Pre operative

radiological
check list in FESS
BY :Rabab Mahmoud
Emad Bawady
Under supervision of Prof.Dr:Ayman
El-medany

Pre operative radiological check list in FESS

CT is important in evaluation of chronic sinusitis and in paranasal sinus anatomy

.preoperatively
.Most sinus CT evaluation includes axial and coronal views
CT should be done after chronic rhinosinusitis based on history and physical finding
and after being treated with medical treatment for at least 2-4 weeks with persistent
.inflammation
When evaluating a CT scan in a preoperative FESS patient several issues must be
.addressed
1. Is the uncinate process opposed to the medial orbital wall (an atelectatic
infundibulum)?
If so its vigorous removal may result in orbital penetration.
2. Are there areas of dehiscence in the lamina papyracea or do the orbital
content protrude into the ethmoid sinus?
May lead to unintentional orbital entry because orbital hematoma the most
common orbital complication of FESS
3. Is the internal os of the frontal sinus occluded with bone?
Bony diseases of the frontal sinus typically precludes an endoscopic approach
4. Are there areas of dehiscence in the ciribriform plates that may lead to
production of a dural tear and a CSF leak?
5. Are the bony walls between the sphenoid sinus, the posterior ethmoid sinus,
and the optic nerve intact?
It has been shown that in four percent of the patient there is no bony border
between the optic nerve and the sphenoid sinus and in 78-88%of patient the
bony thickness is less than 0.5mm .The posterior ethmoid air cells contact the
optic canal in 48% and may have a very thin bony border
Optic nerve transection during sphenoethmoidectomy may be due to dehiscence
of the sphenoid wall
6. If an onodi cell extends far lateral to the lateral wall of the sphenoid sinus the
surgeon must be close to the midline as he perforate into the sphenoid sinus
otherwise orbital entry may occur .The angel at which the sphenoid sinus
should be entered based on the superior and inferior relationship of the onodi
cell and sphenoid sinus

7. In 8-14% there is no bone between I.C.A. and sphenoid sinus .An intersinus
septum in the sphenoid sinus that attaches to the carotid canal is important to
recognize preoperatively in the axial view
8. The height of the ethmoid roof in relationship to the ciribriform plate ,normally
the ciribriform plate is lower than the ethmoidal roof , and therefore the
surgeon can dissect more superiorly if he proceeds laterally along the ethmoid
roof during his ethmoidectomy variations may be present as low fovea
ethmoidalis
9. The presence of middle turbinate pneumatization(concha bullosa),paradoxical
turbinate ,Hallers cells ,and uncinate pneumatization were not shown to have
a significantly higher rate in patient with sinusitis than others with no sinus
symptoms
It appears that the size not the presence of these normal variations is the critical
factor
10. Ostiomeatal complex opacifications correlate with the development of sinusitis
The cause of the blockage can be determined by the presence of thickened
mucosa, polyp, or anatomic abnormalities

11. The presence of nasal septal deviations may predispose to recurrent sinusitis
NB: if there is bony dehiscence or erosion MRI must be done particularly if intra
cranial invasion is suspected.
MRI is also important in evaluating areas of dehiscence in the skull base for
.possible encephaloceles and differentiating tumor from fluid inside the sinus