Info Dpv
Nasal mucosa presents a ciliated columnar pseu-dostratified epithelium that lines the nose and the paranasal sinuses and is bounded by squamous epithelium at the level of the nasal vestibulum. The area of the luminal surface of the sinonasal epithelium is greatly expanded by 300-400 microvilli x cell. Also, columnar cells bear about a hundred cilia x cell beating 1000 x min in sequence with those of neighboring ciliated cells Mygind 1978 . The cilia beat in a serous periciliary fluid of low...
Info Imn
Bone remodeling consists of displacement and - usually - thinning of bony walls. In most cases, it is observed in tumors contacting very thin walls as cribriform plate, lamina papyracea, turbinates, and medial maxillary sinus wall. Bone remodeling is a continuously occurring adaptive dynamic process involving both osteoblasts and osteoclasts Giacchi et al. 2001 . Activation of this process is triggered by mechanical stress - exerted by expansile lesions - as well as by chemical mediators -...
Info Aso
Different staging systems based on the extension of the lesion Kadish et al. 1976 Dulguerov and Calcaterra 1992 have been specifically proposed for olfactory neuroblastoma Table 9.4, 9.5 . The main source of criticism towards Kadish classification is that it groups together in the C category situations with a different impact on prognosis as, for example, skull base involvement and widespread disease. Dulguerov and Calcaterra 1992 provided a more reliable prognostic stratification of patients,...
A 1
Fig. 8.2a,b. Fronto-ethmoidal osteoma. Plain CT on coronal a and sagittal reformatted plane b . a A large fronto-ethmoidal osteoma exhibits a mixed pattern, ivory in its lateral part, ground glass in the medial portion. Lamina papyracea is encroached. The lesion contacts the medial rectus muscle arrowhead . b Unexpectedly, sagittal reformation demonstrates patency of the frontal recess, all along its course black and white arrows Fig. 8.2a,b. Fronto-ethmoidal osteoma. Plain CT on coronal a and...
Info Jji
Key Information to Be Provided by Imaging Presence of thickened nasal and paranasal sinus mucosa Entity of bony and cartilaginous alterations Presence of sinusitis, with particular attention to complications requiring surgical treatment Entity of intraorbital involvement in those patients with ocular symptoms diplopia, exophthalmos, reduced visual acuity Atypical pattern of diffusion, like perineural spread Mazziotti et al. 2001
Info Yuf 1
Definition, Epidemiology, Pattern of Growth Adenoid cystic carcinoma accounts for 1 of all head and neck malignancies it occurs more frequently in minor than in major salivary glands. In the head and neck, the sinonasal tract is the most common localization for adenoid cystic carcinoma of the minor salivary glands Kim et al. 1999b . The majority of the lesions occur in middle-aged patients there are very few cases below the age of 20 and over the age of 80. Histologically, three patterns with...
Info Fdh
The morphology of the ethmoid roof is usually inconstant. Asymmetry of the cribriform plate may be seen, directly related to the length of the vertical lamella, that inserts on it Fig. 2.15 . It has been observed in about 10 of patients Dessi et al. 1994 LEbowitz et al. 2001 . During surgery, this anomaly entails an increased risk of iatrogenic CSF fistulization or of injury of the anterior ethmoid artery, which courses along the most lateral aspect of the cribriform plate Fig. 2.12 . The depth...
Info Ksw
Signal vs Time Curves in Follow-Up Studies After surgery and or radiation therapy, precise discrimination between scar tissue and recurrent persistent tumor is often a hard task. An easy and reliable guide for differential diagnosis may be obtained by comparing signal vs time curves of suspected lesions vs normal mucosa, muscle, or vascular structures. This approach requires a dynamic sequence GE T1 , acquiring the same section with a frame rate of 1 s, for 1 min. Signal curves are then...
Info Ffs
Surgery is the mainstay of treatment for adenoid cystic carcinoma. Fulfilling the oncologic principle of achieving clear margins is more difficult in this tumor than in other malignant lesions, due to its insidious submucosal and subperiosteal growth as well as to the tendency to spread along named nerves even far from the site of the lesion. Therefore, the surgeon should be aware of the need to check the radical tumor removal with multiple frozen sections and, possibly, to extend the resection...
Info Joi
Definition, Epidemiology, Pattern of Growth First reported in the nineteenth century by Poncet and Dor 1897 with the term of botryomycoma, pyo-genic granuloma is a benign, rapidly growing lesion, characterized by a lobular proliferation of capillaries Mills et al. 1980 , also known with several other names i.e., telangiectatic granuloma, granuloma pe-dunculatum, infected granuloma . Even though the term pyogenic granuloma is the most commonly used, it does not address the true nature of the...
Info Llq
The approach to the frontal recess and to the frontal sinus is by far the most difficult step in the learning curve of microendoscopic surgery. This is mainly due to the extremely complex and variable anatomy of a very narrow area, where mucosal and bony alterations related to the disease make the identifica- tion of the surgical landmarks even more challenging. Understanding the anatomy of the single patient through a careful analysis of imaging studies and, in general, the use of a very...
Info Ttc
Imaging Findings of Pterygopalatine Fossa, Root of Pterygoid Process, and Cavernous Sinus Invasion Fat tissue surrounding nerves and vessels inside fossae and fissures is a key point to assess neoplastic invasion, b oth on CT and MR. As an example of this, the sphenopalatine artery is a useful landmark to early detect neoplastic involvement of the pterygopalatine fossa. The artery appears as a twisted signal void surrounded by fat tissue on both T1 and TSE T2 se quences, easily detectable in...
Info Nhe
Definition, Epidemiology, Pattern of Growth Sinonasal neuroendocrine carcinoma and sinonasal undifferentiated carcinoma are two rare and aggressive malignancies, which have been only in recent years recognized and categorized. They share the prevalent site of origin i.e., superior part of the nasal cavity, upper ethmoid as well as some imaging, clinical and histological features. Both the identification and the distinction of the two histotypes require an evaluation of the immunohistochemical...
Info Qob
There are two problems to solve when assessing the extent of inverted papilloma to distinguish it from intrasinusal-retained secretions, and to define its relationship with both the orbit and the skull base Yousem et al. 1992 Savy et al. 2000 . MR can adequately answer both issues Oikawa et al. 2003 . Three relevant aspects regarding inverted pap-illoma pathways of spread have to be outlined adjacent bony structures are destroyed by mean of pressure erosion extension into adjacent sinusal...
Info Sou
During the development of ethmoid pneumatiza-tion, some cells may extend inferiorly and laterally to reach the medial orbital floor and the most inferior portion of the lamina papyracea, below the ethmoid bulla and lateral to the uncinate process infraorbital ethmoid cells or Haller cells Fig. 2.15 StackpolE and EdElStEiN 1997 . When large in size, these cells may narrow the ethmoid infundibulum. Size and Fig. 2.15. Bilateral infraorbital ethmoid cells IEC Haller cells . Black arrows indicate...
Sarcoid And Maxillary Sinus
Fig. 6.27a,b. Wegener granulomatosis. Plain SE T1 a and enhanced VIBE b in the axial plane. On plain SE T1, relevant thickening of the mucosa lining the right maxillary sinus is seen, combined with soft tissue signal within the pterygopalatine fossa 1 . b Marked enhancement of both the tissue in the pterygopalatine fossa and along the maxillary sinus walls is demonstrated. The fat suppressed sequence clearly shows the relevant enhancement of parapharyngeal spaces and nasopharyngeal walls 2 ....
Info Ihc
CT appearance of sinonasal melanomas is nonspecific. Density values and enhancement pattern do not provide key information. Bone destruction is observed in most malignant tumors. The site of origin may offer more substantial clues for the differential diagnosis whenever the lesion arises from the anterior nasal septum or middle inferior turbinates Azizi et al. 2001 . MR findings largely depend upon the histological features of the lesion Fig. 9.29 . Melanotic melanomas exhibit a peculiar...
Criteria For Orbital Exenteration
CT and MR Findings of Orbital Invasion Most nasosinusal neoplasms invade the orbit through the floor maxillary sinus squamous cell carcinomas or the medial wall ethmoid adenocarcinomas . The other walls are less frequently involved by primitive tumors. In fact, it is more likely to observe this path of orbital invasion by recurrent neoplasms or metastases. Apart from the infrequent event of perineural spread along the infraorbital nerve, rarely tumors extend into the orbit through the fissures...
Info Pib
In general, there are two clinical settings in which imaging is faced with the diagnosis of inverted pap-illoma, namely the evaluation of a unilateral nasal obstruction or the assessment of the local spread of a lesion already identified by the endoscopic examination Lehnerdt et al. 2001 Woodruff and Vrabec 1994 . In the first case, there is a high probability that the lesion is detected on a screening CT for rhinosinus-itis, while in the second one the patient is more frequently imaged by MR....
Info Irp
Definition, Epidemiology, Pattern of Growth Melanoma is composed by a proliferation of me-lanocytes, which derive from the neural crest and subsequently migrate into the skin and mucosal surfaces with an ectodermal origin Ramos et al. 1990 Manolidis and Donald 1997 Lund et al. 1999 Pandey et al. 1999 . Malignant melanoma is usually divided in two categories cutaneous and mucosal , which, despite a common cytological derivation, differ for biologic behavior. Mucosal melanoma, which is more...
Info Itr
The imaging features of olfactory neuroblastoma are nonspecific. Nevertheless, this neoplasm should be suspected when a mass is detected in the superior nasal cavity, causing either remodeling or destruction of adjacent bony structures, and erosion of the cribriform plate or of the fovea ethmoidalis Som et al. 1986 Woodhead and Lloyd 1988 Li et al. 1993 Derdeyn et al. 1994 Schuster et al. 1994 PickutH et al. 1999 . In fact, because olfactory neuroblastoma arises from the olfactory epithelium,...
Info Onp
Permeative invasion with or without sclerosis is a peculiar pattern observed mostly in lymphomas and in adenoid cystic carcinoma Suei et al. 1994 Yasumoto et al. 2000 . In this pattern, the most relevant finding is the extensive replacement of the medullary bone even in the absence of evident cortical erosion. Fig. 4.5a-d. Recurrent myxosarcoma. TSE T2 a , plain CT b , enhanced T1 c , and enhanced CT d . Intraspongiotic spread within the greater wing, ptery-goid process, lateral sinus wall and...
Info Rkj
In some patients with recurrent maxillary sinusitis, inflammatory changes at the level of the inferior part of the ethmoid infundibulum interfere with the patency of the natural ostium, but only minimal mucosal alterations are present within the sinus. Whenever, after performing an inferior uncinectomy and removing with atraumatic technique the polyps possibly present in the inferior part of the ethmoid infundibulum, the natural ostium is well evident and patent, harvesting a middle antrostomy...
Imaging Findings Ivq
Among all the small vessel vasculitides listed in the Chapel Hill classification, Wegener granulomatosis is by far the most common in the ENT area up to 90 of patients Jennette and FALk 1997 , basically involving three anatomic subsites, namely, sinona-sal cavities and orbit, middle ear and mastoid, and larynx. Wegener granulomatosis manifestations in the nose and paranasal sinuses are extremely polymorphic they may consist of mucosal and or bone changes. Mass-like pseudotumor lesions are...
Treatment Guidelines
The treatment of choice of acute rhinosinusitis is antibiotic therapy. The most frequently used antibiotics for non-complicated rhinosinusitis are amoxicillin-clavulanate and second generation cephalosporins for at least 10 days. If the patient does not improve within 72 h, an alternative antibiotic should be used. In the very rare event medical therapy fails, microendoscopic surgery, based on a preoperative CT, is indicated. This may encompass a very limited dissection aimed at restoring the...
Info Guv
Wide surgical excision is the mainstay of treatment of sinonasal hemangiopericytomas Castelnuovo et al. 2003 . In order to minimize intraoperative bleeding, a preoperative selective embolization may be effective Catalano et al. 1996 Serrano et al. 2002 , but it should not be routinely indicated Hekkenberg et al. 1997 . The most accepted surgical approaches for sinonasal hemangiopericytomas are the external ones, such as lateral rhinotomy, midfacial degloving, craniofacial resection,...
Info Hhv
Cortical destruction is detected at CT as a break of the mineralized bone through its whole thickness, whereas on MR a defect of the continuous hypoin-tense thickness of the cortex, replaced by solid tissue, implies invasion also of the periosteum Maroldi et al. 1996 . It can be observed in aggressive inflammatory lesions both non-invasive and invasive fungal rhinosinusitis , some benign, but aggressive, neo plasms as inverted papilloma and juvenile angiofibroma and in malignant tumors Som et...
Treatment Guidelines 1
The goals of medical therapy for chronic rhinosi-nusitis are control of infection, reduction of tissue edema, and improvement of ostia patency and sinus drainage. Reduction or elimination of irritating environmental factors is also important. Medical therapy is mainly based on 1 antibiotics, which help to control infection in the closed sinus cavities. A 3-week antibiotic course has been suggested as minimum treatment for chronic rhinosinusitis Wagner 1996 . Bacterial growth probably does not...
Clinical and Endoscopic Findings 1
Patients with maxillary sinus fungus ball generally complain of symptoms similar to those of a chronic maxillary sinusitis unilateral nasal obstruction, purulent rhinorrhea, cacosmia, and facial pain , even though the disease may silently progress for a long time. When the fungus ball is located in the sphenoid sinus, vertex headache is the main complaint reported by the patient, while nasal symptoms may be less evident. Nasal endoscopy often shows nonspecific changes as medialization of the...
Info Pqk
The diagnosis of juvenile angiofibroma on CT and MR is based on three features the site of origin of the lesion Lloyd et al. 2000b its hypervascular appearance after contrast enhancement Schick and Kahle 2000 and its pattern of growth. First, as juvenile angiofibroma arises close to the sphenopalatine foramen - either just on its submu-cosal aspect or from the adjacent pterygopalatine fossa - it usually presents as a mass expanded medially into the nasal cavity, and eroding the root of the...
Clinical and Endoscopic Findings
Patients with acute rhinosinusitis commonly complain of nasal obstruction, rhinorrhea, headache, facial pain, and dysosmia. The occurrence of an orbital complication may be suspected when fever, exacerbation of headache, and ocular symptoms appear Younis et al. 2002a . In the presence of preseptal cellulitis, erythema and edema of the eyelid without ophthalmoplegia or visual loss are observed. When proptosis, chemosis, and impairment of extraocular movement occur, a subperiosteal or...
Contents Xqr
9.1 Malignant Neoplasms General Remarks 159 9.1.2 Pattern of Growth and Clinical Evaluation 160 9.1.3 Endoscopic Appearance 162 9.1.5 Treatment Guidelines and Outcome 163 9.1.6 Key Information to Be Provided by Imaging 164 9.1.7 Imaging Strategies. Key Findings 165 9.1.7.1 Imaging to Assess the Patterns of Growth of Maxillary Sinus Neoplasms 166 9.1.7.2 Imaging to Assess the Pattern of Growth of Naso-Ethmoidal Neoplasms 170 9.2 Adenoid Cystic Carcinoma 177 9.2.1 Definition, Epidemiology,...
Info Onj
Clinical manifestations of sinonasal neuroendocrine and undifferentiated carcinoma are nonspecific, though suggestive for a rapidly growing neoplasm. Therefore, involvement of multiple sinonasal structures as well as extension into the orbit and or the cranial cavity are not infrequently detected at presentation Musy et al. 2002 . Paraneoplastic hypersecretion of ACTH and cal-citonin have been reported in two cases of sinonasal neuroendocrine carcinoma Kameya et al. 1980 more recently, also a...
Info Syd
The pattern of sinonasal involvement is variable and different symptoms and signs are detected in relation to the duration of the active phase of the disease. In fact, sarcoidosis is characterized by periods of spontaneous remission and exacerbation, with a very variable clinical course. At presentation, nasal obstruction is the most common complaint other frequent signs and symptoms are epistaxis, rhinor-rhea, crusting, hypo-anosmia, epiphora. The clinical presentation reflects the alterations...
Info Jys
Definition, Epidemiology, Pattern of Growth According to Shanmugaratnam 1991 , inverted papilloma is an epithelial benign neoplasm com Fig. 8.12a,b. Pneumosinus dilatans. Plain CT on coronal plane a and, after surgery, on axial plane b . Abnormal enlargement of the right maxillary sinus, medially contacting the nasal septum arrow , no bone destruction is appreciated. After surgical resection of the medial maxillary sinus wall and middle turbinate, normal caliber of the nasal fossa is restored...
M
Fig. 4.13a,b. Squamous cell carcinoma of left nasal cavity with extensive orbital infiltration. Invasion through the bony periosteal hypointense interface of the fovea ethmoidalis 1 with minimal enhancement of the dural layer. Residual vertical lamella of the middle torbinate 2 Fig. 4.13a,b. Squamous cell carcinoma of left nasal cavity with extensive orbital infiltration. Invasion through the bony periosteal hypointense interface of the fovea ethmoidalis 1 with minimal enhancement of the dural...
Bulla Frontalis
Fig. 2.9a-d. Bulla frontalis type I. a On the coronal image either agger nasi cells and frontal cells type I are shown. The axial plane b corresponds to the lower transversal grid on the coronal image. On the postero-medial aspect of the agger nasi cells the attachment of the uncinate processes is visible. The upper transversal grid cuts both frontal cells giving the axial plane in c . Mucosal thickening on the internal surfaces on the right bulla frontalis arrow . d The plane corresponds to...
Unilateral Watery Rhinorrhea
Unilateral bilateral watery persistent or intermittent rhinorrhea, a previous history of head trauma or surgery on the sinonasal tract, middle ear mastoid or skull base, and recurrent meningitis are the clinical findings which should alert the physician to the diagnosis of CSF leak. Nasal discharge usually increases or may be elicited by maneuvers elevating CSF pressure i.e., compression of the internal jugular veins, Valsalva maneuver . In case of a leak through the temporal bone, CSF reaches...
Planum Sphenoidale
Imaging to Assess the Pattern of Growth of Naso-Ethmoidal Neoplasms Neoplasms arising from ethmoid sinus or nasal cavity do not usually have a well defined bony box to completely fill before extending through its walls to become symptomatic, as in maxillary sinus neoplasms. Unilateral or bilateral nasal obstruction, possibly leading earlier to endoscopic or CT examination, is more frequently observed than in maxillary tumors Fig. 9.9 . Therefore, imaging findings may range from the detection of...
Info Wza
Uncinectomy is the first surgical step to gain access to the ostiomeatal complex. In the case of isolated disease of the maxillary sinus, resection can be limited to the inferior part of the uncinate process just to expose the natural ostium of the maxillary sinus and the area of the posterior fontanelle Fig. 5.4a . On the other hand, when the patient presents inflammatory changes only in the frontal sinus, superior uncinec-tomy may enable an adequate exposure of the frontal recess Fig. 5.4b ....
Imaging Findings Uvn
Diagnosis of Osteoma is generally simple diagnosis, based on the detection - either on X-ray films or on CT scans - of a radiodense mass occupying the frontal sinus more commonly or, less frequently, the ethmoid or maxillary sinus GiLLmAN et al. 1997 . According to the amount of mineralized bone within the lesion, osteomas may exhibit very high density, resembling cortical bone, or a gradually decreasing X-ray opacity density to a ground-glass pattern Fig. 8.1 . All different patterns can be...
Info Jrt
Any microendoscopic surgical procedure for inflammatory diseases should be planned by taking into account the nature and extent of the disease together with the specific anatomy of the single patient. For example, whenever a patient presents with a disease limited to a specific sinus maxillary, frontal, or sphenoid , the aim of surgery should be opening, clearance, and reventilation of the affected sinus through the more conservative approach. In contrast, most patients with sinonasal polyposis...
Definition Epidemiology Pathophysiology and Etiology
Rhinosinusitis is defined as an inflammation of the mucosa of the nose and paranasal sinuses. It is classified as acute, subacute, and chronic according to whether the duration of symptoms persists as long as 4 weeks, between 4 and 12 weeks, and more than 12 weeks, respectively Brook et al. 2000 . More than 2 billion is spent annually in the United States for over-the-counter medications for rhinosinusitis National Center for Health Statistics 1994 . Even though data regarding the incidence of...
Info Rqe 1
CSF Leak Presenting with Recurrent Meningitis In this second group of patients, CSF leak is suspected because of recurrent meningitis in the absence of rhinorrhea. In this setting, the first line approach entails both endoscopy and imaging. BTP is, of course, unhelpful. Endoscopy, CT and or MR may succeed in demonstrating lesions both in post-traumatic and spontaneous fistulae. Compared to patients with CSF leak and rhinorrhea, the main difference consists in the absence of imaging findings of...
Info Bpa
Chronic Rhinosinusitis Staging Systems Besides the above-mentioned more traditional classification in five patterns reflecting the pathophysi-ology of chronic rhinosinusitis, several efforts were made to measure the severity of this disease entity based on both clinical manifestations and on CT findings. Among the latter, the Lund-Mackay system Lund and Mackay 1993 is the most popular because of its high inter- and intra-observer agreement rate, as well as its simplicity and reproducibility....
Can You Get Pain At The Glabella With Sinusitus
Many patients with chronic rhinosinusitis present nasal obstruction as the primary complaint. Other symptoms include nasal discharge, postnasal drip, facial pain, dysosmia, chronic cough, and headache. Headache is usually dull and radiating to the top of the calvarium or bitemporal for sphenoid or posterior ethmoid disease. Pain at the glabella, inner can-thus, or between the eyes suggests anterior ethmoid or frontal rhinosinusitis. Pain over the cheeks most frequently suggests maxillary...
Info Cdl
Definition, Epidemiology, Pattern of Growth Ewing's sarcoma, a tumor arising within bone marrow, is included in the group of primitive neuroec-todermal tumors, which encompasses three different subtypes 1 neuroblastoma 2 central nervous system tumors like medulloblastoma 3 peripheral neuroec-todermal tumors like Ewing's sarcoma Batsakis et al. 1996 . Even though two variants skeletal and extra-skeletal of Ewing's sarcoma are traditionally recognized, it is sometimes difficult to separate the...
Info Ckc
Imaging to Assess the Patterns of Growth of Maxillary Sinus Neoplasms Progressive growth of maxillary sinus malignant neoplasms leads to extra-sinusal spread through the invasion of one or more of its five bony walls medial, anterior, postero-lateral, inferior alveolar recess , and roof Fig. 9.2 . According to the direction of tumor growth, different implications regarding treatment and prognosis will result. Invasion of the medial wall is certainly the less critical pathway of spread as it...
Info Nse
Because endoscopy accurately delineates the intranasal extent, the key point of imaging studies is to Fig. 9.24a,b. Olfactory neuroblastoma. a Coronal CT shows a soft tissue mass with its epicenter within the right ethmoid, associated with contralateral invasion and remodeling of right lamina papyracea. b On coronal T2 sequence the epicenter is more precisely located close to the lamina cribrosa. While on CT the lamina cribrosa appears regular, MR demonstrates that the tumor extends into the...
Imaging Findings
Acute rhinosinusitis does not require a radiologic study of the paranasal sinuses because the symptoms reported by the patient in association with the endoscopic examination are the only diagnostic steps required for making a correct diagnosis Phillips 1997 . When an orbital complication is suspected, generally secondary to acute ethmoiditis, CT permits differentiation between edema, phlegmon, and abscess, and precise identification of the site of the lesion, which is necessary for proper...