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Thickening of the Sinus & Nasal Linings

By:
Douglas Hoffman

Question :

What is mucoperiosteal thickening? Is it dental or sinus related? Where is it located?

S.

Answer :

Let's pick this word apart. Muco refers to mucosa, the tissue that lines the nasal, sinus and middle ear cavities. Peri means "next to," and osteal means "bone." Periosteum is a thin layer of tissue that is found on the outer surface of bones. Mucoperiosteal thus describes the specialized tissue (mucoperiosteum) that lines the bone of the sinus and nasal cavities. Mucoperiosteum is sort of a two-layer sandwich of mucosa and periosteum.

Mucoperiosteal thickening is a radiologic descriptive term. I suspect you had a CT scan of your sinuses, and the radiologist noted "mucoperiosteal thickening" of one or more sinuses. Normally, sinus mucoperiosteum is so thin that it is not seen on a CT scan. Sinuses, of course, are merely air pockets in the bones of your face/skull. On a CT scan, a normal sinus will be a black space (air) bordered by bright, white tissue (bone). If there is a noticeable gray layer interposed between the black and white, this represents thickened mucoperiosteum.

Mucoperiosteal thickening may or may not have any significance to your health. It is usually a sign of inflammatory sinus or nasal diseases, such as chronic sinusitis or allergic rhinitis. However, if the owner of the thickened mucoperiosteum (in this case, YOU) has no symptoms, then the finding is usually insignificant. In other words, if you are not having any postnasal drainage, sinus headaches or nasal congestion, then you probably don't need to worry about this "problem."


If you had an MRI scan and not a CT, then "sinus mucoperiosteal thickening" is often noted, but this has even less significant than the same finding on CT. That's because MRIs tend to exaggerate mucoperiosteal thickness. What looks abnormal on an MRI may look completely normal on CT. For most clinical situations, CT is a better study of the sinuses than MRI.

It is a truism in medicine that we should "treat the patient, not the (insert test or study here)." In other words: Treat the patient, not the chest X-ray. Treat the patient, not the white blood cell count. Treat the patient, not the CT scan. The study is a tool -- nothing more.


Needless to say, the responsibility for explaining these CT (or MRI) results to you resides with the physician who ordered the study. That physician knows why the study was ordered. I don't. I can imagine a few clinical situations where you might be asymptomatic, yet your "mucoperiosteal thickening" is, nevertheless, significant. So, you still need to review these results with your physician.

 

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