ABSTRACT
Figure 22.1 A thin streak of pus (short arrow) lateral to a congested right middle turbinate (long arrow) which obliterates the middle meatus. The congestion and the pus suggest an acute infection
Figure 22.2 A streak of pus (short arrow) medial to the left middle turbinate. The middle meatus (long arrow) in this case is patent
meatus. The long arrow points to the belly of the middle turbinate
Figure 22.4 Purulence (short arrow) between the congested mucosa of the uncinate process (long arrow) and the middle turbinate (arrowhead) in a case of a right maxillary pyocele
Figure 22.5 inferior meatal nasoantral window. The long arrow points to a partially resected inferior turbinate
Figure 22.6 A streak of pus (short arrow) coming out of a posterior accessory ostium of the right maxillary sinus. The long arrow points to the middle turbinate
Figure 22.7 Two streaks of pus (short arrows) moving posteriorly and coming out of a right middle meatal antrostomy (long arrow), and an anterior ethmoid cell (arrowhead)
Figure 22.8 A granular area (short arrow) on the medial part of the right inferior turbinate in a patient diagnosed with a common cold. The long arrow points to the middle turbinate, and the arrowhead to the septum. A week later, this area was no longer seen and the mucosa appeared normal. This picture illustrates the rare condition of a circumscribed rhinitis
Figure 22.9 in a patient who had undergone, many years before, an external ethmoidectomy for a mucocele
Figure 22.10 CT scans of the patient in Figure 22.9 showing the mucocele (short arrows) and the defect in the medial orbital wall (long arrows) resulting from the previously performed external ethmoidectomy
Figure 22.11 A homeless man presented with a left superior orbital swelling of 3 months’ duration
Figure 22.12 A nasal endoscopy of the patient in Figure 22.11 showed a soft swelling in the left frontal recess (short arrow), and a streak of pus (long arrow) between the swelling and the middle turbinate (arrowhead)
Figure 22.14 Purulence (short arrow) and a crust (long arrow) blocking a left middle meatal antrostomy. The arrowhead points to the middle turbinate
Figure 22.16 A cicatricial chronic ethmoiditis on the left side following multiple surgeries for chronic sinusitis. The short arrows point to the small abscesses and the long arrow to the septum. Note that the middle turbinate is missing. This patient grew methicillin-resistant S. aureus repeatedly and failed to respond to the appropriate antibiotics
Figure 22.17 Another patient with a cicatricial chronic ethmoiditis following multiple surgeries. The short arrow points to an obvious small abscess and the long arrow to the left middle turbinate
responsible for recurrent frontal sinusitis. The long arrow points to the middle turbinate
Figure 22.19 A more discrete single polyp (short arrow) in the right frontal recess. The long arrow points to the middle turbinate
Figure 22.20 Two polyps (short arrows) in the left frontal recess. The long arrow points to the septum and the arrowhead to the middle turbinate
Figure 22.21 A fleshy polyp (short arrow) lateral to the left middle turbinate (long arrow). A biopsy is needed to differentiate a fleshy polyp from an inverted papilloma
Figure 22.22 Two polyps (short arrows) in the posterior ethmoid cavity on the left. Note the large ostium of the concha bullosa which contained a polyp (long arrow)
Figure 22.23 Polyps (short arrows) in the right olfactory area, between the septum (long arrow) and the middle turbinate (arrowhead). Similar polyps were found on the left. This patient with chronic nasal allergies presented with anosmia as her only symptom. No other polyps were seen on endoscopy
Figure 22.24 A small polyp (short arrow) in the left spheno -ethmoid recess. The long arrow points to the natural sphenoid ostium
Figure 22.25 A sessile polyp arising from the lower border of the right inferior turbinate
Figure 22.26 A polyp (short arrow) seen through a left nasoantral window. The long arrow points to the inferior turbinate
Figure 22.27 A retention cyst or a polyp (short arrow) filling the right maxillary sinus and seen through a posterior accessory ostium. The long arrow points to the middle turbinate
Figure 22.28 A retention cyst (short arrow) coming out of a right middle meatal antrostomy. It was opened and emptied painlessly in the office. It is not always easy to differentiate a cyst from a polyp on nasal endoscopy. The long arrow points to the middle turbinate
Figure 22.29 A patient with recurrent nasal polyposis who had undergone multiple surgeries including a right CaldwellLuc 20 years before. She presented with a dull pain over the right maxillary sinus. Endoscopy revealed a soft swelling (short arrow) over the right inferior turbinate (long arrow)
Figure 22.30 The CT scan of the patient in Figure 22.29 showed that the swelling was due to a maxillary mucocele, a known very late complication of the Caldwell-Luc operation
Figure 22.31 A firm swelling (short arrow) below the right inferior turbinate (long arrow), discovered incidentally in a patient with no rhinological symptoms
Figure 22.32 The CT scan of the patient in Figure 22.31 showed a cyst which proved to be a recurrent radicular cyst
Figure 22.33 An adult with a history of right nasal congestion and cheek discomfort. Nasal endoscopy revealed a soft bulge (short arrow) in the inferior meatus, displacing the inferior turbinate (long arrow) superiorly
Figure 22.34 The CT scan of the patient in Figure 22.33 showed a cyst which proved to be odontogenic
Figure 22.35 A small capillary hemangioma on the left middle turbinate
Figure 22.36 A 50-year-old male with a few months ’ history of left epistaxis on nose-blowing. Endoscopy showed a blood streak (short arrow) coming out of the lower aspect of the hiatus semilunaris. The long arrow points to the middle turbinate and the arrowhead to the uncinate process. This patient proved to be suffering from an ameloblastoma of the maxilla. (Courtesy of Dr Nicolas Busaba)
Figure 22.37 A bilobed fleshy polyp in the roof of the anterior right nasal cavity. It proved to be a hamartoma
Figure 22.38 A recurrent inverted papilloma 10 years after a left medial maxillectomy
Figure 22.39 An adult patient with sudden right eye blindness. She had been treated for years for allergies. A CT scan showed a mass invading the orbital apex
Figure 22.40 Nasal endoscopy on the patient in Figure 22.39 revealed a fleshy polypoid mass filling the upper third of the right nasal cavity. On biopsy, it proved to be a squamous cell carcinoma arising within an inverted papilloma
Figure 22.41 Significant adhesions (short arrows) lateral to the right middle turbinate (long arrow) several weeks following endoscopic sinus surgery
Figure 22.42 Moderate adhesions (short arrows) between the septum and the right middle turbinate following a septoplasty. The long arrow points to a small septal perforation
Figure 22.43 Significant adhesions (short arrows) between the septum (long arrow) and the left middle turbinate (arrowhead) following a septorhinoplasty. Similar adhesions were also found on the right side. The patient’s only complaint was anosmia
Figure 22.44 A total stenosis of the right middle meatal antrostomy. The arrow points to the stump of a partially resected middle turbinate
Figure 22.45 A retracted left posterior fontanelle (short arrow) in a case of maxillary atelectasis. The long arrow points to the bulla ethmoidalis, and the arrowhead to the middle turbinate
Figure 22.46 An adult with a chronic and resistant left nasal blockage. Nasal endoscopy revealed a long bony structure (short arrow) hanging from the left sphenoethmoid recess toward the nasopharynx. Its lower end was polypoid (long arrow)
Figure 22.47 The polypoid end (short arrow) of the bony structure in Figure 22.46 could also be seen from the right side. The long arrow points to the posterior edge of the vomer
22.47 to be tubular. It was excised. It proved to be a part of the middle turbinate which failed to be resected properly. It must have been pushed toward the nasopharynx and kept there. The patient’s nasal blockage improved after surgery
