Fisiología Anomalías de La Cavidad Nasal, Radiología, CT Scan

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13/04/2012Seminarios Anatoma Clnico Radiolgica Tel.

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Anatomia, Fisiologa,

Nasal , Anomalas de laCavidad nasal.Anatoma radiolgica,CT

Scan

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Fisiologa NasalClnica de Asma yAlergia

Nasal Aerodynamics

Author: Samuel J Lin, MD; ChiefEditor: Arlen D Meyers, MD, MBA

Revisin

Dr. Juan HerreraSalazar

Overview

Nasal Resistance

Clinical Evaluation ofthe Nose

Flow Mechanics of

Airflow Rhinomanometry

Clinical Causes ofNasal Obstruction

Rhinoplasty and 13/04/2012Seminarios Anatoma Clnico Radiolgica Tel.

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http://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overview


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Dr. Juan Herrera Salazar


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Foro Mdico Nicaragense

Portales Mdicos

Medbook

Mi blog de Asma y Alergia
http://colmedni.ning.com/profile/DrJuanHerreraSalazarhttp://colmedni.ning.com/profile/DrJuanHerreraSalazarhttp://www.medbook.es/profile/JuanHerreraSalazarhttp://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://www.medbook.es/profile/JuanHerreraSalazarhttp://colmedni.ning.com/profile/DrJuanHerreraSalazarhttp://colmedni.ning.com/profile/DrJuanHerreraSalazarhttp://colmedni.ning.com/profile/DrJuanHerreraSalazar


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Bibliografa

13/04/2012Seminarios Anatoma Clnico Radiolgica

Tel. 22781169,22703359, 88825513

4

Atlas Netter II edicin.

Atlas Netter IV edicin Interactiva.

Atlas, Anatomy,Carmine de Clemente 3rd ed.. Gray s Anatomy Ed. Longman 1973.

Emedecine collection

Nasal Cavity Anatomy, Physiology, andAnomalies on CT Scan Author: Belachew Tessema,MD; Chief Editor: Arlen D Meyers, MD, MBA. Updated: Mar29, 2011
http://emedicine.medscape.com/article/875126-overviewhttp://emedicine.medscape.com/article/875126-overviewhttp://emedicine.medscape.com/article/875126-overviewhttp://emedicine.medscape.com/article/875126-overviewhttp://emedicine.medscape.com/article/875126-overview


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Bibliografa Emedecine


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Nasal Physiology Author: Sanford M Archer, MD;Chief Editor: Arlen D Meyers, MD, MBA more...

Olfactory System Anatomy Author: Amir

Vokshoor, MD; Chief Editor: Arlen D Meyers, MD,MBA more...

Nasal Aerodynamics Author: Samuel J Lin, MD;Chief Editor: Arlen D Meyers, MD, MBA more...

Nasal Reconstruction Author: Ali Sajjadian, MD,FACS; Chief Editor: Arlen D Meyers, MD,MBA more...
http://emedicine.medscape.com/article/874771-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/876456-overviewhttp://emedicine.medscape.com/article/876456-overviewhttp://emedicine.medscape.com/article/876456-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/874771-overviewhttp://emedicine.medscape.com/article/874771-overviewhttp://emedicine.medscape.com/article/874771-overview


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Lo ms dificil es ver lo que esta delante de tus ojos W.Goethe

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Seminarios Anatoma Clnico Radiolgica

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Anatomia radiolgica


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Radiografa Craneo Rx. . Lateral


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Anatomia y fisiologa


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Favor leer notas alpie de pagina..

o ..

o ..

o .. Gracias


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Definicin de Sinusitis Sinusitis is an inflammation of the mucosal lining

of the paranasal sinuses. As the mucosa of thesinuses is continuous with that of the nose,rhinosinusitis is a more suitable term.[1, 2]

Sinusitis can be subdivided into acute, subacute,

and chronic disease. Acute sinusitis is defined asdisease lasting less than 1 month. Subacutedisease lasts 1-3 months, and chronic sinusitis

lasts longer than 3 months and is generallyrelated to suboptimally treated acute or subacutedisease. Acute and subacute sinusitis are treatedmedically, whereas chronic sinusitis may

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Derrame del seno maxilar

Air-fluid levels,

as shown in theimage below,generally

indicatebacterialsinusitis.

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Tratamiento antibitico Levofloxacin,

moxifloxacin, andamoxicillin/clavulanate- Greater than 90%

High-dose amoxicillin,cefpodoxime proxetil,cefixime, cefuroxime

axetil, andtrimethoprim-sulfamethoxazole -80-90%

Clindamycin,doxycycline, cefprozil,azithromycin,

clarithromycin, anderythromycin - 70-80%

Cefaclor - 50-60%

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Otros medicamentos

Rinosinusitis Decongestionantes

Ver notas

Limpieza consolucin salina ver

docs jhs

Nasal 2 spray

Expectorants

Corticosteroids

Anticholinergics

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http://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medicationhttp://emedicine.medscape.com/article/232670-medication


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Diagnostico diferencial Allergic Fungal Sinusitis

Sinusitis, Chronic, Medical Treatment

Sinusitis, Ethmoid, Acute, Surgical Treatment

Sinusitis, Frontal, Acute, Surgical Treatment Sinusitis, Fungal

Sinusitis, Maxillary, Acute, Surgical Treatment

Sinusitis, Maxillary, Chronic, Surgical Treatment

Sinusitis, Sphenoid, Acute, Surgical Treatment

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http://emedicine.medscape.com/article/834401-overviewhttp://emedicine.medscape.com/article/861768-overviewhttp://emedicine.medscape.com/article/862183-overviewhttp://emedicine.medscape.com/article/862292-overviewhttp://emedicine.medscape.com/article/863062-overviewhttp://emedicine.medscape.com/article/862030-overviewhttp://emedicine.medscape.com/article/861886-overviewhttp://emedicine.medscape.com/article/862435-overviewhttp://emedicine.medscape.com/article/862435-overviewhttp://emedicine.medscape.com/article/861886-overviewhttp://emedicine.medscape.com/article/862030-overviewhttp://emedicine.medscape.com/article/863062-overviewhttp://emedicine.medscape.com/article/862292-overviewhttp://emedicine.medscape.com/article/862183-overviewhttp://emedicine.medscape.com/article/861768-overviewhttp://emedicine.medscape.com/article/834401-overview


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CT Scan Anatomia y Fisiologa

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CT scan, nasal cavity.

Normal anteriorostiomeatal complexanatomy.

The anatomy of theethmoid infundibulum

and the uncinateprocess isdemonstrated here.


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CT Scan Anatomay Fisiologa

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The uncinate process(UP) and lateral wall ofthe nasal cavity form

the ethmoidinfundibulum (EI). Theabove sinuses drain intothe EI via various ostia.The maxillary sinusostia and the frontal

sinus recess or ductdrain into the anterior-most portion of theOMC and areconsistently identifiable

on CT scan. Normalfrontal recess/duct.Frontal sinus emptiesinto the middle meatus

just lateral to the moreanterior portion of the

middle turbinate. The

COMComplejo Osteo

Meatal


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Anatoma yFisiologa

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Stammberger andMesserklinger

Drainage

Normal posteriorostiomeatal

complex. The vomerseparates the twoostia into thesphenoid sinus.

These ostia arelocated in thesphenoethmoidrecess. The vomer is

normally

Complejo OsteoMeatal Posterior

Normal


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Anatoma yFisiologa

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A normal sagittalreconstruction of the

OMC, showing thecurved edge of the

semilunar hiatus withthe inferior mucosal

edge covering the UP,can be seen in theimage below. Thefrontal recess is also

shown.Complejo OsteoMeatal Posterior

Normal


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El septo nasal

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Desviacin del Septo

Fisiologa de las desviaciones del SeptoNasal

Factor predisponente. SinusitisVer el papel de las alergias


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Septo NasalEstructura Osea y Cartilaginea.

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Anomalas de la Cavidad Nasal

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Congenital or truefusion of the uncinateprocess to the orbitfloor. The maxillarysinus is hypoplastic andnot aerated. Theethmoid infundibulumdoes not exist or endsblindly as the recessusterminalis.

The UP tip can also

fuse directly to thelateral wall or laminapapyracea of the orbit.This anomaly producesthe same imaging

findings as inferomedialfusion.


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Anomalas de la Cavidad Nasal

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Bilateral

pneumatization of

the uncinate tips.

Expansion of thetips can

compromise the

ethmoid

infundibulum, thesemilunar hiatus,

or the middle

meatus.


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Anomalas de la cavidad nasal

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Concha bullosa of the

left middle turbinatewith expansion and

narrowing of theethmoid infundibulumand the middlemeatus. Note

absence of the rightuncinate process,another anatomicvariant.


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Anomalias del

proceso uncinato.

Conchae (anomalas)

Turbinatosparadjicos

Duplicados

Accesorios

Fusin turbinato-turbinato


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Large Haller air cellclearly narrowing the

ethmoid infundibulum.


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Overexpansion of theethmoid sinus floors

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Anomalias de la Cavidad Nasal

Polipos nasales Polipos coanales

Turbinatos accesorios

Fracturas

Absence of basal orground lamella

Absence of the basalor ground lamella is

problematic only ifFESS of the posteriorOMC is beingconsidered..

Bony septa:N.Videano

Lesiones lagrimeo.

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Ciruga FESS

C t ti


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Caractersticas

radiolgicas de la sinusitis

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El NivelHidro-aereo, en

el seno maxilarsugiere

sinusitis.

P t dil i l CT


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Patrones radilogicos al CT

Scan

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Right-sided

sphenoethmoidalpattern ofsinusitis.

P t dil i l CT


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Patrones radilogicos al CT

Scan

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Bilateral ethmoid

sinusitis on anMRI.


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Hiatus semilunaris Es el espacio delimitado

entre el proceso uncinatoanteoinferior y la bulaetmoidal

Las celdas etmoidalesanteriores drenan

anteriormente en el hiatussemilunaris atraves delducto fronto nasal.Themiddle group drains into thehiatus semilunaris on orabove the ethmoidal bulla.

El seno frontal drena pormedio del ducto frontal o atravs de las celdasetmoidales anteriores en elhiatus semilunaris.

El infundibulum maxilardrena en la reginposterior del hiatussemilunaris.

El seno frontal, maxilar,

las celdas anteriores ymediales drenan en elhiatus semilunaris.

Cualquier obstaculomecanico en esta reginm

causa inflamacin de lossenos mencionados. Estose le conoce como patronosteomeatal.

Sindrome del meato

medio. 13/04/2012Seminarios Anatoma Clnico Radiolgica Tel.

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El Complejo Osteo Meatal

Anatomia: Para evaluara el

patron de unasinusitis debemos

conocer primero elderaje de los senosnasales.

Unidad Osteomeatal:

esta no es unaestructuramorfologica unicasino una combinacin

de estructuras:

Turbinate Medio Bulla Etmoidal

Proceso Uncinato

Infundibulo Maxilar Hiatus semilunaris

(espacio debajo delturbinato)

Hueso Maxilar os

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Complejo Osteomeatal

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Mucosalthickening in

the left anteriorethmoid and

maxillarysinuses and inthe region of

theinfundibulum.This indicatesan ostiomeatal

pattern ofsinusitis


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Estructura Osea pared lateral de lacavidad nasal, reseccin parcial turbinatos

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Pared lateral de la cavidad


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Pared lateral de la cavidadnasal

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Drenaje del seno esfenoidal

The sphenoid sinus drains posterior to thesuperior turbinate into the sphenoethmoidrecess through the sphenoid ostium.

The posterior ethmoid air cells also drainthrough the superior meatus into thesphenoethmoid recess.

An obstruction in this region gives rise to thesphenoethmoid pattern of sinusitis.

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Conca Bulosa

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Concha

bullosa ofthe rightmiddle

turbinate.


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Celdas de Haller

Paradoxical curves ofboth middle turbinatescause narrowing ofthe ostiomeatal units.

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CT Scan Metodo Preferido

Computed tomography (CT)scanning is the examination ofchoice in sinusitis, particularly incases of chronic sinus disease,providing excellent detail of sinusanatomy. However, CT is usually notuseful in acute sinusitis, as

diagnosis in acute cases is primarilybased on clinical findings. Goodanatomic definition is desirablebefore surgical intervention.

Coronal CT imaging is the preferredinitial procedure. Bone-window

views provide excellent resolutionand good definition of the completeostiomeatal complex and otheranatomic details that play a role insinusitis. In addition, the coronalview is best correlated with findingsfrom sinus surgery, with anatomy

and pathology visualized in a plane

CT provides an excellent anatomic

display of soft-tissue attenuation.This depiction includes fluidlevels and polypoid masseswithin the normally air-filledcavities of the sinuses, nasalcavity, and postnasal space. Mostimportant, disease extending

beyond the bony perimeters ofthe sinuses into the adjacent softtissue of the orbit,[7] brain, andinfratemporal fossa can beimaged.

In general, nonenhanced CT scans

suffice in cases of uncomplicatedsinusitis. Multisection CT seemsto have the potential to replaceprimary coronal CT of theparanasal sinuses without anyloss of image quality, and it mayeven improve the overalldiagnostic value. However, the13/04/2012


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CT scan Spiral CT scan

1mm cuts

Magnetic ResonanceImaging

The exclusive use of coronal CT scansfor sinus imaging could result in thefailure to diagnose nasal cavityneoplasms. In the absence of bonedestruction, an esthesioneuroblastoma or

other neoplasm may be mistaken for anasal polyp on a CT scan, whereas onMRI, the nature of this tumor is quiteapparent. Beyond anatomic variants, anysuspicious findings should be imaged by

means of MRI.

Despite advances in MRItechnology, insufficient tissue, plusthe problems of susceptibility due tothe air-containing passages, makeMRI a less effective study for nasalcavity sinusitis problems, unless ofcourse the sinusitis turns out to berelated to squamous cell carcinoma(SCCa).

To date, no new MRI contrastagents that have an affiliation for

SCCa have been released.

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Prxima serie III parte

Magnetic ResonanceImaging

Ultrasonography

Nuclear Imaging

Angiography

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http://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overview


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Gracias !


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Gracias por la oportunidad

Desde la Clnica de Asma y Alergia

Managua , Nicaragua. Tel 22781169, 22703359,88825513

Dr. Juan Herrera Salazar

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Fisiología Anomalías de La Cavidad Nasal, Radiología, CT Scan

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