CBCT in sinonasal imaging

- morphology, diagnostic capability, tracks of ENT surgeryDirk Schulze, Freiburg, DE

3rd World NewTom Day07-21-2006, Verona, IT

Osteomeatal complex most important structure

Communication centre between all sinuses (“heavy traffic“)

Obstruction or swelling of the OC leads to consecutive retained secretion and sinusitis

Sinusitis can descend and ascend via the OC

Anatomy

Anomaly

Aplasia – frontal and sphenoidal sinus more frequent

Hypoplasia – relatively common

Hyperplasia – maxillary and frontal sinus, sphenoidal sinus can stretch along the optic canal

Sinusitis

Rhinogenic or odontogenic

Thickening of the mucosa

Fluid level (acute)

Pillow-like swelling, complete or partial, mostly with central ventilation (chronic)

Cysts

Odontogenic, mucosal retention or pseudocysts

Round shaped, homogenous, all walls can be affected

Calcification, air trapping (perforation)

Differentiation from polyposis may be difficult

Mucocele

Ventilation problem (OC)

Sinus completely filled

Expansion, bone destruction

Differentiation from malign neoplasm may be difficult

Teeth (or parts of )

Dislocated teeth, roots, germs

Extraction wound, empty pocket

Fluid level (blood)

Mucosa swelling - sinusitis

Foreign bodies

Dislocated fillings, implants, root fillings, impression material ...

Associated tooth or mouth-antrum-connection

Mucosa swelling – sinusitis, especially associated with root fillings (fungal infection!)

Surgery CMF or ENT surgery

Bone augmentation

Mucosa displaced by scars, scars contract, bone distraction

Widening of physiologic apertures, additional apertures; re-entry mechanism

Chronic sinusitis after sinus surgery (CALDWELL-LUC procedure)

dirk.schulze@uniklinik-freiburg.de

Thank you!