1. Radiology of Nasal Cavity and Paranasal Sinuses

2. Radiology
XRAY CT
MRI

3. Normal Anatomy

4. Drainage system Lamella: 1) uncinate 2) ethmoidal bulla
3) basal lamella
4) superior turb lamella

6. Uncinate attachment variations

7. Agger Nasi

8. Frontal sinus outflow tract
May be narrowed by agger anteriorly or bulla posteriorly
Frontal cells (Type 1-4)
Frontal recess
Lateral: lamina papyracea
Medial: middle turbinate
Anterior: posterior wall of agger nasi
Posterior: ethmoid bulla

9. Basal lamella B U L

10. Keros Classification

11. Sphenoid sinus

12. Haller cells

13. Other anatomic variations
Concha bullosa
Septal deviations
Paradoxic middle turbinate
convex curvature on the lateral, rather than medial side of the turbinate
Dehiscent lamina
Aerated crista galli
Optic nerve/carotid artery

14. MRI Helpful for evaluation of regional and intracranial complications
Detection and staging of neoplastic processes
Improved display between intraorbital and extraorbital compartments
Helpful for diagnosing fungal concretions which show low or no signal on T2
Helps for evaluation of mucoceles and cephaloceles
Appearance varies with changing concentrations of proteins and free water protons
T2  more “watery”, higher signal
T1  more protein, higher signal
However, once protein content reaches too high signal decreases

17. Epistaxis

18. Epistaxis Most common otolaryngologic emergency Majority idiopathic
60% of population in their lifetime
Maxillary sinus ostium serves as dividing line between “anterior” and “posterior bleeds”

19. Vascular anatomy

21. Endoscopic SPA ligation
Epistaxis controlled in 98%
Locate SPA at level of crista ethmoidalis
Key in surgery is to ligate all branches which can vary

22. Embolization
Risk of complications: CVA, hemiplegia, ophthalmoplegia, facial nerve palsy, seizures, soft tissue necrosis
Effective only for ECA supply very dangerous for ICA supply due to high risk of blindness
Success rate 71-95%
Complication rate 27%

23. Anterior ethmoid artery bleeding
Associated with nasoethmoid fractures
Bleeding rarely subsides with conservative measures
Variable position
Always seen between second and third lamellae
Most common site in the suprabullar recess (85%)