Paranasal Sinus Diseases

Question 1

Overview of the intrinsic diseases of the paranasal sinuses

Answer 1

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

Question 2

Overview of the Extrinsic diseases of the paranasal sinuses

Answer 2

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

Question 3

Maxillary sinus
-Gestational development

• Clinically significant size achieved
• development completed

Answer 3

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

Question 4

Ethmoid Sinus
-Gestational development

• Clinically significant size achieved
• development completed

Answer 4

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

Question 5

Frontal Sinus
Gestational development

• Clinically significant size achieved
• development completed

Answer 5

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

Question 6

Sphenoid Sinus
-Gestational development

• Clinically significant size achieved
• development completed

Answer 6

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

Question 7

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

Answer 7

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

Question 8

ostiomeatal complex (OMC)

Answer 8

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

Question 9

drainage pathway for max sinus

Answer 9

middle meatus through hiatus semilunairs

Question 10

drainage pathway for sphenoid sinus

Answer 10

sphenoethmoidal recess

Question 11

drainage pathway for frontal sinus

Answer 11

middle meatus via infundibulum

Question 12

drainage pathway for anterior ethmoidal group

Answer 12

middle meatus via infundibulum

Question 13

drainage pathway for middle ethmoidal group

Answer 13

middle meatus / bulla ethmoidalis

Question 14

drainage pathway for posterior ethmoidal group

Answer 14

superior meatus

Question 15

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

Answer 15

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

Question 16

mucositis definition?
appearance?
treatment?

Answer 16

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

Question 17

definition of sinusitis?

disease process

Answer 17

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

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

Question 18

pansinusitis definiton

Answer 18

sinusitis affecting ALL the paranasal sinuses

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

Question 19

major affect of sinusitis and implication

Answer 19

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

Question 20

acute sinusitis

Answer 20

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

Question 21

chronic sinusitis

Answer 21

present for more than 12 consecutive weeks

where we can start to see changes in the bone

Question 22

sub-acute sinusitis

Answer 22

4 weels up to 12 weeks

Question 23

tx for sinusitis depends mostly on?

Answer 23

whether or not it is affecting the osteomeatal complex

• just soft tissue lining affected - not much to do

Question 24

retention cyst define

Answer 24

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

Question 25

do retention cyst cause symptoms? | implication?

Answer 25

Not usually - so usually discovered incidentally clinically becuase they are slow gorwing and usually require no treatment

Question 26

retention cyst radiogrphic features | usual location?

Answer 26

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

Question 27

retention cyst differential diagnosis

Answer 27

sinonasal polyp paranasal sinus mucocoele

Question 28

paranasal sinus mucocele

Answer 28

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

Question 29

paranasal sinus mucocele most common location

Answer 29

ethmoid and frontal sinus

Question 30

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

Answer 30

film-- appears as opacified CT or MRI --> have hyperattenuating or near water intensity signal

Question 31

paranasal sinus mucocele displace surrounding structure? treatment?

Answer 31

yes most of time are surgicially removed

Question 32

osteomas found when?

Answer 32

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

Question 33

osteoma radiographic appearance

Answer 33

HYPER-dense and WELL-CIRCUMSCRIBED mass usually uniformly dense and mature ones will resemble 'normal' bone with marrow space sometimes visible

Question 34

osteomas clinical presentation

Answer 34

asymptomatic snd incidental findings

Question 35

osteomas found where

Answer 35

frontal - 80% ethmoid air cells 15% maxillary sinus 5% sphenoid - rare (2%) seen elswhere in the head and neck - particularly the mandible

Question 36

osteomas assoicated with?

Answer 36

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

Question 37

antroliths

Answer 37

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)

Question 38

maxillary antral carcinomas describe present when? why?

Answer 38

uncommon/ rare head and neck MALIGNANCY | present LATE despite growing large since they remain confined to maxillary sinus and produce no symptoms

Question 39

maxillary antral carcinomas epidemiology

Answer 39

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

Question 40

maxillary antral carcinomas clinical presentation

Answer 40

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

Question 41

maxillary antral carcinomas types?

Answer 41

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

Question 42

maxillary antral carcinomas radiographic features

Answer 42

irregular radio-opacity within the sinus, can erode the sinus wall loss of cortical outline in the maxillary sinus

Question 43

maxillary antral carcinomas tx and prognoisis?

Answer 43

surgery followed by radiation therapy - poor prognosis (due to seeing it late) - 5 year survival of about 10%

Question 44

two major things discussed in extrinsic diseases involving the paranasal sinuses

Answer 44

inflammatory lesions (like peri-apical abscess) AND dental structures displaced into the sinuses (like tooth / implant)

Question 45

peri-apical lesion and sinus relation?

Answer 45

keep in mind if it has close proximity it may or may not displace the outline of the sinus

Question 46

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

Answer 46

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

Question 47

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

Answer 47

look for PDL or lamina dura surounding the fragment