Role of Imaging in Rhinology

Balasu a a ia Thiaga aja ISBN - - - - Otola gologist’s Pe spe i e Mo e tha I ages Role of Imaging in Rhinology Balasubramanian Thiagarajan is li e sed u de a C eai e Co o s At i uio -No Co e ial-NoDe i ai es . I te aio al Li e se. A out the autho P of. Balasu a a ia Thiaga aja is u e tl P ofesso of otola golog Sta le Medi al College Che ai. Autho He is o pleted his Post g aduaio i otola ai tai i g a ade i He is the pu lishe of Otola golog f o Mad as Medi al College. e sites fo the e eit of stude ts of otola golog . golog o li e jou al. Asso iate Edito of MERLOT Muli edia Edu aio al Resou e fo Lea i g a d O li e Tea hi g Asso iate Edito of DOAJ Di e to of Ope A ess Jou als - X- a s i the p ese t da o te t is o side ed to e outdated Rhi ologists. CT s a i ages ha e epla ed o e io al - a i agi g. Cu e t o se sus is that sill - a s ha e a ole i the ield of hi olog . Its i he e t ad a tages like eas a aila ilit , ost efe i e ess akes this i esigaio sill ele a t i the p ese t da s e a io. Bo lesio s i ol i g ose a d si uses, a e e aluated ith easo a le deg ee of a u a pe fo i g o e io al adiog aphs. Ai p ese t i side the pa a asal siuses se e as e elle t o t ast ediu fo plai - a e aluaio . Pathologies i ol i g pa a asal si uses e oa h upo these ai spa es ausi g alte aio s i thei t a slu e With the ad e t of CT / MRI i agi g plai adiog aphs a e losi g thei ele a e as fa as hi ologi al diag osis is o e ed. This a i le ate pts to e plo e the u e tl p e aili g i di aio s fo the use of plai adiog aphs i hi olog . E e though CT s a p o ides i p o ed esoluio of sot issue de siies it has its o d a a ks like i eased ost of i esigaio a d ot so eas a aila ilit . Pa a asal si uses a e ai illed a iies. Patholog i ol i g these st u tu es ause a i g deg ees of ate uaio of these ai o t ast ediu hi h a easil e o se ed i a o e io al adiog aphs. Ce tai pathologi al o diio s a ause a uulaio of luid ithi the si us a it . This a e lea l de o st ated if plai - a s a e take ith paie t i e e t posiio . Fluid le els a lea l e de o st ated e e i plai adiog aphs. Ad a tages of - a i agi g i hi olog i lude: . Cost efe i e ess of the i esigaio . Eas a aila ilit . Cu e tl a aila le digital - a i agi g te h i ues p o ide ete sot issue a d o e esoluio he o pa ed to o e io al - a s. Disad a tages of o e io al adiog aphs: . Plai adiog aphs ha e a false posii e ate of % . . Plai adiog aphs ha e false egai e ate of o e tha % . . Dii ulies i paie t posiio i g If the a t u i ate ’s ie de o st ates a loss of t a slu e hi h ould e a i di ato of luid le el, the a othe a is take ith a ilt of saggital pla e to a a gle of deg ees. This ie ill lea l de o st ate o e e t of luid to a e posiio . I this ie the luid o es to a ds the late al po io of the a t u he e it a lea l e see . I age sho i g paie t posiio i g i I - a pa a a asal si uses ate ’s ie pla ed as: . Cloudi g of a illa . Opa ii aio of - a si us Wate ’s ie ho i a illa si usiis is dis- si uses a illa si uses . Mu osal thi ke i g of a illa si uses . Fluid le el see i the a illa si uses A o g these sig s least a u ate happe s to e loudi g of a illa siuses. This has a false posii e alue of o e tha % i so e studies. Total opa ii aio of a illa si us is a o e elia le sig of i fe io ith a u a le els a gi g et ee - % . Sou es fo e o i i te p ei g a pa a asal si uses ate s ie e: ould . A ato i al . Te h i al A ato i al auses fo i te p etaio e o s i ate ’s ie : - a +pa a asal si uses . H poplasi si us – This ould ause loudi g / total opa ii aio of a illa si us . O ital loo e posu e- This ould appea as false . ) go ai e ess – This ould appea as false u osal thi ke i g . Supe io o ital issu e- This ould appea as false false i te p etaio as luid le el. Te h i al auses fo i te p etaio e o s i ate ’s ie i lude: . Sot e posu e – This a si uses u osal thi ke i g u osal thi ke i g o - a pa a asal si uses ause a i p essio of loudi g of a illa . Late alizaio of adiog aphi tu e – This ill ause u osal thi ke i g o the side of late alizaio to e issed i the adiog aph. . I ade uate ili g of tu e / head – This ill ause a a ii ial i p essio of p ese e of luid le el. . Ma ked ili g of tu e / head – This ill ause i p essio of loudi g of a illa si uses . Paie t i e u e t posiio – This a the a illa si uses to e issed. ause etai ed se eio s i X- a pa a asal si uses Wate ’s ie . Ma illa lea l sho s: si uses . F o tal si us . Eth oidal si uses . O it . Sphe oid si us . Nasal a iies . Al eola a hes . ) go a Sta da d adiog aph posiio s fo stud i g ose a d pa a asal si uses: Radiog aphi stud of pa a asal si uses a e sta da dized a ou d th ee posiio s. These i lude: . T o a ato i al posiio s – Co o al a d saggital . Radiog aphi – This posiio pe tai s to adiog aphi aseli e. This is a tuall a i agi a li e d a f o the oute a thus of the e e to the id poi t of e te al audito a al. Posiio s used to stud pa a asal si uses i lude: . O ipito e tal ie . O ipital f o tal ie . Su e to- e i al ie ate ’s ie Cald ell ie Hi tz ie Wate ’s ie : Also k o as o ipito e tal ie is the o o est ie take . This ie as de eloped Wate s a d Wald o i . This as a tuall a odii aio of o ipito f o tal p oje io Cald ell ie . Paie t is ade to sit fa i g the adiog aphi ase li e ilted to a a gle of deg ees to the ho izo tal aki g the sagital pla e e i al. The adiologi al ea is ho izo tal a d is e t ed o e a poi t i h a o e the e te al o ipital p otu e a e. I o ese paie ts ith a sho t e k it is i tuall i possi le to o tai a a gulaio of deg ees. These paie ts ust e ade to e te d the e k as u h as possi le a d the - a tu e is ilted to o pe sate fo the dife e e i a gulaio . The outh is kept ope a d the sphe oid si us ill e isi le th ough the ope outh. If the adiog aph is o tai ed i a o e t posiio the skull sho s a fo esho te ed ie of the a illa si uses, ith the pet ous ape o e l i g just eeath the loo of the a illa a t u . I this ie the a illa si uses, f o tal si uses a d a te io eth oidal si uses a e see . The sphe oid sius a e see th ough the ope outh. X- a pa a asal si uses ate ’s ie is sill a ia le i esigaio i paie ts ith fa io a illa t au a. E a i aio of Dola ’s li e i - a siuses ate ’s ie helps i ide if i g paie ts ith z go ai o- a illa o ple f a tu es. X- a si us Wate ’s ie Dola ’s li e: This as i st popula ized Dola etal. The des i ed th ee li es hi h i o ju io ese led elepha t’s head i p oile. . O ital li e – This ese les the elepha t’s ea . Dis upio of this li e ould e due to f a tu e th ough late al o ital i o diastasis of f o toz go ai sutu e li e. Dis upio of i fe io po io of o ital li e ould e due to f a tu e i ol i g i fe io i of o it / loo of o it. . ) go ai li e – This li e ese les elepha t’s fo ehead a d t u k. This li e follo s the late al o ital i to the supe io a gi of z go ai a h. Dis upio of this li e i di ates f a tu e i ol i g z go a. . Ma illa li e – This ese les elepha t’s hi a d t u k. This li e follo s the late al all of the a illa si us to the i fe io a gi of z goai a h. F a tu es a e e pe ted i this zo e. Figu e sho i g Dola ’s li e I a pa a asal si uses ate s ie the o al f o tal si us a gi s sho s allopi g. Loss of this s allopi g is a lassi featu e of f o tal u oele. If f o tal si us is o ge itall a se t age esis the a sutu e li e k o as the etopi sutu e is isi le i the fo e head a ea. So ei es a pai of la ge a te io eth oidal ai ells a take up the pla e of f o tal si uses. He e too the etopi sutu e li e is isi le. This sutu e di ides the t o halfs of f o tal o e of the skull i i fa ts a d hild e . This sutu e li e usuall disappea s at the age of he it fuses. If this sutu e is ot p ese t at i th it ill ause a keel shaped defo it of the skull t igo o ephal . X- a si uses ate ’s ie sho i g Metopi sutu e ith H poplasi illa si us a d a se t f o tal si us a - E pa sio is ha a te ised i ease i the size of a illa he o pa ed to its ou te pa t o the opposite side. a tu E osio a o u i the edial all of the a t u o i its a te o late al all. The a i e fossa a ea is the thi est po io of a illa a t u a te o late al all. E osio is he e o o i this a ea. Opa it is the te used to des i e a a illa si us a t a i ol ed ith alig a t g o th. This opa it is due to the pe iosteal ea io due to alig a t g o th. X- a si uses ate ’s ie sho i g e pa sio a d e osio of ight la a t u due to alig a a il- A o di g to Vete a s Afai s ge e al edi i e li i stud usi g the follo i g ite ia to diag ose si usiis f o - a si uses ate ’s ie i p o ed its a u a to o e tha %. These ite ia i lude: . P ese e of ai luid le el . Si us opa it . Mu osal thi ke i g g eate tha X- a PNS ate ’s ie sho s etopi sutu e a o f o tal sutu e. hi h is a pe siste t Usuall it disappea s at the age of f o tal si uses. ith the o al de elop e t of Pe siste e of Metopi sutu e i.e. sutu a f o talis pe siste s . I paie ts ith age esis of f o tal si uses the etopi sutu e is sill pe siste t. I the a o e - a the f o tal si us is a se t a d is epla ed a pai of la ge a te io eth oidal ai ell. * Note: The let a illa si us appea haz , possi l due to si usiis . Roui e CT s a i agi g is ot i di ated oui el to diag ose paie ts ith a ute si usiis. E e though it has high se sii it i diag osi g a ute si usiis it has lo spe ii it . Studies e eal that o e tha % of as pto ai paie ts too sho CT s a a o aliies i di ai g p ese e of si usiis . Digital - a s: With the ad e t of digital i agi g te h i ues the ost of i agi g has d asi all edu ed. The ualit of i ages ge e ated a e u h ete tha a alog o es hi h as aptu ed o a il . I addiio this p o edu e i ol es less a ou t of adiaio to the paie t he o pa ed to that of o e io al - a te h i ues. O ipito-f o tal ie Cald ell ie : This posiio is ideall suited fo stud i g f o tal si uses. I this posiio the f o tal si uses a e i di e t o ta t ith the il he e the e is o ha e fo a disto io o geo et i lu to o u . He e it is ideall suited to eate f o tal si us te plates fo e te al su ge ies i ol i g f o tal si uses. Figu e sho i g paie t posiio fo Cald ell ie adiog aph To get a Cald ell ie the paie t is ade to sit i f o t of the il ith the adiog aphi ase li e ilted to a a gle of – deg ees up a ds. The i ide t ea is ho izo tal a d is e t ed / i h elo the e te al o ipital p otu e a e. This ie is also k o as the f o tal si us ie . I this ie the pet ous po io of the te po al o e o s u es the isualizaio of a illa si uses. F o tal si uses a e lea l studied usi g this ie . This ie also helps i te plai g the f o tal si us efo e e te al F o to eth oide to su ge ies. This ie also lea l de o st ates f o tal a d eth oidal si uses. Ma illa si us is ot lea l isi le eause the pet ous ape o s u es its ie . I this ie a s all i de taio / g oo e a e see alo g the uppe po io of the edial all of o it. This g oo e is aused a te io eth oidal a te a d aso ilia e e. The eth oido- a illa plate is lea l see i this ie . This is a tuall a useful la d a k fo lo alizi g sp ead of tu o s. X- a si uses ald ell ie sho i g: - F o tal si us - Eth oid si us -Pet ous ape -I fe io o ital issu e -Ma illa si us o s u ed pet ous ape *- Site of a te io eth oidal a te Su e to e i al ie H itz ie : This ie is p i a il take to ie sphe oid si us. Fluid le els i spheoid si uses a e lea l sho i this ie . To take a a i this posiio , the a k of the paie t is a hed as fa as possi le so that the ase of skull is pa allel to the il . The a ea is e t ed i the idli e at a poi t et ee the a gles of the ja s. I elde l paie ts this ie a e easie to a hie e if a ied out i the supi e posiio ith the head ha gi g a k o e the e d of the ta le. This ie also de o st ates the elai e thi kesses of the o alls of the a t u a d the f o tal si uses. Figu e sho i g posiio i g of paie t fo su e to- e i al ie Fluid le els i sphe oid si us a e lea l see i this ie . ) go ai a h a also e lea l deli eated i this ie . This ie is ot popula these da s e ause CT s a s gi e ete esoluio of this a ea. CT s a s ha e la gel epla ed this ie . So e pathologi al o diio s that a e lea l see i si us adiog aphs: I the - a sho a o e, a s elli g ould e see i the asal septal a ea. Gas shado ould also e see i side the s elli g. This gas shado ould e aused gas eleased p oge i o ga is s. The a ilagi ous po io of the asal septu is ot isi le, ould ha e ee e oded. P o a le diag osis is septal a s ess. Both the a illa siuses also appea haz due to i fe io . Colle io of pus et ee the Pe i ho d iu a d the asal septal a ilage o p o ises the ut iio al status of the a ilage as it is depe de t o the Pe i ho d iu fo its ou ish e t. This a ilage u de goes e osis. Septal a s ess i this paie t ould ha e ee aused h o i si us i fe io i.e. Note hazi ess of oth a illa si uses i this paie t . I age sho i g Rhi olith X- a late al ie : This ie helps i diag osi g pathologies i ol i g f o tal si uses. It helps i dete i i g hethe the loss of t a slu e is due to thi ke i g of the a te io o all o i fe io of the f o tal si us pe se. This ie also de o st ates luid le els i the a t u . This ie also gi es i fo aio o the aso pha a d sot palate. This is i fa t a sta da d p oje io used to as e tai e la ge e t of ade oid issue. Figu e sho i g skull posiio fo - a skull late al ie Fo this ie the paie t is ade to sit ith the sagital pla e pa allel to the - a il a d the adiog aphi ase li e is ho izo tal. The i ide t a is ho izo tal a d the i ide t ea is e t ed at the id poi t of the a tu . O li ue ie : This ie helps i de o st ai g poste io eth oid ai ells a d opi fo ae . To o tai this p oje io the paie t is ade to sit fa i g the il . The head is otated so that the sagital pla e is tu ed to a a gle of deg ees. The adiog aphi ase li e is at a a gle of deg ees to the ho izo tal. The i ide t ea is ho izo tal a d is e t ed so that the ea passes th ough the e t e of the o it ea est to the il . X- a asal o e: This is usuall take to ule out asal o e f a tu es. O e should e auio ed agai st isi te p ei g g oo e fo aso ilia e e hi h ould i i f a tu e. F a tu e asal o es is a tuall a li i al diag osis ased o the follo i g i di gs: . Te de ess o e . C epitus o e asal o e a ea asal o e a ea . S elli g a d defo it o e asal o e a ea I age sho i g f a tu ed asal o e Li itaio s of o e io al X- a s: . I ei ie t - a a so pio ausi g % of useful data to go a aste . High s ate to P i a - a aios—C eates a kg ou d i te sit u elated to o e l i g a ato . Supe i posiio & Co spi u it —Co e io al adiog aphs o e t di e sio al i ages to di e sio al o es. This auses loss of useful data as ell as ausi g data to e o e i o spi uous. . Re epto o t ast e sus laitude—Sui ie t e posu e laitude should e p o ided fo a ato i al st u tu es to e o e isi le i a plai adiog aph. To ake o ple ate s si ple this is ot possi le i a o e io al adiog aph. References: 1. Axelson A , Grebelius N , Chidekel N , Jensen C . The correlation between radiology examination and irrigation findings in maxillary sinuses Acta otolaryngol ( stockh ) 1970 ; 90 : 302-6 2. Pfleiderer AG , Drake – lee AB , Lowe D. ultrasound of the sinuses ; a worth while procedure ? A comparison of ultrasound and radiography in predicting the findings of proof puncture on the maxillary sinuses .clin otolaryngol 1984 ;9: 335-9 3. WATERS, C. A., and WALDRON, C. V. (1915) Roentgenology of the accessory nasal sinuses describing a modification of the occipitofrontal position. American Journal of Roentgenology, 2: 633-639. 4. BALLANTYNE, J. C , and ROWE, A. R. (1949) Some points in the pathology, diagnosis and treatment of chronic maxillary sinusitis. Journal of Laryngology and Otology, 63: 337-341. 5. Ros SP, Herman BE, Azar-Kia B. Acute sinusitis in children: is the Water’s view sufficient? Pediatr Radiol. 1995;25:306–7. 6. Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg. 1991;104:480–3. Histo of CT I agi g Fi st CT s a as pe fo ed o st O to e at Atki so Mo le Hospital Lo do . The paie t as a lad suspe ted ith F o tal Lo e tu ou . Su geo ho pe fo ed the su ge e a ked that the tu ou ese led the s a ed i age a u atel . The s a e used as the p otot pe de ised Godf e Hou sield a d his tea at EMI esea h la . It as Ia Ishe ood ho p esided o e a uisiio a d e aluaio of i st o e ial B ai CT s a e i the o ld at Ma heste Ro al I i a Lo do . The i st EMI Head S a e had dete to s alo g the )a is. Fi st li i al CT s a as pe fo ed i US at Ma o Cli i . I .. Godf e Hou sield Si Godf e Hou sield as a a ded the No el P ize alo g ith Co a k i fo desig i g CT s a e . ’s as ha a te ized apid ada es i the ield of CT i agi g. I o i uous s a i g de i es Spi al CT s a e s e e de eloped ith just . se s a i es. Basi p i iples of Fi st CT s a e: Hou sield theo ized the su je t to e s a ed ei g di ided i to a ial sli es. The - a ea s used fo s a i g is olli ated i to pe il thi ea s . It is the ea idth that spe iies the s a thi k ess. The X- a tu e a d the - a dete to situated o the opposite side s a s a oss the su je t . This s a i g oio of the tu e a d the dete to a oss the paie t is k o as a t a slaio . Du i g this oio easu ee ts of - a t a s issio th ough the su je t a e ade dete to s at a lo aio s. The o igi al CT s a e desig ed Hou sield as a ai s a e hi h as ate ooled. The ate illed o edu ed the a ge of i te siies o e hi h the dete to eed to espo d. The i st ate less hole od s a e as de eloped Ledlet etal i . Refe e es . Be k a , EC. CT s a i g the ea l da s. BJR ; : - 2. Alla Ma Leod Co a k. Ea l T o-Di e sio al Re o st u io a d Re e t Topi s Ste i g F o It. No el P ize Le tu e, th De e e . Hou sield GN. Co pute ized t a s e se a ial s a pa t : des ipio of s ste . B J Radiol. ; : i g to og aph , – . . Ledle RS, Di Chi o G, Luesse hop AJ, T igg HL. Co pute ized t a sa ial - a to og aph of the hu a od . S ie e. ; : – . A ato of Late al Nasal all I t odu io : A ato of the late al asal all is highl o ple a d a ia le. With the popula it of e dos opi si us su ge a th ough k o ledge of this o ple a ato is e ital. Highl a ia le a ato a d pau it of sta da d la d a k akes this egio ul e a le fo o pli aio s du i g e dos opi si us su ge . The lea i g u e fo e dos opi si us su ge is ade . Stud of a ato of late al athe steep this highl a ia le a ato asal all dates a k to Gale AD . He des i ed the po osit of o es i the head. Da i i i his lassi al a ato i al d a i gs has illust ated a illa si us a t u . He also des i ed a illa si us as a iies i des i ed a illa the o e that suppo ts the heek . High o e si us a ato . He e it is also k o as a t u of High o e . It as du i g the th e tu that )u ke ka dl a e out ith the i st detailed des ipio of a illa si us a d its su ou di g a ato . Pa a asal si uses a e fou ai illed a iies situated at the e t a e of the uppe ai a . Ea h of these si uses a e a ed ate the skull o e i hi h it is lo ated . Nasal tu i ates: The tu i ates a e the ost p o i e t featu e of the late al asal all . The a e usuall th ee o so ei es fou i u e . These tu i ates appea as s olls of o e, deli ate, o e ed iliated olu a epitheliu . These tu i ates so ei es a o tai a ai ell, i hi h ase it is te ed as a o ha. Figu e sho i g t tu i ates i the late al asal all These tu i ates p oje t f o the late al all of the ose. Out of these tu i ates the follo i g a e p ese t i all i di iduals: The supe io , iddle a d i fe io tu i ates. A s all sup e e tu i ate a e p ese t i so e i di iduals. A o g these tu i ates the supe io a d the iddle tu i ates a e o po e ts of the eth odial o ple he e as the i fe io tu i ate is a sepa ate o e. Co o l a p o ie e a e see at the ata h e t of the iddle tu i ate. I age sho i g late al asal all ate e o al of tu i ates This p o i e e is k o as the agge asi ell. This p o i e size i dife e t i di iduals. These agge asi ells o e lie the la sepa ated f o it just a thi la e of o e. I fa t this agge o side ed to e a e a t of aso tu i al o es see i a i the a te io ata h e t of the i fe io a d iddle tu i ates a o ed, the la i al d ai age s ste a d si us d ai age s ste lea l see . The i fe io tu i ate is a sepa ate o e de eloped e the a illotu i al o e. e a ies i i al sa , asi ell is als. Whe e ea e ologi all f o The i fe io eatus is p ese t et ee the i fe io tu i ate a d the late al asal all. The asal ope i g of the aso la i al du t ope s i the a te io thi d of the i fe io eatus. This ope i g is o e ed a u osal al e k o as the Hass e ’s al e. The ou se of the aso la i al du t f o the la i al sa lie u de the agge asi ell. The iddle eatus lie et ee the iddle tu i ate a d the late al asal all. The iddle tu i ate is pa t of the eth oidal o ple . The si uses ha e ee di ided i to the a te io a d poste io g oups. The a te io g oup of si uses a e f o tal, a illa a d a te io eth oidal si uses. These si uses d ai i to the iddle eatus, i.e. u de the iddle tu iate. The iddle eatus hosts f o a te io to poste io the follo i g st u tu es: . Agge asi . U i ate p o ess . Hiatus se ilu a is . Eth oidal ulla . Si us late alis . Poste io fo ta elle U i ate p o ess: a tuall fo s the i st la e o la ella of the iddle eatus. This is the ost sta le la d a k i the late al asal all. It is a i g o oo e a g shaped pie e of o e. It ata hes a te io l to the poste io edge of the la i al o e, a d i fe io l to the supe io edge of the i fe io tu i ate . Supe io ata h e t of the u i ate p o ess is highl a ia le, a e ata hed to the la i a pal a ea, o the oof of the eth oid si us, o so ei es to the iddle tu i ate. The o igu aio of the eth oidal i fu di ulu a d its elaio ship to the f o tal e ess depe ds la gel o the eha iou of the u i ate p o ess. The U i ate p oess a e lassiied i to t pes depe di g o its supe io ata h e t. The a te io i se io of the u i ate p o ess a ot e ide iied lea l e ause it is o e ed ith u osa hi h is o i uous ith that of the late al asal all. So ei es a s all g oo e is isi le o e the a ea he e the u i ate ata hes itself to the late al asal all. The a te io o e pa o ple . It is he e the d ai . U i ate p o ess poidal issue, o late all t fo s the a te io ou da of the osio eatal a illa , a te io eth oidal a d f o tal si uses a e displa ed ediall the p ese e of pol agai st the o it i i di iduals ith a illa si us h poplasia . Re o i g of this pie e of o e is the ost i po ta t step i E dos opi si us su ge . T pe I u i ate: He e the u i ate p o ess e ds late all i its uppe ost po io a d i se ts i to the la i a pap a ea. He e the eth oidal i fu di ulu is losed supe io l a li d pou h alled the e essus te i alis te i al e ess . I this ase the eth oidal i fu di ulu a d the f o tal e ess a e sepa ated f o ea h othe so that the f o tal e ess ope s i to the iddle eatus edial to the eth oidal i fu di ulu , et ee the u i ate p o ess a d the iddle tu i ate. The oute of d ai age a d e ilaio of the f o tal si us u edial to the eth oidal i fu di ulu . T pe I u i ated i se io T pe II u i ate: He e the u i ate p o ess e te ds supe io l to the oof of the eth oid. The f o tal si us ope s di e tl i to the eth oidal i fu di ulu . I these ases a disease i the f o tal e ess a sp ead to i ol e the eth oidal i fu di ulu a d the a illa si us se o da il . So ei es the supe io e d of the u i ate p o ess a get di ided i to th ee a hes o e gei g ata hed to the oof of the eth oid, o e gei g ata hed to the la i a pap a ea, a d the last gei g ata hed to the iddle tu i ate. Figu e sho i g T pe II u i ate i se io T pe III u i ate p o ess: He e the supe io e d of the u i ate p o ess tu s ediall to get ata hed to the iddle tu i ate. He e also the f o tal si us d ai s di e tl i to the eth oidal i fu di ulu . Ra el the u i ate p o ess itself a e hea il p eu aised ausi g o st u io to the i fu di ulu . Figu e sho i g T pe III U i ate i se io Figu e sho i g Middle Meatus Re o al of u i ate p o ess e eals the atu al osiu of the a illa sius. This is a othe ital la d a k i the late al asal a it . The supe io all of the atu al osiu of the a illa si us is at the le el of loo of the o it. Agge asi: This is a Lai o d fo Mou d . This a ea efe s to the ost supe io e a t of the i st eth otu i al hi h p ese ts as a ou d a te io a d supe io to the i se io of iddle tu i ate. Depe di g o the p eu aisaio of this a ea a ea h up to the le el of la ial fossa the e ausi g a o i g of f o tal si us ouflo t a t. Ethoidal i fu di ulu : is a let like spa e, hi h is th ee di e sio al i the late al all of the ose. This st u tu e elo gs to the a te io eth oid. This spa e is ou ded ediall the u i ate p o ess a d the u osa o e i g it. Majo po io of its late al all is ou ded the la i a pap a ea, a d the f o tal p o ess of a illa to a lesse e te t. Defe ts i the edial all of the i fu di ulu is o e ed ith de se o e i e issue a d pe iosteu . These defe ts a e k o as a te io a d poste io fo taelles. A te io l the eth oidal i fu di ulu e ds li dl i a a ute a gle. Bulla eth oidalis: This is de i ed f o Lai . Bulla ea s a hollo thi alled o p o i e e. This is a othe la d a k si e it is the la gest a d o a ia t of the ai ells elo gi g to the a te io eth oidal o ple . This ai ell is fo ed p eu aizaio of ulla la ella se o d ethoid asal la ella . This ai ell appea s like a le situated i the la i a pap a ea. So e autho s o side this to e a iddle eth oid ell. If ulla e te ds up to the oof of eth oid it a fo the poste io all of f o tal e ess. If it does ot ea h up to the le el of skull ase the a e ess a e fo ed et ee the ulla a d skull ase. This e ess is k o as sup a ulla e ess. If the poste io all of ulla is ot i o ta t ith asal la ella the a e ess is fo ed et ee ulla a d asal la ella. This e ess is k o as et o ulla e ess / si us late alis. This et o ulla e ess a o u i ate ith the sup a ulla eess. Osteo eatal o ple : This te is used the su geo to i di ate the a ea ou ded the iddle tu i ate ediall , the la i a pap a ea late all , a d the asal la ella supe io l a d poste io l . The i fe io a d a te io o de s of the osteo eatal o ple a e ope . The o te ts of this spa e a e the agge asi, asof o tal e ess f o tal e ess , i fu di ulu , ulla eth oidalis a d the a te io g oup of eth oidal ai ells. This is i fa t a a o a ato i al egio o sisi g of : . Muliple o eth oidalis st u tu es Middle tu i ate, u i ate p o ess, Bulla . Ai spa es F o tal e ess, eth oidal i fu di ulu , . Osia of a te io eth oidal, a illa a d f o tal si uses. I this a ea, the u osal su fa es a e e lose, so ei es e e i o ta t ausi g se eio s to a u ulate. The ilia thei s eepi g o e e ts pushes the asal se eio s. If the u osa li i g this a ea e o es i la ed a d s olle the u o ilia lea a e is i hi ited, e e tuall lo ki g the si uses. So e autho s di ide this osteo eatal o ple i to a te io a d poste io . The lassi osteo eatal o ple des i ed al ead has ee des i ed as the a te io osteo eatal o ple , hile the spa e ehi d the asal la ella o tai i g the poste io ethoidal ells is efe ed to as the poste io eth oidal o ple , thus e og isi g the i po ta e of asal la ella as a a ato i al la da k to the poste io eth oidal s ste . iddle eatus He e the a te io a d the poste io osteo eatal o ple has sepa ate d ai age s ste s. So he the disease is li ited to the a te io o pa te t of the osteo eatal o ple , the eth oid ells a e ope ed a d diseased issue e o ed as fa as the asal la ella, lea i g the asal laella u distu ed i i isi g the isk du i g su ge . Hiatus se ilu a is: Lies et ee the a te io all of the Bulla a d the f ee poste io a gi of the u i ate p o ess. This is i fa t a t o di e sio al spa e. Th ough this hiatus a let like spa e a e e te ed. This is k o as the eth oidal i fu di ulu . This eth oidal i fu di ulu is ou ded ediall alo g its e i e le gth the u i ate p o ess a d its li i g u osa. The late al all is fo ed the la i a pap a ea of the o it, ith pa i ipaio f o the f o tal p o ess of the a illa a d the la i al o e. The a te io g oup of si uses d ai i to this a ea. I fa t this a ea a ts as a ess pool fo all the se eio s f o the a te io g oup of si uses. Figu e sho i g Osteo eatal o ple Co ha ullosa: So ei es iddle tu i ate a e o e p eu aised. This p io is k o as o ha ullosa. This p o ess of p eu aisaio the f o f o tal e ess o agge asi ai ells. This is usuall o e a o al a ia t. So ei es this p eu aisaio a e o te si e that it ould ause o st u io i Osteo eatal o ple eu aizasta ts eiside ed to e so e . Co o al CT of si uses sho i g Co ha ullosa. A te io eth oid a te ies a e a ked ith ed a o s Refe e es:  . Oh ishi T, Ta hi a a T, Ka eko Y, et al. High- isk a eas i e dos opi si us su ge a d p e e io of o pli aio s. La gos ope. ; : –  . Sto e P, Ma Ka A, Ha ke M.The a t u of High o e o of da Vi i? J Otola gol. De ; :  . Bla to PL, Biggs NL Eightee hu d ed ea s of o t o e s : the pa a asal si uses. A J A at : – .  . G a e DO, Ri e DH, Pa a asal si uses a ato . I : Cu i gs CW, F ed i kso JM, Ha ke LA et al Otola golog Head a d Ne k Su ge . Mos , d ed .  . Bodi o C, Ja ko ski R, G ig o B et al Su gi al a ato of the tu i al all of the eth oidal la i th.Rhi olog : – .  . Bolge WE, A ato of the Pa a asal Si uses. I : Ke ed DW, Bolge WE, )i ei h J Diseases of the si uses, Diag osis a d a agee t. B.C. De ke . . htp://jo l. et/i de .php/jo l/a i le/ ie /  . Joe JK, Ho SY, Ya agisa a E Do u e taio of a iaio s i sio asal a ato i t aope ai e asal e dos op . La gos ope : – . I t odu io : Gale as the i st pe so to des i e eth oidal ai ells. He as a fa ous Ro a su geo . A o di g to Gale a good ph si ia is also a good philosophe . He i fa t o side ed hi self to e a good philosophe tha a good ph si ia . His igu es ased o ei ulous disse io of hu a skull is o side ed to e fai l a u ate e e toda . The a ato of eth oidal ai ells is highl a ia le, it eeds e elle t i agi g te h i ues to stud . With the ad e t of CT i agi g a d i age e o st u io te h ologies it is possile to p e isel i age this a ea a d stud the diso de s i ol i g it. I age of Gale Leo o do da i i i i st des i ed a illa a a ato ist a d pai te u su passed. Mo e fa o t i uio s to the ield of hu a a ato a He as gi e spe ial pe issio to disse t hu a of Sa ta Ma ia Nuo a Flo e e. His a ato d a e e p ese t da sta da ds. si us . He as a tuall ous fo his pai i gs his ot e u de esi ated. o pses at the Hospital i gs a e fai l a u ate Sphe oid si us as i st des i ed Ja opo Be e ga io da Ca pi i . His ook itled A ato ia Ca pi as o side ed to e the est. It as Coite ho i t odu ed a ato ists to the p ese e of f o tal ai ells. This feat a tuall happe ed so ei e du i g the th e tu . The edit fo the ost ode des ipio a d depi io of pa a asal si uses should go to E il )u ke ka dl. This th e tu a ato ist's des ipio is sill o side ed to e a u ate. This Hu ga ia a ato ist eall set the sta da d fo p ese t da a ato ists to follo . Leo o do da i i The de elop e t of i st ode f e Hou sield of EMI Co p. CT s a e as sta ted i God- Roui e use of CT s a has helped the su geo to u de sta d the o ple a ato of pa a asal si uses. CT s a i the p ese t da o te t has eo e a i tual oad ap du i g e dos opi si us a d skull ase su ge ies. It should e o e i i d that a ato of eth oids a d othe si uses a e highl a ia le a d it is i tuall i possi le to take i to o side aio all these a iaio s du i g e dos opi si us su gi al p o edu es. A oad ap ould dei itel help the su geo . A ato of ose a d pa a asal si uses has i tuall ee e ite ate stud i g these adiologi al i ages. Ideall he s a i g ose a d pa a asal si us it should e pe fo ed at least i t o a is i.e. A ial a d o o al. Cuts should e ade e e i o de to e su e that o st u tu e is lost i et ee se io s. I agi g should e pe fo ed usi g oth sot issue a d o e i do s. I o de to de i e a i u e eit f o i agi g studies it is i pe ai e o the pa t of the su geo to s ste ai all e aluate the s a uts. It is just like alki g th ough the ose a d a ious pa a asal si uses. I agi g studies of paa asal si uses ill also help i e eali g pote ial sites of o st u io , e a li g the su geo to take p e e i e easu es e e efo e a tual si us osiu o st u io a set i . The a ilit of CT s a to opi all displa o e, sot issue a d ai akes it the ost p efe ed i agi g odalit of ose a d pa a asal si uses. It also lea l sho s the i e o details of si us ouflo t a ts. A ute si usiis is a li i al diag osis, CT s a is e o e ded o l if s pto s pe sist. Po t ait of the g eat E il )u ke ka dl Usi g i t a e ous o t ast age ts efo e pe fo i g a tual i agi g of paa asal si uses ill help i deli eai g sot issue st u tu es f o o es. This stud also helps i assessi g the as ula it of the tu o . Co t ast i agi g is a ust hile e aluai g paie ts ith tu o s i ol i g ose a d pa a asal si uses . As fa as i la ato lesio s of pa a asal si uses a e o e ed plai i agi g ould sui e. Elde l paie ts i d it dii ult to assu e p o e posiio fo p olo ged du aio of i e hi h is a ust fo p odu i g o o al uts. These paie ts ill e eit f o o pute ge e ated e o st u ted o o al i ages f o thi a ial se io s. Fo ge e ai g e o st u ted o oal i ages a ial uts is a ust. It is al a s opi al to defe i agi g i paie ts ho ha e sufe ed a ute episodes of si us i fe io s. The opial pe iod of ait fo these paie ts efo e u de goi g CT s a s of ose a d pa a asal si uses should at least e a out eeks. Si ila l paie ts sufe i g f o h o i si us i fe io s / alle gi si usiis / asal pol posis should e ei e a i al edi al the ap fo at least a pe iod of eeks efo e su je i g the to i agi g. S ee i g i agi g of pa a asal si uses happe s to e a ost efe i e a of i agi g pa a asal si uses. I s ee i g i agi g thi ke a ial uts a e take . If s ee i g e eals a patholog i ol i g si uses the egula i agi g a e pe fo ed i these paie ts. Cu e tl a aila le spi al CT s a e s has eall sho te ed the s a i g i e. It is possi le to pe fo . uts usi g these ad a ed s a i g s ste . Wi do sei g efo e i agi g: CT s a e dete i es the a ou t of - a s a so ed ea h a d e e ele e t i a pla e of issue. This detail is faithfull ep ese ted a pi el o the ideo displa . The a ou t of - a s a so ed is easu ed i Hou sield u its. This u it of easu e e t as de eloped Si Godf e Hou sield ho used adio de sit of ate as a efe e e ze o poi t a d ai at . This s ale e te ds i a posii e di e io to a out + hi h epese ts e adio de se etals. CT s a . Wi do ideo displa ill ha e t o u e s displa ed: idth W . Wi do le el L Wi do idth: This alue des i es the a ge of Hou sield u its displa ed. The a i u i do idth possi le is usuall a out HU. O e poi t to e e e e ed is that hu a e es a e ot apa le of seei g a d dife e iai g this a shades. I fa t it a dis i i ate o l a out shades of g a . He e the i do idth alue is di ided usuall , a d ea h of these g oups of alues a e o e ted to o e of shades of g a . The lo est Hou sield u e s i the i do a ge a e sho as la k a d the highest a e hite. Wi do le el: This alue is the Hou sield u e i the e te of the i do idth. These t o sei gs a e i di ated as W/L sei gs. O displa s ee s the i do idth i eases as the ouse is d agged to the ight a d the alue de eases as the ouse is d agged do . Whe pe fo i g CT i agi g of a do e hi h a e just a litle de se tha ate ha . T pi al W/L sei g ould e / ill e displa ed e te ed a ou d a de sit HU ill sho up as a dife e t shade of g a hi h o tai s ostl sot issue i g Hou sield alues et ee . dife e t shades of g a of HU. Ea h dife e e of . Su stan e HU Ai - Lu g Sot Tissue to— - Fat - Wate CSF Blood + —+ Mus le + Bo e Ca ellous + De se Bo e + Ta le sho i g adio de siies of a ious od st u tu es Role of CT i agi g fo E dos opi Si us Su geo I t odu io : CT s a of ose a d si uses se es as a oad ap fo the su geo . Fo ose a d si us i agi g s a i g should i lude o o al a d a ial uts ideall apa t. If thi e a ial uts a e pe fo ed it ould fa ilitate a u ate sagital e o st u io . Highl a ia le a ato of late al asal all akes its i pe ai e that these i ages e studied efo e the p o edu e. The i i g of CT i agi g has a e i po ta t ole i de idi g hethe the patholog is i e e si le. Su gi al a age e t is i di ated o l fo i ee si le diseases. At least a eek i te al should e allo ed to elapse efo e o de i g CT i agi g of si uses . I je i g o t ast efo e s a i g ould help i ete deli eaio of sot issues a d as ula lesio s. Co t ast CT s a s a e useful i e aluai g eoplasi lesio s. Bo e i do s a s a e e useful i stud i g the o a ato of ose a d si uses. Paie t Posiio i g: A ial ie s : Paie t’s ha d palate is pla ed pe pe di ula to the CT s a e ta le. While aptu i g the i ages it should e e su ed that the e te al audito a al is i li e ith the i fe io o ital i . Co o al ie s: While taki g o o al i ages the ga t is pla ed pe pe di ula to the paie t’s ha d palate. Misalig e t / otaio a ause disto io of o al a ato . S ee i g CT s a s: uts a e ideal fo apid s ee i g of paie ts. This ot o l edu es the s a i g i e ut also edu es u e essa adiaio e posu e to the paie t. To e su essful the s ee i g CT p oto ol should eet the iteia of a epta ilit , elia ilit a d alidit . Ad a tages of S ee i g CT . Si ple a d i e pe si e . No i asi e . Well tole ated . Ca easil ide if o st u io s at the le el of i fu di ulu the paie t I di aio s of s ee i g CT : . The disease should e a e a le to s ee i g . It should e a epta le, elia le a d eas to alidate . Highl a u ate o i . The e is ei a ious ied s ee i g ato test should e a aila le ea s of t eat e t a aila le fo the disease ide i- Refe e es: . htp://e edi i e. eds ape. o /a i le/ . Youse ; DM. I agi g of si o asal i la : - -o e ie #a ato aa disease. Radiolog . Aug . Ro e ts CJ. Epide iolog fo Cli i ia s. Lo do , E gla d: Pit a Medial pu lishi g : . Mo iso AS S ee i g i e sit p ess : - h o i disease d ed. Ne Yo k,O fo d U i- Co o al a d A ial CT i agi g I age sho i g Co o al CT s a . La i a pap a ea . Co ha Bullosa . Right Middle tu i ate . Right a illa si us With the ad e t of E dos opi si us su ge Co o al CT s a s of pa a asal si uses has assu ed i po ta e e ause of the e essit to i age osteo eatal o ple . Co o al I agi g of asal si uses has e o e a dato efo e pe fo i g e dos opi si us su ge e ause of its a ilit to sho su geo ’s ie of the a ea. Co o al se io s a ot lea l p o ide i fo aio a out st u tu es like asal la ella hi h lies pa allel i this ie . O l a s a pe fo ed i the a ial pla e ill e a le to de o st ate this a ea lea l . A ial s a is ete tha . Poste io . Bo . Pte go a illa o o al i isualizi g the follo i g a eas : all of f o tal si us all et ee poste io eth oid a d sphe oid si us issu e a d pte gopalai e fossa No al o o al ie a te io uts I the a te io ut asal o es e o e isi le. No al gothi a h fo the asal o es should e looked fo . This gothi a h is disto ted i f a tu es i ol i g asal o es. ed Ala a ilages e o e isi le. Nasal septu ould also e see . F o tal si us is appea i g. Just elo the f o tal si us agge ell ould e ide iied. Ma illa si us ould e see appea i g. CT s a should ideall e ead f o the i st ut. CT s a should e ead o a ut to ut asis. Not e e a si gle ut should e issed. All the a ato i al la d a ks should e ide iied efo e d elli g i to the pathologi al ha ges. Co o al CT ose a d si uses a te io . F o tal si us . Agge Nasi . O it . Ma illa . Nasal septu . I fe io tu i ate ut st u tu es: si us Nasal septu appea s ogg . The te septal tu i ate is used to des i e this t pe of asal septu . This is a o al a ato i al a ia t. Co o al CT ose a d si uses at the le el of f o tal e ess. St u tu es see i this ut i lude aso la i al du t NLD , i fe io tu i ate, f o tal eess, a d iddle tu i ate Co o al CT ose a d si uses sho i g: . o it . I fe io o ital e e . Ma illa . C i ifo . Middle tu i ate . I fe io tu i ate si us plate Co o al CT ose a d si uses sho i g i ifo oidalis plate a ea a d fo ea eth- Ke os lassii aio of depth of olfa to fossa: The depth of olfa to fossa is dete i ed the height of late al la ella of the i ifo plate. Ke os lassiied this depth i to th ee atego ies. T pe I : Depth of T pe II : Depth of T pe III : Depth of - o o est ae T pe III e poses o e of thi late al la ella of i ifo plate aki g this a ea o e sus epi le to i ju du i g e dos opi si us su ge . Diag a ai ep ese taio of Ke os lassii aio I age sho i g Ke os t pe I lassii aio I age of Co o al CT ose a d si uses sho i g T pe II ke os skull ase I age sho i g Ke os T pe III skull ase A ato of skull ase is highl a ia le e ause of a iaio s of eth oid si uses. E aluaio of oof of eth oid a d skull ase ill help i p ee i g o pli aio s like CSF leak follo i g oui e e dos opi si us su ge . Co o al CT i ages a e est suited fo this e aluaio . Studies eeal that the a ea at isk du i g su ge is ot the highest poi t of the ethoid si us fo ed fo ea eth oidalis, ut the late al la ella of i ifo plate i the egio of olfa to sul us . It is p e isel he e the a te io eth oidal a te is fou d ou si g fu the eake i g the a ea. Co o al CT i age sho i g t pe III ke os. Site i di ated the a o is the ost ul e a le a ea to i ju du i g su ge . I this ase e e a s all aipulaio of iddle tu i ate is sui ie t to ause skull ase ea h a d CSF leak. P io k o ledge of this a ato i a iaio ill p e e t da age to this a ea. Eth oid ai ells: This a ea is highl a ia le. Eth oid si us o sists app o i atel ells ith highl a ia le p eu aizaio pate s. Fo sake of ete u de sta di g this a ea is di ided i to: . A te io eth oidal ai ells—D ai i g i to iddle eatus . Middle eth oidal ai ell Bulla eth oidalis - This is o sta tl see i al ost all i di iduals . Poste io eth oidal ai ells—These ells d ai i to the sphe oeth oidal e ess I age of o o al CT ose a d si uses sho i g Bulla eth oidalis * a d La i a pap a ea Basal la ella: This is the ho izo tal po io of iddle tu i ate hi h sepa ates a te io eth oidal ai ells f o poste io eth oid g oup. Late all asal la ella is ata hed to la i a pap a ea. I the e i al a is the asal la ella is ata hed supe io l to a te io skull ase. The i se io of iddle tu i ate gi es ise to this u i ue a ato . A ato i all iddle tu i ate a io s lie i dife e t pla es. e di ided i to po io s . All these po - A te io po io : Lies sagitall gei g ata hed to the skull ase at the late al edge of la i a i osa. Middle po io : This po io lies al ost i the f o tal pla e, a d gets ata hed to the la i a pap a ea. Poste io po io : Is al ost ho izo tal a d gets ata hed to la i a pap aea. The sta ilit of pla es. Dou le iddle tu i ate is depe de t o its i aio i these th ee iddle tu i ate: This is a tuall ot a t ue a ia t. This as i st des i ed Kauf a This is a tuall is a ediall e t u i ate p o ess u i g out of the eatus like the i of a hat. . iddle Middle tu i ate p eu aizaio : Nasal tu i ates de elop as outg o ths a isi g f o the late al asal all k o as eth otu i als . The iddle tu i ate a ises f o the thi d idge. Va iaio s i p eu aizaio of these eth otu i als a lead to a ato i al a iaio s ithi the o st u tu es of eth oidal la i th. Bolge lassiied p eu aizaio of iddle tu i ate i to th ee t pes: La ella t pe p eu aizaio : This i ol es p eu aizaio of e i al la ella of iddle tu i ate. Bul ous t pe p eu aizaio : I ol es p eu aizaio of i fe io po io of iddle tu i ate E te si e p eu aizaio : I ol es p eu aizaio of oth la ella po io a d i fe io po io of iddle tu i ate. It is also k o as Co ha ullosa. CT i age sho i g huge o ha ullosa of e oa hi g i to the a illa si us CT i age sho i g ul a p eu aizaio of iddle tu i ate. It ould e see iddle tu i ate CT i age sho i g la ella t pe p eu aizaio Figu e sho i g Kauf a ’s dou le iddle tu i ate hi h is a tuall a ediall de iated u i ate p o ess A te io eth oidal a te : A ato i al k o ledge of a te io eth oidal a te is ital du i g e dos opi si us p o edu es if o pli aio s a e to e i i ized. Du i g its ou se the a te io eth oidal a te osses th ee a iies the o it, eth oidal la i th a d a te io a ial fossa of skull . The a te io eth oidal a te e te s the olfa to fossa th ough the late al la ella of i ifo plate alo g the a te io eth oidal sul us. The o e o e the a te io eth oidal sul us is e thi a d is at isk du i g e dos opi su ge . The elaio ship of the a te io eth oidal a te to the oof of the eth oid is highl a ia le a d is at isk du i g e dos opi si us su ge ies. Ide ii aio of this a te is i po ta t i ide if i g f o tal si us ouflo t a t a d supe io li its of skull ase. A eas supplied a te io eth oidal a te : It supplies the a te io eth oidal ells a d the f o tal si us. As it ou ses alo g the olfa to fossa it gi es ise to e i geal essels. This a te also supplies the a te io thi d of asal septu a d late al asal all. Sta e ge epo ted that a te io eth oidal a te a e i di e t o ta t ith skull ase. This is pa i ula l t ue if the oof of the eth oid si us is lo . I ajo it of ases he epo ted that a o ese te ould o e t the a te io eth oidal a te to the skull ase. He also epo ted that the e ould e a spa e of a out et ee the a te io eth oidal a te a d skull ase. A o di g to Got al ho e te si el studied the ou se of a te io eth oidal a te ie i g o o al CT s a s of ose a d si uses fou d that the p ese e of a ot h i the edial all of o it i di ates the p o a le site of a t io eth oidal fo a e . He also suggested that the p ese e of fo al fu eli g i the olfa to fossa ould i di ate the p o a le posiio of a te io eth oidal a te . Co o al CT sho i g a di ple i the edial all of o it i di ai g p o a le site of a te io eth oidal a te Co o al CT sho i g a te io eth oidal a al ou si g th ough a te io ethoidal ells Co o al CT sho i g a te io eth oidal a te i skull ase It should e o e i i d that o ha ullosa of iddle tu i ate is al ost al a s asso iated ith de iated asal septu to the opposite side. Septated o ha ullosa: Co ha ullosa of iddle tu i ate a also e septated,. It as i st des i ed Ya agisa a et al. i . CT I age sho i g septated o ha ullosa A ato i al a iaio s of . P eu aizaio . Late alizaio . H poplasi . H pe t ophi . Pa ado i all . Bifu ate / t ifu ate . Septate u ed iddle tu i ate i lude: CT s a of ose a d si uses should ideall help: . I esta lishi g the a ato of the a ea . I Ide if i g p edisposi g fa to s ausi g the p o le . I ide if i g the disease p o ess . I ide if i g su gi al pifalls . I su gi al pla i g hi h ould e usto ized to paie t’s eeds A ial CT i agi g of ose a d si uses helps i de o st ai g st u tu es that lie pa allel to the o o al pla e. Most of the st u tu es that sepa ate a ious si uses lie i this pla e. These st u tu es i lude: . Basal la ella . A te io . Thi d asal la ella all of sphe oid si us Nasola i al du t, olfa to g oo e a d the opi e e a e lea l isi le i oth these se io s. A te io eth oid a te ies a e lea l isi le i the o oal s a s o l . It a e lea l de o st ated he the pe et ate the la ia pap a ea to e te the o it. A ial CT sho i g . o it, . Sphe oid si us, . Eth oidal ai ells . Pituita gla d Halle ell ausi g o st u io of Osteo eatal o ple is lea l see o l i o o al s a s. A ial s a s do ot displa it lea l . A ial CT sho i g O odi ai ell To ake up fo the li itaio s of o o al s a s a fe a ial uts a e o de ed. These dis o i uous s a s a o l e useful fo diag osi pu poses o l . Su ge should ot e e tu ed ith these dis o i uous s a s as it ould e atast ophi . Refe e es: . Nass RL, Hollida RA, Reede DL. Dig osis of su gi al si usiis usi g asal e dos op a d CT. La gos ope ; : . Mafee MF, Cho JM, Me es R Fu io al e dos opi si us su ge . A ato CT s ee i g, i di aio a d o pli aio s. AJR : : . htps://sites.google. o /site/d t alusotola od golog / hi olog /septal- . Ke os P. O the p a i al alue of dife e es i the le el of the la i a i osa of the eth oid. ) La gol Rhi ol Otol. ; : - . . Kai z J Sta e ge H The oof of a te io eth oid a lo us i o is esiste ia i the skull ase. La go Rhi ol Otol stutg : : . Sta kie i z JA Co pli aio s of e dos opi i t a asal eth oide to La gos ope : : . htp:// s.ajou.a .k /~e t/ e / ase_topi /RHINODATA/A ato . B au H, Sta e ge H. P eu aizaio of tu i ates. La ; : - . . PNS.ht gos ope . Kauf a E. U e ei e t pis he Fo o S hlei hautges h ulst "late ale S hlei haut ulst" a de ausse e Nase a d. Mo atss h Oh e heilkd ; - . Cited i )a iko C. K a kheite de Nase u d des Nase a he s. Be li : Ka ge , . . Bolge WE, Butzi CA, Pa so s DS. Pa a asal si us o a ato i a iaio s a d u osal a o aliies: CT a al sis fo e dos opi si us su ge . La gos ope. ; : – . E. Ya agisa a, J. P. Mi a te, a d D. A. Ch ist as, E dos opi ie of a septated o ha ullosa, Ea , Nose a d Th oat Jou al, ol. , o. , pp. – , A ato i al a iaio s Stud of a ato i al a iaio s of ose a d pa a asal si uses a e athe i po ta t. Poi ts to e o e i i d du i g the stud i lude: . A ato i al a iaio s a e e o o i this a ea . Majo it of these a iaio s a e as . So e of these a iaio s a ause a ato i al o st u io to ii al d ai age a eas of pa a asal si uses. This e o es a i di aio fo e dos opi si us su ge . So e of these a iaio s a pto ai eeds o i te e io ause os ei issues to the paie t Pate of d ai age of asal si uses is athe i po ta t e ause the u osal li i g of ose a d asal si uses hi h is o i uous i a ph si al se se seetes a out lit e of u ous pe da . This eeds to e d ai ed o a o i ui g asis. O st u io to this p o ess of d ai age p edisposes to h o i si usiis. Majo a ato i al a iaio s leadi g to o st u io i the Osteo eatal o ple a ea i lude: . De iated asal septu . Co ha ullosa i ol i g . Pa ado i al . I f ao ital ai ell Halle ell iddle tu i ate iddle tu i ate A o g these a iaio s de iaio of asal septu o est o e. happe s to e the o - De iated asal septu : Va i g deg ees of de iaio s i ol i g asal septu at i th. These de iaio s te d to a e tuate as the t al asal septu is a li i al u iosit as it is e a io s i ol i g the asal septu do ’t ause a s has ee do u e ted hild g o s. A dot e e. Majo it of de iapto s . Cotle’s lassii aio of septal de iaio : Cotle lassiied septal de iaio i to t pes. . Si ple de iaio : O l a ild de iaio of asal septu ith o s to s of o st u io . This is the ost o o t pe see . p- . De iaio ith o st u io : He e de iaio tou hes the late al all of ose, ut o de o gesio the tu i ates sh i k a d i p o es the asal ai a . I pa io : Massi e a gulaio of asal septu ith p ese e of spu . Co o al CT i age of ose a d si uses sho i g septal spu A ial CT i age of Nose a d si uses sho i g de iated asal septu ith spu Nasal septal de iaio s a e usuall a o pa ied o t alate al o pe sato h pe t oph of i fe io tu i ate. This is a tuall atu e’s ate pt to edu e the size of e la ged asal ai a o the o t alate al side due to septal de iaio . A ial CT i age of ose a d si uses sho i g septal spu ausi g a edu io i the olu e of a illa si us Septal Bod : Septal tu i ate This is a ide ed a ea of asal septu lo ated supe io to the i fe io tu iate a d a te io to the iddle tu i ate. It is o posed of septal a ilage. Septal a ilage is thi ke he e tha the othe pa ts of asal septu . The u osal o e i g of septal od is thi ke tha the othe po io s of asal septu . This od is i i i ate elaio ship to the i te al asal al e. It is suspe ted to pla a ole i the ai te a e of asal esista e. Histologi Septal od ite ia fo the ide ii aio of septal od : a e ide iied usi g the follo i g Histologi The li i g epitheliu ells. . The epitheliu . Ma is is pseudost aiied olu – μ a epitheliu ite ia. ith go let thi k. se o u i ous gla ds a e p ese t . Nu e ous lood si usoids a e p ese t Most o o l is ould e a i ide tal i di g. O oui e e a i aio a septal od should e dife e iated f o high septal de iaio . Septal od should e i luded a o g the e e ile issues fou d i a it . It should e a aged i the sa e a as h pe t ophied tu ases of asal o st u io aused these st u tu es. Its p o i it te al asal al e a ouses the suspi io as the ause fo asal o st Septal tu i ate has a te de a t i p eg ated olle gauze. the asal i ates i to the i u io . to sh i k he pa ked ith asal de o gest- Co o al CT Nose a d pa a asal si uses a te io ut sho i g septal od I e dos opi e a i aio appea s as a p o i e e alo g the a te io a d iddle po io of asal septu . This o diio is usuall isdiag osed as high septal de iaio . Palpaio of the a ea usuall li hes the diag osis. Nasal septal od he o pa ed to i fe io tu i a ou t of e e ile issue a d he e does ot sho e t of i fe io tu i ate. E e i i al ha ges i od a ause apid i ease i the asal esista ate o tai lesse the apid e pa sile p opthe size of the septal e. Co o al CT i age of ose a d si uses sho i g o ha ullosa a d high septal de iaio o the opposite side Agge Nasi ells: This is the a te io ost of eth oidal ai ells. It lies a te olate al a d i fe io to the f o toeth oidal e ess. E dos opi all it lies a te io a d a o e the ata h e t of iddle tu i ate. These ells a e ide iia le i a out % of hu a s. It also se es as a ital la d a k fo f o tal si us osiu . E la ge e t of this ai ell a lead to f o tal si usiis. This ell pe u aizes i st. Co o al CT i age of ose a d si uses sho agge asi ai ell. MT - Middle tu i ate IT - I fe io tu i ate MS - Ma illa si us FS - F o tal si us PE - Poste io eth oid SPS - Sphe oid si us CT ose a d si uses late al efo ated ie sho i g the elaio ship et ee agge asi a d f o tal si us d ai age path a Agge asi ai ell ould p eu aize poste io l to a ds the f o tal e ess a ea ausi g o st u io to d ai age of f o tal si us. The i te a io et ee the uppe po io of u i ate p o ess a d agge asi ai ell is i po ta t i the u de sta di g of f o tal si us d ai age path a . Whe agge asi p euaizes poste io l it pushes the poste osupe io ata h e t of u i ate p o ess a k a d to the la i a pap a ea leadi g to the fo aio of te ial e ess . Figu e sho i g E dos opi ie of Agge Nasi Agge asi ell a ut the pape thi la i a pap a ea. A disease p o ess afe i g the late al all of agge asi a sp ead to adja e t la i al sa ausi g epipho a a d i la ato o diio s of la i al s ste . Halle Cell: These ells a e also k o as i f ao ital eth oidal ai ells/ Ma illo ethoid ai ells . These ells i a ia l e te d i to the i fe o edial po io of o ital loo . These ells a e o o l see i % of paie ts . This ai ell is a tuall a ed ate Al e t o Halle the S edish A ato ist ho des i ed these ai ells. Co o al CT i age of ose a d si uses sho i g Halle ell I ajo it of paie ts Halle ells a Radiologi al lassii aio of Halle ell: . S all . Mediu . La ge e as pto ai . . I age sho i g Halle ell as see i A ial CT i age of ose a d si uses Co o al CT i age of ose a d si uses sho i g la ge i fe ted Halle ell CT asal si uses late al ie sho i g i fe ted Halle ell Right poste io Halle ell ith iddle tu i ate o ha o e ess u i ai g ith sup a ulla Pa ado i al Middle tu i ate: Middle tu i to a ds the e it of the ause a o ate has a u atu e. No all the o e it of the u atu e is asal septu . I pa ado i all u ed iddle tu i ate the o u atu e is to a ds the iddle eatus. This o diio a i g of Osteo eatal o ple a ea. Co o al CT I age of ose a d si uses sho i g ilate al pa ado i all i ate u ed iddle tu - Eth oid si us: This is situated late al to the olfa to fossa, et ee late al asal all a d edial all of o it. This si us is the ost o pa t e talized of all pa a asal si uses, he e it sho s the a i u a ato i al a iaio s. At i th o l a fe eth oid ai ells a e p eu aised, this u e s ells to as adult hood is ea hed. Fo eas a d ete u de sta di g eth oidal la i th is di ided o li uel di e ted pa allel la ella. . Fi st la ella a te io la ella : This is the u i ate p o ess, hi h e ologi all o espo ds to the asal la ella of i st eth otu i al. . Se o d la ella: This is the eth oid ulla Bulla eth oidalis . This is the ost o sta t of all eth oid ai ells. A o di g to )u ke ka dl this is the la gest of all a te io eth oid ai ells. . Thi d la ella: This is the ost i po ta t. It is the asal la ella of iddle tu i ate sepa ai g a te io f o poste io eth oid ai ells. This is the e a t su gi al poste io li it of a te io eth oide to . . Fou th la ella: Is the asal la ella of supe io tu i ate . Fith la ella: is the asal la ella of sup e e tu i ate Co o al CT Nose a d si uses sho i g U i ate p o ess Ma ked i g ee U i ate P o ess: The u i ate p o ess is a i g o oo e a g shaped pie e of o e. It fo s the i st la e o la ella of the iddle eatus . It ata hes a te io l to the poste io edge of the la i al o e, a d i fe io l to the supe io edge of the i fe io tu i ate. Supe io ata h e t of the u i ate p o ess is highl a ia le, a e ata hed to the la i a pap a ea, o the oof of the eth oidal si us, o so ei es to the iddle tu i ate. The o igu aio of the ethoidal i fu di ulu a d its elaio ship to the f o tal e ess depe ds la gel o the eha io of the u i ate p o ess. The u i ate p o ess a e lassiied i to t pes depe di g o its supe io ata h e t. The a te io i se io of the u i ate p o ess a ot e ide iied lea l e ause it is o e ed ith u osa hi h is o i uous ith that of the late al asal all. So ei es a s all g oo e is isi le o e the a ea he e the u i ate ata hes itself to the late al asal all. T pe I U i ate: Figu e sho i g T pe I u i ate p o ess He e the u i ate p o ess e ds late all i its uppe ost po io a d i se ts i to the la i a pap a ea. He e the eth oidal i fu di ulu is losed supe io l a li d pou h alled the e essus te i alis te i al e ess . I this ase the eth oidal i fu di ulu a d the f o tal e ess a e sepa ated f o ea h othe so that the f o tal e ess ope s i to the iddle eatus edial to the eth oidal i fu di ulu , et ee the u i ate p o ess a d the iddle tu i ate. The oute of d ai age a d e ilaio of the f o tal si us u edial to the eth oidal i fu di ulu . Co o al CT ose a d si uses sho i g T pe I u i ate T pe II U i ate: He e the u i ate p o ess e te ds supe io l to the oof of the eth oid. The f o tal si us ope s di e tl i to the eth oidal i fu di ulu . I these ases a disease i the f o tal e ess a sp ead to i ol e the eth oidal i fu di ulu a d the a illa si us se o da il . So ei es the supe io e d of the u i ate p o ess a get di ided i to th ee a hes o e gei g ata hed to the oof of the eth oid, o e gei g ata hed to the la i a pap a ea, a d the last gei g ata hed to the iddle tu i ate. Figu e sho i g T pe II u i ate Co o al CT pa a asal si uses sho i g T pe II u i ate T pe III u i ate p o ess: I this t pe the supe io e d of the u i ate p o ess tu s ediall to get ata hed to the iddle tu i ate. He e also the f o tal si us d ai s di e tl i to the eth oidal i fu di ulu . U i ate p o ess should e e o ed i all e dos opi si us su gi al p o edu es i o de to ope up the iddle eatus. I fa t this is the i st step i e dos opi si us su ge . Ra el the u i ate p o ess itself st u io to the i fu di ulu . a e hea il p eu aised ausi g o - Figu e sho i g T pe III u i ate p o ess Co o al CT sho i g T pe III u i ate P eu aized U i ate p o ess: U i ate p o ess a o ple . e p eu aized ausi g a o i g of Osteo eatal Co o al CT of ose a d si uses sho i g p eu aized u i ate p o ess a d p eu aized iddle tu i ate * hite a o s The e a t e ha is of u i ate p eu aizaio is ot k o . It ould e due to g o th of agge asi ells i to the ost a te osupe io egio of u i ate p o ess. Refe e es: . B o J Baile & Jo as T.Joh so , Head a d Ne k su ge ,p , th ed . G a L.P .De iated asal septu . I ide e a d eiolog . A La gol. spp pp - . htp:// . htps://sites.google. o /site/d t alusotola od . We le D, B a e a I, A a M. Histolog of asal septal s ell od septal tu i ate . Otola gol Head Ne k Su g ; : . . )ha g L, Ha D, Ge W, Xia J, )hou B, Fa E, et al. A ato i al a d o puted to og aphi a al sis of the i te a io et ee the u i ate p oess a d the agge asi ell. A ta Otola gol ; : - . . htp://jo l. et/i de .php/jo l/a i le/ ie / . Youse ; . A ato i ele a e of Halle ells i si usiis Sta kpole SA A e i a J of Rhi olog Ma - ju .otol.Rhi ol. .d t alu. o.i /d s.ht l golog / hi olog /septal- DM. I agi g of si o asal i la ato disease. Radiolog . : - . Radiolog a st a t [pu ed itaio ] . Pola a a R, De aiah AK, Sakai O et al A ato i a ia ts a d pea ls-fu io al e dos opi si us su ge . Otola gol Cli No th A : – . . htps://sites.google. o /site/d t alusotola u i ate-p o ess golog / hi olog / . Bolge WE, Butzi CA, Pa so s DS. Pa a asal si us o a ato i a iaio s a d u osal a o aliies: CT a al sis fo e dos opi si us su ge . La gos ope ; : - . Osteo eatal o ple Osio eatal o ple : This te is used the su geo to i di ate the a ea ou ded the iddle tu i ate ediall , the la i a pap a ea late all , a d the asal la ella supe io l a d poste io l . The i fe io a d a te io o de s of the osteo eatal o ple a e ope . The o te ts of this spa e a e the agge asi, asof o tal e ess f o tal e ess , i fu di ulu , ulla ethoidalis a d the a te io g oup of eth oidal ai ells. This is i fa t a a o a ato i al egio . Muliple o oidalis o sisi g of : st u tu es Middle tu i ate, u i ate p o ess, Bulla eth- . Ai spa es F o tal e ess, eth oidal i fu di ulu , . Osia of a te io eth oidal, a illa iddle eatus a d f o tal si uses. I this a ea, the u osal su fa es a e e lose, so ei es e e i ausi g se eio s to a u ulate. The ilia thei s eepi g o e pushes the asal se eio s. If the u osa li i g this a ea e o es i a d s olle the u o ilia lea a e is i hi ited, e e tuall lo ki uses. o ta t e ts la ed g the si- So e autho s di ide this osteo eatal o ple i to a te io a d poste io . The lassi osteo eatal o ple des i ed al ead has ee des i ed as the a te io osteo eatal o ple , hile the spa e ehi d the asal la ella o tai i g the poste io eth oidal ells is efe ed to as the poste io ethoidal o ple , thus e og isi g the i po ta e of asal la ella as a a ato i al la d a k to the poste io eth oidal s ste . He e the a te io a d the poste io osteo eatal o ple has sepa ate d ai age s ste s. So he the disease is li ited to the a te io o pa t e t of the osteo eatal o ple , the eth oid ells a e ope ed a d diseased issue e o ed as fa as the asal la ella, lea i g the asal la ella u distu ed i i isi g the isk du i g su ge . Figu e sho i g o po e ts of Osteo eatal o ple O st u io to this a ea a p edispose to si usiis. Solke etal des i ed . t pe of o st u io i Osteo eatal o ple a ea. I fu di ula pate : Si us disease is li ited to i fu di ulu a d a illa si us; f o tal a d ethoidal si uses a e spa ed. Se o da to s olle u osa, pol ps, Halle ells. . Osteo eatal u it pate : Middle eatus, a te io - iddle eth oidal ai ells, a illa a d f o tal siuses a e i ol ed. Se o da to s olle u osa, pol p, o ha ullosa, septal de iaio , asal tu o . . Sphe oeth oidal e ess pate : Sphe oid a d poste io eth oid ai a e i ol ed. ells . Si o asal pol p pate : Pol ps ill asal a it a d si uses ilate all . U lassiia le pate /spo adi pate : Se o da o eles, post-op ha ges Co o al CT si uses sho i g i fu di ula pate Osteo eatal u it pate to ete io of OMC o st u io of o st u io sts, u- A ial CT of ose a d si uses sho i g sphe oeth oidal e ess pate of o st u io Co o al CT ose a d si uses sho i g si o asal pol pi pate A ial CT ose a d si uses sho i g a t al ete io st Eth oidal i fu di ulu : This is a let like th ee di e sio al spa e i the late al all of the ose. This spa e a tuall elo gs to the a te io eth oid. Bou da ies of this spa e i lude: Medial all - U i ate p o ess a d its Late al all - La i a pap a ea of o it ess of a illa, a el la i al o e. Poste io u osal o e i g edial all of o it , f o tal p o- all - A te io su fa e of ulla eth oidalis The a te io o de of u i ate p o ess fuses ith f o tal p o ess of a illa, this auses i fu di ulu to e d li dl a te io l i a a ute a gle. This auses i fu di ulu to appea like a V i ho izo tal se io s i.e. a ial CT . Hiatus se ilu a is: This is a t o di e sio al spa e et ee the a te io a d the f ee poste io a gi of u i ate p o ess. all of eth oid ulla Co o al CT ose a d si uses sho i g Eth oidal i fu di ulu a is lue li e ed li e Hiatus se ilu- Hiatus se ilu a is a e o side ed as a doo th ough hi h o e a the eth oidal i fu di ulu . ea h Refe e es: . htps://sites.google. o /site/d t alusotola osteo eatal- o ple . Egges ø HB. Radiologi al i agi g of i la a it a d pa a asal si uses. Eu Radiol. golog / hi olog / ato lesio s i the asal Ap ; : - . F o tal Si us I t odu io : F o tal si us is a o ple a d highl a ia le st u tu e. These a ato i a iaio s ha e a t e e dous i pa t o the di e io of d ai age, ei ie of u o ilia lea a e e ha is a d f o tal e ess o pholog . CT s a s of f o tal si us ha e o e io all ei g pe fo ed ith o i uous o o al a d a ial sli es. High esoluio ulipla a s a e s ha e ade sagital efo ated i ages a possi ilit . These s a e s e a le i agi g i th ee pla es. E olog : Si o asal e olog pla s a i po ta t ole i the a ato i al a iaio s see i a ious paie ts. Pa a asal si uses egi thei de elope t du i g the i st t i este f o the si eth otu i als. These tu i als e la ge a d p og essi el oales e to fo the late al asal all. The agge asi ell de elops f o the ost supe io e a t of the i st eth otu i al. The e a t f o the des e di g po io of i st eth otu i al fo s the u i ate p o ess. Basal la ella of the se o d eth otu i al p eu aizes to fo Bulla eth oidalis. The asal la ella of thi d eth otu i al fo s the asal la ella of the iddle tu i ate. Nasal u osa i agi ates at spe ii poi ts i to the late al asal all fo i g si us pits. These si us pits e la ge to f o the a illa , f o tal a d ethoidal si uses. The ese h e a ou d these si us pits eso s allo i g fo e la ge e t of si us a iies. The poi t of u osal i agi aio gi es ise to the si us osiu . F o tal si us d ai age path a is o ple e ause of the a ia le a ato of agge asi, a te io eth oidal ells, a d pate of i se io of u i ate p o ess. E olog : Si o asal e olog pla s a i po ta t ole i the a ato i al a iaio s see i a ious paie ts. Pa a asal si uses egi thei de elope t du i g the i st t i este f o the si eth otu i als. These tu i als e la ge a d p og essi el oales e to fo the late al asal all. The agge asi ell de elops f o the ost supe io e a t of the i st eth otu i al. The e a t f o the des e di g po io of i st eth otu i al fo s the u i ate p o ess. Basal la ella of the se o d eth otu i al p eu aizes to fo Bulla eth oidalis. The asal la ella of thi d eth otu i al fo dle tu i ate. s the asal la ella of the id- Nasal u osa i agi ates at spe ii poi ts i to the late al asal all fo i g si us pits. These si us pits e la ge to f o the a illa , f o tal a d ethoidal si uses. The ese h e a ou d these si us pits eso s allo i g fo e la ge e t of si us a iies. The poi t of u osal i agi aio gi es ise to the si us osiu . F o tal si us d ai age path a is o ple e ause of the a ia le a ato of agge asi, a te io eth oidal ells, a d pate of i se io of u i ate p o ess. F o tal si us d ai age path a : The f o tal si us g o s a d e pa ds i to the diploi spa e of f o tal o e f o the f o tal si us osiu . Ea h f o tal si us g o s i depe de tl of the othe . Thei g o th o la k of it is depe de t o the e ilaio , d ai age a d g o th of su ou di g si uses a d skull ase. The f o tal si us a o s i fe o ediall i to a fu el shaped a ea k o as f o tal si us osiu . A te io all of this a ea is ou ded a o idge k o as asal eak . The f o tal si us osiu is o ie ted pe pe di ula to the poste io all of the si us at the le el of a te io skull ase. So e autho s di ide f o tal si us d ai age path a i to supe io a d i fe io o pa t e ts. The supe io o pa t e t is fo ed the u io of adjae t ai spa es at the a te o i fe io po io of the eth oid o e. Its size a d shape a ies ith the a ia le a ato of f o to eth oidal ai ells. The supe io o pa t e t o u i ates di e tl ith the i fe io o pa te t. The i fe io o pa t e t is a a o passage a fo ed the ethoidal i fu di ulu o the iddle eatus. If the u i ate p o ess gets ata hed to the skull ase the i fe io po io is fo ed the eth oidal i fu di ulu . O the o t a if the u i ate p o ess gets ata hed to the la i a pap a ea the i fe io o pa t e t is fo ed the iddle eatus. F o tal e ess a ea: Is a ato i all dei ed as the ost a te io a d supe io pa t of a te io eth oidal o ple . This is p e isel he e f o the f o tal o e gets p eu aized. I the sagital pla e the f o tal e ess appea s like a i e ted fu el. I the sagital pla e the f o tal e ess appea s like a i e ted fu el. It ope s supe io l i to the f o tal si us osiu . The late al all of f o tal eess a ea is fo ed la i a pap a ea. Its edial all is fo ed the e i al ata h e t of iddle tu i ate. Its poste io all is highl a ia le, a d is fo ed the ulla eth oidalis if it ea hes up to the le el of skull ase. A la ge ulla ould ause a o i g of this ii al a ea o st u i g f o tal si us d ai age ha el. A i agi g odalit should ii all e a i e this a ea he e patholog ould lu k. The agge asi ells a d the u i ate p o ess pla a ole i the fo aio of the loo of this a ea. If the u i ate p o ess is ata hed to skull ase as sho i the igu e a o e the f o tal e ess d ai s i to the supe io e d of eth oidal i fu di ulu . If the u i ate p o ess gets ata hed to the supe io -a te io po io of the iddle tu i ate as sho i the igu e a o e the f o tal e ess d ai s i to the supe io e d of eth oidal i fu di ulu . Figu e sho i g te i al e ess If the u i ate p o ess gets ata hed to la i a pap a ea the f o tal e ess ope s di e tl i to the supe io aspe t of iddle eatus. The eth oidal i fu di ulu e ds di e tl i to a te i al e ess. F o tal si us d ai age a o u ia eth oidal i fu di ulu p o ess does ’t get ata hed to the la i a pap a ea. if the u i ate A ial CT sho i g la ge agge asi ell a o i g the f o tal e ess a ea o st u i g f o tal d ai age t a t Ne t a ial ut sho i g e la ged agge asi ell o st u i g the f o tal e ess a ea Co o al CT sho i g e la ged agge asi lo ki g f o tal ouflo t a t CT sho i g u i ate p o ess ata hed to skull ase. The f o tal e ess is see the agge asi a d u i ate p o ess et ee Co o al CT s a sho i g u i ate p o ess ei g ata hed to la i a pap a ea. This auses te i al e ess to fo . F o tal si us d ai s di e tl i to iddle eatus as sho i this igu e This o o al CT s a sho s the u i ate p o ess ei g ata hed to the iddle tu i ate. Note the p ese e of i fu di ulu et ee the ulla a d the u i ate p o ess. F o tal si us is see ope i g i to the i fu di ulu . Note also the fai l deep olfa to fossa. A ato i a ia ts of f o tal si uses: Detailed u de sta di g of a iaio s see i the a ato of f o tal si us ill help the su geo to a oid u e essa o pli aio s du i g su gi al p o edu es i ol i g the f o tal si us a d skull ase. F o tal ells: These a e a e a ato i a ia ts that i ol e eth oidal p euaizaio that i pi ge o the f o tal e ess a ea. These ells a also e te d to i ol e the lu e of f o tal osiu . A o di g to Be t the e a e fou t pes of f o tal ells. Be t’s lassii aio of f o tal ells: T pe I f o tal ells: This is a si gle f o tal e ess ell a o e the agge T pe II f o tal ells: This is a ie of ells a o e agge the f o tal e ess asi. asi, p oje i g ithi T pe III f o tal ell: This is a si gle a d assi e ell a isi g a o e the agge asi. The p eu aizaio o u s i a ephalad di e io i to the f o tal sius. T pe IV f o tal ell: This is a si gle isolated ell ithi the f o tal si us. This ell is so ei es dii ult to isualize due to its e thi alls. Co o al CT s a sho i g t pe I a d t pe II f o tal ells Co o al CT i age sho i g T pe III f o tal ell Co o al CT i age sho i g T pe IV f o tal ell Sup ao ital eth oidal ai ell: These ells a e aused p eu aizaio of o ital plate of f o tal o e poste io to the f o tal e ess a d late al to the f o tal si us. So ei es these sup ao ital ai ells a ea h up to the a te io a gi of the o ital plate i i ki g a f o tal si us. A ial CT sho i g sup ao ital ell Ma illa si us I t odu io : This is the la gest of pa a asal si uses. Alo g ith eth oidal si us this si us is p ese t at i th. Ma illa si us egi s its de elop e t f o the i fe io aspe t of eth oidal i fu di ulu at a out eeks . Di e sio s of a illa si us at i th : Height A te oposte io depth Width - . Rapid p eu aizaio of a illa si uses o i ue et ee ages – . I iiall the loo of the a illa si us e te ds just a o e the le el of the loo of the asal a it . Follo i g e foliaio a d epla e e t of p i o dial de iio a illa si us p eu aizaio ea hes up to the le el of loo of the a illa si us. I a hild the supe io all of a illa si us slopes i fe olate all . As the hild g o s up this slope g aduall e o es edu ed to fo a st aight all. I adults the a illa u e of l. Co po e ts fo si us takes the fo i g the thi of p a id ith a i te io edial all of . Ma illa . I fe io tu i ate . U i ate p o ess . Pe pe di ula plate of palai e o e . La i al o e ol- a illa i lude: Late al ape of a illa si us e te ds i to the z go ai p o ess of the a illa. So ei es it a e te d up to the z go ai o e. Roof the a illa si us is a tuall the loo of the o it o tai i g a al fo the i f ao ital e e. So ei es this e e a e aked e et of its o o e i g. This ould e a pote ial ause fo fa ial pai . Co o al CT of ose a d si uses sho i g i f ao ital e e i the oof of a illa si us The loo of a illa si us is fo ed the palai e p o ess of a illa. This poi t a tuall lies elo the le el of the loo of the asal a it . The a illa si us is usuall sepa ated f o ola de iio a la e of o pa t o e. So ei es this la e of o e ould e thi o a se t p o idi g a di e t oute of sp ead of de tal i fe io s i to the a illa si us. The a illa si us lassi all de o st ates iphasi g o th . The i st phase of g o th o u s du i g the i st ea s of life hile the se o d g o th phase o u s et ee ea s of age. The a te io all of a illa si us is thi est o e the a i e fossa a ea. It a just e thi k. Si e this po io is the eakest po io of the a teio all of a illa this is ea hed i te io all du i g Cald el Lu su ge p o edu es. Bou da ies of Ca i e fossa: I fe io : Bou ded the al eola idge Late al: Bou ded tooth. the a i e e i e e hi h is aused the a i e Supe io : I f a o ital fo a e Medial: P ifo ape tu e Ma illa si us osiu is pla ed poste o supe io l a d he e g a it does ot pla a ole i its d ai age. It is o l the u o ilia lea a e e hais hi h lea s se eio s out of a illa si us. Natu al osiu a e fou d at a poi t alo g the ou se of eth oidal i fu di ulu . It is o e o o l fou d to ope i to poste io thi d of i fu di ulu . So ei es a esso osiu ould e see i the edial all of a illa si us. This o o l de elops i the poste io fo ta el. Wide i g this a esso osiu does ot help i d ai age of a illa si us e ause u o ilia lea a e e ha is does ot allo d ai age th ough a esso osiu . Natu al osiu A esso osiu P ese t a te io l ot isi le u de P ese t poste io l a d a e easil oui e di e t asal e dos opi e a i- isualized du i g oui g asal e doaio s opi e a i aio O al i shape Sphe i al i shape O ie ted t a s e sel O ie ted a te oposte io l Dife e es et ee atu al a d a esso osiu Co o al CT of ose a d si uses sho i g atu al osiu Co o al CT ose a d si uses sho i g a illa si uses e te di g of loo of the asal a it u h elo the le el Co o al CT of ose a d si uses sho i g oth a esso osia hite a o head ed a o head a d atu al Co o al CT i age of ose a d si uses sho i g H poplasi a illa si uses H poplasia of Ma illa si uses: H poplasia of a illa e eal that so fa o l si us is a athe a e o diio . Re ie of lite atu e ases ha e ee epo ted . I ide e of a illa si us h poplasia a ges et ee . – %. Majo it of these paie ts epo ted e e as pto ai a d h poplasia i ol i g a illa si uses e e ide iied o l o oui e adiolog . A othe stud epo ts that o l a out ases of t ue a illa si us h poplasia ha e ee epo ted. Reaso s fo a illa si us h poplasia: Hall's H pothesis : Hall p oposed that i t aute i e de elop e tal a o alies to e the ause fo h poplasi a illa si us. Wasso 's H pothesis : A o di g to Wasso si us i fe io s du i g the i st ea of life ould ause a illa si us h poplasia. Bolge 's lassii aio of a illa si us h poplasia: Bolge as the i st to asso iate h poplasia / aplasia of u i ate p o ess ith h poplasia of a illa si us. He o side ed eth oid a d a illa si uses to e i i atel elated E ologi all . He suggested that de elop e tal a o aliies i ol i g u i ate p o ess ill lead to h poplasia of a illa si us also. He lassiied h poplasia of a illa si uses i to th ee t pes. T pe I: Mild si us h poplasia. No all de eloped u i ate p o ess, ell deeloped i fu di ulu ith a i g deg ees of si us u osal thi ke i g, T pe II: Sig ii a t a illa si us h poplasia, h poplasi / a se t u i ate p o ess, poo l dei ed o a se t i fu di ulu , total opa ii aio of afe ted si us. T pe III: P ofou d h poplasia of a illa si us, a se t u i ate p o ess Bassiou et al 's The lassiied atego ies. Classii aio of a illa a illa si us h poplasia: si us h poplasia i to de elop e tal a d a ui ed De elop e tal atego ies: . Isolated h poplasia due to de elop e tal a est due to i fe io / i adiaio / i ju . De elop e tal a a olies like fa ial d sostosis A ui ed atego ies: . T au a ith defo . I la ato it due to f a tu e of fa ial skeleto / su ge osteiis Wege e 's g a ulo a . H poplasia due to Thalassae ia / C ei is . Neoplasi osteiis The fa t that the e a e a u e of theo ies ate pi g to e plai this o diio itself suggests that the last o d is ot et out o this. C ite ia fo diag osis of a illa si us h poplasia: Ge aght a d Dola 's diag osi illa si us: ite ia fo diag osi g h poplasia of . E la ge e t of e i al o ital di e sio . Late al posiio of i f ao ital eu o as ula a al . Ele ated a i e fossa . E la ge e t of supe io o ital issu e . E la ge e t of pte gopalai e issu e a - Co o al CT of ose a d si uses sho i g h poplasia of ight a illa si us Co o al CT of ose a d si uses sho i g ight a illa si us h poplasia. Not the e t e e late al ata h e t of iddle tu i ate. Co o al CT of ose a d si uses sho i g h poplasia of ight a illa. Note the opa it of H poplasi si us. This ould lead to a e o eous diag osis of a illa si usiis Co o al CT of ose a d si uses sho i g h poplasia of oth a illa si uses. Note the thi ke ed i f ao ital a gi Ata h e t of iddle tu i ate to a thi ke ed la i a pap a ea a d Ha o k skull ase Su gi al i po ta e of a illa si us h poplasia: . E o eous diag osis of si usiis leadi g o to u edu es . FESS su ge i du ed o pli aio s e ause of the dii ult i ide if i g atu al osiu . Thi ke ed all of the si uses ause p o le s ith a t osto . Ve dii ult to ide if the a i e fossa a ea du i g a t osto du es . Du i g su ge ie ts CSF leak a d skull ase i ju e essa ae o su gi al p o- p o e- o i these pa- Septate Ma illa si us: Septaio s i ol i g a illa si uses a e athe o o . The a e as pto ai . These septaio s a e lassiied i to p i a a d se o da t pes. Pi a Ma illa si us septaio s: These septa o u ate tooth e upio . Se o da Ma illa si us septaio s: These septa o u ate edu tulaio . Co plete o ea o plete a illa si us septa a e eall a e. I fe io s i ol i g a illa si us is o o i the p ese e of o plete o ea o plete septa of a illa si us. Co o al CT i age of ose a d si uses sho i g septaio s of Sagital efo a illa ated CT i age of ose a d si uses sho i g septa i the si us a illa si us A ato i al disse io studies u de take U de ood de o st ated that septa i ol i g a illa si us is o o l see i the poste io sege t. A ato i al studies sho ed a illa si us septa to e o o l o ie ted i sagital o t a s e sal edial to late al . CT i agi g is the p efe ed ethod i ide if i g this a ato i al a iaio . E dos opi ie of Septate a illa si us Refe e es: . Ke ed D, Bolge W, )i ei h S. Diseases of the Si uses: Diag osis a d Ma age e t. Lo do : BC De ke ; . Wa g RG, Jia g SC, Gu R. The a ilagi ous asal apsule a d e de elop e t of hu a pa a asal si uses. J Otola gol ; . Whitet HB. I f ao ital e e dehis e e: the a ato i a illa ; si us : a uu heada he ? Otola o i : – ause of gol Head Ne k Su g – . htp:// .d t alu. o.i /a a_p s.ht l . htp:// . i. l . ih.go /p /a i les/PMC / . Thiaga aja , Balasu a a ia , a d Seethalaksh i Na ashi a . "H poplasia of all pa a asal si uses A ase se ies a d Lite atu e eie ." Otolaryngology online journal . . . Hall GW. E est Medi e olog a d a ; : – o al a ato . Wasso WW. Cha ges i the asal a esso la gol ; : – . of the a illa si uses ate si us. No thi th. A h Oto- . Bolge WE, Wood uf J WW, Mo ehead J. Ma illa si us h poplasia: Classii aio a d des ipio of asso iated u i ate p o ess h poplasia. Otola gol Head Ne k Su g ; : – . Bassiou A, Ne la ds WJ, Ali H, )aki A. Ma illa supe io o ital issu e as et . La gos ope si us h poplasia a d ; : – . Ge aght JJ, Dola KD. Co puted to og aph of the h poplasi la si us. A Otol Rhi ol La gol ; : – a il- . Maest e-Fe i , L, Ca illo-Ga ia, C, Gala -Gil, S, Pe a o ha-Diago, M, Pe a o ha-Diago, M. P e ale e, lo aio a d size of a illa si us septa: pa o a i adiog aph e sus o puted to og aph s a . J O al Ma illofa Su g ; , . . U de ood AS: A i ui la si us. J A at Ph siol : i to the a ato , Pt a d patholog of the a il- Sphe oid si us Sphe oid si uses a e lo ated at the skull ase at the ju io of a te io a d iddle a ial fossae. P eu aizaio of sphe oid sta ts at the age of , ea hes up to the sella tu ia at the age of . The e i e p eu aizaio p oess is o pleted he the hild ea hes tee age . The t o sphe oid siuses a e as et i al sepa ated i te si us septu . The poste io ata h e t of i te si us septu is also a ia le. It a get ata hed to the o a oid a al i the late al all of sphe oid si us . C ude ate pts to eakdo this septu i su h ases a e da ge i te al a oid a te ausi g i sta ta eous death. I te sphe oid septu should e e o ed to e pose the loo of the sella. Co o al CT ose a d si uses sho i g ifu ated sphe oid i te si us septu the o o e i g of i te al a oid a te ata hed to It is safe to use t ue ut fo eps to e o e i te sphe oid septu . P eu aizaio of sphe oid si us a e te d i to a te io a d poste io li oid p oess, poste io po io of asal septu a d o e . Co o al CT of ose a d si uses. Red s ua e i di ates a te io li oid p o ess p eu aizaio , Red dot pte goid p eu aizaio , Red a o opi a al, ed a o head p olapsi g idia e e i the loo of sphe oid si us. R i di ates fo a e otu du . Co o al CT of ose a d si uses sho i g p eu aizaio of poste io asal septu Sphe oid si us d ai s th ough a si gle osiu i to the sphe o eth oidal eess. Sphe oid osiu is situated f o the ase of the olu ella at a a gle of ° ith the loo of the ose i a pa asagital pla e. This lo aio o espo ds to the half a poi t i the a te io all of the si us. The supeio tu i ate a e used as a useful i t a asal la d a k du i g e dos opi si us su ge . The poste o i fe io e d of supe io tu i ate poi ts supe io l a d ediall to a ds the sphe oid osiu . E dos opi Supe io ie of sphe oid osiu all of sphe oid si us usuall ep ese ts the loo of sella tu i a. Depe di g o the e te t of p eu aizaio , the sphe oid si us a siied i to t pes: e las- Co hal: The a ea elo the sella is a solid lo k of o e ithout p eu aizaio . P esella : The sphe oid is p eu aized upto the le el of the f o tal pla e of the sella a d ot e o d Sella : This is the ost o o t pe of sphe oid p eu aizaio e te di g e o d the od of sphe oid, so ei es e e up to the li us. Possi le a iaio s of i te si us septu . A si gle la. idli e i te si us septu . Muliple i o plete septae a a e as follo s: e te di g o to the a te io all of sel- e see . A esso septa a e p ese t. These ould e see te the a oid a al o opi e e. i ai g o to Late al all of sphe oid si us: is elated to the a e ous si us. This si us is fo ed splii g of the du a. It e te ds f o the o ital ape to the posteio li oid p o ess. Ca e ous si us o tai s e deli ate e ous ha els, a e ous pa t of i te al a oid a te , d, th a d th a ial e es. It also o tai s so e a ou t of fat issue. The p o i e e of i te al a oid a te is see i the poste o late al aspe t of the late al all of sphe oid si us. This p o i e e a e ell ide iied i p eu aized sphe oid o es. O the a te o supe io aspe t of the late al all of sphe oid si us is see the ulge fo ed the u de l i g opi e e. These t o p o i e es a e sepa ated a s all di ple k o as the opi o a oid e ess. The opi e e a d i te al a oid a te is sepa ated f o the sphe oid si us a e thi pie e of o e. Bo e dehis e e is also o o i this a ea. The oof of the sphe oid pla u sphe oidale a te io l is o i uous ith the oof of eth oidal si us. At the ju io of the oof a d poste io all of sphe oid, the o e is thi ke ed to fo the tu e ulu sella. I fe io to the tu e ulu sella o the poste io all is the sella tu i a. It fo s a ulge i the idli e. The o e o e the sella ould e . thi k. This a get thi e i fe io l . It is he e eas to ee h the sella i this thi est pa t. This a ea a e easil ide iied a luish i ge of the du a hi h is isi le th ough the thi o o e i g. Co o al CT of ose a d si uses sho i g Sphe oid si us a d its a ato i al elaio s Cu e tl t a sphe oid oute is o side ed to e the sta da d app oa h to pituita su ge ies . Sphe o a illa plate: Whe the e is e essi e p eu aizaio of sphe oid si us it a a ut the a illa si us. The sepa ai g all et ee these t o si uses is k o as sphe o a illa plate . If p ese t this plate lies e t to eth o a illa plate. Co o al CT ose a d si uses sho i g ifu ai g sphe oid i te si us septu to opi e e ata hi g I te si us septu a de iate to o e side di idi g the sphe oid si us i to u e ual po io s. A esso i te si us septa a e also o o l see . The a also e ata hed to i te al a oid a te . The sella tu i a is see as a p o i e e i the oof of ell p eu aised sphe oid si us. This ulge is k o as the sella ulge . Sella ulge is a se t i highl p eu aised sphe oid si us. He e it is e i po ta t to a u atel dete i e the idli e he ope i g the sella. This idli e a e o i ed f o the ase of sphe oid i fe io l o f o the e ai i g a te io sphe oid all septu ata h e t supe io l . A esso i te si us septu see i side sphe oid si us gei g ata hed to the i te al a oid a te . Highl p eu aised sphe oid si us a disto t a ato ate uai g the o all o e the late al sphe oid all. This pla es the opi e e a d i te al a oid a te at isk du i g su ge ies i ol i g this a ea . Opi e e a iaio s i side sphe oid si us : A ato of opi e e ithi sphe oid si us is highl a ia le. Opi elaio ship ith sphe oid si us a e lassiied i to t pes: T pe I opi e e e e: I this t pe the opi e e ou ses i ediatel adja e t to the sphe oid si us ithout i de i g the all o o ta t ith the poste io eth oidal ai ells. This is the o o est t pe see i ea l % of i di iduals. I age sho i g T pe I opi T pe II opi e e e e: I this t pe opi e e ou ses adja e t to sphe oid si us ausi g a i de taio of the si us all, ut ithout o ta t ith the poste io eth oidal ai ell. I age sho i g T pe II opi e e T pe III opi e e: I this t pe the opi e e ou ses th ough the sphe oid si us, ith at least % of it ei g su ou ded ai . CT i age sho i g T pe III opi T pe IV opi e e e e: Opi e e lies i si uses. ediatel adja e t to the sphe oid a d poste io eth oid CT i age sho i g T pe IV opi e e I age sho i g the elaio ship et ee opi e e a d i te al a oid a te sphe oid si us i side O odi ell: This ell elo gs to poste io eth oidal g oup. This ell also goes the a e Sphe oeth oidal ai ell. This ell lies poste io to sphe oid si us. Ve a el it ould lie supe io to sphe oid si us e t al o odi ai ell . The opi e e lies e lose to this ai ell, a e as litle as . . I te al a oid a te ould also lie lose to this ai ell. T pe IV opi e e is o o i the p ese e of o odi ai ell. I ide e of o odi ell is athe high, o e stud goi g to the e te t of a out % . I fe io s i ol i g o odi ai ells puts opi e e at isk. If su geo is ot a a e of this ai ell he ould ause i ad e te t da age to opi e e du i g e dos opi si us su gi al p o edu es. A ial CT i age of ose a d si uses sho i g o odi ell o CT I age sho i g O odi ai ell S– sphe oid o - O odi Vidia e e a d sphe oid si us : The idia e e is fo ed post s api pa as pathei i e s a d p es api s pathei i e s. This is also k o as the Ne e of pte goid aal . Ne es that gets i ol ed i the fo aio of idia . G eate pet osal e e p ega glio i pa as . Deep pet osal e e post ga glio i s . As e di g sphe oidal a hf o e e: pathei i e s pathei i e s oi ga glio Vidia e e is fo ed at the ju io of g eate pet osal a d deep pet osal e es. This a ea is lo ated i the a ilage ous su sta e hi h ills the foa e la e u . F o this a ea it passes fo a d th ough the pte goid a al a o pa ied a te of pte goid a al. It is he e the as e di g a h f o the oi ga glio joi s this e e. The idia e e e its its o a al i the pte gopalai e fossa he e it joi s the pte gopalai e ga glio . Vidia a al: It is th ough this a al the idia e e passes. This is a sho t o tu el see lose to the loo of sphe oid si us. This a al t a s its the idia e e a d idia essels f o the fo a e la e u to the pte gopalai e fossa. A o di g to CT s a i di gs the idia a al is lassiied i to: T pe I: The idia ithi the loo of sphe oid si us a al lies o pletel T pe II: I this t pe the idia oid si us T pe III: He e the idia oid o e a al pa iall p ot udes i to the loo of sphe- a al is o pletel e edded i the od of sphe- CT i age sho i g the th ee t pes of Vidia a al i elaio to sphe oid si us Co o al CT i age sho i g p eu aizaio of let g eate i g of sphe oid. A o i di ates p ot usio of a illa e e The a illa e e is fou d i the a illa a al fo a e otu du . This a e dehis e t i so e i di iduals. P eu aizaio of g eate i g of sphe oid is o o l asso iated ith p ot usio of a illa e e. Refe e es: . Ri e DH, S haefe SD, A ato of the Pa a asal Si uses. I : Ri e DH, S haefe SD E dos opi Pa a asal Si us Su ge . Lippi ot Willia s & Wilki s, d ed . Sethi DS, Sta le RE, Pilla PK oid si us a d sella tu i a. J La . Ca allo LM,Messi a A, Cappa ia a P, et al. E dos opi e do asal su ge of the idli e skull ase: a ato i al stud a d li i al o side aio s. Neu osu g Fo us ; :E . Melo i F, Mi i R, Ro asio S, Sto eo F, Teai i GP. A ato i a iaio s of su gi al i po ta e i eth oid la i th a d sphe oid si us. A stud of adiologi al a ato . Su g Radiol A at ; : – . . Ro a o A, )u a ello M, Va Lo e e HR, Kelle JT. . E pa di g the ou da ies of the t a s-sphe oidal app oa h: a ato i stud . Cli A at ; : – . Si ik i A, Ba azit YA, Ba a M, Mu u S, Gu go K, Ka lika a M. Va iaio s of sphe oid a d elated st u tu es. Eu Radiol ; : – . DeLa o MC, Fu FY, )i ei h SJ. Opi e e elaio ship to the poste io pa a asal si uses.CT A ato i stud . AJR A J Neu o adiol ; : - . . Tha a i ata a i h S, Chaisi a o gkol K, K ait akul S et-al. The p e ale e of a O odi ell i adult Thai ada e s. Ea Nose Th oat J. ; : - E dos opi a ato of the sphegol Otol : – . . htps://sites.google. o /site/d t alusotola a ato -of- idia - e e golog / hi olog / i oa - I la ato lesio s of ose a d si uses I t odu io : Mu osal li i g of ose a d si uses should e o side ed as a si gle e it e ause the fo o e o i uous li i g. I la aio i ol i g asal uosa a also afe t the u osal li i g of pa a asal si uses, si ila l i e e sa is also possi le. He e the te hi osi usiis ould e apt . I la aio i ol i g u osa of ose a d si uses ould e aused : . Alle gi ea io . Vi al i fe io s . Ba te ial i fe io s . Fu gal i fe io s Si usiis a also e lassiied a o di g to the du aio of ill ess: . A ute si usiis - Du aio of ill ess is less tha . Su a ute si usiis - Du aio of ill ess a gi g et ee . Re u e t si usiis - Re u e t si usiis ith disease f ee pe iods i et ee ata ks. . Ch o i si usiis - Du aio of ill ess is o e tha eeks eeks Si usiis a also e lassiied a o di g to the si us i ol ed: . F o tal si usiis . Eth oidal si usiis . Ma illa . Sphe oidal si usiis si usiis - eeks The i e f a e i ol ed i lassii aio of si usiis is ot a solute. I a ute i fe io s u osa heals ithout esidual efe ts. I h o i i fe io s the e ill e so e a ou t of esidual efe t o the u osa . Mu osal d ai age s ste of pa a asal si uses a e e i el depe de t o the u o ilia lea a e e ha is . Du i g i fe io s u o ilia lea a e e ha is is afe ted leadi g o to stasis ithi the si us a it . D ai age f o si uses has to pass th ough a o . F o toeth oidal e ess . I fu di ulu . Sphe oeth oidal e ess I a ato i al te s these a eas a e k o o st u ted due to u osal oede a. ha as ight spots hi h a easil F o tal si us F o tal ells Agge asi F o tal e ess Nasof o tal eak Middle els: eatus F o tal e ess ight spot o po e ts e Eth oidal ulla Middle U i ate p o ess Hiatus se ilu a is I fu di ulu Ret o ul a e ess Ma illa Basal la ella si us Natu al osiu of a illa eatus si us Middle tu i ate Tight spot a ato Supe io tu i ate i the i fu di ula a ea Vidia a al Poste io eth oid si us Sphe oid si us osiu Sphe oid si us Opi e e Ca oid a al Fo a e otu du Tight spot a ato i the sphe oid eth oidal e ess a ea These a e u ous e a e li ed path a s hi h o o l e o eo st u ted due to u osal oede a. I a ute phases of i fe io s u osal oede a to these ii al d ai age a ea alo g ith te po a dis upio of uo ilia lea a e e ha is a e the ajo pathoph siologi e ha is s ausi g si usiis. I la ato diso de s of si uses a e efe i el e aluated CT i agi g of the a ea. It is ot oui el i di ated u less the e is a suspi io of i ol ee t of a eas like o it a d adja e t sot issue. A ute si usiis: A ute a te ial si usiis is aused due to a te ial i fe io i a o st u ted si us . O st u io of si us d ai age ha el is aused due to opposiio of o iguous u osal su fa es due to oede a aused i al i fe io . Vi al i fe io s i ol i g u osal li i g of asal a it is k o to p edispose to a te ial i fe io of si uses. O st u io to si us a it auses ha ges i the o ge te sio ithi it p edisposi g to supe added a te ial i fe io . A ute si usiis usuall i ol e a si gle si us, eth oidal si us ei g the ost o o l i ol ed si us. These paie ts ha e i eased isk of i t a a ial o pli aio s ith the i ol e e t of f o tal, eth oid a d sphe oid si uses . O ital o pli aio s a e also o o . A ute i al i fe io s a el ause a ute si usiis. Cli i all the poi t of t a siio f o i al si usiis to a ute a te ial si usiis a e ide iied he lea se eio s fo ed i al i fe io s e o e ello . Yello ish asal se eio i di ate a ute a te ial pu ule t si usiis. Whe i la ed u osa is i aged i a ute si us i fe io s it is see as e ha i g lesio due to the p ese e of a i g a ou ts of ate o te t i the . Pai o u s i a ute si us i fe io s o l he the osiu is lo ked a d the d ai i g si us is illed ith se eio s. Co o al CT si uses sho i g i fu di ula o st u io ith let a illa a ute si usiis Co o al CT i age of pa a asal si uses sho i g a ute i fe io i ol i g Halle ell. Note the luid le el i side the Halle ell a it A ute a te ial si usiis is o e likel to sp ead to o it tha i t a a iall . The thi la i a pap a ea that sepa ates o ital o te ts f o eth oidal siuses a easil e ea hed i fe io s i ol i g eth oidal si uses. I addiio to this the a te io a d poste io eth oidal ei s a e de oid of al es allo i g sp ead of i fe io s f o eth oidal si uses to o it. Co o al CT i age sho i g eth oidal si usiis i ol i g o it A ial CT sho i g a ute eth oidal a d a illa si usiis ith o ital elluliis Co o al CT ose a d si uses sho i g huge i fe ted o ha ullosa Co ha ullosa is usuall asso iated ith septal de iaio to the opposite side. Studies ha e e ealed that septal de iaio does ot ause o ha ullosa, ut it aug e ts iddle tu i ate p eu aizaio if p ese t . P ese e of i fe io i a huge o ha ullosa of iddle tu i ate also auses se o da a illa si usiis o the sa e side. I this s e a io e dos opi ese io of late al all of o ha ullosa ould e helpful . Co iguous sp ead of i fe io f o eth oid si us to i ol e the adja e t la i al d ai age s ste auses s pto s si ila to that of a ute da o siis. He e efo e e a ki g o the a age e t of da o siis it is i pe ai e to pe fo CT i agi g of si uses. A ute a te ial si usiis is aused o st u io to o al d ai age ha els of si uses. He e a ute si usiis o u s as a si us si us e e t athe tha a ge e alized ope . E e i the p ese e of pa si usiis due to a ute a te ial i fe io s it ould e app e iated that o e o o e of the si uses a e o e se e el afe ted tha the est. As et is the lassi featu e of a ute a te ial si usiis. I the ase of alle gi si usiis the e is o e o less u ifo i ol e e t of all the si uses as pathoph siolog i this o diio is o e ge e alized i atu e. Co o al CT i age of ose a d si uses sho i g e ide e of alle gi si usiis. Note the o o ut ke el like thi ke i g of a illa si us u osa Ai luid le els: Ai luid le els a e o o l see i a illa si uses due to a ute o st u io of a illa si us osiu due to a ute a te ial si usiis. This is o o l see i a out % of paie ts ith a ute si us i fe io s. Du i g the e a of a t al ash, esidual luid le el ithi a illa si us ould e isualized e e up to da s follo i g the ash. This has ee at i uted to the p ese e of sali e used fo la age ithi the si us. If paie t gi es histo of a t al la age the CT i agi g should e ideall dela ed up to a eek ate la age. A pe siste t luid le el e e ate a eek follo i g a t al la age i diates pe siste t o st u io to si us d ai age. I age sho i g a ial CT i age of ose a d si uses sho i g luid le el i the si us a it Co o al CT of ose a d si uses sho i g a ute a illa pe iosteal a s ess a illa si usiis ith ight o ital su - Nasogast i tu e pla e e t a d p olo ged supi e posiio i g a ause ai luid le els to o u i a illa si uses. Naso gast i tu e i te fe es ith a illa si us dis ha ge due to asal u osal oede a. Ma illa si us d ai age lo k sta ts ithi the i st hou s of i se io of aso gast i tu e . Sig ii a e of ai luid le el a ies a o di g to the si us i ol ed. If ai luid le el is p ese t i f o tal si uses it i a ia l ea s a ute a te ial si usiis. I t a a ial o pli aio s o u ithi hou s of f o tal si us i fe io . If s pto s do ’t sho i p o e e t o if i agi g sho s e ide e of ai luid le el e e ate hou s ate t eat e t the t ephi i g of the si us should e o side ed. Ai luid le el i eth oid si uses is a a e o u e e. E e if p ese t it should e o side ed as a Mu op o ele due to uptu e of eth oidal u oele ith pa ial d ai age i to the asal a it . A ial CT of ose a d si uses sho i g luid le el i eth oid a d sphe oid si uses P ese e of ai luid le el i sphe oid si us i di ates the p ese e of a ute si usiis / asal o st u io . I paie ts ith histo of head i ju , p ese e of ai luid le el i sphe oid si us i di ates p ese e of he o hage / CSF leak. Ch o i si usiis: This is a o o a d o e p e ale t ill ess. This te i di ates p ese e of i la ato p o ess i the u osal li i g of pa a asal si uses fo eeks o lo ge . Ch o i si usiis is al a s asso iated ith o u e t asal ai a i la aio . Si e h o i si usiis is al a s p e eded hi iis the te h o i hi osi usiis ould e o e app op iate. Majo it of h o i si usiis a e aused o i uaio of u esol ed a ute si usiis. So ei es h o i si usiis a o u i the a se e of a ute si usiis. I A e i a A ade of Otola golog - Head a d e k su ge Mulidis ipli a Task fo e a e out ith adult hi osi usiis diag osi ite ia hi h i luded : . Fa ial pai . Nasal o st u io . Nasal dis ha ge / Pu ule e . H pos ia . A os ia . Fe e . I this ite ia as ide ed to i lude adiologi al e ide e also. Ch o i si usiis a a ifest as o e of the th ee follo i g s d o es: . Ch o i hi osi usiis ithout asal pol pi . Ch o i hi osi usiis ith asal pol pi . Alle gi fu gal si usiis This lassii aio is sig ii a t e ause of the a i g t eat e t gies follo ed to t eat the . ethodolo- Pathoph siolog of h o i si usiis: Stasis of se eio s ithi the si us a iies t igge ed : . Me ha i al o st u io at the le el of Osteo eatal o ple due to p eaili g a ato i al a o alies. . Mu osal oede a due to a ious auses Cu e t o ept: Cu e tl due to: ho i hi osi usiis is o side ed to e a ulifa to ial disease . Pe siste t i fe io I ludi g osteiis a d p ese e of ioil . Alle g a d othe i . I t i si fa to s of uppe ai . Supe a ige s . Colo izi g fu gi that i du e a d sustai eosi ophili i la us u osa . Aspi i se sii it u ologi al diso de s a aio of si- Co o al CT sho i g h o i si usiis ith asal pol posis Note tu i ates a ot e dife e iated f o asal pol pi u less i do sei g is ha ged to o e i do Co o al CT i age of ose a d si uses o e i do sei g. He e tu i ates a d pol pi a lea l e dife e iated Ma age e t of h o i hi osi usiis should e ased o the ausai e fa to s hi h i lude: Osial lo kage Dela ed e o e of u o ilia fu io Mu ous e i ulaio a d p ese e of asso iated osteiis Mi o ial fa to s ausi g pe siste e of i fe io Refe e es: . THIAGARAJAN, Balasu a a ia ; BASITH, Yahia A dul. ROLE OF ANATOMICAL OBSTRUCTION IN THE PATHOGENESIS OF CHRONIC SINUSITIS. Otolaryngology online journal, US, . , . , o t. . ISSN . A aila le at: <htp://jo l. et/ i de .php/jo l/a i le/ ie / / >. . G alt e JM J . Jo es JG. Ke ed DW. Medi al Ma age e t of si usiis: edu aio al goals a d a age e t guideli es. A Otol Rhi ol La gol Suppl : : . We e A. I la gol Cli No th A . Youse . . U gu K, Tuz M, Dog u H. The o elaio ullosa. Otola gol Head Ne k Su g. . htp:// . Odita J, Aka agu a A, Ogisi F, et al. P eu aizaio of the a illa al a d as pto ai hild e . Pediat Radiol ; : – . Re . Repo t of the Rhi osi usiis Task Fo e Co itee Meei g. Ale a d ia, Vi gi ia, August , . Otola gol Head Ne k Su g. Sep ; Pt :S - ato diseases of the pa a asal si uses a d ; : – . D. I agi g of si o asal i la . i. l . ih.go /p ato u o eles. Otola disease. Radiolog ; : – et ee septal de iaio a d o ha Jul; : – /a i les/PMC / si us i ie D, Boles R. I t a a ial o pli aio s of f o tal si usiis. La ; : – o- gos ope - Mu o eles I t odu io : Mu o eles a e g aduall e pa di g lesio i ol i g pa a asal si uses. This is usuall aused due to o st u io to the o al d ai age ha els of pa aasal si uses leadi g o to pe t up se eio s ithi it. These paie ts lassiall do 't p ese t ith s pto s pe tai i g to ose a d si uses ut ith ophthal ologi al sig s a d s pto s. The i a ia l p ese t to the opthalologist efo e i di g thei a to a otola gologist. Dei iio : A u o ele is dei ed as u ous illed epitheliu li ed sa . Mu o eles o o l i ol e eth oidal a d f o tal si uses. Mu o eles a e o o l aused due to o st u io to d ai age ha el of pa a asal si uses. These e pa sile si asses a e so ei es illed ith u opu ule t se eio s . So ei es asso iated o e dest u io is also e ide t . Mu o eles a e athe o o i f o tal si uses. Ne t o es the eth oidal si uses. Isolated u o eles i ol i g eth oidal si uses a e athe a e . The al a s o u i o i aio ith f o tal / sphe oid u o eles . Eiopathoge esis: Mu o eles ha e ee postulated to fo due to o st u io of si us osia follo i g h o i i fe io s / alle gi ea io s i ol i g pa a asal si uses . P e ious t au a / su ge a also ause o st u io to si us ouflo ha els ausi g fo aio of u o eles. Eth oidal u o eles if p ese t i isolaio ould e aused e dos opi eth oide to . So e studies ha e epo ted o u e e of isolated eth oidal u o eles e e ea s ate su ge . Pa a asal si uses o i ues to e pa d slo l o i g to pe t up u ous se eio s. These u o eles a e li ed dilated iliated olu a epitheliu hi h se ete u ous ausi g e pa sio of the st. Co i ui g e pa sio of this st puts p essu e o the o alls of pa a asal si uses, ausi g o e osio a d e odeli g. U he ked e te it, asopha ato ediato p ese t ithi Th ee lated: sio of si us a it a d a ial a it s like p ostagla di u o eles also o t a ause e te sio of u o ele i to o . I addiio to p essu e ha ges i la s, i te leuki s a d tu o e osis fa to i ute to thei e pa sio apa ilit . ai theo ies of pathoge esis of u o ele fo aio has ee postu- . P essu e e osio . C si dege e aio of gla dula issue . A i e o e eso pio a d ege e aio Sites i ol ed u o eles i lude : . A te io eth oid . F o tal . Ma illa . Poste io eth oid . Sphe oid A out egio % of pa a asal si us u o eles a e p ese t i the f o toeth oidal Co o al CT of ose a d si uses sho i g f o toeth oidal te sio u o ele ith i t a a ial e - Role of i agi g i u o eles: Mu o eles a e est i aged usi g a o i aio of CT a d MRI s a s. CT s a s helps to assess o ha ges hile MRI s a s assess e te sio s i to o it / a iu ith g eat deg ee of a u a . CT s a featu es: . Co plete Opa ii aio of i ol ed si us . E pa sio a d thi i g of i ol ed si us a gi s . A eas of o plete o e eso pio e t a eas like o it a d a iu . Co t ast CT sho s pe iphe al e ha e e t ith esulta t e te sio i to adja- Co o al CT i age sho i g Eth oid si us u o ele Co o al CT of ose a d si uses sho i g u o ele i ol i g ight e osio of i fe io o ital all Co o al CT i age of ose a d si uses sho i g f o tal a illa u o ele si us ith A ial CT of ose a d si uses sho i g Sphe oidal Note: Sphe oidal u o eles a p ese t ith isio distu a es. Classii aio of f o tal F o tal u o ele u o ele: u o eles ha e ee lassiied i to t pes depe di g o its e te t. T pe I: I this t pe the u o ele is li ited to the f o tal si us o l ithout o ital e te sio . ith o T pe II: He e the u o ele is fou d i ol i g the f o tal a d eth oidal si uses ith o ithout o ital e te sio . T pe IIIa: I this t pe the u o ele e odes the poste io si us ith i i al o o i t a a ial i ol e e t. all of the f o tal T pe III : I this t pe the a ial e te sio . all ith T pe IV: I this t pe the us. u o ele e odes the poste io u o ele e odes the a te io ajo i t a all of the f o tal si- T pe Va: I this t pe the e is e osio of oth a te io a d poste io f o tal si us ithout o i i al i t a a ial e te sio . alls of T pe V : I this t pe the e is e osio of oth a te io a d poste io f o tal si us ith a ajo i t a a ial e te sio alls of Refe e es: . Ca alis RF, )ajt huk JT, Je ki s HA. Eth oidal gol Head Ne k Su g : , u o eles. A h Otola - . Nat ig K, La se TE. Mu o eles of the pa a asal si us. J La , . Ch ist as DA, Mi a te JP, Ya agisa a E. Isolated eth oid si us ele. ENT Rhi os opi Cli i ; . Lai PC, Liao SL, Jou JR, et al. T a s a u ula app oa h fo the e t of f o toeth oid u o eles. B J Ophthal ol ; : . E a s C. Aeiolog a d t eat e t of f o toeth oidal gol Otol : , . Busa a NY, Sal a SD. Eth oid u o ele as a late o pli aio of e dos opi eth oide to . Otola gol Head Ne k Su g ; : . Lai PC, Liao SL, Jou JR, et al. T a s a u ula app oa h fo the e t of f o toeth oid u o eles. B J Ophthal ol ; : . Co o PJ, Jo es NS. The pla e of e dos opi si us su ge i the t eate t of pa a asal si us u o eles. Cli Otola gol ; : . Si us u o ele: Natu al histo a d lo g te e u e e ate M. De a s du Ma e, A. Mo aPla a, D. Mali aud, O. La ou e e, P. Bo ils Eu opea A als of Oto hi ola golog , Head a d Ne k diseases gol Otol : u oa age- u o ele. J La - a age- . Mafee MF, Val asso i GE, Be ke M. I agi g of the head a d e k. Geo ge Thie e Ve lag. ISBN: Fu gal Si usiis I t odu io : Fu gi a e euka oi o ga is s o p isi g of oulds, easts, ush oo s a d othe si ila o ga is s. A o g this g oup of o ga is s o l a out . % a e hu a pathoge s. The te osis is used to dei e diseases aused fu gi . M osis a e lassiied u de of i fe io . heads ased o the po tal of e t a d site T pes of M osis: T pe Pathoph siolog Route E a ple Supe i ial Li ited to ke ai ized issues Topi al T. pedis Su uta eous Lo alised to su uta eous issues B oke ski Rhi ospo idiosis S ste i Disse i ated idel I halaio Histoplas osis Oppo tu isi Lo al / Disse i ated Cell ediated i u it o p o ise Ca dida / Mu o osis Fu gal i fe io s of ose a d si uses a e gei g o o these da s. With i easi g i ide e of HIV a d othe diseases like dia etes hi h o p oise host i u it it is o o de that the i ide e of fu gal i fe io s i ol i g ose a d pa a asal si uses is o the ise. I I dia the i ide e of fu gal si usiis i i u o o pete t paie ts is also sho i g a ise. This pa i ula fa t eed to e studied fu the . Classii aio of fu gal si usiis : The e a e dife e t t pes of fu gal si usiis ith dife i g pathoph siolog a d li i al p ese taio . The i lude: . A ute ful i a t i asi e si usiis . Ch o i i asi e fu gal si usiis . G a ulo atous i asi e fu gal si usiis . Fu gal all . Alle gi fu gal hi o si usiis Re e tl o e o e g oup is added i.e. Eosi ophili fu gal hi osi usiis. A ute ful i a t i asi e si usiis: The hole du aio of ill ess i these paie ts is just less tha eeks. These paie ts a e ostl i u o o p oised i di iduals. The edu ed i u it ould e ell e a esult of a. Dia etes ellitus . AIDS .I u osupp essi e d. Malig a ausi g i edi i es u e supp essio A ute ful i a t i asi e fu gal si usiis is aused fu gal i fe io s due to: . Mu o a ea fa il – see u de i os ope as oad h phae hi h e a el septates. B a hi g out is see at ight a gles. This is lea l see u de etha a i e / PAS stai i g of the issue. . Aspe gillous fa il – see u de the i os ope as a o a d septate h phae. B a hi g ould e see to o u at a ute a gles. If u o is the ofe di g pathoge the it is a gioi asi e ausi g e te si e dest u io of o e a d sot issue. These paie ts ha e a e high o talit ate . Co side i g the a ou t of issue e osis i ol ed i these paie ts, su gi al de ide e t follo ed i t a e ous a ifu gal edi aio s a phote i i B is the t eat e t of hoi e. This should also e asso iated ith good eugl ae i o t ol. Si e g a ulo tes a e e essa i o ai g this o diio , g a ulo te t a sfusio has ee ate pted ith e tai deg ee of su ess i these paie ts follo i g ou d de ide e t. Ch o i i asi e fu gal si usiis : This o diio is also k o as o g a ulo atous h o i i asi e fu gal siusiis. This o diio is o o l see i paie ts ith dia etes ellitus. Featu e of this i fe io is lo g ade i la aio ith issue e osis. Usuall this disease lasts et ee - eeks. Vas ula i asio is ot see . G a ulo a fo aio is lassi all see . O ital i ol e e t O ital ape s d o e is o o i these paie ts. This o diio afe ts i u o o pete t paie ts. F o to eth oidal egio is o o l i ol ed. Ma illa si us a d sphe oid si us a e e a el afe ted. Mo e tha % of these paie ts ha e f o to eth oidal si us i ol e e t. Aspe gillosis ha e ee i pli ated as the o o est pathoge i ol ed . O ital ape s d o e is ha a te ized . De ease i . O ula i . P optosis isio o ilit : Ideall these paie ts a e a aged su gi al de ide e t follo ed te i a ifu gal d ugs like a phote i i B i fusio . Ch o i i asi e fu gal si usiis is athe a e. A o di g to Fe guso o situtes less tha . % of all fo s of fu gal si usiis ope ated o . s sit CT s a o o al ut ose a d si uses of a paie t ith h o i i asi e fu gal si usiis ith o ital i ol e e t Note as et i al i ol e e t of the si uses. This is a lassi featu e of fu gal si usiis G a ulo atous i asi e fu gal si usiis: This o diio is also k o as I dole t fu gal si usiis . Classi all these paie ts ha e i ta t ell ediated i u e espo se. These lesio s a e aused Aspe gillus la ous Cli i all this o diio is i disi guisha le f o h o i i asi e fu gal si usiis. This is a tuall a histopathologi al e it . The i ta t ell ediated i u it li its the lesio to he su fa e u osa. G a ulo as ould e see su ou di g the fu gal ele e ts the e efe i el p e e i g thei i asio . G a ulo as t pi all o aseai g a d de o st ate the p ese e of uliu leated gia t ells a d eosi ophils. This o diio is efe i el a aged su gi al de ide e t. Ate su essful ou d de ide e t the i ta t i u e s ste takes a e of the disease. T eat e t ith it a o azole / a i o azole has sho p o isi g esults. Co o al CT s a i age sho i g hete o de se o e dest u i e lesio i ol i g ight a illa si us ith dest u io of its supe io a d a te olate al alls. Note s all opa ue pa i les ithi the ass. These a e aused etalli ele e ts ithi the fu gal ass . Fu gal Ball: These a e also k o as eto as. M eto as o o l p ese t as u ilate al opa ii aio of a illa / sphe oid si uses. This o diio is athe a e i eth oid a d f o tal si uses . Fu gal all is o posed of ightl pa ked h phae ostl f o aspe gillus, alte a ia a d P. Bo dii . This is a tuall a se uest aio of fu gal h phal ele e ts ithi the si us ithout a i asi e / g a ulo atous ha ges. Nasal u osa is a solutel o al i these paie ts. This disease is lassi all aused due to i halaio of spo es, hi h e e tuall gets se ueste ed eithe i to a illa o sphe oid si uses. Co o al CT s a of ose a d si uses sho i g fu gal all ithi let a illa si us a it Fu gal g o th o u s ithi the o i es of the afe ted si us a it . Fu gal g o th o u s e ause of the a ilit of the i fe i g pathoge to a oid host i u e espo se. Sig s a d s pto s a i i h o i hi osi usiis i ad a ed ases. Cli i al e a i aio e eals e ol ed si us a it . litle. CT i agi g e eals opa it of the i - This o diio is a aged su gi al e o al of the fu gal all a d eai g good e ilaio to the i ol ed si uses ide i g the si us osiu . S ste i a ifu gal age ts a e ot i di ated i these paie ts. Topi al a ifugal age ts ha e ee ad i iste ed ith a i g deg ees of su ess. I ajo it of these paie ts this o diio as diag osed as a i ide tal i di g he oui e i agi g of ose a d si uses e e pe fo ed. Alle gi Fu gal si usiis: This athe poo l u de stood e it as i st epo ted i .I Katze stei et al des i ed a o diio a d oi ed the te i olog alle gi aspe gillus si usiis. The ade the diag osis ased o the p ese e of histologi al t iad of lu ps / sheets of e oi eosi ophils, Cha ot – Le de stals p o a l f o dege e ai g eosi ophils a d o i asi e fu gal h phae ese li g aspe gillus spe ies. These paie ts ha e a o i aio of asal pol posis, ust fo aio a d posii e ultu e fo aspe gillus. It as Ro so i ho i t odu ed the te alle gi fu gal siusiis to des i e the i di gs asso iated ith this disease. A o di g to Cod aspe gillus spe ies as espo si le fo o l % of alle gi fu gal si usiis. This as e ide t f o the et ospe i e stud o du ted hi o e i g a la ge sa ple size . I ide e of alle gi fu gal si usiis a o g h o i si usiis is pla ed a ou d - % . Based o li i al i di gs Be t a d Kuh p oposed e tai sis of alle gi fu gal si usiis. Be t's ite ia ite ia fo diag o- fo the diag osis of alle gi fu gal si usiis: . De o st a le t pe I h pe se sii it to fu gi . Nasal pol posis . Radiologi al i di gs Hete ode se . P ese e of eosi ophili u i ass lesio i ed ith o i asi e fu gus . Posii e fu gal stai / fu gal ultu e S ai 's odii aio of Be t's ite ia: deShazo a d S ai slightl odiied the diag osi ite ia laid out Be t. The let out the t pe I h pe se ii it ite ia alo e si e o l / of paie ts ith alle gi fu gal si usiis a ifested ith h pe se sii it to fu gal p otei i a ious studies. Be t a d Khu odiied thei diag osi ite ia fo diag osis of alle gi fu gal si usiis addi g ajo a d i o diag osi ite ia. Majo C ite ia Mi o C ite ia T pe I h pe se sii it Asth a Nasal Pol posis U ilate al disease Cha a te isi CT i di gs Bo e e osio Eosi ophili Mu i Fu gal ultu es Posii e fu gal stai Cha ot Le de stals a d eosi ophlia U disputed diag osi ite ia fo the diag osis of alle gi fu gal si usiis i lude: . Ch o i hi osi usiis . P ese e of alle gi u i . P ese e of fu gal o ga is ithi the u i Alle gi fu gal si usiis like o diio : I this atego those paie ts ho do ot de o st ate posii e fu gal p ese e i the u i o i ultu es of u i a e i luded. The pau it / a se e of fu gal ele e ts i these paie ts ould e a ou ted fo the p ese e of i eased a ou ts of ajo asi p otei eleased eosi ophils. Majo asi p otei has ee fou d to e to i to fu gi . Cli i al featu es of alle gi fu gal si usiis: These paie ts p ese t ith p og essi e asal o st u io , usi g, hi o hoea, a d h o i hi osi usiis. These paie ts a also o e ith d a ai s pto s like isual loss a d total asal o st u io . Classi all adiolog sho s u ilate all e pa sile lesio of the si uses asso iated ith o e osio . The ass appea s as hete ode se due to the p ese e of etalli ele e ts i the fu gal h phae. U ilate al as et i i ol ee t of si uses is the lassi featu e of this o diio . The e ha is of ausaio of alle gi fu gal si usiis is IgE ediated h pe se sii it to fu gal p otei s espe iall to aspe gillus. Both t pe I a d t pe III h pe se sii it ea io s to fu gal p otei s ha e ee i pli ated. Alle gi fu gal si usiis sill e ai s a u de epo ted o diio due to la k of a a e ess a o gst t eai g ph si ia s. Co o al CT ose a d si uses sho i g E pa sile lesio i ol i g the ight a illa sius. E osio of edial all of a illa, the asal a it is illed ith hete ode se ass. The septu is see ei g pushed to the opposite side. CT s a featu es of AFRS: CT s a pa a asal si uses e eal uliple opa iied si uses ith e t al h pe ate uaio , u o ele fo aio , e osio of la i a pap a ea / skull ase, pushi g o de s. Bo e e osio i paie ts ith asal pol posis should aise suspi io of alle gi fu gal si usiis Eosi ophili fu gal si usiis: This te i olog as i t odu ed of h o i si usiis. Po ikau etal to e plai pathoph siolog This diso de is usuall ilate al. Fu gal h phae has ee de o st ated i alost all these paie ts. Studies ha e ot a aged to de o st ate i eased le els of IgE i these paie ts. H pe se sii it ea io has ee uled out as a ause fo this t pe of fu gal si usiis. It has ee postulated that this o diio ould e aused a o al ell ediated i u it to fu gal p otei s. These paie ts espo d ell to su gi al e o al of pol poidal u osa, a d eaio of ide a t osto hi h i p o es e ilaio to the si us u osa. Co o al CT s a of ose a d si uses sho i g e ide e of fu gal pol posis i side oth asal a iies ith e osio of skull ase o the ight side. Both a illa si uses a e o st u ted ith pe t up se eio s. Co o al CT s a of pa a asal si uses poste io ut sho i g opa it of sphe oid si us ith e osio of sphe oid si us oof. Fu gal Sphe oidal si usiis Co o al CT s a ose a d si uses sho i g fu gal si usiis of a illa si us Refe e es: . htp:// .d t alu. o.i /fu g_si usiis.ht l . Fu gal si usiis diag osi a age e t a d lassii aio . Pe dje I, Bo i iæ I, A siæ V, Dud a ski ), Dotliæ J, Jo i e iæ O, Ja ose iæ L. Sou e KCS, I situt za ORL i aksilofa ijal u hi u giju, Beog ad. A ta Chi Iugosl. ; : - . . Gillespie MB, O'Malle BW J , F a is HW. A app oa h to ful i a t i asi e fu gal hi osi usiis i the i u o o p o ised host. A h Otola gol Head Ne k Su g. Ma ; : - . . G a ulo te T a sfusio i the Ma age e t of Ful i a t I asi e Fu gal Rhi osi usiis Sa adi, Da iel S.; Gold e g, A d e N.; O la di, Ri ha d R. A e i a Jou al of Rhi olog , Volu e , Nu e , Jul -August , pp. - . Fu gal Rhi osi usiis. Diseases of the Si uses Diag osis a d Ma agee t. Ke ed DW, Bolge WE a d )i ei h SJ. BC De ke I . Ha ilto , Lo do , ; : . Fe guso BJ. . Pa ikh SL, Ve kat a a G a d DelGaudio JM. I asi e fu gal si usiis: a - ea e ie f o a si gle i situio . A J Rhi ol. Ma -Ap ; : - . S hu e t MS. . deShazo RD, O'B ie M, Chapi K, Soto-Aguila M, Ga d e L, S ai R A e lassii aio a d diag osi ite ia fo i asi e fu gal siusiis. A h Otola gol Head Ne k Su g : . . Sai stei B. Alle gi the uppe espi ato . Ro so JM, Hoga PG, Be RA, Gate PA. Alle gi fu gal si usiis p ese i g as a pa a asal si us tu ou . Aust N ) J Med. ; : . o hopul o a aspe gillosis ith o st u io of t a t. Chest. ; : . . Cod DT II, Neel HB III, Fe ei o JA, Ro e ts GD. Alle gi fu gal si usiis: the Ma o Cli i e pe ie e. La gos ope. ; : . . Katze stei AL, Sale SR, G ee e ge PA. Alle gi Aspe gillus si usiis: a e l e og ized fo of si usiis. J Alle g Cli I u ol. ; : . . Be t JP III, Kuh FA. Diag osis of alle gi fu gal si usiis. Otola Head Ne k Su g. ; : - gol . deShazo RD, S ai RE. Diag osi le g Cli I u ol. ; : - . ite ia fo alle gi fu gal si usiis. J Al- . E e BK. Gou le OS, lo ge so NL, et al: Alle gi fu gal si usiis. A Rhi : , . . Ma ple BF. Alle gi fu gal hi osi usiis: u e t theo ies a d e t st ategies. La gos ope. ; : . a age- Nasal Pol p Dei iio : Pol p is dei ed as si ple oede atous h pe t ophied u osa of the asal a it . It a e u ilate al / ilate al . P e ale e of asal pol p i ge e al populaio has ee esi ated to e a ou d % . Causes of asal pol p: . I fe io s . Alle g . Pol p due to u o isidosis Classii aio : Nasal pol p a e lassiied as: . Si ple pol p . Eth oidal pol pi . A t o hoa al pol p . Fu gal pol p . Malig a t pol p I agi g pla s a u ial ole i the diag osis a d a age e t of asal pol pi. The follo i g a e so e of the i po ta t o t i uio s i agi g is supposed to ake: It li hes the diag osis It helps i e aluaio of p og essio of disease Helps i su gi al pla Helps i i g o ito i g fo e u e e CT appea a e of asal pol pi : The appea as ou ded odies of sot issue a isi g f o the u osal su fa es of ose a d pa a asal si uses. The a e lea l dife e iated f o the su ou di g i la ed u osal li i g a d asal se eio as the a e o e adio de se a d he e appea ighte . Ra el a pedi le ata hi g the pol poidal ass to the asal u osal li i g a e see lea l i the CT s a pedi le sig . If p ese t it is i tuall diag osi of asal pol pi. O e i po ta t poi t that should e o e i i d hile e aluai g CT i ages f o a paie t ith asal pol pi is that the e e ause o e e osio . If sot issue ass a isi g f o the asal u osa is asso iated ith o e e osio the it is a dei ite poi te to a ds the diag osis of alig a . P essu e efe ts of asal pol p a e e ide tl see i i agi g. These efe ts i lude lo al o e e odelli g ausi g a s allopi g efe t. This s allopi g efe t should ot e o fused ith that of the s allopi g of a gi s p odu ed the u o ele si e it is al a s asso iated ith e la ge e t of the si us a it . Ra el this o e e odelli g a o asio all ause thi i g of the o septa of the eth oidal si us. This thi i g ould e so e t e e that it ould go e e elo that of the esoluio of the CT s a . This eates a pi tu e of o e e osio hi h is ot a t ue o e. Appea a e of asal pol p he o t ast CT is take : Nasal pol pi do ot sho e ha e e t o i je io of o t ast edia. The u osa su ou di g the asal pol i a sho e ha e e t ausi g a i p essio of i e ha e e t a ou d the asal pol pi. T pes of asal pol p: Eth oidal pol pi – a isi g f o eth oidal si us a d a e uliple. The a e isualized i the CT s a of pa a asal si uses as uliple pol poid lesio s. Pol pi a isi g lose to the i ifo plate a ea a ause olfa to distu a es. Pol p a isi g f o the a illa si us – is usuall solita . It e its the a t u ia the atu al / a esso osiu . This auses a e la gee t of osia. Radiologi all it appea s like a du ell e ause of the o st i io p ese t i the idli e osial e it poi t . I these paie ts the edial all of the a illa si us o s i to the asal a it . This a e lea l isualized i the CT s a i ages. O st u io aused this pol p to the d ai age ha els of eth oidal a d f o tal si uses iddle eatus a ause opa ii aio of those si uses also the e aki g it dii ult to ide if the e a t o igi of the asal pol p. I this s e a io the o e e odelli g that takes pla e i the edial all of a illa si us ould e the li he . If these pol p passes poste io l to e it ia the hoa a it ould e lea l isualized i the a ial uts take at the hoa al le el. Fu gal disease a oe ist ith asal pol pi. If p ese t the ould e isualized as h pe de se a eas et ee the asal pol pi shado s. CT dife e es et ee a ute si usiis & asal pol pi : A ute si usiis auses a ea u ifo Opa ii aio of the pa a asal si uses he eas asal pol pi i addiio to the Opa ii aio sho uliple o e iies. Mu ous ete io st a e safel eli i ated if the pol p sho s a pedi le adiologi all . If the e is asso iated o e e odelli g the i all p o a ilit it ould e asal pol p athe tha u ous ete io st. I ase of diag osi dile a MRI ill li h the diag osis. I si i osis i addiio to the adio de siies see i the CT s a i ages the e is also asso iated thi ke i g of the a illa si us alls due to osteoeoge esis. Co o al CT sho i g asal pol posis ith o e e odelli g Dife e es et ee eth oidal pol pi a d a t o hoa al pol p Eth oidal Pol pi A t o hoa al pol p See i adults Alle g is the o o See i ause Muliple a d ilate al appea s like a u h of g apes A ises f o eth oidal la i th See i a te io hi os op X- a si uses sho s o al a t u a d haz eth oids Re u e e is o o hild e a d adoles e ts I fe io is the o o ause U ilate al a d si gle A ises f o a illa a tu See du i g post asal e a i aio X- a si uses sho haz a t u Re u e e is u o o A t o hoa al pol p : S o s: A t o hoa al pol p, Killia 's pol p, Nasal pol p. Histo : I ie t. Palf i st des i ed a a t o hoa al pol p i a fe ale pa- The pol p as fou d illi g the asopha e te di g up to the u ula of the paie t. Palf elie ed that this pol p a ose f o the hoa a. It as Killia i ho de o st ated that this pol p a ose f o the a illa si us a tu . Dei iio : A t o hoa al pol p is a e ig solita pol poidal lesio a isi g f o the a illa si us a t u ausi g opa ii aio a d e la ge e t of a t u adiologi all ithout a e ide e of o e dest u io . It e its the a t u th ough the a esso osiu ea hes the asal a it , e pa ds poste io l to e it th ough the hoa a i to the post asal spa e. I ide e: It o o l afe ts hild e a d ou g adults. Eiopathoge esis: This disease is o o l see o l i o atopi pe so s. Its eiolog is sill u k o . I fa t this diso de is ot asso iated ith asal alle g . P oetz theo : P oetz suggested that this disease ould e due to fault deelop e t of the a illa si us osiu , si e it as al a s ee fou d to e la ge i these paie ts. H pe t ophi u osa of a illa a t u sp outs out th ough this e la ged a illa si us osiu to get i to the asal a it . The g o th of the pol p is due to i pedi e t to the e ous etu f o the pol p. This i pedi e t o u at the le el of the a illa si us osiu . This e ous stasis i eases the oede a of the pol poid u osa the e i easi g its size. Be oulli's phe o e o : P essu e d op e t to a o st i io io efe t pulli g the si us u osa i to the ose. Mu opol sa ha ide ha ges: Jakso postulated that ha ges i sa ha ides of the g ou d su sta e ould ause asal pol p. auses a su u opol - I fe io s: Re u e t asal i fe io s ha e also ee postulated as the ause fo asal pol p. Mill's theo : Mills postulated that A t o hoa al pol p ould e a illa ould e aused due to o st u io of u i ous gla ds. u o eles hi h E i g’s theo : E i gs suggested that a a o al hi h ould o u du i g a illa si us de elop e t ould lea e a u osal fold lose to the osiu . This fold ould late e aspi ated i to the si us a it due to the efe ts of i spi ed ai ausi g the de elop e t of a t o ho al pol p. Vaso oto i ala e theo : This theo at i utes pol p fo aio due to auto o i i ala e Pol poidal issue f o the a illa a t u e its out th ough the a esso a illa si us osiu a o di g to so e o ke s. This a esso si us osiu is pla ed poste io l , hi h ould e the easo fo the pol p to p ese t poste io l . The a esso si us osiu ide s p og essi el , uli atel at o e stage e gi g ith the atu al osiu of the a illa si us fo i g o e huge ope i g i to the a illa a t u . I fe io / I la aio : This theo suggests that a i ous u ous gla ds ithi the a illa si us a it gets lo ked due to i fe io / i la aio i ol i g the u ous li i g of the si us a it . This leads to the fo aio of a si lesio ithi the a illa si us a it . This st g aduall e la ges to o up the hole of the a illa si us a it . It e its the si us a it e la gi g the a esso osiu a d e te s the asal a it . Usuall these sts a ise f o the a te o i feio / edial all of a illa a t u . Possi le easo s fo spa e: ig aio of A t o hoa al pol p i to the post asal . The a esso osiu th ough hi h the pol p gets out of the a t u is p ese t poste io l . a illa . The i spi ato ai u e t is o e po e ful tha the e pi ato the e pushes the pol p poste io l . ai u e t . The atu al slope of the asal a it is di e ted poste io l , he e the pol pal a s slips poste io l . . The ilia of the iliated olu a epithelial ells li i g the asal a it ala s eats a te o poste io l pushi g the pol p ehi d. Histolog : Sho s espi ato epitheliu o e o al ase e t e a e. The i te siial la e is g ossl oede atous, ith o eosi ophils. The i te sial la e o tai s othe i la ato ells. Cli i al featu es: Si e the diso de is u ilate al o a s p ese t ith: o l the paie t al- . U ilate al asal o st u io . U ilate al asal dis ha ge . Heada he ostl u ilate al . Epista is . Sleep ap oea . Rhi olalia lausa due to p ese e of pol p i the post asal spa e . Dii ult i s allo i g if the pol p e te ds i to the o opha A te io hi os op i age of A t o hoa al pol p CT s a of pa a asal si uses is diag osi . It ill sho the pol p illi g the a illa a it . a tu a d e ii g out th ough the a esso osiu i to the asal Co o al CT of ose a d si uses sho i g A t o hoa al pol p. Note the a t al o poe t a d the asal o po e t E dos opi ie of hoa al o po e t of A t o hoa al pol p Mu ous ete io st a illa a tu hi h ould e a p e u so to A t o hoa al pol p Se ial Co o al CT i ages sho i g A t o hoa al pol p Refe e es: . htps://sites.google. o /site/d t alusotola pol p . Nasal pol p: Pol p is a Lai o d a J, Kap io J, Poussa T, et al. e a e, asal pol posis a d h o i populaio - ased stud . I t J Epide . htp:// .d t alu. o.i /i age_ aslpol p.ht l . htp:// . . htps:// i. l . ih.go /p .s i d. o /do / golog / hi olog / asal- ea i g pol pous a footed . Hed. P e ale e of asth a, aspi i i tolo st u i e pul o a disease i a iol, : – . /a i les/PMC /a -pol p# / Role of i agi g i Fa io a illa t au a I agi g pla s a ital ole i assess e t of the se e it of Fa io a illa t aua. P ope l pe fo ed CT i agi g e eals ot o l the e a t f a tu e site ut also helps the su geo i de idi g the opi al a age e t odalit . The e i e fa ial skeleto is suppo ted t o ut esses, o e ho izo tal a d o e e i al . These ut esses pla a i po ta t ole i a so i g defo i g fo es of i ju . The ut ess s ste of idfa e is fo ed st o g f o tal, a illa , z goai a d sphe oid o es a d thei ata h e ts to o e a othe . The e t al idfa e o tai s a f agile o es that ould easil u le he su je ted to st o g fo es. These f agile o es a e su ou ded thi ke o es of the fa ial ut ess s ste le di g it so e st e gth a d sta ilit . Co po e ts of But ess s ste : Fo ete u de sta di g the o po e ts of the fa ial ut ess s ste ee di ided i to: ha e . Ve i al ut esses . Ho izo tal ut esses Ve i al ut ess: These ut esses a e e ell de eloped. The i lude: . Naso a illa . ) go ai o a illa . Pte go a illa . Ve i al a di le Majo it of the fo es a so ed idfa e a e asi ato the e i al ut esses a e ell de eloped i hu a s. i atu e. He e Ho izo tal ut esses: These ut esses i te o es. The i lude: e t a d p o ide suppo t fo the e i al ut ess- . F o tal a . I f ao ital i & asal o es . Ha d palate & a illa al eolus Figu e sho i g a ious ut esses of idfa e F a tu e asal o es: Nose is the ost p o i e t pa t of the fa e, he e it is likel to e the ost o o st u tu e to e i ju ed i the fa e. Although f a tu es i ol i g the asal o es a e e o o , it is ote ig o ed the paie t. Paie ts ith f a tu es of asal o e ill ha e defo it , te de ess, he o hage, ede a, e h osis, i sta ilit , a d epitaio . These featu es a e p ese t i a i g o i aio s. A ial CT of ose a d si uses sho i g f a tu e of oth asal o es Nasal o e f a tu es a e o . Nose happe s to e the o e ause: ost p o i e t po io of the fa e .I easi g u e of oad t ai a ide ts .I easi g i ide e of do esi .I ease i the u iole e e of i di iduals taki g pa t i o ta t spo ts Nasal o es a e pai ed o es. Both these o es p oje t like a te t o the f o tal p o ess of a illa. I the idli e the a i ulate ith o e a othe . Just u de this idli e a i ulaio lies the asal septu . Supe io l the asal o es a e thi ke he e it a i ulates ith the asal p o ess of f o tal o e. This a ea is elai el sta le a d i . Nasal o e f a tu es o o l o u at the t a siio zo e et ee the p o i al thi ke a d distal thi e po io s. This zo e p e isel o espo ds to the lo e thi d of the asal o e a ea. F a tu es i ol i g asal o es if ot p ope l a d p o ptl t eated leads to: . Nasal defo iies . I t a asal d sfu io like asal lo k F a tu e asal o e is k o to ause highe i ide e of o idit a d o pli aio s he o pa ed that of f a tu es i ol i g othe fa ial o es . I o de to t eat this o diio p ope l it is e essa to a u atel diag ose this o diio : . Looki g fo epitus a d te de ess o e the asal o e a ea . Radiog aphi e aluaio of asal o es. Radiog aph helps i diag osis a d lassii aio of asal o e f a tu es, a d also i he ki g the ade ua of edu io . Pathoph siolog : The follo i g poi ts should e o e i i d efo e ate pi g to u de sta d the pathoph siologi al fa to s that lead to f a tu es i ol i g asal o es. . Nasal o es a d u de l i g a ilage a e sus epi le fo f a tu e e ause of thei o e p o i e t a d e t al posiio i the fa e. . These st u tu es a e also p et pa t. itle a d poo l ithsta ds fo e of i - . The ease ith hi h the ose is oke a help p ote t the i teg it of the e k, e es, a d ai . Thus it a ts as a p ote i e e ha is . . Nasal f a tu es o u i o e of t o ai pate s- f o a late al i pa t o f o a head o i pa t. I late al t au a, the ose is displa ed a a f o the idli e o the side of the i ju , i head-o t au a, the asal o es a e pushed up a d spla ed so that the uppe ose idge appea s oad, ut the height of the ose is ollapsed saddle- ose defo it . I oth ases, the septu is ote f a tu ed a d displa ed. . The asal o e is o posed of t o pa ts: A thi k supe io po io a d a thi i fe io po io . The i te a thal li e de a ates these t o po io s. F a tu es o o l o u elo this li e. . Nasal f a tu es o u i o e of t o ai pate s- f o a late al i pa t o f o a head o i pa t. I late al t au a, the ose is displa ed a a f o the idli e o the side of the i ju , i head-o t au a, the asal o es a e pushed up a d spla ed so that the uppe ose idge appea s oad, ut the height of the ose is ollapsed saddle- ose defo it . I oth ases, the septu is ote f a tu ed a d displa ed. . The asal o e is o posed of t o pa ts: A thi k supe io po io a d a thi i fe io po io . The i te a thal li e de a ates these t o po io s. F a tu es o o l o u elo this li e. . Nasal o es u de go f a tu e i its lo e po io a d seldo the uppe po io is i ol ed i the f a tu e li e. This is e ause the uppe po io s of the asal o e is suppo ted its a i ulaio ith the f o tal o e a d f o tal p o ess of a illa. . Be ause of the lose asso iaio et ee asal o e a d the a ilagi ous po io s of the ose, a d the asal septu it is uite u usual fo pu e asal o e f a tu es to o u ithout afe i g these st u tu es. If losed edu io alo e is pe fo ed to edu e asal o e f a tu es ithout o e io of asal septal f a tu es, this ould ause p og essi e asal o st u io due to u o e ted de iaio of asal septu . This is e ause of the te de of the asal septu to heal i osis hi h auses iza e de iaio s like C S et . Si e ose is the ost p o i e t po io of the fa e, its suppo i g o st u tu es ha e lo eaki g st e gth the aso eth oidal o ple f a tu es he e posed to fo es of a out g a s. This fa t as de o st ated S ea i ge i . A ial CT of ose a d si uses sho i g u kli g of asal septu asal o es due to f a tu e i ol i g F a tu e z go a: ) go a is a e u ial o po e t hi h ai tai s fa ial o tou . F a tu es i ol i g z go a is e o o , i fa t it is the se o d ost o o fa ial o e to the f a tu ed follo i g fa ial t au a e t o l to asal o es . F a tu es i ol i g a illa ot o l eates os ei defo iies, it also auses dis upio of o ula a d a di ula fu io s too. The o a hite tu e of this o e is athe u i ue, it e a les it to ithsta d lo s ith sig ii a t i pa t ithout ei g f a tu ed. At the ost it gets disa i ulated alo g its sutu e li es. F a tu es a i ol e a of the fou a i ulaio s of z go a hi h i lude z go ai o- a illa o ple , z go ai o ple p ope , o itoz go ai o ple . F a tu es i ol i g z go a should e epai ed at the ea liest e ause it a ause oth fu io al a d os ei defe ts. I po ta t fu io al defe ts i ol i g this o e is est i io of outh ope i g due to i pi ge e t o the o o oid p o ess . It is he e a dato to diagose a d t eat this o diio p ope l . It is also i po ta t to edu e this f a tu e a d i it a u atel , e ause skeletal heali g ate i ade uate edu io a ause edu ed p oje io of ala egio of the fa e leadi g o to os ei defo iies. A u ate assess e t of posiio of the f a tu ed o e should e pe fo ed i elaio to skull ase poste io l a d idfa e a te io l . This assess e t is e i po ta t efo e edu io is ate pted to e su e a u ate edu io of the f a tu ed f ag e ts. Classii aio of z go a f a tu e: Leefo t lassii aio : . No displa ed – S pto ai t eat e t. No edu io e essa . Displa ed – Closed edu io is e essa . Co i uted – Ope edu io is e essa . O ital all f a tu e – If o ula s pto s p edo i ate it should e ate ded i st. Ate oede a su sides the ope edu io a e ate pted. . ) go ai a h f a tu e – Ope plates / i i g. edu io ith sta lizaio usi g CT i age of ose a d si uses sho i g f a tu e of z go a ith K ight & No th lassii aio i o edial displa e e t : This lassii aio suggested K ight etal i helped to dete opi al t eat e t odalit fo these i di iduals. i e p og osis a d G oup I f a tu es: I these paie ts f a tu e li es i z go a ould e see o l i i agi g. The e is a solutel o displa e e t. These paie ts ould ideall e a aged o se ai el o se aio a d aski g the paie t to eat sot diet. A ial CT of ose a d si uses sho i g f a tu e li es i ol i g z go a ello a o s G oup II f a tu es: This g oup i ludes isolated f a tu es of the a h of z go a. These paie ts p ese t ith t is us a d os ei defo iies. A ial CT of ose a d si uses sho i g f a tu e of a h of z go a ed a o s G oup III f a tu es: This i lude u otated f a tu es i ol i g od of z go a. A ial CT s a sho i g F a tu e i ol i g od of z go a. Note the e is o displa e e t of od of z go a G oup IV f a tu es: This i ol es ediall otated f a tu es of od of z go a. A ial CT sho i g ediall otated f a tu ed od of z go a G oup V f a tu es: This i ol es late all otated f a tu es of od of z go a. This t pe of f a tu e is e u sta le a d a ot e a aged losed edu io . Ope edu io ill ha e to e eso ted to. A ial CT i age sho i g f a tu e od of z go a ith u sta le late al otaio G oup VI f a tu es: This is o ple f a tu e. It has uliple f a tu e li es o e the od of z goa. This o diio is dii ult to a age losed edu io . Ope edu io a d i oplate i aio is i di ated i these paie ts. This t pe of f a tu e should ot e a aged losed edu io alo e e ause the p ese e of oede a / he ato a ould ask the os ei defo it gi i g a i p essio that edu io has o u ed. Ate edu io of oede a a d follo ed the a io of assete the f a tu ed f ag e t a dist a t aki g the osei defo it ell oi ea le. Co o al CT of ose a d si uses sho i g uliple f a tu es i ol i g z go a Blo out f a tu e: Blo out f a tu e of o it i ol es f a tu e of o ital loo ithout f a tu e of i f ao ital i . This i ju is o o f o f o tal lo to o it. F o tal lo to o it auses i eased i t ao ital te sio ausi g f a tu e of loo of the o it eak poi t ith p olapse of o ital o te t i to the a illa sius a it . This auses e ophthal os a d diplopia. I f ao ital i is ot i ol ed i pu e lo out f a tu e, it is also i ol ed the it should e o side ed as a i pu e lo out f a tu e . E t ap e t of i fe io e tus us le et ee the f a tu e f ag e ts ill ause diplopia i these paie ts CT ose a d si uses o o al se io sho i g lo out f a tu e. Note p olapse of o ital fat i to the a illa si us Tea d op sig T o theo ies ate pt to e plai this i ju . Bu kli g theo . H d auli theo phe o e o : Bu kli g theo : This theo p oposed that if a fo e st ikes at a pa t of the o ital i , these fo es gets t a sfe ed to the pape thi eak alls of the o it i.e. loo a d edial all ia ippli g efe t ausi g the to disto t a d e e tuall to f a tu e. This e ha is as i st des i ed Lefo t. H d auli theo : This theo as p oposed Pfeife i . This theo elie es that fo lo out f a tu e to o u the lo should e e ei ed the e e all a d the fo e should e t a s ited to the alls of the o it ia h d auli efe t. So a o di g to this theo fo lo out f a tu e to o u the e e all should sustai di e t lo pushi g it i to the o it. Wate House i did a detailed stud of these t o e ha is s appl i g fo e to the ada e i o it. He i fa t used f esh u i ed ada e s fo the i esigaio . He des i ed t o t pes of f a tu es: T pe I: A s all f a tu e o i ed to the loo of the o it a tuall id edial loo ith he iaio of o ital o te ts i to the a illa si us. This f a tu e as p odu ed he fo e as applied di e tl to the glo e H d auli theo . T pe II: A la ge f a tu e i ol i g the loo a d o ital o te ts. This t pe of f a tu e as aused theo . edial all ith he iaio of fo e applied to the o ital i Bu kli g I iial sig s a d s .I pto s of lo out f a tu e i lude: ediate s elli g of the e e . Te de ess o e i ol ed o it . Pai a d dii ult ith e e o e e ts . Dou le isio . E opthal os . Nu ess / i gli g o e lo e e elid, ose, a d uppe lip Co pli aio s of lo out f a tu e: . He iaio of o ital fat i to a illa si us . O ital e ph se a . Bleedi g i to a illa si us . E t ap e t / uptu e of o ula . Is he i us les us le o t a tu es . Celluliis . Diplopia Co o al CT sho s lo out f a tu e ight o it ith he osi us of ight a illa a tu A ial CT i age sho i g f a tu e of a te o late al all of ight a illa A ial CT of ose a d si uses sho i g f a tu e i ol i g a te olate al all of oth la si us. Note he osi us of oth a illa si uses a il- F a tu e f o tal si us: F a tu es i ol i g f o tal o e is athe a e e ause of its p ote ted lo aio . It is asi all p ote ted f o t au a the p o i e e fo ed the asal p a id. I ide e of f a tu es i ol i g this a ea a ges et ee - % F a tu es i ol i g this o e is o side ed to e athe da ge ous e ause of its p o i it to ai as ell as due to the os ei defe ts it a p odu e. The p o i it of this o e to the o it a d aso f o tal du t does 't help ate s eithe . F a tu es i ol i g this a ea if ot t eated p o ptl a lead to : . Me i giis . Mu op o ele . E ephaliis . Ce e al a s ess It should e o e i i d that all ases of f a tu es i ol i g f o tal o e should e o side ed as a pote ial head i ju a d should e a aged si ila l e ause of its lose p o i it to the ai . Causes of f o tal si us i ju ies: . Road t ai a ide t . Assault . I dust ial a ide ts . Re eaio al a ide ts Classii aio of f o tal o e f a tu es: A te io ta le f a tu e . With / ithout displa e e t . With / ithout ouflo t a t i ju Poste io ta le f a tu e o f a tu e o l o u si . With / ithout displa e e t . With / ithout du al i ju / CSF leak . With / ithout ouflo t a t i ju o i aio ith a te io ta le Displa e e t is o side ed to e p ese t if it is a out the idth of o e ta le of the f o tal o e. Cli i al p ese i g featu es: These i lude: . Cos ei defe t . Heada he . CSF leak i paie ts ith poste io ta le f a tu es Co o al CT ose a d si uses sho i g f a tu e i ol i g poste io ta le of f o tal si us ed a o CT i age sho i g dep essed f a tu e of a te io ta le of f o tal si us Co o al CT of ose a d si uses sho i g f a tu e i ol i g the fo eal a gle a o Refe e es: . htps://sites.google. o /site/d t alusotola -s ste -of- idfa e golog / hi olog / ut ess . Aighe hi S, Ka i i G: Se ial asal o e edu io : A e app oa h to the a age e t of asal o e f a tu e. J C a iofa Su g : , . S e so DM, Ya d EE, Colli s CL, Fields SK, Co sto k RD. Epide iolog of US high s hool spo ts- elated f a tu es, . Cli J Spo t Med. Jul ; : - . S hultz RC: O e thousa d o se ui e ases of ie Su g : , . Ya e T, Oza a T, Saka oto M, et al: P e- a d postope ai e - a a d o puted to og aph e aluaio i a ute asal f a tu e. A Plast Su g : , . Na a MS: Ma age e t of z go ai ia s Su g Pak , : . . Ma so PN, Ma ko itz B, Mi is S, et al. To a d CT ased fa ial f a tu e t eat e t. Plast Re o st Su g. Fe ; : ; dis ussio . htp:// . Rhee JS, Kilde J, Yoga ada N, Pi ta F. O ital lo out f a tu es: e pe ie tal e ide e fo the pu e h d auli theo . A h Fa ial Plast Su g. ; : - ajo fa ial i ju . Re- o ple f a tu e. J Coll Ph si- .d t alu. o / lo _out.ht l . Wate house N, L e J, U da g M, Ga e L. A i esigaio i to the e ha is of o ital lo out f a tu es. B J Plast Su g. ; : . . Moo e KL. Cli i all O ie ted A ato & Wilki s; . d ed. Bali o e, MD: Willia s . Gil a d SM. Ma age e t of o ital lo out f a tu es: the p og osi sig ii a e of o puted to og aph . Ad Ophthal i Plast Re o st Su g. ; : . Kaise PK, F ied a NJ, Pi eda R. The Massa husets E e a d Ea I i a Illust ated Ma ual of Opthal olog . d ed. Philadelphia, PA: Sau de s; . IOANNIDES CH, FREIHOFER HP, FRIENS J. F a tu es of the f o tal si us: a aio ale of t eat e t. B J Plasi Su g ; : . . LUCE EA. F o tal si us f a tu es: guideli e to st Su g ; : . a age e t. Plast Re o - Fi ous d splasia of Fa io a illa egio Fi ous d splasia is a e ig slo g o i g i o-osseous disease ha a te ized epla e e t of o al o e ith a i g deg ees of i ous issue / i atu e o e o e. This as i st des i ed Li hte stei i ho alled it pe e ted a i it of o e fo i g ese h e . Classii aio of i ous d splasia : . Mo ostoi a iet – I ol i g si gle o e . Pol ostoi a iet – I ol i g uliple o es . M Cu e-Al ight s d o e – Cha a te ized pol ostoi i ous d splasia i asso iaio ith h pe fu io al e do i opathies p e o ious pu e t , h pe th oidis , o a o egal a d afe au lait spots i ol i g the ski . Classi epide iologi al featu es of this diso de i lude: . It a ou ts fo a out . Mo ostoi % of all o a iet is te i es tu o s o e p e ale t tha pol ostoi . Majo it of o ostoi i ous d splasia de ades of life a iet a ifest du i g the i st th ee . Pol ostoi i ous d splasia p ese ts ea l du i g hildhood . M Cu e-Al ight s d o e also . A o g fa ial o es o f o tal a d a illa . a ifests du i g ea l hildhood. o est to e i ol ed is eth oid, follo ed Pathoph siolog : I t a edulla lesio s g ossl appea as ell i u s i ed tu o s a i g g eatl i size. La ge i t a edulla lesio s te d to ause o e e pa sio a d disto io . Mi os opi appea a e: These lesio s appea as i egula t a e ulae of oe i atu e o e. The ese le Chi ese ha a te s. These lesio s a e su ou ded o al o e a d o e ed ellula i ous st o a ith osteo last p oge ito ells losel ese li g i o lasts. I i ous d splasia o e leads to p olife aio of i plasia. a o st o al ell dife e iaio is a ested. This atu e ells ausi g the ha a te isi i ous d s- The e a t ole ula eiolog ausi g this p o le has ee ide iied as soai isse se utaio i ol i g GNAS ge e o h o oso e . This ge e is espo si le fo e odi g ά su u it of si ulato G p otei oupled e epto Gs ά. I i ous d splasia ells a gi i e is epla ed eithe stei e / hisidi e. This esults i i hi iio of i t i si GTPase a i it of Gs ά p otei . This auses i depe de t a i aio a d a u ulaio of C li AMP. I o e this auses a efe t si ila to that of o i uous pa atho o e si ulaio . G o th of i ous d splasia is e ha ed i the p ese e of g o th si ulai g ho o es. G o th ate of i ous d splasia de eases ith age as the g o th si ulai g ho o e le els de ease. Cli i al featu es of i ous d splasia: Cli i al featu es a e la gel depe de t o tu es. . As et pto ai pai less o . Heada he . Blu i g of isio . Visual ield defe ts . Diplopia . Hea i g loss . Epipho a . E elid posiio a o aliies o p essio of adja e t st u - e la ge e t ausi g defo it a d as - No skeletal .A o a ifestaio s of Fi ous d splasia: al uta eous pig e taio Jagged oast of Mai e o de . P e o ious pu e t . H pe th oidis . Cushi g's disease . H pe pa ath oidis . H pophosphate i i kets Role of adiolog i the diag osis of i ous d splasia: Majo it of i ous d splasia a e as pto ai ut fo the as et aused the lesio . Si e these tu o s a e e slo g o i g o es, it ould take a lo g i e efo e the efe ts of eu o as ula o p essio egi to take pla e. Radiologi al diag osis alo e ould sui e fo all paie ts ith o ostoi ious d splasia. But pol ostoi i ous d splasi lesio s should al a s e iopsied fo histopathologi al o elaio . CT appea a e of i ous d splasia: Co o l the lesio appea s like g ou d glass – Ho oge ous de se pate C si pate – See i – see i - - - % % % of ases CT o o al ut of ose a d pa a asal si uses sho i g i ous d splasia of let This is the lassi ho oge ous de se pate a illa. CT s a sho i g i ous d splasia of z go a A ial CT sho i g i ous d splasia i ol i g poste io eth oid ells g ou d glass t pe o the ight side. Note the lesio is see o p essi g opi e e Che & Noo dof lassii aio of a iofa ial i ous d splasia: . )o e I : Fi ous d splasia i ol i g f o to o ital, z go ai a d uppe po io s of a illa . )o e II: Fi ous d splasia i ol i g a iu i its hai ea i g a ea . )o e III: Fi ous d splasia i ol i g the e t al po io of skull ase . )o e IV: Fi ous d splasia i ol i g teeth ea i g egio s of a di le. This lassii aio helps i de idi g the Cli i al photog aph a d CT s a i age f o a age e t a illa a d odalit . a paie t ith zo e IV i ous d splasia. A ial CT sho i g i ous d splasia of eth oids Note g ou d glass appea a e Co o al CT i age sho i g i ous d splasia of eth oid ith ata h e t to skull ase Co o al CT sho i g i ous d splasia of o it ith i ol e e t of skull ase A ial CT of ose a d si uses sho i g i ous d splasia i ol i g a te io eth oid. Co o al CT i age sho i g i ous d splasia i ol i g a te io eth oid e te di g i to the o it. Not f o tal si us d ai age a ea is o p o ised Refe e es: . S. N. Si ha a d D. S. Sa da a . Fi ous D splasia of Eth oid. The Jou al of La golog &a p; Otolog , , pp doi: . / S . Classii aio a d pathoge esis of i ous d splasia Lio el Gold AB Jou al of o al su ge a d o al edi i e ol issue August . Fi ous d splasia of a illa A ee j.Med s ie e . E e sole LR, Sa es WR, Ro i S. Fi ous d splasia: a osologi p o le the diag osis of i o-osseous lesio s of the ja s. J O al Pathol ; : . . Bia o P, Ri i u i M, Majolag e A, et al. Mutaio s of the GNAS ge e, st o al ell d sfu io , a d osteo ala i ha ges i o -M Cu eAl ight i ous d splasia of o e. J Bo e Mi e Res ; : o e a ase epo t Su eedh Gupta Al : - . Natu e of i ous d splasia Li u Felle Head a d fa e edi i e , : i At ophi Rhi iis I t odu io : At ophi hi iis is dei ed as a h o i asal disease ha a te ized p og essi e at oph of the asal u osa alo g ith the u de l i g o es of tu i ates. The e is also asso iated p ese e of is id se eio hi h apidl d ies up fo i g foul s elli g usts. This feid odo is also k o as ozaea. The asal a it is also a o all pate t. The paie t is fo tu atel u aa e of the ste h e ii g f o the ose as this diso de is asso iated ith e iful a os ia . This disease is athe a e i de eloped ou t ies, ut a e athe o o i de elopi g ou t ies . No a da s it is o e o o as a se uelae of edi al i te e io s. O e zealous tu i ate su ge has ee i pli ated as a p o a le iat oge i ause . S o s: The follo i g a e the a ious te io : i ologies used to i di ate the sa e o di- . Rhi iis si a .D hi iis . Oze a . Ope ose s d o e . E pt ose s d o e Eiolog : The eiolog of this p o le ee asso iated ith this o diio , the sill e ai s o s u e. Nu e ous pathoge s ha e ost i po ta t of the . Co o a illus . Ba illus u osus . Co o a illus foeidus ozae ae . Dipthe oid a illi . Kle siella ozae ae. a e: These o ga is s despite ei g isolated f o the ose of diseased paie ts ha e ot atego i all ee p o ed as the ause fo the sa e. Othe p edisposi g fa to s i lude: . Ch o i si usiis SSali o side ed at ophi hi iis to e i fe i e i atu e. He epo ted at ophi hi iis i hild e of a fa il ate a hild ith at ophi hi iis spe t a ight i thei house. Co o o ga is isolated fo asal a iies of these hild e as Kle siella oze ae . E essi e su gi al dest u io of the asal u osa a d tu i ates . Nut iio al dei ie ies: Be at i de o st ated that % of paie ts ith at ophi hi iis e eited ith i o the ap . Ha se de o st ated s pto ai i p o e e t i ajo it of this paie ts ith at ophi hi iis he t eated ith ita i A. . S philis. . E do i e i st uaio ala es Disease is k o to o se . He edit : This as i st epo ted Ba to e t pate of i he ita e ide iied . . Autoi ith p eg a / e - a d Si e t Autoso al do i- u e disease . De elop e tal: Hag ass epo ted sho te ed A te o Poste io asal le gths a d poo a illa a t al p eu aizaio i paie ts ith at ophi hi iis. . Vas ula : E ess s Ruski pathei a i it as o se ed i these paie ts Radiologi al featu es: Radiologi featu es a e si ila fo oth t pes of at ophi hi iis. Plai a s sho late al o i g of asal alls, thi o a se t tu i ates a d h poplasi a illa si uses. CT s a i di gs: . Mu ope iosteal thi ke i g of pa a asal si uses . Loss of dei iio of osteo eatal o ple due to eso pio of eth oidal ulla a d u i ate p o ess . H poplasi a illa si uses . E la ge e t of asal a it . At oph of i fe io a d ith e osio of the late al asal all iddle tu i ates Co o al CT i age of ose a d si uses sho i g lassi ha ges of at ophi hi iis This is a o o al CT s a plai of Nose a d pa a asal si uses. It sho s thi ed asal u osal li i g. The tu i ates appea to e at ophi . The asal a iies appea to e e essi el oo o oth sides. Refe e es: . )oha Y, Tal i YP, St auss M, et al. Oze a e isited. J Otol . htp:// . htp:// iis : , .d t alu. o.i /at o_ hi iis.ht l .ut .ht .edu/oto ef/g ds/At ophi Rhi iis At ophi Rhi- . At ophi hi iis a e ie of ases Moo e, E i J.; Ke , Euge e B A e i a Jou al of Rhi olog , Volu e , Nu e , No e e De e , pp. . Ssali CH. At ophi hi iis. A e Otol ; : . . Be at, I., Ozae a, A P ess u ai e su gi al t eat e t. J La a ifestaio of i o dei ie e gol , O fo d; Pe g o . P i a at ophi hi iis: a i he ited o diio ? R. P. E. Ba to a a a d J. R. Si e ta The Jou al of La golog & Otolog , : pp Copight © JLO Li ited DOI: . /S . Hag ass MAE, Ga ae AM, elShe ief SG, et al. Radiologi al a de dos opi stud of the a illa si us i p i a at ophi hi iis. J La gol Otol : , Rhi olith I t odu io : Rhi oliths a e al a eous deposits sto e like i side the asal a it . These sto e like st u tu es a e highl f ia le a d a u le he ushed. Rhi oliths si e the u le easil a e e o ed ate ushi g ith a lu ’s fo eps ia the asal a it . Si e the hi olith i this paie t as e la ge e te di g up to the hoa a it as e o ed ia late al hi oto app oa h i o de to a oid e essi e i ju to asal u osa du i g the p o ess of e o al. Rhi oliths a e also k o side the asal a it . as asal al uli a e al a eous deposits p ese t i - Rhi oliths a e of t o t pes: E oge ous a d E doge ous. E oge ous hi olith: If o eio s o u a ou d a i pa ted fo eig od the it is o side ed to e e oge ous i atu e. These al a eous deposits a ou d i t a asal fo eig odies is the ost o o a iet of hi olith . E doge ous hi olith: If o eio s o u a ou d lood lot / i spissated fo eig od the it is o side ed to e e doge ous i atu e. This o diio is o o l diag osed histo a d a te io hi os op . This o diio is o o i adults a d elde l i di iduals. U ilate al foul s elli g lood i ged asal dis ha ge i a adult should al a s aise suspiio of hi olith. Si e hi oliths a e o o l see i the a te io asal a it , a te io hi os opi e a i aio of ose li hes the diag osis . Paie ts ith hi olith usuall p ese t ith: . U ilate al asal o st u io . U ilate al foul s elli g lood i ged asal dis ha ge . Ha d ass i side the asal a it Co o al CT of ose a d si uses sho i g adio opa ue ass o up i g the loo of ight asal a it Rhi olith A ial CT of ose a d si uses sho i g hi olith The te hi olith is de i ed f o G eek hi o – ose lithos – sto e . It is o side ed to e a athe a e o diio i.e. A out i , otola golog paie ts . It as Be tholi ho i st ga e the a u ate des ipio of this o diio i . Rhi oliths a e usuall i egula o ish / g e olo ed asses p ese t i the a te io po io of the asal a it . Fo so e u k o easo ales see to e o o l afe ted tha feales . The e a t pathoge esis i ol ed i the de elop e t of hi olith is sill ot k o . It has ee suggested that i pa ted fo eig od / u ous plugs / lood lot a i ite i la ato ea io a d si ulate deposiio of i e als a d salts. The salts hi h gets deposited a ou d the idus is dei ed f o asal se eio s, tea a d i la ato e udate . The idus of hi olith is usuall a fo eig od . E e gauze s a s i ad e te tl let i side the asal a it follo i g su ge has ee k o to ause hi olith. Radiolog is usuall diag osi . T pi al adiologi al pi tu e is adio opa it ith so ei es e t al opa it . The e t al adiolu e ould e due to the p ese e of o ga i ate ial hi h ould ha e fo ed the idus fo hi olith. This des ipio as i st gi e Ma I t ei . CT s a usuall a ot dife e iate hi olith f o othe aliied asses. Refe e es: . htp:// .d t alu. o.i / hi olith.ht l . Tu a A, Gozu A Clet lip/ ose defo ge ; ; . Aksu gu EH, Bi oka FB A hi olith hi h is tu o Eu .J Radiol ; : . Gia t Rhi olith ith asopha geal e te sio a Ra e Case Repo t Bi al Ku a Si ha, Sa geetha Bha da Pakista Jou al of otola golog ; : . Si ha V Ra e A Razda : . Ro al SA Ga d e RE. Rhi olithiasis a u usual paediat i paediat Radiol ; it a d hi olith Plas Re o st Su i i ki g a asal e ig Rhi olith Su gi al Jou al of No th I dia asal ass Rhi opo idiosis I t odu io : Rhi ospo idiosis has ee dei ed as a h o i g a ulo atous disease ha a te ised p odu io of pol ps a d othe a ifestaio s of h pe plasia of asal u osa. The eiologi al age t is Rhi ospo idiu see e i . Rhi ospo idiu see e i: as i iiall elie ed to e a spo ozoa , ut it is o o side ed to e a fu gus a d has ee p o isio all pla ed u de the fa il Olipidia eae, o de h it idiales of ph o etes Ash o th . Mo e e e t lassii aio puts it u de DRIP’S lade. E e ate e te si e studies the e is o o se sus o he e Rhi ospo idiu ust e pla ed i the Ta oo i lassii aio . It has ot ee possi le to de o st ate fu gal p otei s i Rhi ospo idiu e e ate pe fo i g se sii e tests like Pol e ase hai ea io s . A sepa ate hapte has ee dedi ated to this o diio e ause it is u i uel o o i south east Asia ou t ies. U less a te io uts of CT s a s of ose a d si uses a e i te p eted ith a e a d auio this o diio a i a ia l e issed adiologi all . Cli i al featu es: Paie ts usuall p ese t ith leedi g f o the ose. Lesio s i the ose a e pol poidal, eddish a d g a ula asses. The ould e uliple pedu ulated a d f ia le. The a e highl as ula a d leed easil . Thei su fa e is studded ith hiish dots spo a gia . The a e lea l see ith a ha d le s. The hole ass is o e ed u oid se eio . The hi ospo idiu i the ose is est i ted to the asal u ous e a e a d does ot oss the u o uta eous a ie . Co o al CT of ose a d si uses sho i g sot issue ass i ol i g the e i e ight asal a it . Note i ol e e t of la i al sa also lose to the edial a thal a ea Co o al CT i age of ose a d si uses sho i g sot issue lesio i the ight i fe io eatus. Note the asso iated septal pe fo aio i the e t ut. So fa this is the i st ase of septal pe fo aio due to hi ospo idiosis epo ted so fa Refe e es: . See e GR. U eu o espo ozoa io pa asito del ho e: dos asos e o t ades e polipos asales. Thesis, U i e sidad Na io al de Bue os Ai es. . F ed i ks DN, Jolle JA, Lepp PW, Kosek JC, Rel a DA. Rhi ospo idiu see e i: a hu a pathoge f o a o el g oup of a uai p oista pa asites. E e g I fe t Dis. Ma -Ju ; : - . . htp://d t alu. o.i / hi ospo idiosis.ht l C si lesio s of Uppe Ja I t odu io : I te aio al Classii aio of Diseases ICD i ol i g uppe ja i to: . Radi ula sts sts . De ige ous . P i o dial sts st . Late al pe iodo tal . Residual lassiies odo toge i st st . Odo toge i ke ato st . Cal if i g odo toge i . Glo ulo a illa st Go li st st These sts a e the ost o o si lesio s i ol i g a illofa ial a ea . C si lesio s a e o o i the ja o es tha a he e else i the od e ause of the p ese e of epithelial ell ests hi h a e o o l let ehi d follo i g odo toge esis . Radi ula S o sts: s – Pe iapi al st, de tal st This is the o o est of all odo toge i sts . These sts ould also e o side ed as a i la ato st o igi ai g f o Malassez's ell ests . These sts a e aused oot i fe io s i ol i g oots of teeth losel elated to a illa si us a t u . I fe io s / i la aio eleases to i s at the ape of the tooth leadi g o to pe iapi al i la aio . The si ulate the Malassez's ell ests hi h a e fou d i the pe iodo tal liga e t esuli g i pe iapi al g a ulo a hi h ould eithe e i fe ted o ste ile. These sts ould ell e ste ile if the paie t had e ei ed a i ioi the ap fo de tal i fe io s. Radiologi al dife e iaio et ee g a ulo a a d st ould p o e to e athe dii ult. The ge e al ule of the thu ei g if the lesio is la ge i adiologi al i agi g the it should e o side ed as st. These sts i ease i size at the e pe se of the su ou di g o a ie . This e pa sio is aused p essu e efe ts a d efe ts of i la ato e z es o e the su ou di g o e. These sts a e li ed st aiied s ua ous epitheliu ithout ke ai fo aio . E ide e of i la aio a e see alo g the st all. Co o al CT i age of ose a d si uses sho i g adi ula Pathoph siolog of adi ula . I la ato st of uppe ja sts: ediato s / e z es . Ba te ial to i s These t o fa to s ha e ee i pli ated as the p o a le fa to s o t i ui g to Radi ula sts. A o g these t o Ba te ial to i s pla a athe ital ole. Ba te ial e doto i s ha e ee fou d i la ge a ou ts i a d a ou d e oi tooth. These to i s ha e ee sho to e itoge i . These e doto i s also si ulate e p essio of toki es a d he oki es . I la ato ediato s a d p oi la ato toki es eleased the host issue a e k o to odulate the io he i al a i it of epide al g o th fa to EGF the e ausi g i eased p olife aio of ellula ele e ts. The also si ulate lo al io lasts i to h pe a i it e p essi g Ke ai o te g o th fa to . The epithelial ell ests of Malassez a e usuall uies e t / sta le ells. These ells a e i the G phase of thei ell le. These ells eed to e e posed to e t a ellula sig als to push the i to the ell le p ope . These e t a ellula sig als a e olle i el k o as Mitoge . E pe i e tall a ell a e ide iied to e i the p olife ai e phase thei a ilit to e p ess a ke s like PCNA a d Ki- . Kia ke is p ese t i ells elo gi g to all phases of ell di isio e ept G phase. Studies e eal i eased le els of PCNA a d Kia ke s i the epithelial li i g of adi ula . sts The a tual i di g of Mitoge g o th fa to to e epto s p ese t o the ell e a e su fa e i iiates a se ies of i t a ellula ea io s pushi g the ell i to itoi phase. P o a le g o th fa to s Mitoge sts i lude: . EFG & KGF – eleased . TGF-α – eleased i ol ed i the pathoge esis of adi ula st o al i o last a ophages a d l . IGF I suli like g o th fa to – eleased pho tes st o al i o lasts I the pathoph siolog of fo aio of adi ula sts ediato s eleased i la ato ells a ophages a d l pho ts pla a ital ole . E la ge e t of adi ula st: This i a ia l o u s at a athe slo pa e. Va ious fa to s i lue e the ate of e pa sio . These fa to s i lude: . Mu al g o th . H d ostai e la ge e t . Bo e eso i g fa to Rapid e pa sio of adi ula st is asso iated ith i ease i h d ostai p essu e ithi the st. The h d ostai p essu e ithi the st is highe tha that of apilla p essu e, ausi g luid to e te f o the apilla ies i to the st a it . This high h d ostai p essu e ithi the st has ee at i uted due to the a ou t of high ole ula eight p otei p ese t i the st luid. This p otei is eleased i la ato ells i espo se to i la ato si ulus. Role pla ed ast ells i adi ula st e la ge e t: Mast ells pla a sig ii a t ole i adi ula st e la ge e t . Studies eeal that the e a e i eased u e of ast ells i the su epithelial zo e of these sts. Mast ells o t i ute to i ease i the size of these sts i the follo i g a e : . B di e tl eleasi g hepa i i to the lu e .B eleasi g h d ol i e z es .B eleasi g hista i e hi h auses t a sudaio of se u Co o al CT of ose a d si uses sho i g a la ge adi ula pe ja p otei s st i ol i g ight side of up- Bo e eso pio adi ula sts: Radi ula sts auses eso pio of al eola p o ess of a illa. Osteo lasts ha e ee k o to ause this o e eso pio . Osteo lasts eed to e a iated efo e it a ea so o e at i . Osteo lasts a e a i ated : e lo ked : RANKL This ea io a Osteop otege i OPG RANKL is the ole ule hi h a i ates osteo lasts i di g to its e epto RANK hi h is e p essed o the su fa e of osteo last p e u so ells, he e as OPG lo ks this e ea io p e e i g a i aio of osteo lasts. I la ato ediato s like toki es a d I te leuki s si ulate p olife aio of osteo lasts. I espo se to i la aio host ells a e k o to p odu e Mat i Metallo P otei ase MMP . This ole ule is apa le of deg adi g e t a ellula at i like ollage , io e i a d p oteogl a s. E doto i s eleased a te ia also si ulates elease of MMP. This su sta e helps osteo lasts i the o e eso pio p oess. De ige ous sts: Also k o as folli ula st. This st is asso iated ith u e upted tooth. This st is fo ed due to a u ulaio of luid et ee the e a el epitheliu a d the o pletel fo ed tooth o . This o e l i g st p e e ts teeth f o e upi g. This st is al ost al a s asso iated ith pe a e t de iio . I the uppe ja it is o o i the a i e tooth a ea. This st has its highest i ide e du i g the d a d d de ades of life. Radiologi all the p ese e of pe i o o al adiolu e is a diag osi poi te . This tu o should e dife e iated f o a elo lasto a, odo toge i ke ato st a d al if i g odo toge i st. All these lesio s a ifest ith pe i o o al adiolu e i oui e adiog aphs. Co o al CT of ose a d si uses sho i g de ige ous st of uppe ja . Note u e upted teeth ithi the st a it CT s a i age sho i g st i ol i g the a te olate al all of let e te ds up to the asal a it a illa. Note the Figu e sho i g adio de se od The ithi st a it ? U e upted tooth st P i o dial st: This st a ises due to si ha ges that o u i a de elopi g tooth ud efo e the a tual fo aio of e a el a d de i at i . Si e this st a ises f o de elopi g tooth ud the tooth ould e issi g f o the de tal a h, o if teeth a e all p ese t the the p ese e of sup e u e a teeth should e suspe ted. Late al pe iodo tal st: This st de elops f o the pe iodo tal liga e t lose to the late al su fa e of e upted / u e upted teeth. This st is as pto ai . The i ol ed teeth is ital. Residual st: This st a ises f o e io . This a also o u t a ted. This st is o a ts of epithelial ell ests let ehi d ate e t a he a adi ula st at the ape of the teeth is e o l see i the elde l . Odo toge i Ke ato st: This st has a ke ai ized epithelial li i g. Majo d a a k of this o diio is its p ope sit to e u e e ate o plete e o al. This st a i i a of the sts des i ed a o e. It eeds to e ide iied adiologi all a d pathologi all . This st is see et ee ide age g oups. Cal if i g odo toge i st Go li 's st : This is a e a e slo g o i g e ig tu o like st. This o diio a ifests the featu es of solid ass hile displa i g featu es of tu o a d si lesio . This st has e ual i ide e i oth a illa a d a di le. Glo ulo a illa st: This is a tuall a issu al st a isi g f o epithelial i lusio s t apped at the li e of fusio et ee the glo ula po io of the edia asal p o ess a d the a illa p o ess. Pathologists o side this st to e odo toge i athe tha de elop e tal. Radiog aphs sho these sts as pea shaped / i ula shaped et ee the oots of a illa late al i iso a d a i e. Both these teeth a e ital i these paie ts. Co o al CT of ose a d si uses sho i g solita t a slu e t u ilo ula lesio ith s ooth o i ated o de s. Whe it o u s i a illa the it ould i ade i to the a illa si us as ell Co o al CT i age of ose a d si uses a te io ut sho i g si lesio i ol i g the uppe al eola a gi e te di g i to the asal a it . Naso la ial st. U e upted tooth see ate e o al of de ige ous A ial CT i age sho i g glo ulo a illa st. Note thi o st li i g i so e pla es Refe e es: . Shea M Pathol Med De elop e tal odo toge i , - sts. A update. J O al . Regezi JA, S iu a JJ, Jo da RCK O al Patholog : li i al pathologi o elaio s. th ed, WB Sau de s, St Louis, - . Naka u a T, Ishida J, Naka o Y, Ishii T, Fuku oto M, Izu i H, Ka eko K A stud of sts i the o al egio . C sts of the ja . J Niho U i S h De t , - . Be A, Ali i M De ige ous sts of i la ato o igi .A li i pathologi stud . O al Su g O al Med O al Pathol O al Padiol E dod , - . Kiss Cso go . Cell to ell i te a io . E dodo i Topi . Muglali M, Ko e ik N, Bulut E, Ya i GF, Cele i N, Su e M. C toki e a d he oki e le els i adi ula a d esidual st luid. J O al Pathol Med , : - .. . Li LM, Hua g GTJ da Rose e g PA. P olife aio of epithelial ell ests, fo aio of api al sts a d eg essio of api al sts ate pe iapi al ou d heali g. JOE , : - . . Oli ei a MG, Lau e IS, Cha es ACM, Rados PV, Filho MSA. I u ohistohe i al a al sis of the pate of p a d PCNA e p essio i odo togo e si lesio s. Med O al Patol O al Ci Bu al , :E - . Ha ashi M, Ohshi a T, Ohshi a M, Ya agu hi Y, Mi ata H, Takei hi O, et al. P oili g of adi ula st a d odo toge i ke ato st toki e p odu io suggests o o g o th e ha is s. JOE , : - . , : - . . Nai P, Su d ist G, Sjog e U. E pe i e tal e ide e suppo ts the a s ess theo of de elop e t of adi ula sts. O al Su g O al Med O al Pathol O al Radiol E dod , : . . Sh laja S. Mast ells i odo toge i sts. Jou al of Cli i al a d Diagosi Resea h [se ial o li e] Ap il [ ited: O to e ]; : . Malig a t tu o s of pa a asal si uses I t odu io : Malig a t tu o s of ose a d pa a asal si uses o situte a out % of all alig a t tu o s . These tu o s also o situte a out % of head a d e k alig a ies. Malig a t tu o s of a illa a e o e o o i ales i fa t t i e as o o as i fe ales. The a e o o l diag osed i paie ts i the age g oup of – ea s . Histologi all ell a i o eu o lasto o sa e e the o o est t pe of alig a i this a ea is s ua ous a . Othe histologi al t pes like ade o a i o a, sa o as, as, l pho as a d alig a t ela o as a e a e . These tudii ult to t eat e ause: . Of the o ple adja e t a ato o it, skull ase et . These paie ts p ese t fai l i the late stage of thei disease A o g the si us alig a ies, a illa si us alig a happe s to e the o o est, follo ed eth oids a d sphe oid si uses. Malig a t tu o s i ol i g late . a illa has poo p og osis e ause the p ese t Malig a t lesio s i ol i g si uses ha e a p ope sit to sp ead ia a eas of least esista e. This sp ead ould i ol e adja e t ital a eas like: . O it . A te io skull ase . Pte gopalai e fossa . Sp ead i to iddle a ial fossa A eas of least esista e i lude: . Medial all of a illa si us . I fe io all of o it e ause it is eake ed as ula u dle the p ese e of eu o- . A te olate al all of a illa to i ol e ski . Ski i ol e e t i di ates that the tu o is fai l ad a ed e ause odal i ol e e t is o o i these paie ts. Roughl % of si o asal alig a ies o u i a illa si us . % of alig a t tu o s o u ithi the asal a it hile the e ai i g % is o situted eth oid a d sphe oid si us alig a ies . Role of CT s a i paie ts ith si us alig a ies i lude: . To assess the a ato i al e te t of the lesio . To look fo i ol e e t of ii al a eas like skull ase a d o it hi h ould d asi all ha ge the p og osis A ial CT i age sho i g e pa sile lesio i ol i g ight a illa si us ith e osio of a te olate al all of a illa. Note e osio of poste io all of a illa ith e te sio i to pte gopalai e fossa. Pte goid plates a ot e isualized o the ight side Co o al CT i age of ose a d si uses sho i g ass lesio la si us ith e osio of palate ithi let a il- Co o al CT of ose a d si uses sho i g ass a isi g f o ight asal a it e odi g asal septu , i ol i g the opposite side. Note e osio of a te io skull ase. Right a illa si us hazi ess is due to ea i e si usiis. Du al ea h the tu o a e ide iied o l i a o t ast CT o MRI. Ca ilagi ous po io of asal septu esists aliga t e osio . I this pi tu e the o po io is e oded. Medial all of ight o it has also ee e oded I age sho i g A ial CT of ose a d si uses sho i g alig a t tu o a isi g f o ight a illa e odi g edial all of a illa to i ol e the asal a it . Note e osio of a te olate al all of a illa ausi g ski i ol e e t Co o al CT of ose a d si la si us. Note edial a illa has ee pa iall p edo i uses sho i g e pa sile, e osi e lesio i ol i g ight a ilall of a illa has ee dest o ed. Al eola a gi of ight dest o ed. I these paie ts loose i g of teeth ould e a a t s pto hi h should ot e ig o ed. Refe e es: . Thiaga aja , Balasu a a ia , a d Geetha Ra a oo th . "Malig a t g o th Ma illa a age e t a a al sis." Otola golog o li e jou al . : - . . K aus DH, Ro e ts JK, Mede do p SV, et al. No s ua ous ell alig a ies of the pa a asal si uses. A Oto hi ola gol ; : - . . Spi o JD, Soo KC, Spi o RH. No s ua ous ell alig a t eoplas s of the asal a iies a d pa a asal si uses. Head Ne k l ; : - . Ti a i R, Ha dillo JA, Mehta D, et al. S ua ous ell a i o a of la si us. Head Ne k ; : .. . Bhata ha a N. Fa to afe i g su i al i Ma illofa Su g ; : - . B idge GP, Me delsoh MS, Bald i M, S ee R. Pa a asal si us a e . Aust N ) J Su g. Ap ; : - . . Gola ek W, D op A, Gola ek E, Mo shed K. Site of o igi of pa a asal sius alig a ies [i Polish]. Pol Me ku iusz Lek. Sep ; : - . a illa a il- si us a e . J O al