[Use of electroroentgenography in the diagnosis of paranasal sinus diseases].
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Ultrasonography is a useful diagnostic tool in the evaluation of patients with paranasal sinus disease. It is a simple, reliable method with a failure rate of approximately 10%. The increasing use of this diagnostic tool requires the reemphasis and prevention of possible errors in establishing the correct diagnosis.
In the course of inflammatory diseases affecting the paranasal sinuses, a number of complications may occur. One of those is the involvement of neighbouring skeletal portions. By this study evidence is given, that there is a high rate of inflammation, spreading to adjoining bone areas. This applis also to early stages and first manifestations. Especially in cases of surgery, complete recovery is rare. The pattern of chronic recurrent osteomyelitis may develop.
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Panoramic dental radiography does not replace conventional techniques for viewing the maxillary sinuses but is a useful adjunct. Unsuspected antral diseases, from innocuous mucosal cysts to insidious squamous carcinoma, may be detected during routine use of this procedure.
O. E. Van Alyea stated that "The sphenoid sinus is the most neglected of the nasal sinuses." It is neglected by disease because of its location, by the physician because of its subtle symptoms when diseased, and the surgeon because of its inaccessability. An accurate knowledge and understanding of the anatomy of the area help the physician diagnose and manage problems in this area. Eleven cases are used to illustrate the wide spectrum of pathologic conditions in and about the sphenoid sinus. Only two of the patients were asymptomatic. All of the others had deep-seated, retrobulbar headaches. Eight of 11 patients had cranial nerve involvement. The optic nerve was involved in six cases. The abducens nerve was involved in five of 11 cases and the maxillary nerve in four of 11 cases. Initial roentgenographic examination must include lateral and submental vertex views. The newer techniques of angiography, polytomography, and computerized tomography aid in determining the extent of the pathologic condition and the treatment approach.
Of 35 nasal and paranasal sinus masses examined by radiography and tomography, 22 malignant tumors showed purely destructive growth. Bone expansion was observed in 13 benign, and 2 slowly growing malignant masses. Pluridirectional tomography in carefully selected projections is often necessary to reveal expansile growth. The 13 expansile lesions, including mucocele, neurofibroma, dermoid, epidermoid, cementifying fibroma, angiofibroma, inverting papilloma, and cylindroma, are briefly described. Tomographic appearance alone did not characterize histopathologic entities. However, distinctions may be made between fibro-osseous and epithelial tumors, and between fast growing and slowly growing tumors.
The diagnostic value of computer tomography in lesions of the paranasal sinuses has been investigated in three cases with maxillary carcinoma and in five cases with fractures of the facial bones. In most of the cases, particularly in carcinoma, computer tomography was found to provide additional information to that obtained with conventional X-ray techniques. In fractures, however, a supplementary plain film examination was found to be indispensable.
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