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Foreword
Nose and Paranasal sinuses constitute one of the fundamental aspects of
radiology of the Head and Neck, holding great importance for both practicing
radiologists and surgeons due to the diverse clinical implications and
behavior of lesions in this region. In addition, from a surgical point of view,
this region has wide variation in anatomy, knowledge of which is essential
prior to exploration in this area to avoid complications and therapeutic
failure. Multiplanar imaging has revolutionized evaluation of this region and
allows us far deeper understanding than was previously possible.
It is not unusual to nd chronic complaints among patients with
seemingly straightforward diagnosis, and this book addresses multiple
such imaging dilemma, while giving a perspective on prognostication and
management of described lesions, the so called ‘way forward’.
is book has combined input from an expert team of dedicated
radiologists from the All India Institute of Medical Sciences, along with Head
and Neck surgeons and pathologists to give a truly multidisciplinary overview
of the subject.
Lucid illustrations covering anatomical details complemented by
succinct bulleted text make it immensely user-friendly and readable.
Detailed description of pathology with a wide range of illustrative cases make
it a comprehensive guide useful to all. In addition, a structured reporting
format has been provided which is a must for the current generation due to
the advent of functional endoscopic sinus surgery (FESS).
is book will serve as the ‘one-stop’ for residents and postgraduates
of Radiology as well as Otorhinolaryngology, with its unique format and
extensive coverage. In addition, it promises to benet both practicing
radiologists and clinicians, providing an overview of all aspects of sinus
disease.
Niranjan Khandelwal MD Dip NBE FICR FAMS
Professor and Head
Department of Radiodiagnosis and Imaging
Postgraduate Institute of Medical Education and Research
Chandigarh, India
Preface
In clinical practice, it is not uncommon to nd ‘sinus’ equated to ‘sinusitis’,
an omniscient complaint responsible for much chronic morbidity among
its victims. e paranasal sinuses are a group of complex structures with
challenging anatomy, further showing diverse anatomical variation. A
thorough knowledge of these variations and pathology aecting this region
is therefore necessary, as subtle ndings may sometimes confound even a
trained eye.
All diseases of the paranasal sinuses are not sinusitis, and dierentiation
between what is benign vs more sinister disease is essential for optimal
management and protection of adjacent critical structures—orbit and skull
base.
Otorhinolaryngology and Head & Neck surgery is a rapidly expanding
specialty which relies heavily on imaging. erefore, radiologists practicing
Head and Neck radiology need to adopt a systematic approach in reporting
in order to provide a structured and comprehensive report to the surgeon.
Likewise, especially in the era of endoscopic surgery, attention to detail is a
must for surgeons in order to successfully negotiate the complex labyrinths
of bony anatomy. For this purpose, this book contains a separate dedicated
chapter on Functional Endoscopic Sinus Surgery (FESS) imaging.
is book is not intended to be a detailed text on sinus imaging but
we hope that it will help the busy radiologists and surgeons in interpreting
images of the paranasal sinuses. e variety of illustrative cases and proposed
structured reporting format are aimed at this.
We welcome any feedback on enhancing the content of the book, which
can be incorporated in the subsequent editions.
Ashu Seith Bhalla
Manisha Jana
Acknowledgments
We wish to thank all the contributors for their eorts in compiling this
text. We sincerely thank Prof Suresh C Sharma for guiding us in this new
endeavor. We are especially thankful to our Radiology colleagues without the
help of whom this eort would not have been possible. We are also grateful to
our colleagues from the Department of Otorhinolaryngology and Pathology
for their contributions.
We would also like to extend our appreciation to Shri Jitendar P Vij (Group
Chairman), Mr Ankit Vij (Group President), Ms Chetna Malhotra Vohra
(Associate Director–Content Strategy), Mr Subrata Adhikary (Commissioning
Editor), Ms Ritika Chandna (Development Editor), Mr Shakil (Proofreader)
and all the sta of M/s Jaypee Brothers Medical Publishers, New Delhi, India,
for their eorts and input enabling timely publication of the book.
Contents
SECTION 1: NORMAL ANATOMY AND IMAGING
1. Imaging Modalities and Techniques 3
Devasenathipathy Kandasamy, Chandrashekhara SH
2. Sinonasal Anatomy: Structure-wise 14
Jyoti Kumar, Ashu Seith Bhalla, Manisha Jana
3. Sinonasal Anatomy: Section-wise 41
Jyoti Kumar
SECTION 2: INFLAMMATORY NASAL CONDITIONS
4. Imaging in Rhinosinusitis (Inammatory Diseases) 57
Ashu Seith Bhalla, Smita Manchanda
5. Imaging in Polyps and Mucoceles 77
Smita Manchanda, Ashu Seith Bhalla
6. Chronic Rhinosinusitis: Clinical Aspects 94
Arvind Kumar Kairo, Hitesh Verma
7. Imaging in Fungal Sinusitis 99
Ashu Seith Bhalla, Smita Manchanda
8. Fungal Diseases of Nose and Paranasal Sinuses:
Surgical Aspects 113
Suresh C Sharma, Kapil Sikka
9. Pre- and Post-Functional Endoscopic Sinus Surgery Imaging 118
Ankur Goyal, Ashu Seith Bhalla, Arvind Kumar Kairo
SECTION 3: TUMOR AND TUMORLIKE CONDITIONS
10. Pathology of Sinonasal Lesions 137
Deepali Jain
11. Pathology of Bony/Cartilaginous Sinonasal Tumors 150
Asit R Mridha, Adarsh W Barwad
Clinico Radiological Series: Sinonasal Imagingxviii
12. Benign Tumors of the Nose and Paranasal Sinuses: Imaging 160
Smita Manchanda, Ashu Seith Bhalla
13. Benign Sinonasal Tumors: Surgical Perspective 182
Chirom Amit Singh, Suresh C Sharma
14. Malignant Tumors of Sinonasal Cavities: Imaging 188
Mukesh Yadav, Devasenathipathy Kandasamy
15. Malignant Tumors of Nose and Paranasal Sinuses:
Surgical Perspective 201
Rajeev Kumar, Hitesh Verma
16. Radiation and Chemotherapy in Management of
Malignant Sinonasal Tumors 209
Dodul Mondal
SECTION 4: TRAUMA
17. Imaging in Sinonasal Trauma 219
Manisha Jana, Ashu Seith Bhalla
18. Imaging of Cerebrospinal Fluid Leaks 236
Atin Kumar, Ajay Garg
19. Sinonasal Trauma and Cerebrospinal
Fluid Rhinorrhea: Surgical Aspects 249
Kapil Sikka, Alok Thakkar
SECTION 5: CONGENITAL/PEDIATRIC DISEASES
20. Pediatric Sinonasal Disorders: Imaging 257
Priyanka Naranje
21. Pediatric Sinonasal Disorders: Surgical Perspective 290
Prem Sagar, Shuchita Singh
SECTION 6: SYSTEMIC DISORDERS/SURROUNDING
STRUCTURES INVOLVING PNS
22. Systemic Disorders Aecting Sinonasal Cavity 301
Surabhi Vyas, Ashu Seith Bhalla
23. Anterior Skull Base Lesions: Imaging 316
Ajay Garg, Anuj Prabhakar
24. Imaging of Dental Lesions and Sinonasal Cavity 332
Smita Manchanda, Ashu Seith Bhalla
25. Imaging of Disorders Involving Sinonasal Cavity and Orbit 348
Ashu Seith Bhalla, Smita Manchanda
SECTION 7: CLINICORADIOLOGICAL APPROACH
26. Approach to Nasal Obstruction 361
Rakesh Kumar, Ashu Seith Bhalla, Manisha Jana
27. Approach to Epistaxis 382
David Victor Kumar Irugu, Manisha Jana, Ashu Seith Bhalla
28. Imaging Approach to Sinus Lesions 392
Smita Manchanda, Ashu Seith Bhalla
Index 417
xixContents
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