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NEW !

APUNTES DE FISIOLOGA,
ANATOMA-RADIOLGICA-CLNICA

Seminarios Taller Presencial


Clnica de Asma y

CT, MRI , Ultrasonido,


Imagenologa
Sinusitis Crnica otras
patologas
Lean

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las

notas al pie de las


diapositivas

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New !
Updat
RADIOLOGICA ed

ANATOMA
CT SCAN
CORTES AXIALES, SAGITALES Y
RECONSTRUCCIN CORONAL..
REVISIN
DR. JUAN HERRERA SALAZAR
CLNICA DE ASMA Y ALERGIA

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DR. JUAN HERRERA SALAZAR


Tel . 22781169
Movistar Clnica de Asma y Alergia
Claro

Clinica de Asma y Alergia

88825513
84316459

CT Scan of the Paranasal Sinuses


Author
: A John Vartanian, MD, MS, FACS; Chief Editor: Arlen D Meyers,
MD, MBAmore
...
Updated: Mar 21, 2016

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BIBLIOGRAFA
Atlas Netter II edicin.
Atlas Netter IV 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 29, 2011

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84316459 CLARO

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BIBLIOGRAFA EMEDECINE
Nasal Physiology Author: Sanford M Archer, MD; Chief
Editor: Arlen D Meyers, MD, MBA more...
Olfactory System Anatomy Author: Amir Vokshoor, MD;
Chief Editor: Arlen D Meyers, MD, MBA more...
Nasal Aerodynamics Author: Samuel J Lin, MD; Chief Editor:
Arlen D Meyers, MD, MBA more...
Nasal Reconstruction Author: Ali Sajjadian, MD, FACS; Chief
Editor: Arlen D Meyers, MD, MBA more...

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LO MS DIFICIL ES VER LO QUE ESTA DELANTE


DE TUS OJOS W. GOETHE

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COMPLEJO OSTEOMEATAL

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PROCESO UNCINATO , GANCHOSO

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ETHMOID AIR CELLS

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SPHENOID SINUS

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THE FRONTAL SINUS OUTFLOW TRACT


(FRONTAL RECESS)

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IMPORTANT RADIOLOGIC ANATOMIC


LANDMARKS ON CORONAL CT
SECTIONS

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LANDMARKS ON AXIAL CT SECTIONS

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SUMMARY OF BASIC SINONASAL


ANATOMIC TERMS
Agger nasi:

This is a bony prominence that is often pneumatized in the ascending process of the maxilla. Its location below the frontal sinus also defines the
anterior limit of the frontal recess.

Concha bullosa:
The concha bullosa is a pneumatized middle turbinate. An enlarged middle turbinate may obstruct the middle meatus and the infundibulum
causing recurrent disease. It may also serve as a focal area of sinus disease.

Ethmoidal bulla:
This is the largest and most anterior ethmoid cell system. It is found posterior to the middle turbinate and posteromedial to the uncinate process.

Ethmoidal infundibulum: This is a space bordered medially by the uncinate process and laterally by the lamina papyracea. The maxillary sinus ostium is found inferiorly and laterally
within this space.
Haller cell (infraorbital cell): The Haller cell is usually situated below the orbit in the roof of the maxillary sinus. It is a pneumatized ethmoid cell that projects along the medial roof of
the maxillary sinus. Enlarged Haller cells may contribute to narrowing of the ethmoidal infundibulum and recurrent sinus disease, despite previous (incomplete) surgery.
Frontal recess: This is an hourglass-shaped space between the inferomedial aspect of the frontal sinus and the anterior middle meatus. Unfavorable variations of the structures that
define its borders may cause problems with the frontal sinus outflow tract. These structures include the agger nasi cell, supraorbital ethmoid cells, the ethmoid bulla, and inferiorly,
the uncinate process.
Lamina papyracea: This is a thin, bony wall separating the orbit from the ethmoid air cells. Dehiscences may occur for congenital reasons or because of previous surgery or facial
trauma.
Maxillary sinus ostium: This is the opening of the maxillary sinus to the nasal cavity and a part of the ostiomeatal complex.
Ostiomeatal complex or unit: This term refers to a collection of middle meatal structures and is not a discrete anatomic entity. It consists of the ethmoid infundibulum, anterior ethmoid
cells, and the uncinate process. It also represents the final common pathway of drainage for the frontal, maxillary, and anterior ethmoid cells. A patent ostiomeatal complex is
essential for the improvement of patients with sinus disease.
Paradoxical middle turbinate: The major curvature of the middle turbinate may project laterally, leading to narrowing of the middle meatus.
Sphenoethmoid cell (Onodi cell): This is formed by lateral and posterior pneumatization of the most posterior ethmoid cells over the sphenoid sinus. The presence of Onodi cells
increases the chance that the optic nerve and/or carotid artery would be exposed (or nearly exposed) in the pneumatized cell.
Uncinate process: This is a 3-dimensional sickle-shaped (also described as a hook- or L-shaped) bone of the lateral nasal wall. Anteriorly, the uncinate process attaches to the lacrimal
bone; inferiorly, the uncinate process attaches to the ethmoidal process of the inferior turbinate. The posterior edge lies in the hiatus semilunaris inferioris. Superiorly, the uncinate
process may attach to the middle turbinate, lamina papyracea, and/or the skull base.

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Ethmoidal infundibulum:
This is a space bordered medially by the uncinate process and laterally by the lamina
papyracea. The maxillary sinus ostium is found inferiorly and laterally within this space.

Haller cell (infraorbital cell):


The Haller cell is usually situated below the orbit in the roof of the maxillary sinus. It is a
pneumatized ethmoid cell that projects along the medial roof of the maxillary sinus.
Enlarged Haller cells may contribute to narrowing of the ethmoidal infundibulum and
recurrent sinus disease, despite previous (incomplete) surgery.

Frontal recess:
This is an hourglass-shaped space between the inferomedial aspect of the frontal
sinus and the anterior middle meatus. Unfavorable variations of the
structures that define its borders may cause problems with the frontal sinus
outflow tract. These structures include the agger nasi cell, supraorbital
ethmoid cells, the ethmoid bulla, and inferiorly, the uncinate process.

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Haller cell (infraorbital cell): The Haller cell is usually situated below the
orbit in the roof of the maxillary sinus. It is a pneumatized ethmoid cell
that projects along the medial roof of the maxillary sinus. Enlarged
Haller cells may contribute to narrowing of the ethmoidal infundibulum
and recurrent sinus disease, despite previous (incomplete) surgery.
Frontal recess: This is an hourglass-shaped space between the inferomedial
aspect of the frontal sinus and the anterior middle meatus. Unfavorable
variations of the structures that define its borders may cause problems
with the frontal sinus outflow tract. These structures include the agger
nasi cell, supraorbital ethmoid cells, the ethmoid bulla, and inferiorly,
the uncinate process.
Lamina papyracea: This is a thin, bony wall separating the orbit from the
ethmoid air cells. Dehiscences may occur for congenital reasons or
because of previous surgery or facial trauma.

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Maxillary sinus ostium: This is the opening of the maxillary sinus to the
nasal cavity and a part of the ostiomeatal complex.
Ostiomeatal complex or unit: This term refers to a collection of middle
meatal structures and is not a discrete anatomic entity. It consists of
the ethmoid infundibulum, anterior ethmoid cells, and the uncinate
process. It also represents the final common pathway of drainage
for the frontal, maxillary, and anterior ethmoid cells. A patent
ostiomeatal complex is essential for the improvement of patients
with sinus disease.
Paradoxical middle turbinate: The major curvature of the middle
turbinate may project laterally, leading to narrowing of the middle
meatus.

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Sphenoethmoid cell (Onodi cell): This is formed by lateral and posterior


pneumatization of the most posterior ethmoid cells over the
sphenoid sinus. The presence of Onodi cells increases the chance
that the optic nerve and/or carotid artery would be exposed (or
nearly exposed) in the pneumatized cell.
Uncinate process: This is a 3-dimensional sickle-shaped (also described
as a hook- or L-shaped) bone of the lateral nasal wall. Anteriorly, the
uncinate process attaches to the lacrimal bone; inferiorly, the
uncinate process attaches to the ethmoidal process of the inferior
turbinate. The posterior edge lies in the hiatus semilunaris inferioris.
Superiorly, the uncinate process may attach to the middle turbinate,
lamina papyracea, and/or the skull base.

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PEARLS
In general, the larger the air cells, the thinner the bony walls become.
This may increase the chance for injuring structures within or
adjacent to such bony structures lining the air cell.
On CT scan, AFS is depicted as a heterogenous opacification that can
be seen with a typical pattern of central hyperdense areas of
opacification surrounded by less dense areas of opacification.

Unilateral sinonasal polypoid soft


tissue masses in the area of the
ethmoid cells may represent a
herniated encephalocele. An MRI
may be helpful in its
differentiation.
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ANATOMIA RADIOLGICA

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RADIOGRAFA CRANEO RX. . LATERAL

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DEFINICIN DE SINUSITIS
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]
Sinusitis can be subdivided into acute, subacute, and chronic
disease. Acute sinusitis is defined as disease lasting less
than 1 month. Subacute disease lasts 1-3 months, and
chronic sinusitis lasts longer than 3 months and is generally
related to suboptimally treated acute or subacute disease.
Acute and subacute sinusitis are treated medically, whereas
chronic sinusitis may require surgical intervention.

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RADIOGRAFA DE LOS SENOS NASALES


Waters
(occipitomental)
Caldwell
(occipitofrontal)
Vista Lateral
Vista basilar
( submentovrtice)
Polypoid mucosal thickening in the right
maxillary sinus with a mucous retention cyst in
the left on a Waters view.
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CT SCAN METODO PREFERIDO


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.

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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 airfilled 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.

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Tomografa Axial Computadorizada (TC) de l


os senos paranasales

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Si desean
ms
resolucin
hagn clik
inforadiologie.ch

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CT SCAN ANATOMIA Y FISIOLOGA


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 ANATOMA
Y FISIOLOGA

COM
Complejo Osteo
Meatal
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The uncinate process


(UP) and lateral wall of
the nasal cavity form
the ethmoid
infundibulum (EI). The
above sinuses drain into
the EI via various ostia.
The maxillary sinus
ostia and the frontal
sinus recess or duct
drain into the anteriormost portion of the
OMC and are
consistently identifiable
on CT scan. 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 agar
nasi cells

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CT SCAN
ANATOMA Y
FISIOLOGA

Stammberger and
Messerklinger
Drainage

Complejo Osteo
Meatal Posterior
Normal
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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.

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CT SCAN
ANATOMA Y
FISIOLOGA

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
UP, can be seen in
the image below.
The frontal recess
is also shown.

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ANOMALAS DE LA CAVIDAD NASAL


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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ANOMALAS DE LA CAVIDAD NASAL


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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ANOMALAS DE LA CAVIDAD NASAL

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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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ANOMALAS DE LA CAVIDAD NASAL

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

Large Haller air cell


clearly narrowing the
ethmoid infundibulum.

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ANOMALAS DE LA CAVIDAD NASAL

Overexpansion
of the ethmoid
sinus floors

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PATRONES RADILOGICOS AL CT SCAN

Bilateral
ethmoid
sinusitis on an
MRI.

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COMPLEJO OSTEOMEATAL

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CT SCAN

Mucosal
thickening in
the left
anterior
ethmoid and
maxillary
sinuses and
in the region
of the
infundibulum.
This indicates
an
ostiomeatal
pattern of
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CONCA BULOSA

Concha
bullosa of
the right
middle
turbinate.

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CELDAS DE HALLER
Paradoxical
curves of both
middle
turbinates
cause
narrowing of
the ostiomeatal
units.

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Magnetic Resona
nce Imaging

Sinusitis
Imaging
PARA LOS ESPECIALISTAS
Author: Rochita
Ultrasonography
V Ramanan,
MBBS, MD, DNB,
Nuclear Imaging
DMRD; Chief
Editor: L Gill
Angiography
Naul, MD

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CT scan
Spiral CT scan
1mm cuts
Magnetic Resonance
Imaging
The exclusive use of coronal CT scans for
sinus imaging could result in the failure
to diagnose nasal cavity neoplasms. In
the absence of bone destruction, an
esthesioneuroblastoma or other
neoplasm may be mistaken for a nasal
polyp on a CT scan, whereas on MRI, the
nature of this tumor is quite apparent.
Beyond anatomic variants, any
suspicious findings should be imaged by
means of MRI

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Despite advances in MRI


technology, insufficient
tissue, plus the problems of
susceptibility due to the aircontaining passages, make
MRI a less effective study for
nasal cavity sinusitis
problems, unless of course
the sinusitis turns out to be
related to squamous cell
carcinoma (SCCa).
To date, no new MRI contrast
agents that have an affiliation
for SCCa have been released

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Gracias
!

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DR. JUAN HERRERA SALAZAR


Tel . 22781169
Movistar Clnica de Asma y Alergia
Claro

Clinica de Asma y Alergia

88825513
84316459

CT Scan of the Paranasal Sinuses


Author: A John Vartanian, MD, MS, FACS; Chief Editor: Arlen D
Meyers, MD, MBAmore...
Updated: Mar 21, 2016

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Gracias por la oportunidad

Desde la Clnica de Asma y Alergia


Managua , Nicaragua. Tel 22781169, 22703359, 88825513
Dr. Juan Herrera Salazar
Favor ver la III Parte

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