Nose and sinonasal cavities

Question 1

Paranasal sinus developpment

Answer 1

Ethmoid: developed and pneumatized at birth, anterior drainage to ethmoid bulla into hiatus semilunaris in middle meatus. Posterior to superior meatus within the sphenoethmoidal recess
Maxillar: small and pneumatized at birth, adult size at 18yo
Sphenoid: pneumatization in AP direction, starting at 2yo. Complet pneumatization at 10 yo. If lack of pneumatization, should be investigated
Frontal: absent at birth, pneumatization 6-8 yo

Question 2

Ethmoidal variants

Answer 2

Concha bullosa: pneumoatization of the middle turbinate
Agger nasi: inferior anterior cells inot inferomedial floor of the orbit
Onodi: posterior sphenoethmoid with prominent superolateral pneumatization (related to optic nerve canal)

Question 3

Benign sphenoid marrow variants

Answer 3

early fat marrow converstion followed by pneumatization

Question 4

Choanal atresia

Answer 4

Most common congenital abnormality of the nasal cavity
obstruction of the posterior opening, mixed bone-membrane or bony only (30%)
more in girls
can be bilateral, and when bilateral, more associated to other congenital abnormalities like CHARGE
Narrowing of posterior choana 0.34 cm in less than 2 yo
enlargement of vomer to more than 0.23 cm

Question 5

Nasal Pyriform aperture stenosis

Answer 5

bony overgrowth of nasal process of the maxilla
less than 11 mm, bilateral
associations: mega-incisor, holoprosencephaly, hypopituitarism, hypotelorism, cleft palate, clinodactily, absent olfatory bulbs

Question 6

Congenital nasolacrimal duct mucocele

Answer 6

dacryocystocele
dilated nasolacrimal duct with os expansion
intranasal mass (mucocele) below the inferior turbinate

Question 7

Anterior cephalocele

Answer 7

• Basal (10%): transethmoidal, sphenoethmoidal, shpenopharyngeal. Occult and can include pituitary, optic nerves, vascular structures.
• Frontoethmoidal: frontonasal (50%), nasoethmoidal (30%), nasoorbital. External mass contiguos to brain trough bony defect
• Nasopharyngeal

Question 8

temporary fontanelle closure defect (fonticulus nasofrontalis, future frontonasal suture)

Answer 8

Nasal dermal sinus cyst, tract or fistula with or without dermoid/epidermoid cyst
Nasal neuroglial heterotopia

Question 9

Nasal neuroglial heterotopia

Answer 9

anterior neuropore anomaly
sequestered dysplastic, nonneoplastic neurogenic brain tissue that is not connected to the subarachnoid space, but can have fibrous stalk
Midline intranasal 30%
extranasal 60%

Question 10

Cysts

Answer 10

Nasolabial cyst: along anterior maxilla, can have bone remodeling
Tornwald cyst: nasopharyngeal cyst with respiratory epithelium
Adenoid mucous retention cysts: eccentrally wuthin adenoid

Question 11

Polyps

Answer 11

Sinonasal polyposis: rhinosynusitis, asthma (samter triad: polyps in association with allergic asthma, an aspirin allergy, and aggressive polyposis). Common in CF (associated with pseudomonas)
solitary nasal polyp: rare, only nose
antrochoanal polyp: from the maxillary sinus, fills the sinus, and prolapses through the maxillary ostium to result in its characteristic dumbbell shape . DIrected to the choana. Bilateral in 20%

Question 12

Nasal piogenic granuloma

Answer 12

Benign vascular tumor, usually 1-2 cm
recurrent epistaxis, nasal obstruction, rhinorrhea,
and pain
intense enhancement

Question 13

Fungal rhinosinusitis

Answer 13

• Acute fungal rhinosinusitis: expansive without calcifications
• Micetoma: comblement hyperdens without erosion. Hypo T1 an T2
• Acute invasive fulminant disease: extension in immunuosupressed patients, mucormicosis
• Chronic invasive fungitis: more than 12 weeks, hypo T2 and hyperdense

Question 14

Mucocele

Answer 14

frontal 60%

ethmoidal 30%

Question 15

Juvenile Nasopharyngeal Angiofibroma

Answer 15

highly vascular benign neoplasm from sphenopalatine foramen
an 8-25 yo
local aggressive and invasive behavior
adolescent boys, associated with FAP (25x)
enhancement and flow voids
anterior bowing of the posterior wall of the maxillary antrum (Holman-Miller sign)

Question 16

Nasal Pleomorphic Adenoma

Answer 16

most common benign salivary gland tumor (mainly parotid)

can happen at the nose

Question 17

Malignancy

Answer 17

Bone: GCT, ABC
Fibro-oseus: fibrous dysplasia, ossifying fibroma
Rhabdomyosarcoma
Leukemia and lymphoma
Nasopharyngeal carcinoma: less thn 1% of malignant pediatric tumors, EBV
Metastasis: Neuroblastoma
Esthesioneuroblastoma
intermediate T2 with dark fibrous bands