Patterns of Inflammatory Sinus Disease

Sonkens et al described five patterns of inflammatory paranasal sinus disease, which you should think of when describing paranasal sinus disease.

Osteomeatal complex pattern: The osteomeatal complex is responsible for anterior paranasal sinus drainage. Lesions at the middle meatus of the nasal cavity such as mucosal edema, polypoid lesions, concha bullosa, and septal deviation, can lead to involvement of the maxillary sinus and anterior and middle ethmoid air cells. The frontal sinus may be involved, depending on the insertion of the anterior uncinate process. A limited variant of the osteomeatal complex pattern called the frontal recess inflammatory pattern may occur with isolated involvement of the frontal sinus in cases of direct drainage of the frontal recess into the middle meatus.

Infundibular pattern: Isolated obstruction of the ethmoid infundibulum and/or maxillary sinus. The frontal and ethmoid sinuses are normal. In addition to mucosal edema and polypoid lesions, Haller cells can cause this pattern.

Sphenoethmoidal recess pattern: Involvement of the sphenoid sinus with or without posterior ethmoidal air cells. The site of inflammatory change is the sphenoethmoidal recess.

Sinonasal polyposis pattern: Widespread obstruction (apart from the inferior meatus). Extensive polyps throughout the nasal cavity and the paranasal sinuses, resulting in a mixture of the above patterns.

Sporadic pattern: No clear pattern is seen, with apparently random mucosal thickening, polyps, retention cysts, and mucocoeles.

References

• Connor SEJ, Hussain S, and Woo EK. Sinonasal imaging. Imaging. 2007; 19(1): 39-54.
• Eggesbø HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol. 2006 Apr;16(4):872-88.
• Hähnel S, Ertl-Wagner B, Tasman AJ, Forsting M, Jansen O. Relative value of MR imaging as compared with CT in the diagnosis of inflammatory paranasal sinus disease. Radiology. 1999;210(1):171-6.
• Pruna X. Morpho-functional evaluation of osteomeatal complex in chronic sinusitis by coronal CT. Eur Radiol. 2003;13(6):1461-8.
• Sonkens JW, Harnsberger HR, Blanch GM, Babbel RW, Hunt S. The impact of screening sinus CT on the planning of functional endoscopic sinus surgery. Otolaryngol Head Neck Surg. 1991 Dec;105(6):802-13.