Page 66 - Revista Portuguesa - SPORL - Vol 62. Nº1

Figure 1
(A) Nasal endoscopic view of polypoid mass with a lobulated morphology pedicled on the right middle
meatus. (B) Coronal CT image in the same a patient showing complete opacification of with inverted
papilloma shows localized hyperostosis of the superior wall of the posterior ethmoid sinus (white arrow).

imaging studies, through a sinus CT scan and entire nasal cavity and two paranasal sinuses.
a contrast-enhanced MRI. The combination In 19% of the patients this finding affected the
of both studies made it possible to correlate entire nasal fossa and more than two paranasal
the images obtained and their respective sinuses and/or in 1% of the cases opacification
correspondence with the information collected was identified on both anatomical sides.
in the endoscopic evaluation performed at the Focal hyperostosis, considered a tomographic
initial consultation. Imaging studies identified sign predictive of the area of anatomic
different findings commonly observed in adhesion and the site of origin of the SPs, was
patients with SPs, such as opacification, focal identified in 79% of the cases. This finding
hyperostosis and bone erosion by CT scan was observed in the lateral nasal wall in 32%
and images with a contoured cerebriform of patients, within the maxillary sinus in 15% of
pattern and extra-sinonasal extension by cases, in the anterior ethmoidal sinus in 12%,
contrast-enhanced MRI. In 91% of the CT scans in the posterior and frontal ethmoidal sinuses
of patients with SPs, images with different in 2% of cases and the sphenoidal sinus in 5%
degrees of opacification were observed, of cases. Focal hyperostosis was located in
coinciding with the polypoid lesion observed 12% of the assessed patients in two or more
endoscopically. The opacification images anatomical walls. (Figure 2)
observed were present in 60% of the cases The CT scan showed signs of erosion and
on the right side, in 39% of them on the left destruction of bone walls in 84% of the patients
side and in 1% on both sides. Opacification studied. Bone involvement involved non-
tomographic images indicated the anatomic critical bone walls (septum, turbinates, lateral
location and extent of the pathologic process wall) in 69% of the cases and critical bone
in the paranasal sinus cavities. The anatomical walls (orbit, skull base) in 16% of the patients.
involvement partially involved one nasal cavity In patients in whom erosion of critical bone
and one paranasal sinus in 11% of the cases. In walls was found, in 9% of cases, this alteration
35% of patients, the involvement affected the affected the orbital wall, in 6% the skull base,
entire nasal cavity and one paranasal sinus. In and in 1% of cases, this alteration affected both
26% of the cases, the opacification involved an anatomical walls. In 86% of the cases studied,

66 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço