Orbit, Paranasal Sinus, Temporal Bone, and Deep Neck Space Pathologies — WACS Viva & Clinical Scenarios (Neuroradiology and Head and Neck Imaging)

Exam-style orbit, paranasal sinus, temporal bone, and deep neck space pathologies viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: Film Reporting and Case Analysis: A 9-year-old child presents with high-grade fever, severe left periorbital swelling, proptosis, and ophthalmoplegia following an acute upper respiratory infection. Review the multi-planar contrast-enhanced CT of the orbits and paranasal sinuses. Provide a systematic report categorizing the orbital complication according to the Chandler classification, identify all affected sinus compartments, and highlight key imaging features that mandate immediate surgical intervention versus medical management.
• SCENARIO 2: High-Resolution CT Interpretation Station: A 32-year-old adult presents with chronic, foul-smelling otorrhea and progressive left-sided conductive hearing loss. High-resolution non-contrast temporal bone CT scans (axial and coronal planes reconstructed at 0.6 mm slice thickness in bone algorithm) are provided. Characterize the middle ear soft-tissue mass, evaluate the status of the ossicular chain and adjacent bony landmarks (scutum, tegmen tympani, lateral semicircular canal, and fallopian canal), and distinguish middle ear cholesteatoma from chronic mucosal otitis media or cholesterol granul
• SCENARIO 3: Structured Viva Voce / Cross-Sectional Space Mapping: Contrast-enhanced CT of the neck in a 45-year-old diabetic male presenting with trismus, neck swelling, dysphagia, and stridor reveals complex multi-compartmental deep neck fluid collections. Demonstrate the cross-sectional radiological anatomy of the deep cervical fascial spaces (parapharyngeal, retropharyngeal, danger, submandibular, and carotid spaces), track the precise route of infection spread into the posterior mediastinum, and identify vascular complications including internal jugular vein thrombosis (Lemierre syndrome) and carotid
• SCENARIO 4: Diagnostic and Preoperative Staging Scenario: An adolescent male presents with recurrent unilateral unprovoked epistaxis and progressive nasal obstruction. Non-contrast and contrast-enhanced CT along with MRI of the paranasal sinuses and skull base are presented. Identify the diagnostic features of juvenile nasopharyngeal angiofibroma, detail its specific anatomical routes of extension through the sphenopalatine foramen and pterygopalatine fossa, differentiate it from inverted papilloma and nasopharyngeal carcinoma, and outline the role of preoperative diagnostic catheter angiography and endov
• SCENARIO 5: Emergency Radiological Assessment: A 28-year-old male presents following blunt orbital trauma with diplopia on upward gaze and a tense, painful proptosis. Describe the systematic CT evaluation of orbital blowout fractures, identifying inferior rectus and medial rectus muscle entrapment, periorbital fat herniation, intraorbital emphysema, retrobulbar hematoma with optic nerve stretching, and signs of impending orbital compartment syndrome.