Study of anatomical variations of ostiomeatal complex in chronic rhinosinusitis patients
Keywords:Chronic rhinosinusitis, Ostiomeatal unit, Computed tomography, Anatomic variation
Background: Anatomical variations like nasal septal deviations, concha bullosa, paradoxical middle turbinate, pneumatized or medially bent uncinate etc. can encroach upon the ostiomeatal unit and narrow ostiomeatal channels. The aim of the study was to study the anatomical variations of ostiomeatal complex commonly associated with paranasal sinus disease among patients with chronic sinusitis using computed tomography.
Methods: A prospective longitudinal study was conducted in the ENT department of our hospital for a period of one year. All the adult patients with complaints suggestive of chronic rhinosinusitis for a period of more than 12 weeks, patients with acute exacerbation of chronic rhinosinusitis and with persistent chronic rhinosinusitis requiring surgical intervention are included in our study. Based on our inclusion and exclusion criteria a total of 138 patients were involved in the study.
Results: In our study we saw the association between various sinusitis and the anatomic variations of the ostiomeatal complex and we found that concho bullosa found to have a strong significant association with maxillary sinusitis (43.6%) and anterior ethmoid sinusitis (42.1%). Most of the patients with posterior ethmoid sinusitis (53.8%) had a statistical significant association in developing deviated nasal septum type of anatomical variant and majority of the patients with sphenoidal sinusitis had a onodi cell type of anatomical variant and their association was found to be statistical significant (p<0.05).
Conclusions: The importance of CT scan and nasal endoscopy is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease.
Deepthi NV, Menon UK, Madhumita K. Chronic Rhinosinusitis–An Overview. Amrita J Med. 2012:8(1):1-44
Sandring S, Ellis H, Healy JC, Johnson D, Williams A. Gray’s Anatomy 39th ed. Edinburgh. London. New York; 2005: 567-579.
Riello APL, Boasquesvisque EM. Anatomical variants of the ostiomeatal complex: tomographic findings in 200 patients. Radiol Bras J. 2008;41:149-54.
Stammberger HR, Kennedy DW. Paranasal sinuses: anatomic terminology and nomenclature. The Anatomic Terminology Group. Ann Otol Rhinol Laryngol Suppl. 1995;167:7-16.
Thiagarajan B, Basith Y. Role of Anatomical Obstruction in the Pathogenesis of Chronic Sinusitis. Online J Otolaryngol. 2012;2(3):7-15.
Choao TK. Uncommon anatomic variations in patients with chronic paranasal sinusitis. Otolaryngol Head Neck Surg. 2005;132(2):221-5.
Aramani A, Karadi RN, Kumar S. A Study of Anatomical Variations of Osteomeatal Complex in Chronic Rhinosinusitis Patients-CT Findings. J Clin Diag Res. 2014;8:1-4.
Wani AA, Kanotra S, Lateef M, Ahmad R, Qazi SM, Ahmad S. CT scan evaluation of the anatomical variations of the ostiomeatal complex. Indian J Otolaryngol Head Neck Surg. 2009;61:163-8.
Stammberger H. Anatomic and Pathophysiologic Considerations. Endoscopic endonasal surgery. Concepts in treatment of recurring rhinosinusitis. Otolaryngol Head and Neck Surg. 1986;94:143-6.
Zinreich SJ, Kennedy DW. Paranasal sinuses. CT imaging requirements for endoscopic surgery. Radiol. 1987;163:769-74.
Lee KJ. Textbook of otolaryngology and head and neck surgery. New York: Elsevier; 1989: 222-223.
Shpilberg KA, Daniel SC, Doshi AH, Lawson W, Som PM. CT of Anatomic Variants of the Paranasal Sinuses and Nasal Cavity - poor Correlation With Radiologically Significant Rhinosinusitis but Importance in Surgical Planning. Neuroradiology/Head and Neck Imaging AJR. 2015;204:1255-60.
Dua K, Chopra H, Khurana AS, Munjal M. CT scan variations in chronic sinusitis. Ind J Radiol Imag. 2005;15(3):315-20.
Gebrim ES. Relevance of sinonasal anatomical variations in the preoperative evaluation by computed tomography for endonasal surger. Radiol Bras. 2008;41:5-6.
Jones NS. CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings. Clin Otolaryngol Allied Sci. 2002;27:11-7.
Stankiewicz JA, Chow JM. The low skull base-is it important? Curr Opin Otolaryngol Head Neck Surg. 2005;13:19–21.
Hudgins P. Complications of endoscopic sinus surgery: the role of the radiologist in prevention. Radiologic Clin North Am. 1993;31:21–32.
Kumar P, Rakesh BS, Prasad R. Anatomical variations of sinonasal region, a coronal ct scan study. Int J Contemporary Med Res. 2016;3(9):2601-4.
Mackay IS, Lund VJ. Surgical management of sinusitis. In: Scott- Brown's Otolaryngology, 6th ed. Oxford: Butterworth- Heinemann, 1997:4/12/1-4/12/29.
Singh C, Dhawan R, Kawatra R, Khanduri S, Hussain P. Incidence of sinonasal anatomical variants based on CT scan inIndian population. Odisha J Otolrhinollaryngol. 2013;7(2):3136.
Drake-Lee AB. Nasal polyps. In: Mackay IS, Bull TR editors. Scott- Brown’s Otolaryngology 6th ed, vol 4. Oxford: Butterworth Heinemann. 1997;10:1-16.
Wani AA, Kanotra S, Lateef M, Ahmad R, Qazi SM, Ahmad S. CT scan evaluation of the anatomical variations of the ostiomeatal complex. Indian J Otolaryngol Head Neck Surg. 2009:61:163-8.
Sheetal D, Devan PP, Manjunath P, Martin P, Satish Kumar K, Sreekantha et al. CT PNS—Do We Really Require before FESS? J Clin Diagnostic Res. 2011;5(2):179-81.
Gupta AK, Gupta B, Gupta N, Tripathi N. Computerized Tomography of Paranasal Sinuses: A Roadmap to Endoscopic Surgery. Clin Rhinol Int J. 2012;5(1):1-10.
Kayalioglu G, Oyar O, Govsa F. Nasal cavity and paranasal sinus bony variations a computed tomography study. Rhinology. 2000;38:108-13
Baradaranfar MH, Labibi M. Anatomical variations of paranasal sinuses in patients with chronic rhinosinusitis and their correlation with CT scan staging. Acta Medica Iranica. 2007;45(6):477-80.
Sachdeva P, Sachdeva KS, Singh B, Singh M, Kaur M, Goyal I, Kataria G. A CT and DNE study of osteomeatal complex variations and their correlation in chronic rhinosinusitis patients. Int J Otorhinolaryngol Head Neck Surg. 2017;3(3):606-10.
Fadda GL, Rossa S, Aversa S, Petrelli A, Ondolo C, Succo G. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis. Acta Otorhinolarygologica Italica. 2012;32:244-51.
Maru YK, Gupta V. Anatomic varaitions of the bone in sinonasal CT. Indian Journal of Otolaryngol and Head Neck Surg. 2001;53:123- 8.
Zinreich SJ, Kennedy DW, Rosenbaum AE, Gayler BW, Kumar AJ, Stammberger H. Paranasal sinuses: CT imaging requirements for endoscopic surgery. Radiology. 1987;163:709-75
Bolger WE. Paranasal sinus bony an anatomic variation and mucosal abnormalities: CT analysis of endoscopic sinus surgery. Laryngoscope. 1991;101:56–64.
Earwaker J. Anatomic variants in sinonasal CT. Radiographics. 1993;13(1):381–415.
Ozcan KM, Selcuk A, Ozcan I, Akdogan O, Dere H. Anatomical variations of nasal turbinates. J Craniofac Surg. 2008;19:1678-82.
Lom WW, Laing EY. The etiological role of concha bullosa in chronic rhinosinusitis. Eur Radiol. 1996;6(4):550-2.
Jones NS, Strobl A, Holland I. A study of the CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol. 1997;22:47-51
Abri RA, Bhargava D, Bassam WA, Badaai YA, Sawhney S. Clinically significant anatomical variants of paranasal sinuses. Oman Med J. 2014;29:110-3.