The Preoperative Sinus CT: Avoiding a "CLOSE" Call with Surgical Complications

Area of Science:

• Radiology
• Otolaryngology
• Anatomy

Background:

• Functional endoscopic sinus surgery (FESS) effectively treats sinusitis but carries risks of serious complications.
• Preoperative computed tomography (CT) is crucial for identifying anatomical variants that predispose patients to surgical risks.
• Current preoperative imaging reports often lack consistent documentation of these critical anatomical variants.

Purpose of the Study:

• To illustrate key anatomical variants and landmarks on preoperative sinus CT scans.
• To focus on variants that increase the risk of surgical complications during FESS.
• To introduce a mnemonic for improved documentation of critical anatomical findings.

Main Methods:

• Review of preoperative sinus CT scans to identify relevant anatomical variants and landmarks.
• Focus on structures associated with potential surgical complications.
• Development and application of the "CLOSE" mnemonic (Cribriform plate, Lamina papyracea, Onodi cell, Sphenoid sinus pneumatization, and anterior Ethmoidal artery).

Main Results:

• Identification of critical anatomical variants on CT scans.
• Demonstration of how these variants can lead to surgical complications.
• The "CLOSE" mnemonic provides a structured approach to reporting these findings.

Conclusions:

• Consistent documentation of anatomical variants on preoperative CT scans is vital for surgical safety.
• The "CLOSE" mnemonic enhances the value of preoperative imaging reports for otolaryngologists.
• Improved reporting can help reduce the incidence of major surgical complications in FESS.