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CBCT in sinonasal imaging

CBCT in sinonasal imaging - morphology, diagnostic capability, tracks of ENT surgery Dirk Schulze, Freiburg, DE. 3rd World NewTom Day 07-21-2006, Verona, IT. Anatomy. Osteomeatal complex most important structure Communication centre between all sinuses (“heavy traffic“)

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CBCT in sinonasal imaging

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  1. CBCT in sinonasal imaging - morphology, diagnostic capability, tracks of ENT surgeryDirk Schulze, Freiburg, DE 3rd World NewTom Day07-21-2006, Verona, IT

  2. Anatomy • Osteomeatal complex most important structure • Communication centre between all sinuses (“heavy traffic“) • Obstruction or swelling of the OC leads to consecutive retained secretion and sinusitis • Sinusitis can descend and ascend via the OC

  3. Anomaly • Aplasia – frontal and sphenoidal sinus more frequent • Hypoplasia – relatively common • Hyperplasia – maxillary and frontal sinus, sphenoidal sinus can stretch along the optic canal

  4. Sinusitis • Rhinogenic or odontogenic • Thickening of the mucosa • Fluid level (acute) • Pillow-like swelling, complete or partial, mostly with central ventilation (chronic)

  5. Cysts • Odontogenic, mucosal retention or pseudocysts • Round shaped, homogenous, all walls can be affected • Calcification, air trapping (perforation) • Differentiation from polyposis may be difficult

  6. Mucocele • Ventilation problem (OC) • Sinus completely filled • Expansion, bone destruction • Differentiation from malign neoplasm may be difficult

  7. Teeth (or parts of ) • Dislocated teeth, roots, germs • Extraction wound, empty pocket • Fluid level (blood) • Mucosa swelling - sinusitis

  8. Foreign bodies • Dislocated fillings, implants, root fillings, impression material ... • Associated tooth or mouth-antrum-connection • Mucosa swelling – sinusitis, especially associated with root fillings (fungal infection!)

  9. Surgery • CMF or ENT surgery • Bone augmentation • Mucosa displaced by scars, scars contract, bone distraction • Widening of physiologic apertures, additional apertures; re-entry mechanism • Chronic sinusitis after sinus surgery (CALDWELL-LUC procedure)

  10. Thank you! dirk.schulze@uniklinik-freiburg.de

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