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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4416_Библиотеки_им_академика_М_И_Перельмана
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3
CHAPTER
Sinonasal Anatomy:
Section-wise
Jyoti Kumar
• Introduction
• Consecutive Coronal Sections
INTRODUCTION
■ Coronal sections form the basic imaging plane for evaluating the
paranasal sinuses and nasal cavity
■ Similarly bone window is the most informative window setting
■ Axial and sagittal planes delineate some structures better (see Chapters
1 and 9)
■ is chapter depicts the sectional anatomy in all three planes through
sequential images
• Consecutive Axial Sections
• Consecutive Sagittal Sections
Section 1 Normal Anatomy and Imaging42
CONSECUTIVE CORONAL SECTIONS
Consecutive coronal sections from anterior to posterior are depicted in
Figures 3.1A to R. Coronal scans well depict the nasal turbinates and meati,
nasal septum, agger nasi (AN) cell, various sinuses, components of ostiomeatal unit and adjacent skull base.
Coronal Sections (Figs. 3.1A to F)
■ Most anteriorly, the nares, ala and cartilaginous septum (NS) can be
seen.
■ On successive scans, the nasal bones (NB) are visualized which are paired
bones and join together to form the root of the nose.
■ Parts of frontal (FS) and maxillary sinuses (MS) begin to be seen.
■ Agger nasi cell is seen as the anterior most anterior ethmoidal cell, which
is anterior to the vertical attachment of middle turbinate (MT).
Key
AE cells: Anterior ethmoid cells AN: Agger nasi cells
FS: Frontal sinus IT: Inferior turbinate
MS: Maxillary sinus MT: Middle turbinate
NLD: Nasolacrimal duct NB: Nasal bone
NS: Nasal septum
43Chapter 3 Sinonasal Anatomy: Section-wise
A
C
B
D
E
Figs. 3.1A to F: Consecutive coronal sections from anterior to posterior.
F
Section 1 Normal Anatomy and Imaging44
Coronal Sections (Figs. 3.1G to L)
■ Frontal sinus drainage pathway (FSDP) can then be seen just posterior to
the agger nasi cell.
■ Canal for inferior orbital nerve (ION) is seen running along the roof of
the maxillary sinus.
■ Components of osteomeatal unit (Fig. 3.1K) are then well visualized
namely—maxillary ostium (MO), ethmoidal infundibulum, uncinate
process, hiatus semilunaris and bulla ethmoidalis (BE).
■ Crista galli (CG) and medial (ML) and lateral lamella (LL) of cribriform
plate are seen as boundaries of olfactory fossa.
■ Oblique attachment of middle turbinate or basal lamella is seen just
posterior to bulla ethmoidalis.
■ Vertical attachment of middle turbinate (MT) can be seen to the anterior
skull base at the junction of medial (ML) and lateral lamella (LL) of
cribriform plate.
Key
AN: Agger nasi BE: Bullae ethmoidalis
CG: Crista galli FS: Frontal sinus
FSDP: Frontal sinus drainage pathway IM: Inferior meatus
ION: Inferior orbital nerve canal IT: Inferior turbinate
LL: Lateral lamella LP: Lamina papyracea
ML: Medial lamella MM: Middle meatus
MO: Maxillary ostium MT: Middle turbinate
OF: Olfactory fossa NS: Nasal septum
45Chapter 3 Sinonasal Anatomy: Section-wise
G
I
H
J
K
Figs. 3.1G to L: Consecutive coronal sections from anterior to posterior.
L
Section 1 Normal Anatomy and Imaging46
Coronal Sections (Figs. 3.1M to R)
■ Canal for anterior ethmoidal artery is also seen as a notch in the lamina
papyracea (LP) just behind bulla ethmoidalis.
■ Behind the basal lamella lie the posterior ethmoidal cells (PE).
■ ese can extend posterosuperior to the sphenoid cell and are called
onodi cells.
■ e choana are the posterior nasal openings of the nasal cavity into
the nasopharynx separated by the nasal septum (vomer) and bounded
laterally by the medial pterygoid plate.
Key
CC: Carotid canal FR: Foramen rotundum
HP: Hard palate IM: Inferior meatus
IT: Inferior turbinate LL: Lateral lamella
LP: Lamina papyracea ML: Medial lamella
MM: Middle meatus MO: Maxillary ostium
MT: Middle turbinate NS: Nasal septum
OA: Orbital apex OC: Optic canal
OF: Olfactory fossa PP: Pterygoid plate
SP: Soft palate SS: Sphenoid sinus
ST: Superior turbinate VC: Vidian canal
47Chapter 3 Sinonasal Anatomy: Section-wise
M
O
Q
Figs. 3.1M to R: Consecutive coronal sections from anterior to posterior.
N
P
R
Section 1 Normal Anatomy and Imaging48
CONSECUTIVE AXIAL SECTIONS
Consecutive axial sections of paranasal sinuses from superior to inferior are
depicted in Figures 3.2A to L.
Axial Sections (Figs. 3.2A to F)
■ On the superior most scans, frontal sinuses (FS) can be seen, thereafter
followed by crista galli (CG) and anterior skull base structures.
■ Agger nasi is the most anterior ethmoidal cell seen just anterior to frontal
sinus drainage pathway which is better seen on sagittal images.
■ Nasolacrimal duct (NLD) is seen in close association with AN cell.
■ Bulla ethmoidalis (BE) is the largest ethmoidal air cell the posterior
boundary of which is the basal lamella (BL).
■ Behind the basal lamella (BL), lie the posterior ethmoidal (PE) air cells.
■ Piriform aperture is pear-shaped anterior bony opening of the nasal
cavity bounded superiorly by nasal bone, laterally by nasal process of
maxilla and inferiorly by palatine process.
Key
AE cells: Anterior ethmoidal cells AN: Agger nasi
BE: Bullae ethmoidalis CG: Crista galli
FS: Frontal sinus LP: Lamina papyracea
NB: Nasal bone NLD: Nasolacrimal duct
NS: Nasal septum OA: Orbital apex
PE: posterior ethmoidal cells SOF: Superior orbital ssure
49Chapter 3 Sinonasal Anatomy: Section-wise
A
C
B
D
E
Figs. 3.2A to F: Consecutive axial sections from cranial to caudal.
F
Section 1 Normal Anatomy and Imaging50
Axial Sections (Figs. 3.2G to L)
■ e sphenoid cells are seen behind the posterior ethmoidal cells (PE).
Sphenoid ostium (SO and sphenoethmoidal recess (SER) are clearly seen
on the axial scans.
■ eir surrounding critical skull base structures can also be seen on axial
images.
■ Inferiorly, nasolacrimal duct (NLD) is seen to drain into the inferior
meatus.
■ e choana are the posterior nasal openings of the nasal cavity into
the nasopharynx separated by the nasal septum (vomer) and bounded
laterally by the medial pterygoid plate.
■ Hard palate (HP) is the inferior most boundary of the nasal cavity.
Key
FR: Foramen rotundum HP: Hard palate
IT: Inferior turbinate MS: Maxillary sinus
MT: Middle turbinate NB: Nasal bone
NLD: Nasolacrimal duct NS: Nasal septum
PPF: Pterygopalatine fossa SS: Sphenoid sinus
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