Sagittal computerized tomography reconstruction of the lateral nasal wall for functional endoscopic sinus surgery

Abstract

Coronal computerized tomography (CT) scanning is imperative in the preoperative work-up for functional endoscopic sinus surgery (FESS). This study describes additional information provided by lateral CT reconstruction with special attention to the (naso-) frontal recess. Thin axial scans were taken from 10 patients suffering from chronic rhinosinusitis. This procedure avoided artefacts from dental fillings on the computerized reconstructions. The common landmarks of the lateral nasal wall as described in the surgical anatomy of FESS were easily identified on sagittal views. The average angulation of the sagittal plane from the midline required to obtain optimal images of the frontal recess was antero-posteriorly 8.7 degrees (SD, 2.4), cranio-caudally 7.7 degrees (SD, 2.6). Size and condition of the frontal recess could be demonstrated. Variations of the angle between frontal sinus and ethmoid infundibulum appeared to depend on the anterior projection of the frontal sinus and may give an indication as to the optimal endoscopic angle for visualization of the frontal ostium. Sagittal reconstructions provide information for better spatial orientation particularly in the plane of the surgical approach and may help to diagnose underlying functional changes of chronic frontal sinusitis.

Anatomical variation of the nasal septum: Correlation among septal components

“…Sagittal images permit more accurate measurements and can enable examination of the anatomy of living human subjects (Hilger et al, 1999). To date, no studies have examined the anatomy of the nasal septum using sagittal CT images.…”

Osteomyelitis Presenting as Swollen Elbow in A Child: A Case Report

“…Moreover, Hilger et al (15) evaluated ten sagittal reconstructed thin CT cuts and documented the various changes of the angle between the frontal sinus and the ethmoid infundibulum, it appeared to be dependent on the frontal sinus' anterior projection and give an indicator of what angle is needed to view its frontal ostium, according to the authors. When the "front-nasalangle" is smaller, a more angled endoscope is required to see the frontal sinus ostium.…”

Gedanken zum Stellenwert der Computertomographie bei chronischer Rhinosinusitis

“…Ferner sollte neben der Möglichkeit einer koronaren oder axialen Sekundärrekonstruktion aus dem primären Datensatz auch die Chance einer sagittalen Rekonstruktion zur besseren Darstellung des Stirnhöhlenzugangs beachtet werden [13]. Auf eine zur Abbildung der Zellstrukturen im Stirnhöhlenzugang vorgeschlagene primäre sagittale CT-Untersuchung [16] kann in Anbetracht der zusätzlichen Strahlenbelastung bei Möglichkeit einer ausreichenden Rekonstruktion aus dem primären Datensatz verzichtet werden.…”