CT Scan Anomalías Cavidad Nasal.

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Anomalas de la Cavidad
nasal.
CT Scan
Seminarios
Clnica de Asma y Alergia
CT scan Sinusitis Tel. 22781169, 88825513 Mov,

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Lo ms dificil es ver lo que esta delante

de tus ojos
W. Goethe

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Atlas Netter III edicin Interactiva.

Atlas, Anatomy,Carmine de Clemente 3rd ed..
Gray s Anatomy Ed. Longman 1973.
Emedecine collection
Nasal Cavity Anatomy, Physiology, and Anomalies on CT Scan
Author: Belachew Tessema, MD; Chief Editor: Arlen D Meyers,
MD, MBA. Updated: Mar 8, 2013
CT Scan of the Paranasal Sinuses

Author: A John Vartanian, MD, MS, FACS; Chief Editor:
D Meyers, MD, MBAmore... Updated: Mar 21, 2016
Arlen
Bibliografa
CT scan Sinusitis Tel. 22781169, 88825513 Mov, 84316459C
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Craneo Antero Posterior

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Craneo Rx. . Lateral

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Sinusitis is an inflammation of the

mucosal lining of the paranasal sinuses. As
the mucosa of the sinuses is continuous
with that of the nose, rhinosinusitis is a
more suitable term.[1, 2]
Definicin de Sinusitis
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Radiografa de los Senos Nasales
Waters (occipitomental)
Caldwell
(occipitofrontal)
Vista Lateral
Vista basilar
( submento-vrtice)
Nasales
Polypoid mucosal thickening in the right maxillary

sinus with a mucous retention cyst in the left on a
Waters view.
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El Nivel
Hidro-aereo, en
el seno maxilar
sugiere sinusitis.

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Air-fluid levels,
as shown in the
image below,
generally
indicate bacterial
sinusitis.
Derrame del seno maxilar

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Tratamiento antibitico
Semanas 1-3 de duracin

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DecongestionantesVer not
as
Limpieza con solucin sali
na ver docs jhs
Nasal 2 spray
Expectorants
Corticosteroids
Anticholinergics
Otros medicamentos
Rinosinusitis
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Allergic Fungal Sinusitis
Sinusitis, Chronic, Medical Treatment
Sinusitis, Ethmoid, Acute, Surgical Treatment
Sinusitis, Frontal, Acute, Surgical Treatment
Sinusitis, Fungal
Sinusitis, Maxillary, Acute, Surgical Treatment
Sinusitis, Maxillary, Chronic, Surgical Treatmen

t
Sinusitis, Sphenoid, Acute, Surgical Treatment
Diagnstico diferencial
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Estudio de la Cavidad Nasal Tomografa

Computerizada
Plano axial

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Reconstruccin axial CT
Paranasal sinuses CT anatomy

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CT scan, nasal cavity.
Normal anterior ostiomeatal

complex anatomy.
The anatomy of the ethmoid

infundibulum and the uncinate
process is demonstrated here
.

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CT scan, nasal cavity

Normal frontal
recess/duct. Frontal
sinus empties into the
middle meatus just
lateral to the more
anterior portion of the
middle turbinate. The
most anterior ethmoid
air cells are called
agger nasi cells

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Infundibular pattern.
This is the most common pattern
encountered in chronic sinusitis.
Processes involving the anterior ethmoid chambers

control maxillary and frontal sinus drainage
into the EI.
The most common cause for frontal and

maxillary sinusitis is anterior ethmoid
disease and a superimposed rhinitis,
whether viral or bacterial.
Functional endoscopic sinus

surgery. Concept, indications and
results of the Messerklinger
technique.
Stammberger H, Posawetz W.
.
abstract
Source
ENT-Hospital, University o
f Graz, Austria
CT Scan
Normal posterior
ostiomeatal complex. The
vomer separates the two
ostia into the sphenoid
sinus. These ostia are
located in the
sphenoethmoid recess.
The vomer is normally
pneumatized.
Complejo Osteo Meatal

Posterior Normal

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A posterior OMC,
located in the
sphenoethmoid
recess, drains the
posterior third of the
bilateral ethmoid and
the sphenoid sinuses,
In chronic sinusitis,
this complex is
involved less
commonly than the
anterior OMC
because the
anatomic variations
are fewer.
CT Scan
Complejo Osteo Meatal

Posterior Normal
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A normal sagittal
reconstruction of the
OMC, showing the curved
edge of the semilunar
hiatus with the inferior
mucosal edge covering the
Uncinate Process.
The frontal recess is also
shown.
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El septo nasal
Desviacin del Septo
Fisiologa de las desviaciones del Septo

Nasal
Factor predisponente. Sinusitis
Ver el papel de las alergias
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Septo Nasal
Estructura Osea y
Cartilaginea.
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The anterior superior septum is

composed of cartilage. The posterior
superior septum contains the
perpendicular plate of the ethmoid
bone, and the inferior septum
contains the vomer and the nasal
crests of the maxilla and palatine
bones.

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The bony portion of the

septum is often pneumatized;
when overexpanded, it may
impair airflow into the
bilateral sphenoid ostia
(which are visible adjacent to
the vomer on both sides on
coronal CT images) in the
sphenoethmoid recess
Spurs and deviation of the

septum may impair airflow,
especially if the spur or
deviated septum compresses
the turbinate mucosa or
lateral wall of the nasal
cavity. Severe
nasal septal deviation may
obstruct the airway and
compress the turbinates.
Nasal septum deviation
The Incidence of Concha Bullosa and Its Relationship to Na

sal ...
www.ajnr.org -
Coronal CT scan of the paranasal sinuses shows a large left concha bullosa with severe
deviation of the nasal septum convexity to the right.
Stallman J S et al. AJNR Am J Neuroradiol 2004;25:16131618

2004 by American Society of Neuroradiology
Coronal CT scans showing the definition of a concha bullosa.

A, Coronal CT scan of the paranasal sinuses shows pneumatization (arrow)
of just under 50% of the vertical height of the right middle
turbinate.

Coronal CT scans showing variation in concha size wth preservation of nasal air channels.A,
Coronal CT scan of the paranasal sinuses shows moderate-sized concha bullosa bilaterally,
with the one on the left side being slightly larger, or dominant.

Coronal CT scans showing the definition of a concha bullosa.A, Coronal CT scan of the
paranasal sinuses shows pneumatization (arrow) of just under 50% of the vertical height of
the right middle turbinate.

The anatomy of the lateral wall of the nasal cavity

is quite complex and is where most anatomic
anomalies occur. Usually, individuals have 3
paired turbinates: superior, middle, and inferior.
Some individuals have a fourth turbinate, the
supreme turbinate.
The space between the turbinates along their
lateral margin and the lateral walls of the nasal
cavity is referred to as the meatus.

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The inferior turbinate is attached to the lateral wall of the

nasal cavity, and only the nasolacrimal duct drains into the
inferior meatus.
Most of the inspired airflow travels through the
middle meatus rather than through the inferior.
Functionally, the middle meatus is the most important because
the maxillary sinuses, anterior two thirds of the ethmoid
sinuses, and frontal sinuses drain into it.
Most anatomic variants occur in the middle meatus and
turbinate region. The posterior third of the ethmoid and
sphenoid sinuses drain into the superior meatus.
Apofisis Unciforme
Anomalas de la Cavidad Nasal

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Fusion (apparent) of uncinate

process to the ethmoid floor.
Note the normal uncinate process
on the other side.
Airway flow is compromised from
the sinuses to the middle meatus
because of the functionally
occluded semilunar hiatus.
Because the maxillary sinus is
patent and aerated, this is not a
true congenital
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Fusin congnita de la Apfisis

Unciforme , al piso orbitario

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Congenital or true fusion of the

uncinate process to the orbit floor.
The maxillary sinus is hypoplastic
and not aerated. The ethmoid
infundibulum does not exist or ends
blindly as the recessus terminalis.
The UP tip can also fuse directly to
the lateral wall or lamina papyracea
of the orbit. This anomaly produces
the same imaging findings as
inferomedial fusion.
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Bilateral
pneumatization of
the uncinate tips.
Expansion of the
tips can
compromise the
ethmoid
infundibulum, the
semilunar hiatus,
or the middle
meatus.
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Concha bullosa of the left

middle turbinate with
expansion and narrowing
of the ethmoid
infundibulum and the
middle meatus.
Note absence of the right
uncinate process, another
anatomic variant.
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Anomalas de la cavidad nasal
Turbinatos paradjicos
Duplicados
Accesorios
Fusin turbinato-turbinato

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Anomalas del proceso

uncinato.
Conchae ( anomalas)
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Large Haller air cell

clearly narrowing the
ethmoid infundibulum.
Anomalas de las celdas etmoidales

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Overexpansion of the
ethmoid sinus floors
Bula etmoidal gigante, cierre del

hiato semilunar
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Polipos nasales
Absence of basal or
ground lamella
Absence of the basal or
ground lamella is
problematic only if FESS
of the posterior OMC is
being considered..
Bony septa: N.Videano
Lesiones lagrimeo.
Polipos
coanales
Turbinatos
accesorios
Fracturas
Ciruga FESS
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Cottle Test For Nose Obstruction

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Cottle test
is done to detect if the obstruction is due to
vestibular component of
nasal
valve. 88825513
YoutubeMov,
video
CT scan Sinusitis
Tel. 22781169,
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Anatomia:
Para evaluar el patrn
de una sinusitis
debemos conocer
primero el drenaje de
los senos nasales.
Unidad Osteomeatal:
esta no es una estructura
morfolgica nica sino
una combinacin de
estructuras:
Turbinate Medio
Bulla Etmoidal
Proceso Uncinato
Infundibulo Maxilar
Hiatus semilunaris
(espacio debajo del
turbinato)
Hueso Maxilar os
El Complejo Osteo
Meatal
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Pared lateral de la
cavidad nasal
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El infundibulum maxilar drena en la regin

posterior del hiatus semilunaris.
El seno frontal, maxilar, las celdas anteriores
y mediales drenan en el hiatus semilunaris.
Cualquier obstaculo mecnico en esta regin
causa inflamacin de los senos mencionados.
Esto se le conoce como patrn osteomeatal.
Sindrome del meato medio.
Hiatus semilunaris
Es el espacio delimitado entre el proceso uncinato

anteoinferior y la bula etmoidal
Las celdas etmoidales anteriores drenan anteriormente
en el hiatus semilunaris atraves del ducto fronto
nasal.The middle group drains into the hiatus semilunaris
on or above the ethmoidal bulla.
El seno frontal drena por medio del ducto frontal o a
travs de las celdas etmoidales anteriores en el hiatus
semilunaris.
Hiatus semilunaris
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Sinusitis
Computed tomography (CT) scanning is the examination of choice in

sinusitis, particularly in cases of chronic sinus disease, providing excellent
detail of sinus anatomy.
However, CT is usually not useful in acute sinusitis, as diagnosis in acute
cases is primarily based on clinical findings. Good anatomic definition is
desirable before surgical intervention.
Coronal CT imaging is the preferred initial procedure. Bone-window views
provide excellent resolution and good definition
. of the complete ostiomeatal
complex and other anatomic details that play a role in sinusitis.
In addition, the coronal view is best correlated with findings from sinus
surgery, with anatomy and pathology visualized in a plane almost identical
to that seen by the endoscopist.
CT Scan Mtodo Preferido

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CT provides an excellent anatomic display of soft-tissue

attenuation.
This depiction includes fluid levels and polypoid masses within
the normally air-filled cavities of the sinuses, nasal cavity, and
postnasal space.
Most important, disease extending beyond the bony perimeters
of the sinuses into the adjacent soft tissue of the orbit,[7]brain,
and infratemporal fossa can be imaged.
In general, nonenhanced CT scans suffice in cases of
uncomplicated sinusitis.
Multisection CT seems to have the potential to replace primary
coronal CT of the paranasal sinuses without any loss of image
quality, and it may even improve the overall diagnostic value.
However, the doses of radiation may still have to be reduced.
Bilateral ethmoid
sinusitis on an
MRI.
Patrones radilogicos al
CT Scan
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Bilateral ethmoid sinusitis on an MRI.
Patrones radilogicos al CT Scan
Right-sided
sphenoethmoidal
pattern of sinusitis.

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Mucosal thickening
in the left anterior
ethmoid and
maxillary sinuses and
in the region of the
infundibulum. This
indicates an
ostiomeatal pattern of
sinusitis
Patrn Complejo Osteomeatal

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Estructura Osea pared lateral de la cavidad

nasal, reseccin parcial turbinatos
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The sphenoid sinus drains posterior to the

superior turbinate into the sphenoethmoid
recess through the sphenoid ostium.
The posterior ethmoid air cells also drain
through the superior meatus into the
sphenoethmoid recess.
An obstruction in this region gives rise to the
sphenoethmoid pattern of sinusitis.
Drenaje del seno esfenoidal

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Concha
bullosa of
the right
middle
turbinate.
Conca Bulosa
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Paradoxical
curves of both
middle
turbinates cause
narrowing of the
ostiomeatal
units.
Celdas de Haller
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Magnetic Resonance
Imaging
Ultrasonography
Nuclear Imaging
Angiography
Prxima serie III

parte

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Gracias !

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Gracias por la oportunidad
Clnica de Asma y Alergia

Managua , Nicaragua.
Llmenos: 22781169, 88825513M,
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Dr. Juan Herrera Salazar

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CT Scan Anomalías Cavidad Nasal.

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NEW !

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

Lo ms dificil es ver lo que esta delante

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

Atlas Netter III edicin Interactiva.

CT Scan of the Paranasal Sinuses

Craneo Antero Posterior

Craneo Rx. . Lateral

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

Sinusitis is an inflammation of the

Radiografa de los Senos Nasales

Polypoid mucosal thickening in the right maxillary

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

Derrame del seno maxilar

Semanas 1-3 de duracin

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

Allergic Fungal Sinusitis

Sinusitis, Chronic, Medical Treatment

Sinusitis, Ethmoid, Acute, Surgical Treatment

Sinusitis, Frontal, Acute, Surgical Treatment

Sinusitis, Maxillary, Acute, Surgical Treatment

Sinusitis, Maxillary, Chronic, Surgical Treatmen

Estudio de la Cavidad Nasal Tomografa

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

Paranasal sinuses CT anatomy

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan, nasal cavity.

Normal anterior ostiomeatal

The anatomy of the ethmoid

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

CT scan, nasal cavity

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

Processes involving the anterior ethmoid chambers

The most common cause for frontal and

Functional endoscopic sinus

Complejo Osteo Meatal

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

Complejo Osteo Meatal

Desviacin del Septo

Fisiologa de las desviaciones del Septo

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

The anterior superior septum is

CT scan Sinusitis Tel. 22781169, 88825513 Mov,

The bony portion of the

Spurs and deviation of the

Nasal septum deviation