Type:
Educational Exhibit
Keywords:
Ear / Nose / Throat, CT, Normal variants, Diagnostic procedure, Structured reporting, Education and training
Authors:
N. Schembri, A. S. Gatt, D. Ellul, J. Brunton; Dundee/UK
DOI:
10.1594/ecr2013/C-2607
Background
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 via nostrils
|
|
Indications for FESS
Chronic sinusitis refractory to medical treatment is the main clinical indication,
which includes:
- recurrent acute sinusitis
- nasal polyposis
- antrochoanal polyps
- sinus mucoceles
Other uses include excision of selected tumours,
CSF leak closure,
orbital decompression (e.g.
in Graves’ ophthalmoplegia,
optic nerve decompression),
dacryocystorhinostomy,
choanal atresia repair.
What does the surgeon want to know?
The surgeon relies on expert radiologist interpretation of CT of the paranasal sinuses such that imaging acts as a road-map of anatomy,
highlighting normal variants,
in particular hazardous ones,
in order to prevent catastrophic complications.
The radiologist’s goal is to report on five key points:
- the extent of sinus opacification/disease
- opacification of sinus drainage pathways
- anatomical variants
- critical variants
- condition of surrounding soft tissues of the neck,
brain and orbits