Computed Tomography in the Evaluation of Pathological Lesions of Paranasal Sinuses

Computed tomography is now the modality of choice for imaging paranasal sinuses and along with Functional Endoscopic Sinus Surgery has empowered the modern rhinologist to treat patients more effectively. This study aims to evaluate anatomical variation in paranasal sinuses; compare computed tomography with histopathological and surgical findings and establish its diagnostic value.

A hospital based observational study including all patients referred from the department of Ear, Nose and Throat for computed tomography scan of paranasal sinus to the department of radiology and imaging of Trubhuvan University Teaching Hospital from August 2011 to July 2012. Both axial and coronal sections were evaluated and findings were correlated with surgical findings and histopathology.

A total of 44 patients were included in the study. The most common clinical diagnosis was sinonasal polyposis and chronic rhinosinusitis. Most common anatomical variation was deviated nasal septum (68.2%) followed by choncha bullosa(27%). In most cases more than one sinus was involved. Maxillary sinus was involved in 90.9% followed by ethmoid sinus in 81.8%. Inflammatory pathology was seen in 35 (79.5%) patients with sinonasal polyposis pattern being the most common pattern of involvement. Findings of computed tomography were similar to surgical findings in 84.6% cases. The sensitivity and specificity of computed tomography was fairly good except for fungal rhinosinusitis.

CT scan should be performed preoperatively in order to guide the surgeon for Functional Endoscopic Sinus Surgery or other surgical procedures.