Sinonasal imaging after Caldwell-Luc surgery: MDCT findings of an abandoned procedure in times of functional endoscopic sinus surgery.
OBJECTIVE
Today, functional endoscopic sinus surgery (FESS) is performed in most of the patients with sinonasal inflammatory disease. The postoperative imaging findings of FESS in multidetector computed tomography (MDCT) considerably differ from those of historic Caldwell-Luc (CL) maxillary sinus surgery which is an uncommon procedure today. Thus, the postoperative CL imaging findings may lead to diagnostic confusion and misinterpretation. Therefore, this study explicitly presents the MDCT findings of post-CL patients which have not been described previously.


METHODS
Twenty-eight patients with clinically suspected sinusitis and documented history of CL-procedure underwent 16 row MDCT (MDCT Mx8000 IDT Philips) with multiplanar reconstructions of the paranasal sinuses in the axial plane. The following parameters were used: 140kV, 50mAs; 16mmx0.75mm detector collimation; 1mm reconstructed slice thickness; 0.5mm increment. The studies were reconstructed with a bone algorithm (W3000/L600; 1mm slice thickness) in axial plane and coronal plane (3mm slice thickness). The images were retrospectively evaluated for the presence of normal surgery-related and pathological findings.


RESULTS
Surgery-related imaging characteristics presented as follows: an anterior and a medial bony wall defect and sclerosis and sinus wall thickening were observed in all 28/28 cases (100%). Collaps of the sinus cavity was seen in 26/28 cases (92.9%). Furthermore, inflammatory disease of the operated sinus(es) was found in 23/28 cases (82.1%): 14/28 patients (50%) had inflammatory mucosal thickening of the operated sinus(es) as well as of other sinonasal cavities and 9/28 patients (32.1%) had inflammatory mucosal thickening limited to the operated sinus(es). A postoperative mucocele was depicted in 3/28 cases (10.7%). 2/28 patients (7.1%) showed neither maxillary nor other mucosal swelling.


CONCLUSIONS
MDCT with multiplanar reconstructions is a precise method to evaluate post-CL patients and helps to differentiate normal surgery-related findings, which may mimic pathology, from real pathological findings.
Nemec
Stefan Franz
SF
Department of Radiology, Division of Neuroradiology and Musculoskeletalradiology, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
Peloschek
Philipp
P
Koelblinger
Claus
C
Mehrain
Sheida
S
Krestan
Christian Robert
CR
Czerny
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012852:Sinusitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome