Classifications

77 Classifications


77.1 Otology


77.1.1 Chronic Otitis Media


• Healed COM: healed perforation, tympanosclerosis


• Inactive mucosal COM: dry TM perforation, uninflamed ME mucosa


• Inactive squamous COM: TM retraction, not retaining debris or infected


• Active mucosal COM: TM perforation with mucopus, inflamed ME mucosa


• Active squamous COM: cholesteatoma


77.1.2 Retraction Pockets


• TOS classification: pars flaccida/attic retractions


figure Type I: dimple/visible air space


figure Type II: retraction to neck of malleus + no visible air space


figure Type III: bony erosion (scutum); retraction beyond osseous malleus with full extent seen


figure Type IV: keratin accumulation/cholesteatoma


• SADE classification: pars tensa retractions


figure Type I: annular retraction


figure Type II: retraction onto long process of incus/ISJ


figure Type III: retraction onto promontory (nonadhesive)


figure Type IV: adhesion onto medial wall


77.1.3 Petrous Apex Cholesteatoma


• Moffett–Smith classification


figure Supralabyrinthine: above the labyrinth


figure Supralabyrinthine–apical: above the labyrinth extending to petrous apex


figure Infralabyrinthine: below the labyrinth


figure Infralabyrinthine–apical: below labyrinth extending to petrous apex


figure Massive labyrinthine: extensive destruction of inner ear


figure Massive labyrinthine apical: extensive destruction of inner ear extending to petrous apex


figure Apical: confined to petrous apex


77.1.4 Glomus Tumours


• Fisch


figure Type A: limited to middle ear


figure Type B: limited to tympanomastoid area with no infralabyrinthine extension


figure Type C: infralabyrinthine involvement to petrous apex


– C1: limited involvement of vertical portion of carotid canal


– C2: invasion of vertical portion of carotid canal


– C3: invasion of horizontal carotid canal


figure Type D1: intracranial ext <2 cm


figure Type D2: intracranial ext >2 cm


77.1.5 Facial Nerve Palsy


• House–Brackmann


figure See Table 77.1


figure Clinically important to differentiate grade III from IV as this relates to patients’ ability to be able to fully close and therefore protect their eye


77.2 Rhinology


77.2.1 Nasal Fracture


• Class I (Chevallet): fronto/frontolateral blow with vertical fracture septum + depressed/displaced nasal bone


• Class II (Jarjavay): lateral blow with horizontal C-shaped fracture septum + perpendicular plate of ethmoid and frontal process maxilla


• Class III: fracture extends to ethmoid labyrinth, septum collapses into face, nasal bones pushed under frontal bone leading to telecanthus


77.2.2 Olfactory Neuroblastoma


• Kadisch staging


figure Type A: limited to nasal cavity


figure Type B: + paranasal sinuses


figure Type C: extension beyond



figure

77.2.3 Oroantral Fistulas


• Type 1: from molar extraction and healthy maxillary sinus (1–5 mm)


• Type 2: from molar extraction and maxillary sinus acute/chronic disease (6–19 mm)


• Type 3: secondary to surgical removal (>20 mm)


77.2.4 Frontal Sinus Surgery


• Draf I—frontal recess is defined + opened + agger nasi cell roof is “uncapped”


• Draf IIA—frontal sinus opened between lamina papyracea and insertion of middle turbinate


• Draf IIB—frontal sinus opened medial to middle turbinate by removal of most of anterior attachment of middle turbinate to skull base


• Draf III


figure Aka endoscopic Lothrop


figure Transseptal frontal sinusotomy with superior part of nasal septum and floor of frontal sinuses and intersinus septum removed to create one large cavity


77.2.5 Juvenile Angiofibroma


• Andrews staging


figure Stage I: limited to nasopharynx/sphenopalatine foramen with minimal bone destruction


figure Stage II: invading pterygopalatine fossa or maxillary, ethmoid, sphenoid sinus, and bone destruction


figure Stage III: invading infratemporal fossa or orbit


– A: without intracranial involvement


– B: intracranial/extradural involvement


figure Stage IV: intracranial intradural involvement


– A: no cavernous sinus, pituitary fossa, or optic chiasm involvement


– B: all areas above involved


77.2.6 Lund–Mackay Staging Sinus Disease on CT Scans


• Scores


figure 0 (normal)


figure 1 (partial opacification)


figure 2 (complete opacification)


figure Osteomeatal complex:


– 0 (not occluded)


– 2 (occluded)


• Areas scored


figure Maxillary


figure Frontal


figure Anterior ethmoid


figure Posterior ethmoid


figure Sphenoid


figure Osteomeatal complex


• Score range


figure 0 to 24 (max. 12 each side)


figure Score ≥4 for FESS or 2 with unilateral disease


77.2.7 Kuhn Cells


• Anterior ethmoidal cells impinging on frontal recess or frontal sinus


figure Type 1: single frontal recess cell above agger nasi


figure Type 2: tier of cells in frontal recess above the agger nasi


figure Type 3: single large cell extending beyond frontal os


figure Type 4: isolated cell within frontal recess—probably an artifact of older imaging protocols


77.2.8 Nasal Polyp Grading


• Lindholt


figure 0: no visible polyps


figure 1: polyps confined to middle meatus


figure 2: polyps below the middle turbinate


figure 3: massive polyps completely obstructing the nasal cavity


• (Alternative = grade I–IV where III is to nasal floor and IV is to anterior nares)


77.2.9 Frontal Sinus Mucocele


• Type I: limited to the frontal sinus only with or without orbital extension


• Type II: frontal and ethmoidal sinuses with or without orbital extension


• Type IIIa: erosion of the posterior wall frontal sinus with minimal or no intracranial involvement


• Type IIIb: erosion of the posterior wall with major intracranial extension


• Type IV: erosion of the anterior wall of the frontal sinus


• Type Va: erosion of both anterior and posterior walls of frontal sinus without or minimal intracranial extension


• Type Vb: erosion of both anterior and posterior walls of frontal sinus a major intracranial extension


77.2.10 Saddle Nose Deformity


• Tardy


figure Minimal: supratip depression greater than the ideal 1–2 mm tip–supratip differential


figure Moderate: moderate degrees of saddling due to loss of height of the quadrangular cartilage, usually with septal damage


figure Major: more severe degree of saddling with major cartilage loss and major stigmata of a saddlenose deformity


77.2.11 Orbital Cellulitis Complicating Sinusitis


• Chandler


figure Group 1: preseptal cellulitis


figure Group 2: orbital cellulitis


figure Group 3: subperiosteal abscess


figure Group 4: orbital abscess


figure Group 5: cavernous sinus thrombosis


77.2.12 Olfactory Fossa Depth


• Keros


figure Type I: 1 to 3 mm


figure Type II: 4 to 7 mm


figure Type III: 8 to 16 mm


figure Type IV: asymmetrical


77.2.13 Inverting Papilloma


• Krouse


figure Type I: tumour confined to nasal cavity


figure Type II: tumour involving osteomeatal complex and ethmoids and/medial wall of maxillary sinus (with or without nasal cavity involvement)


figure Type III: tumour involving any wall of maxillary sinus (but medial wall), sphenoid or frontal sinus, with or without stage II criteria


figure Type IV:


– Tumour with extranasal and extrasinus extension


– Tumours associated with malignancy


• Modified Krouse


figure Type A: limited to within the nasal cavity, ethmoid sinus, or medial maxillary wall


figure Type B


– Involvement of any maxillary wall (other than medial wall), or


– Frontal sinus or sphenoid sinus


figure Type C: extension beyond the paranasal sinus


77.2.14 Sinonasal Sarcoidosis


• Krespi


figure Stage 1: limited reversible involvement


figure Stage 2: moderate disease involvement or limited single sinus involvement


figure Stage 3: irreversible disease causing synechiae, stenosis, and cartilage destruction


Table 77.2 Grading system for sinus cavities in post-op AFRS patients






















Grading State of mucosa
0 No oedema
1–3 Mucosal oedema (mild/moderate/severe)
4–6 Polypoid oedema (mild/moderate/severe)
7–9 Frank polyps (mild/moderate/severe)

77.2.15 Staging System for Sinus Cavities in Post-op AFRS Patients


• See Tables 77.2 and 77.3


77.3 Head and Neck


77.3.1 Neck Trauma


• Zone I: superior cricoid to inferior thoracic inlet


• Zone II: superior angle of mandible to inferior cricoid


• Zone III: superior skull base to inferior angle of mandible


77.3.2 Apnoea/Hypopnea Index


• 5 to 20: mild


• 20 to 40: moderate


• >40: severe


77.3.3 Posterior Glottic Stenosis


• Type I: interarytenoid adhesion


• Type II: posterior commissure



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  4. Tumours of the Ear and Skin

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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Classifications

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