Pre-FESS Imaging of Paranasal Sinuses and Nasal Cavity: Using Multi-detector Computed Tomography (MDCT) in Understanding Normal Anatomy and Anatomical Variations: Tips and Tricks.

With the advent of Multi-detector Computed Tomography (MDCT), imaging evaluation of paranasal sinuses (PNS) and nasal cavity has witnessed a paradigm shift. Submillimetric slice thickness with superior quality multiplanar reconstructions in orthogonal as well as non-orthogonal planes have resulted in better understanding of the intricate details of complex sino-nasal anatomy and their normal variations. Sagittal plane images have gained increasing acceptance among the sinus surgeons for understanding frontal sinus drainage pathway as well as lateral nasal wall. Analyzing the axial volume dataset in three dimensions has become a routine both for the radiologists as well as sinus surgeon. Besides default window settings, customized window settings enable better appreciation of air containing structures and their boundaries. Mandatory scan check list and template based structured reporting helps the sinus surgeon in better pre-operative planning. Regular mutual interaction between radiologists and sinus surgeon helps better understanding of the surgically relevant anatomy and anatomical variations.