[The incidence and location of inflammatory paranasal sinus lesions in CT]

Several recent studies have labelled the anterior ethmoid as the main source of chronic and/or recurrent sinusitis in the entire paranasal sinus system. In an attempt to identify other possible patterns of developing sinusitis, 1,345 computed tomographies of neurological and neurosurgical patients with no previous history of paranasal sinusitis were evaluated. These scans were made between 1985 and 1989 in the Neurosurgical Clinic of the University of Freiburg. Seventy-five of these studies revealed evidence of inflammatory changes. In 57 scans maxillary sinus disease was evident, while in 46 there was en ethmoid disease, in 24 a sphenoid sinus disease and in 17 a frontal sinus disease. Nine scans showed pansinusitis. In 24 studies, one sinus location was involved (uni- or bilaterally) and among these were 21 with maxillary, 2 with anterior ethmoidal and 1 with frontal sinus involvement. In 38.7% of the examined scans, the anterior ethmoidal complex was free of disease. This study shows that, at least radiographically, the ethmoidal infundibulum is not always the origin of paranasal sinus disease. An isolated frontal, maxillary or sphenoidal sinusitis can develop as well. These results show that a simple anterior ethmoidectomy cannot be considered the panacea for chronic and/or recurring sinusitis. Surgical therapy of inflammatory sinus disease should, on the contrary, be tailored to each patient depending on anamnesis, clinical findings and CT results.