COMPUTED-TOMOGRAPHY OF THE PARANASAL SINU SES - A PREOPERATIVE CHECKLIST

Background: Computed tomography (CT) is being used increasingly both t o evaluate location and extent of sinus disease and to detect anatomic abnormalities prior to surgery. Analysis of the CT scan should be und ertaken in a routine, standardized fashion to ensure that important de tails are not missed. To aid in this evaluation, a checklist has been developed which focuses on the most salient and potentially dangerous areas of the paranasal sinuses. Regular preoperative analysis using th is system may prevent unforseen technical difficulties and excess morb idity. Materials and Methods: Before obtaining a CT scan, the patient is placed on optimal medical therapy including antibiotics, and topica l and occasionally systemic steroids. Coronal scans are then performed with 3 mm sections through the frontal and sphenoid sinuses and 2 mm sections through the ethmoid region. Intravenous contrast is used. The study is then analyzed focusing on specific critical anatomic landmar ks. When additional information is required due to severe pathology or atypical anatomy, axial sections are added. Results: Out of 300 CT ex aminations that where analyzed, a preoperative checklist was developed with eight items that must be evaluated preoperatively. Methods for t he identification and analysis of this anatomy as well as the types of anatomic variation are discussed. We have found this evaluation to be extremely useful and efficacious in preventing morbidity in endoscopi c sinus surgery. Conclusions: Evaluation of the preoperative CT examin ation with a strictly applied checklist of important details and landm arks allows the recognition of hazardous anatomy and pathology which s hould increase the safety and efficacy of paranasal sinus surgery.