بسم الله الرحمن الرحيم

ORL IMAGING

Plain X-Rays Nasal Bones

Normal Bony Nasal skeleton

Plain x-rays nasal bones Normal # Nasal bones

CT nasal bones

Important Note Radiology is NOT NECESSARY for the management of fractured nasal bone The main factor that determine the treatment is the CLINICAL APPEARANCE of the nose

PARANASAL SINUSES

IMAGING OF THE PARANASAL SINUSES Plain X-Rays CT scan MRI

PLAIN X-RAYS OF THE PARANASAL SINUSES Occipitomental Occipitofrontal

OCCIPITOMENTAL VIEW (WATER’S VIEW)

OCCIPITO-FRONTAL VIEW (CALDWELL VIEW)

LATERAL VIEW

Occipito mental Occipito frontal Lateral

Indication X Ray Paranasal Sinuses Management of sinusitis if CT is not available

Acute & Chronic Sinusitis

Mucosal thickening

Fluid Level

Complete opacity

CT SINUSES Axial (Transverse) Coronal

Normal Axial

Normal coronal

SINUSITIS

SINUSITIS

Radiology of Fungal sinusitis Heterogeneous opacity Bone destruction

FUNGAL SINUSITIS

FUNGAL SINUSITIS

COMPLICATIONS OF BACTERIAL SINUSITIS Pharyngeal, laryngeal and ear infections Mucocele Osteomyelitis Orbital complications Intracranial complications

MUCOCELE

Osteomyelitis

Plain X rays

CT

CT

ORBITAL COMPLICATIONS OF BACTERIAL SINUSITIS Periorbital inflammatory edema Orbital cellulitis Subperiosteal abscess Orbital abscess Cavernous sinus thrombosis

ORBITAL COMPLICATIONS OF SINUSITIS

ORBITAL COMPLICATIONS OF SINUSITIS Periorbital edema

ORBITAL COMPLICATIONS OF SINUSITIS Orbital cellulitis Subperiosteal abscess

Superior Subperiosteal abscess

ORBITAL COMPLICATIONS OF SINUSITIS Orbital abscess

ORBITAL COMPLICATIONS OF SINUSITIS Cavernous sinus thrombosis

INTRACRANIAL COMPLICATIONS

INTRACRANIAL COMPLICATIONS

INTRACRANIAL COMPLICATIONS Subdural abscess Frontal lobe abscess

BENIGN SWELLINGS Simple nasal polypi

Antro-choanal polyp

Inverted papilloma

Osteoma

MALIGNANT TUMORS

SINUSES’ TRAUMA

Blow-out fracture

BLOW-OUT FRACTURE Tear-drop sign

MRI PARANASAL SINUSES Cavernous sinus thrombosis

IMAGING OF THE NECK AND PHARYNX

Anatomy

Normal Lateral Plain X-rays Neck

Lateral View nasopharynx Normal Nasopharynx Soft tissue swelling Nasopharynx

PLAIN X-RAYS NECK & PHARYNX Pharyngeal or retropharyngeal swelling Normal

FOREIGN BODIES PHARYNX

FOREIGN BODIES PHARYNX

Retropharyngeal abscess + FB

CT NASOPHARYNX Unilateral choanal atresia Bilateral choanal atresia Normal

CT NASOPHARYNX Angiofibroma

Carcinoma nasopharynx CT NASOPHARYNX Normal Carcinoma nasopharynx

CT OROPHARYNX Normal

Acute retropharyngeal abscess

Parapharyngeal abscess

Retropharyngeal Combined Parapharyngeal

THE ESOPHAGUS

PLAIN X-RAYS

BARIUM SWALLOW

Zenker’s (pharyngeal) pouch

BARIUM SWALLOW Leiomyoma Achalasia

Web

Carcinoma esophagus

PLAIN X-RAYS OF THE LARYNX

Acute epiglottitis Thumb sign Normal

ACUTE EPIGLOTTITIS

ACUTE LARYNGO-TRACHEO-BRONCHITIS “CROUP” Normal PA plain X ray neck Steeple sign

RADIOLOGY OF TRACHEOBRONCHIAL F.B’S Normal Radio-opaque FB

5. Bronchopneumonia Collapse Emphysema

RADIOLOGY OF SALIVARY GLANDS

Plain X-Rays

SIALOGRAM Sialectasia Stone

CT SALIVARY GLANDS Pleomorphic adenoma Malignant parotid

IMAGING OF TEMPORAL BONE

PLAIN X-RAYS MASTOIDS

TYPES OF MASTOID AEREATIONS Cellular Diploic Acellular (Sclerotic)

CT TEMPORAL BONE

CT TEMPORAL BONE Trauma Infection Tumor

FRACTURE TEMPORAL BONE Longitudinal # Transverse #

Infection Chronic suppurative otitis media

CT in CSOM Preoperative to display the normal anatomy

Normal i = internal auditory canal c = cochlea v = vestibule f = facial nerve m = malleus in = incus me = middle ear a = aditus

Normal e = external auditory canal i = internal auditory canal v = vestibule in = incus f = facial nerve c = cochlea black arrow = oval window white arrow = stapes

CT in CSOM Preoperative to display the normal anatomy Shows the extent of the disease

Cholesteatoma

CT in CSOM Preoperative to display the normal anatomy Shows the extent of the disease Shows the possible complications

COMPLICATIONS OF SUPPURATIVE OTITIS MEDIA Extracranial complications Cranial (intra-temporal) complications Intracranial complications

EXTRACRANIAL COMPLICATIONS Otitis externa Retropharyngeal abscess Septicemia

CRANIAL (INTRATEMPORAL) COMPLICATIONS Acute mastoiditis Petrositis Facial nerve paralysis Labyrinthine fistula and labyrinthitis

INTRACRANIAL COMPLICATIONS Extradural abscess Lateral sinus thrombophlebitis Subdural empyema Meningitis Brain abscess Otitic hydrocephalus

Fistula lateral SCC

Mastoid abscess

Apical petrositis

Mastoid abscess + Cerebellar abscess

Extradural abscess

Lateral sinus thrombophlibitis

Temporal lobe abscess Cerebellar abscess

Otitic hydrocephalus

ACOUSTIC NEUROMA

CT INTERNAL AUDITORY MEATI Normal IAM Wide IAM

Yousry El-Sayed http://faculty.ksu.edu.sa/yousryelsayed THANK YOU Yousry El-Sayed http://faculty.ksu.edu.sa/yousryelsayed