Normal Anatomy Anatomical Variants
Introduction
Normal Anatomy and Variants
CT Report Proforma
Proforma Printable Version
Introduction
It is critically important on the part of surgeon to view the CT scan systematically before the surgery to study the anatomy, anatomical variations, pathology and the structures which may be at risk, such as the skull base, orbit, optic nerve and internal carotid artery. Develop your own systematic way of reading the CT films, stage and pattern of the disease and then plan the surgical pathway. The following 10 points formula could be useful in studying the scan films:
1. Orientation: Orient and study the scans from anterior to posterior ie., from nasion to posterior wall of the sphenoid sinus.
2. Sides: Mark the right and left sides properly.
3. Nasal septum: Study the position and course of the nasal septum in all sections and note any deviation or spurs that may be Aetiologic factor or block the access during surgery.
4. Skull base: Note the height and asymmetry of the skull base in all sections.
5. Lamina papyracea: Look for dehiscence of lamina papyracea in all sections.
6. Frontal recess: Note superior insertion of uncinate process and type of frontal recess drainage and presence of agger nasi and frontal cells.
7. Middle turbinate: Note attachments of middle turbinate and variants, if any.
8. Ethmoid bulla: Constant landmark though size varies from person to person and side to side.
9. Sphenoid: Note degree of pneumatization, asymmetry, position and course of the inter sinus septum, carotid or optic canal dehiscence.
10. Note presence of Sphenoethmoid cells or Onodi cell.
Make your own proforma to note these points. The following proforma is the one we are using:
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Normal Anatomy and Variants
Frontal Sinus and variations
Frontal Sinus Drainage System
Frontal Recess and variations
Frontal cells
Agger Nasi cells and Variations
Lacrimal drainage system:
Middle turbinate and variations:
Ethmoid sinus and Variations:
Ethmoid Roof:
Uncinate Process:
Ethmoid bulla:
Ethmoid Infundibulum:
Sinus lateralis:
Maxillary sinus:
Infra-orbital ethmoidal cell:
Posterior ethmoidal cells:
Sphenoid sinuses:
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Proforma
Name: Age/Sex:
Address:
Phone No.......
OP/IP number.........
Referring Doctor:
Endoscopy findings : (Make one more proforma to note these findings.
Clinical diagnosis:
Radiological findings:
Nasal septum: Deviation/Dislocation/Spur/Posterior widening. Deviation to R/L
Ethmoid roof: Type I/ Type II / Type III
Foveal Plane: High/Middle/Low
Foveal angle: Wide/Narrow
Lamina papyracea: Dehiscence/...........mm from nasion
Frontal sinus: Type of frontal recess: Middle meatus/lnfundibular
Number of chambers: Depth :
Posterior wall: Erosion/Dehiscence
Inter sinus septa: Number: Position: Dehiscence
Agger nasi cells: Unilateral/Bilateral Pathology:
Frontal cells: Type I/Type ll/Type lll/Type lV. Side:R/L
Supra orbital ethmoid cell/Frontal bulla Side: R/L
Uncinate process : Normal/Atelectatic/Medially bent/Horizontal/not seen
Superior attachment: Lamina papyracea/Middle turbinate/Skull base
Infundibulum: Wide/Narrow/Shallow/Deep/Terminal recess
Maxillary sinus: Normal/Hypoplastic/lntrasinus septa/Pathology:
Haller's cell: Number & Size:
Middle turbinate: Normal/Concha/Paradoxic/lnterlamellar cell/Turbinate sinus
Ethmoid bulla: Absent/Hypoplastic/Large/Lateral sinus
Superior turbinate: Normal/Pneumatized
Sphenoethmoid cells: Relation to optic nerve:lndirect/Direct+ve/Direct-ve
Sphenoid: No of chambers: Anterior clinoid pneumatization/Pathology:
Sphenoid Inter sinus septa: No......... /Dehiscence/ Septa Ending on:0ptic nerve/Internal carotid artery/Horizontal septa.
Inferior turbinate: Normal/hypertrophy
Pathology: Fluid collection/Mucosal thickening/Polyp/Fungus/Bone remodeling/bone erosion. Others:
Complications:
Radiological diagnosis: Normal/Anatomical variants/Osteomeatal unit disease/
Advanced disease: Frontoethmoid/Sphenoethmoid.
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