anatomi based on CT scan sinus paranasal imaging

anatomi based on CT scan sinus paranasal imaging

1. Anatomy of Paranasal Sinuses Based on CT-San Imaging

2. -Identity of patient - Had marker (left or right sight) - Bone setting SPN CT Had 3 slice orientation: coronal, sagittal & axial Slice thickness was 3 mm Window width 1500-2500 Window level 250-300 How to choose the best paranasal sinus CT-Scan for assessment??

3. Landmark Division of the Paranasal Sinus 1 2a 2b 3 4

4. Landmark clue: Frontal beak 1 st Division: Frontal Sinus Area

5. Divided into 2 area: (2a) Frontal recess area: responsible for frontal sinus drainage (2b) Ethmoid anterior area 2 nd Division: Ethmoid Anterior What is Frontal recess?? T he most anterosuperior part of the ethmoid, inferior to the frontal sinus opening Posteriorly by the anterior wall of ethmoid bulla, anteroinferior agger nasi, laterally by lamina papiracea , inferiorly by teriminal recess

6. Landmark clue: No frontal beak Nasolacrimal duct Septal tubercle No middle turbinate No maxillary sinus 2 a Area: Frontal Recess

7. Landmark Clue: Superior attachment of basal lamella middle turbinate to skull base Other Clue: -maxillary sinus Crista Galli Meatus inferior well establish 2b Division: Ethmoid Anterior

8. Ethmoid bula : largest anterior ethmoid cell. Anterior face of the bulla forms the posterior border of the inferior semilunar hiatus, ethmoidal infundibulum and frontal recess Ager nasi cells: the most anterior part of the ethmoid. Part division of frontal recess. L arge agger nasi cell may narrow the frontal recess posteriorly and/or laterally Ethmoid Anterior Air Cells

9. Landmark Clue: Horizontal attachment basal lamella of middle turbinate to lateral wall Other Clue: Superior turbinate Down slope lamina papiracea 3 rd Division: Ethmoid Posterior

10. 4 th Division: Sphenoid sinus Landmark Clue: Roof of choana Posterior part of nasal septum Small posterior part of inferior turbinate

11. functional unit & physiological concept comprising the clefts & drainage pathways of the middle meatus together with the anterior ethmoid complex, frontal and suprabullar recesses, & ethmoidal infundibulum Osteo-Meatal Complex Consist of: Ethmoid infundibulum, semilunar hiatus, ethmoid bulla, uncinate process, frontonasal recess Function: Mucus drainage & airflow from the maxillary sinus, anterior ethmoid air cells, and frontal sinus into the middle nasal concha.

12. Uncinate Process: thin, sickleshaped structure which is part of the ethmoid bone and runs almost in the sagittal plane from anterosuperior to posteroinferior Ethmoid infundibulum: three-dimensional space in the ethmoidal labyrinth of the lateral nasal wall. Anterior border of bula . opening into the middle meatus via the inferior semilunar hiatus semilunar hiatus ( superior&inferior ): crescent-shaped cleft between the concave posterior free edge of the uncinate process and the convex anterior face of the ethmoidal bulla, forming the entrance to the ethmoidal infundibulum Terminology Maxillary Hiatus: anatomical term referring to a large natural opening in the medial wall of the disarticulated maxillary bone

13. OMC MT up EB IT

14. Anatomical variations that may increase the risk of OMC narrowing Uncinate process attachment: Divided into 3 category Attachment to lamina papiracea (A) Attachment to skull base (B) Attachment to middle turbinate (C) Attachment to lamina papiracea: uncinate process deflection to lateral  create space called terminal recess. In this condition discharge drainage flow from fontal recess to medial UP Attachment to middle turbinate: this condition can obstruct the OMC and as the common etiology of CRS

15. Middle turbinate Anatomical variation in middle turbinate divided into: Bullous middle turbinate Paradoxical middle turbinate Bullous middle turbinate divided into: Lamellar type (pneumatization in lamella/neck of MT) Bulbous type (pneumatization in body/inferior part MT) Extensive type (pneumatization in lamella into body of MT

16. Middle turbinate Paradoxical middle turbinate: the concave side facing to the nasal septum, the convex side facing the lateral wall. This variation commonly happened in bilateral side.

17. Deviated nasal septum The nasal septum formed by cartilaginous and osseus. Cartilaginous part was formed by quadrangularis lamina & columella Osseus part was formed by: perpendicular lamina of os etmoid , vomer, nasal crist of os maxilla, & nasal crist of os palatina Nasal septal deviated can be form of c-shaper or s-shape. If the deviation angle contact with inferior or middle turbinate risk factor CRS.

18. Deviated nasal septum

19. Haller cell (infraorbital ethmoid cells): ethmoid aircells located anteriorly to ethmoid bulla, along the orbital floor, adjacents to the natural ostium of maxillary sinus obstruction of OMC Ethmoid Anterior variation

20. IFAC (International Frontal Sinus Anatomy Classification

21. Ethmoid & Sphenoid Bone variation Ethmoid Anterior Cells: Agger Nasi Cells (ANC), Supra Agger Cells (SAC), Supra Agger Frontal Cells (SAFC) Ethmoid Bula (EB), Supra bula cells (SBC), Suprabula Frontal Cells (SBFC) Supra Orbital ethmoid Cells (SOEC) Haller Cells Ethmoid Posterior: Sphenoetmoid cells ( Onodi Cells), ethmomaxillary sinus (EMS), Retroantral Pneumatization of Posterior ethmoid cells (RP.PE/RAEC) Sphenoid: pneumatization ( conchal , pre- sellar , sellar , post- sellar ), latelar sphenoid recess (LSR)/Lateral pterygoid pneumatization, Intersinus septum, Optic nerve classification (Delano), anterior clinoid process (related to dehiscence internal carotid artery)

22. IFAC (International Frontal Sinus Anatomy Classification

23. Anterior cells pushed frontal drainage pathway Agger Nasi Cells

24. Supra Agger Nasi Cells (SAC) Anterior cells pushed frontal drainage pathway

25. Supra Agger Frontal Cells (SAFC) Anterior cells pushed frontal drainage pathway

26. Supra Agger Frontal Cells (SAFC) Anterior cells pushed frontal drainage pathway

27. Posterior Cells pushed the drainage pathway anteriorly Supra Bula Cells (SBC)

28. Supra Bula Frontal Cells (SBFC) Posterior Cells pushed the drainage pathway anteriorly

29. Supraorbita Ethmoid Cells (SOEC) Posterior Cells pushed the drainage pathway anteriorly

30. Frontal Septal Cells (FSC) Medial Cells Pushes the medial wall lateraly

31. Frontal Anatomy Variation ( Tonah )

32. Frontal Anatomy Variation ( Tonah )

33. CLOSE MNEMONIC

34. Cribriform Plate (KEROS)

35. Cribriform Plate (KEROS) Classification of varying depth of the olfactory fossa. The depth of the olfactory fossa is determined by the height of the lateral lamella of the cribriform plate ,  which can be classified into three categories: type 1:  has a depth of 1-3 mm (26.3% of population) type 2:  has a depth of 4-7 mm (73.3% of population) type 3:  has a depth of 8-16 mm (0.5% of population)

36. Danger variation that can risk for lamina papiracea injury was lateral attachment of uncinate process to lamina papiracea & Haller Cells Lamina Papiracea

37. ON, optic nerve; ICA, the cavernous segment of internal carotid artery; FR, foramen rotundum and V2 nerve; VC, vidian canal. In hyperpneumatized sinus, when pneumatization extends laterally between foramen rotundum and vidian canal, creating a recess known as the lateral recess (asterisk). When pneumatization extends below the optic canal " between optic canal and internal carotid artery " resulted in infraoptic " opticocarotid " recess (IOR). CP, anterior clinoid process.  Sphenoid

38. Onodi Cells Sphenoethmoidal cells: variant of posterior ethmoid air cells that pneumatized extend to posterior sphenoid. Greatly risk for the optic nerve injury

39. (a) When the ethmoidal notch abuts the fovea ethmoidalis (arrow) or lateral lamella, it is considered protected. (b) With supraorbital pneumatization of the ethmoid sinus above the ethmoid notch (∗), the anterior ethmoidal artery is at risk for intraoperative injury. Ethmoid artery