HEADACHE RHINOGENIC: radiological aspects maxillo-facial

HEADACHE RHINOGENIC: radiological aspects maxillo-facial


Were examined 49 patients with headache deafness, ENT-related pathologies, in patients who reported clinically as well as migraine-type front, fronto-orbital, fronto-parietal symptoms characterized by nasal obstruction and / or chronic runny nose, symptoms sinusitica at least 6 weeks, undergo regular medical ENT and sino-nasal endoscopic findings and initiated the study maxillofacial radiology through the use of computerized axial tomography.
Patients were examined between November 1998 and December 1999, the age of patients ranges from 16 to 70 years, mean age 43 years, 22F and 27M, with M / F ratio of 1.2.
The study was conducted by the EU. O. of Radiology, Hospital S. James Monopoli in collaboration with the UO of Otolaryngology of the same hospital. In this study, the patients recruited were selected on the basis of the above-described symptoms of headache-related symptoms and subjected to appropriate antibiotic therapy with ciprofloxacin 750 mg x 2 v / day x 8 days. and deflazacort 30 mg x 2 v / day x 8 days. and subsequent CT maxillofacial surgery.
The intent of the ear specialist colleagues was to evaluate the extent of pathology for the presence of naso-sinus polyposis and / or ethmoid-maxillary sinusitis and / or deviations of the nasal septum (especially the rear and above) and / or frontal sinusitis and or ethmoid bulla, excluding, by prior medical treatment, the presence of inflammatory exudate, for the purpose of any surgical treatment, appears to be a supporting element to the diseases described and the presence of which does not allow a proper definition of the images radiology.
The selected patients underwent FESS (functional surgery of the sino-nasal cavity by endoscopy) designation by endoscopy and CT.
The clinical and radiological results showed a significant correlation between headache and deafness ethmoid-maxillary sinusitis in the presence of ethmoidal bulla pneumatized too, clearly marked with the coronal CT scan conducted at the unit level ostiomeatale. The ethmoid-maxillary-nasal polyposis and nasal septal deviation back to a lesser extent were related to deafness headache, nasal obstruction being the first of the symptom most frequently reported by patients.
Proper CT maxillofacial, especially in the coronal scan without contrast medium, may, after a visit to ENT and nose-sinus endoscopy, an examination of effective and useful for the study of headache deafness, identifying opportunities for intervention surgery and follow-up of patients.
Headache deafness is closely related to diseases which persist in the level of the ostiomeatale. The study conducted with colleagues from the EU. O. ORL has been found that in patients undergoing FESS during surgery performed under general anesthesia was performed antrotomia average bilateral anteroposterior ethmoidectomy and bilateral (95%) for hollow turbinoplastica bullosa (90%), septoplasty (45%) , 30% nasal polyposis. In patients undergoing CT scan have disappeared turbinoplastica most debilitating disorder, which is the frontal headache and / or fronto-parietal.
Therefore, CT of the paranasal cavities is a major test for the diagnosis of deafness in headache patients previously evaluated by the ENT specialist and is an important garrison in the preoperative evaluation of the patient should undergo nasal surgery.
CT helps identify areas not easily accessible nose-sinus endoscopy as the ostium of the maxillary sinus, the frontal recess el'infundibolo ethmoid, and the location and extent of disease processes, anatomy of the region and specific variants individual.
The diagnostic evaluation of patients with nasal disease and headache could also be envisaged in a systematic and optimal combination of systematic nasal endoscopic examination and CT, for the tight complementarity of the two approaches in the study of headache deafness.
Dr. Carmine Capasso
MD ENT