Imaging of chronic sinusitis in adults: X-ray, computed tomography, and magnetic resonance imaging

Two decades ago, otolaryngologists became aware that greater attention should be given to the area of the anterior ethmoid sinus. Before then, the maxillary sinus was the primary focus of attention. This was the site at which most surgical procedures were performed on patients with chronic sinusitis (Caldwell-Luc, nasal antrostomy, and irrigation procedures).’ A better understanding of the mucociliary clearance of the nasal cavity and paranasal sinuses underscores the shift in attention to the anterior ethmoid sinus.‘-’ Procto? believed that the seat of infectious disease in the nasal cavity and paranasal sinuses resided in the anterior ethmoid sinus. He suggested that disease in the anterior ethmoid sinus area was the cause of secondary inflammatory disease in the frontal and maxillary sinus. Messerklinge?, 6 was the first to use endoscopes to demonstrate the mucociliary pattern in the nasal cavity and paranasal sinuses, thus confirming Proctor’s beliefs. Messerklinger’s use of telescopes led to the innovative surgical technique of functional endoscopic surgery. The key to most inflammatory sinus disease is the air passage lateral to the middle turbinate, the middle meatus, and the communication with the adjacent sinuses through their respective ostia (ostiomeatal complex) (Fig. 1).‘.4,” The role of mucociliary clearance as it relates to the ostiomeatal complex is less well defined than the major functions of the nasal passages. However, a complete understanding of this area and the pattern of mucociliary clearance is crucial. The ostiomeatal complex is composed of narrow channels and is subject to wide normal anatomic variation (Fig. 2). It contains the ostia needed not only for the drainage of the anterior ethmoid sinuses but also for the frontal and maxillary sinuses. These sinuses are therefore dependent on the integrity of the