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CT Scan, Nasal Cavity: Multimedia

Author: Belachew Tessema, MD, Assistant Clinical Professor, Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine; Co-director, The Connecticut Sinus Institute
Coauthor(s): Seth M Brown, MD, MBA, Assistant Clinical Professor, Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine; Director, The Connecticut Sinus Institute
Contributor Information and Disclosures

Updated: Nov 24, 2009

Multimedia

CT scan, nasal cavity. Normal anterior ostiomeata...Media file 1: CT scan, nasal cavity. Normal anterior ostiomeatal complex anatomy. The anatomy of the ethmoid infundibulum and the uncinate process is demonstrated here.
CT scan, nasal cavity. Normal anterior ostiomeata...

CT scan, nasal cavity. Normal anterior ostiomeatal complex anatomy. The anatomy of the ethmoid infundibulum and the uncinate process is demonstrated here.

CT scan, nasal cavity. Normal frontal recess/duct...Media file 2: 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 agar nasi cells.
CT scan, nasal cavity. Normal frontal recess/duct...

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 agar nasi cells.

CT scan, nasal cavity. Normal posterior ostiomeat...Media file 3: CT scan, nasal cavity. 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.
CT scan, nasal cavity. Normal posterior ostiomeat...

CT scan, nasal cavity. 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.

CT scan, nasal cavity. This reformatted image of ...Media file 4: CT scan, nasal cavity. This reformatted image of a normal sagittal reconstruction of the ostiomeatal complex shows the curved edge of the semilunar hiatus with the inferior mucosal edge covering the uncinate process. The frontal recess/duct is also shown.
CT scan, nasal cavity. This reformatted image of ...

CT scan, nasal cavity. This reformatted image of a normal sagittal reconstruction of the ostiomeatal complex shows the curved edge of the semilunar hiatus with the inferior mucosal edge covering the uncinate process. The frontal recess/duct is also shown.

CT scan, nasal cavity. Fusion (apparent) of uncin...Media file 5: CT scan, nasal cavity. 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 fusion.
CT scan, nasal cavity. Fusion (apparent) of uncin...

CT scan, nasal cavity. 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 fusion.

CT scan, nasal cavity. Congenital or true fusion ...Media file 6: CT scan, nasal cavity. 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.
CT scan, nasal cavity. Congenital or true fusion ...

CT scan, nasal cavity. 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.

CT scan, nasal cavity. Bilateral pneumatization o...Media file 7: CT scan, nasal cavity. Bilateral pneumatization of the uncinate tips. Expansion of the tips can compromise the ethmoid infundibulum, the semilunar hiatus, or the middle meatus.
CT scan, nasal cavity. Bilateral pneumatization o...

CT scan, nasal cavity. Bilateral pneumatization of the uncinate tips. Expansion of the tips can compromise the ethmoid infundibulum, the semilunar hiatus, or the middle meatus.

CT scan, nasal cavity. Large Haller air cell clea...Media file 8: CT scan, nasal cavity. Large Haller air cell clearly narrowing the ethmoid infundibulum.
CT scan, nasal cavity. Large Haller air cell clea...

CT scan, nasal cavity. Large Haller air cell clearly narrowing the ethmoid infundibulum.

CT scan, nasal cavity. Concha bullosa of the left...Media file 9: CT scan, nasal cavity. 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.
CT scan, nasal cavity. Concha bullosa of the left...

CT scan, nasal cavity. 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.

CT scan, nasal cavity. Overexpansion of the ethmo...Media file 10: CT scan, nasal cavity. Overexpansion of the ethmoid sinus floors. Floors bulge downward, compressing the middle turbinate and compromising the semilunar hiatus (not shown on this image).
CT scan, nasal cavity. Overexpansion of the ethmo...

CT scan, nasal cavity. Overexpansion of the ethmoid sinus floors. Floors bulge downward, compressing the middle turbinate and compromising the semilunar hiatus (not shown on this image).

The CT scan shows an opacified middle turbinate c...Media file 11: The CT scan shows an opacified middle turbinate concha bullosa (D). The resulting occlusion of the ethmoid infundibulum (B) causes an acute ethmoid sinusitis, most likely related to direct communication of the infection from the concha to the infundibulum and thus to the ethmoid sinus. The expanded concha bullosa narrows the middle meatus (E) and deviates the uncinate process (C) toward the nasal cavity wall, narrowing the ethmoid infundibulum (B). This narrowing led to repeat sinusitis and eventually to a bacterial infection. The lamina papyracea is normally riddled with small holes for perforating arteries. From there, the infection spread directly from the infected ethmoid sinus into the orbit to manifest as a supraorbital abscess (A). Following antibiotic therapy during the acute crisis, the infection was brought under control after drainage of the supraorbital abscess. Functional endoscopic sinus surgery (FESS) was performed at a later time.
The CT scan shows an opacified middle turbinate c...

The CT scan shows an opacified middle turbinate concha bullosa (D). The resulting occlusion of the ethmoid infundibulum (B) causes an acute ethmoid sinusitis, most likely related to direct communication of the infection from the concha to the infundibulum and thus to the ethmoid sinus. The expanded concha bullosa narrows the middle meatus (E) and deviates the uncinate process (C) toward the nasal cavity wall, narrowing the ethmoid infundibulum (B). This narrowing led to repeat sinusitis and eventually to a bacterial infection. The lamina papyracea is normally riddled with small holes for perforating arteries. From there, the infection spread directly from the infected ethmoid sinus into the orbit to manifest as a supraorbital abscess (A). Following antibiotic therapy during the acute crisis, the infection was brought under control after drainage of the supraorbital abscess. Functional endoscopic sinus surgery (FESS) was performed at a later time.

The normal basal or ground lamella is seen on the...Media file 12: The normal basal or ground lamella is seen on the right side (B). On the left side, the arrow (A) points to the expected location of the absent basal lamella. Therefore, the first mucosal bony structure encountered after puncturing the ethmoid floor was the cribriform plate. Puncture of this structure resulted in a CSF leak.
The normal basal or ground lamella is seen on the...

The normal basal or ground lamella is seen on the right side (B). On the left side, the arrow (A) points to the expected location of the absent basal lamella. Therefore, the first mucosal bony structure encountered after puncturing the ethmoid floor was the cribriform plate. Puncture of this structure resulted in a CSF leak.

More on CT Scan, Nasal Cavity

References

References

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  7. Stammberger H. Functional Endoscopic Sinus Surgery. 1991;1-529.

  8. Wallace R, Salazar JE, Cowles S. The relationship between frontal sinus drainage and osteomeatal complex disease: a CT study in 217 patients. AJNR Am J Neuroradiol. Jan-Feb 1990;11(1):183-6. [Medline].

  9. Zinreich SJ, Mattox DE, Kennedy DW, Chisholm HL, Diffley DM, Rosenbaum AE. Concha bullosa: CT evaluation. J Comput Assist Tomogr. Sep-Oct 1988;12(5):778-84. [Medline].

Further Reading

Keywords

CT scan, nasal cavity, nasal cavity CT scanning, chronic sinusitis, computed tomography, CT scanning, nasal cavity anatomical anomalies, ostiomeatal complex, functional endoscopic sinus surgery, FESS, OMC

Contributor Information and Disclosures

Author

Belachew Tessema, MD, Assistant Clinical Professor, Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine; Co-director, The Connecticut Sinus Institute
Belachew Tessema, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Seth M Brown, MD, MBA, Assistant Clinical Professor, Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine; Director, The Connecticut Sinus Institute
Seth M Brown, MD, MBA is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Rhinologic Society, and North American Skull Base Society
Disclosure: Nothing to disclose.

Medical Editor

David Rubinstein, MD, Associate Professor, Department of Radiology, University of Colorado Health Sciences Center
David Rubinstein, MD is a member of the following medical societies: American Society of Neuroradiology and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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