Excelent ifhackness, A sitisfactory compromise might be aoosey ceollimation contiguous, 1mm thickness axial eee i hould be reconstructed in the axial, coronal SNS jell planes using both soft-tissue and high reso- sree Sigorithm bone windows with a reconstruction weeckness of 3mm or less.!? The standard bone window! level settings range between 1500-2000/300 Hounsfield tints (HU} and 450/50 HU for soft rissue windows . Many Centres have access to picture archiving and communica fon system (PACS), which allow the end user to easily ler the window settings. This is particularly helpful in fungal ball and chronic fungal sinus disease, where soft tissue window settings may demonstrate double densi- tics associated with clefcation and eosinopillic mucin, respectively tary and the effecti Feduced to the order antra-operat MAGNETIC RESONANCE IMAGING (MRI) MRI offers excellent soft tissue detail but ao bony defi nition. It is very useful in differentiating, icons retained secretions. Tumours. tend Ti-weighted gadolinium enhance do not. Mucus and sei mour from : to enhance with scans while fluid ‘cretions tend to avidly enhance MIU is very helpful in assessing the eh cavity, and the orbit hancement of the lam. indicate tumour involvement, treater than 2m, loss of the hancement are highly eam ey malignancy." MRI is par. yn have paste wth ongoing sy i ; reviously under, peat lag lap with obliteration, ‘T he : pes alia : i ion from far Necrosis id ic aatinguish is and infection.22.23 “V2-weighted in mages. MRI is ve dual imerfaces beresecn the toms, It is recommended case, both CT and nang two imaging modality a The characteristic appene,?*Pillog Ma" iso- of hypo-attenuated fates of 7,2 (ee a signal void on T2. Von py Pa (a images ai 20 ee CONGENITAL FRO, a MALFORMATIONS "°EASy, Nasal dermoids, cysts a Rarely, the frontal abnormalitics of the ska (2° craniofacial dysostosis or nants, Congenital midline moids, encephaloceles and the least rare of these, and j opmental anomaly. Unli Ome, these lesions can Baa Sorbet eri (Figure 99.9a) and may have 902"? sine (Figure 99.9b).25 The incidence i", 20,000 and 1:40,000 live birtp t= extend from the skin to the front, Tee: sure atrophy and narrowing of shy oped. Progressive enlargement of hen cause Joc: on, meningitis ang yoo” cas a 8 of ed Sipsna “Weighted nd Misti, have, Tyo"eg Persistenes tbe Nasal lesi sliomay mt an une Pathogenesis Sessions? was the first ro coin the term: cyst to include all the lesions conainne ane mesoderm located in the nose. Briefly st a dermal tract recedes, dermal attachments cin along its course. As the dura mater recede met nasal space it may pull nasal ectoderm upusr=! to form a sinus or a cyst.2® Imaging Imaging is a critical component in the evaluation’ dermoids given the associated risk of intr Surgery a The following principles are importan Ni cess 0 the ideal surgical approach: permit ©