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Radiology > Paranasal Sinus Diseases > Flashcards

Paranasal Sinus Diseases Flashcards

1
Q

Overview of the intrinsic diseases of the paranasal sinuses

A
  1. inflammatory disease
  2. neoplasms
  3. benign
  4. malignant
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2
Q

Overview of the Extrinsic diseases of the paranasal sinuses

A
  1. inflammatory diseases
  2. benign odontogenic cysts and neoplasms
  3. bone dysplasias
  4. dental structures displaced into the sinuses
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3
Q

Maxillary sinus
-Gestational development

  • Clinically significant size achieved
  • development completed
A
  • Gestational development
  • 2 months
  • Clinically significant size achieved
  • birth
  • development completed
  • 12 years
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4
Q

Ethmoid Sinus
-Gestational development

  • Clinically significant size achieved
  • development completed
A
  • Gestational development
  • 3 months
  • Clinically significant size achieved
  • birth
  • development completed
  • 12 years
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5
Q

Frontal Sinus
Gestational development

  • Clinically significant size achieved
  • development completed
A
  • Gestational development
  • 4 months
  • Clinically significant size achieved
  • 3 years
  • development completed
    18-20 years
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6
Q

Sphenoid Sinus
-Gestational development

  • Clinically significant size achieved
  • development completed
A
  • Gestational development
  • 3 months
  • Clinically significant size achieved
  • 8 years
  • development completed
    12-15 years
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7
Q

ostiomeatal complex (OMC) is composed of which 5 structures?

A
  1. mazillary ostium
  2. infundibulum
  3. ethmoid bulla
  4. uncinate process
  5. hiatus semilunars
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8
Q

ostiomeatal complex (OMC)

A

AKA ostiomeatal unit

a COMMON CHANNEL that links the frontal sinus, anterior ethmoid air cells and the maxillary sinus to the middle meatus, allowing airflow and mucociliary drainage

representing the integrity of the middle meatus

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9
Q

drainage pathway for max sinus

A

middle meatus through hiatus semilunairs

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10
Q

drainage pathway for sphenoid sinus

A

sphenoethmoidal recess

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11
Q

drainage pathway for frontal sinus

A

middle meatus via infundibulum

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12
Q

drainage pathway for anterior ethmoidal group

A

middle meatus via infundibulum

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13
Q

drainage pathway for middle ethmoidal group

A

middle meatus / bulla ethmoidalis

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14
Q

drainage pathway for posterior ethmoidal group

A

superior meatus

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15
Q

effect on appearance of max sinus if no teeth present in the alveolar bone above?

A

may look like the floor of the max sinus is dropping down / dropping below

due to resoprtion of bone and lack of teeth in the bone

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16
Q

mucositis definition?
appearance?
treatment?

A

LOCALIZED thickened sinus mucosa
- so it will stop on its own (no treatment usually)

radiographically - can appear more hazy and a thickened outline
- but 1-2 mm thickened lining is considered normal

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17
Q

definition of sinusitis?

disease process

A

GENERALIZED inflammatory condition of the sinus mucosa caused by an allergen, bacteria, or a virus

inflammation –> ciliary dysfunction –> retention of sinus secretion –> ostiomeatal complex

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18
Q

pansinusitis definiton

A

sinusitis affecting ALL the paranasal sinuses

if see this in young children - think of other things too because not normal

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19
Q

major affect of sinusitis and implication

A

you get dysfunction in the cilia – so retention of sinus secretion resulting in affecting the ostiomeatal complex

20
Q

acute sinusitis

A

present for 4 weeks or less, causes pain, tenderness to pressure or swelling

21
Q

chronic sinusitis

A

present for more than 12 consecutive weeks

where we can start to see changes in the bone

22
Q

sub-acute sinusitis

A

4 weels up to 12 weeks

23
Q

tx for sinusitis depends mostly on?

A

whether or not it is affecting the osteomeatal complex

  • just soft tissue lining affected - not much to do
24
Q

retention cyst define

A

BENIGN LESION usually discovered incidentally on a plain sinus radiograph or cross-sectional imaging of the head

25
Q

do retention cyst cause symptoms?

implication?

A

Not usually
- so usually discovered incidentally clinically becuase they are slow gorwing

and usually require no treatment

26
Q

retention cyst radiogrphic features

usual location?

A

mucosal and cortical integrity is preserved

it will appear more radio-opaque, DOME-SHAPED structures with a ROUNDED edge, located on the FLOOR OF MAX SINUS

27
Q

retention cyst differential diagnosis

A

sinonasal polyp

paranasal sinus mucocoele

28
Q

paranasal sinus mucocele

A

complete ossification of one or more paranasal sinuses by mucus, often associated with bony expansion due to obstruction of the nasal sinus drainage

29
Q

paranasal sinus mucocele most common location

A

ethmoid and frontal sinus

30
Q

paranasal sinus mucocele apppearance on plain film? on CT or MRI?

A

film– appears as opacified

CT or MRI –> have hyperattenuating or near water intensity signal

31
Q

paranasal sinus mucocele displace surrounding structure? treatment?

A

yes

most of time are surgicially removed

32
Q

osteomas found when?

A

HYPER-dense strucutres seen within the sinus

found in patients undergoing imaging of the sinuses, appearing in 3% of CT examinaitons of the paranasal sinuses

frequent in 20-50 year olds

33
Q

osteoma radiographic appearance

A

HYPER-dense and WELL-CIRCUMSCRIBED mass

usually uniformly dense and mature ones will resemble ‘normal’ bone with marrow space sometimes visible

34
Q

osteomas clinical presentation

A

asymptomatic snd incidental findings

35
Q

osteomas found where

A

frontal - 80%
ethmoid air cells 15%
maxillary sinus 5%
sphenoid - rare (2%)

seen elswhere in the head and neck - particularly the mandible

36
Q

osteomas assoicated with?

A

Gardernes syndrome and abouot 30% of patients have a history of rhinosinusitis

male predilection

37
Q

antroliths

A

radio-opqaue foreign body or tissue debris (becomes like trapped) usually in the max sinus

do not need to treat and usualy incidental findings and asymptomatic
(unless cause too much irritation and inflammation)

38
Q

maxillary antral carcinomas
describe
present when? why?

A

uncommon/ rare head and neck MALIGNANCY

present LATE despite growing large since they remain confined to maxillary sinus and produce no symptoms

39
Q

maxillary antral carcinomas epidemiology

A

over 45 years old and hs a strong male predilection (5:1) and more common in Africa and Asia than Europe or North America

40
Q

maxillary antral carcinomas clinical presentation

A

UNILATERAL stifdness and obstruction, blood tinged nasal discharge, proptosis, diplopia, pain resembling tooth ache, enlargement and ulceration

41
Q

maxillary antral carcinomas types?

A

squamous cell carcinoma (80%) o adenoid cystic carcinoma (10%) - more lymph origin

42
Q

maxillary antral carcinomas radiographic features

A

irregular radio-opacity within the sinus, can erode the sinus wall

loss of cortical outline in the maxillary sinus

43
Q

maxillary antral carcinomas tx and prognoisis?

A

surgery followed by radiation therapy

  • poor prognosis (due to seeing it late)
  • 5 year survival of about 10%
44
Q

two major things discussed in extrinsic diseases involving the paranasal sinuses

A

inflammatory lesions (like peri-apical abscess)

AND
dental structures displaced into the sinuses (like tooth / implant)

45
Q

peri-apical lesion and sinus relation?

A

keep in mind if it has close proximity

it may or may not displace the outline of the sinus

46
Q

T/F a peri-apical lesion can change the sinus floor?

A

TRUE
- it may or may not but it can displace it and may see a hazy mucosal outline into the sinus area

note the pdl and lamina dura of the associated tooth - as it can leach into the sinus

*note furcation involvment or not – can displace the sinus and it can be pushed

47
Q

how to tell if it is a tooth or not that has been displaced into the sinus?

A

look for PDL or lamina dura surounding the fragment

Radiology (26 decks)

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