Computed tomography (CT) has superseded plain radiography in delineating bony anatomy. The role of CT in preoperative planning prior to functional endoscopic sinus surgery (FESS) has been well established. Complex anatomy and congenital anatomical variants of the paranasal sinuses impose an interpretation challenge to radiologists and intraoperative technical challenges to the surgeon. This poster aims to present a systematic approach utilising reformat CT reconstructions to discuss i. anatomy ii. clinically significant anatomical variants iii. terminology used in FESS with a view to encourage more accurate...

What is FESS? Devised by Messerklinger & Stammberger in the 1980s & 1990s, FESS is a minimally invasive surgical procedure that offers access to nasal and sinus cavities facilitating the use of different instruments to identify & restore the proper drainage & ventilation relationships between the nose and sinus cavities. It relies on preservation and restoration of normal flow of mucosal secretions. Advantage Disadvantage Minimally invasive technique Proximity of the sinuses to the eyes, optic nerves, brain and internal carotid arteries Access to nasal cavity...

The following is a stepwise approach, starting at the external nares, to viewing the nasal cavity with cross-sectional imaging using 3D multiplanar reformats (MPR) of the paranasal sinuses acquired using a 64-slice multidetector CT scanner. STEP 1 – NASAL SEPTUM - 1st structure encountered Normal Variant - Septal deviation may cause nasal cavity obstruction limiting endoscopic visualisation and access. Implication - Patients may need pre-operative counselling for the need of septoplasty during FESS procedure. STEP 2 - FRONTAL/KUHN'S AIR CELLS The frontal air cells constitute...

Major complications of FESS can be catastrophic. Detailed knowledge of normal and anomalous anatomy is essential for safe, successful sinus surgery. CT is the gold standard imaging modality in the preoperative diagnosis for FESS. Radiologists’ familiarity with FESS technique & adopting a systematic approach is crucial to reviewing CT imaging for normal and variant anatomy of the paranasal sinuses.

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N. Schembri(corresponding author) Specialist Registrar Clinical Imaging Department Ninewells Hospital and Medical School Dundee DD1 9SY U.K. Tel: 00441382-660111 Bleep 3008 Email: [email protected] A.S. Gatt Specialist Registrar Clinical Imaging Department Ninewells Hospital and Medical School Dundee DD1 9SY U.K. D. Ellul Specialist Registrar Department of Otolaryngology Ninewells Hospital and Medical School Dundee DD1 9SY U.K. J.N. Brunton Consultant Radiologist Clinical Imaging Department Ninewells Hospital and Medical School Dundee DD1 9SY U.K.