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CT Scan of the Paranasal Sinuses

History

Many historical references to the paranasal sinuses exist. The earliest such reference can be dated back to the works of Galen, who described the presence of the ethmoid air cells. Later descriptions of the maxillary sinuses by Leonardo da Vinci (1489), the sphenoid sinuses by Giacomo Berengario da Carpi (1521), and the frontal sinuses by Coiter (16th century) introduced early anatomists and scholars to the presence of these craniofacial air cells.

The first modern and accurate descriptions of the paranasal sinuses can be traced to the works of the late 19th century Austrian anatomist Emil Zuckerkandl. His detailed study and illustrations of the paranasal sinuses set the standard for generations of anatomists and physicians. Countless 19th and 20th century anatomists, radiologists, and surgeons have further contributed to advancing the knowledge of sinus anatomy (see the image below). The introduction of computed tomography (CT) and the wider use of it in the last 20 years have further contributed to the physician’s ability to appreciate nuances of paranasal sinus anatomy and accurate disease correlation.

Ostiomeatal unit line drawing: inferior turbinate

Ostiomeatal unit line drawing: inferior turbinate (1), middle turbinate (2), maxillary sinus (M), uncinate (U), ethmoidal bulla (B), frontal sinus (F), ethmoidal infundibulum (INF), nasal septum (NS), and middle meatus (*).

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The introduction of head and neck CT imaging and the current wider use of this modality have undoubtedly helped the clinician. CT has become a useful diagnostic modality in the evaluation of the paranasal sinuses and an integral part of surgical planning. It is also used to create intraoperative road maps. Today, CT is the radiologic examination of choice in evaluating the paranasal sinuses of a patient with sinusitis.

The use of CT scanning combined with functional endoscopic sinus surgery (FESS) has empowered the modern sinus surgeon to treat patients more effectively, facilitating reduced morbidity and complications. Physicians who are interested in treating patients with sinus disease must be able to read and interpret sinus CT scans. Mastery of sinus anatomy and its variant features forms the basis from which radiologic interpretation begins. Familiarization with the radiologic landmarks and cross-sectional anatomy on patient CT scans, along with clinical correlation, can further enhance the reader’s ability to understand sinus CT findings.

With experience, CT findings can be accurately correlated with the anatomic and clinical realities of the particular patient. As in all radiologic surveys, sinus CT scans must be read with a systematic approach. In addition to reviewing the scan to determine the presence of disease, CT scans of the sinuses can also be reviewed to evaluate potential areas of occlusion and variations of the patient’s sinus anatomy in the setting of surgical planning.

For excellent patient education resources, see eMedicineHealth’s patient education article CT Scan.

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