Prospective evaluation of chronic rhinosinusitis with reference to anatomical variation
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20200145Keywords:
Chronic rhinosinusitis, Anatomical variation, Deviated nasal septumAbstract
Background: Rhinosinusitis is one of the commonest sinonasal condition with chronic Rhinosinusitis affecting 10% of population worldwide. Although the diagnosis of chronic rhinosinusitis is clinical, the final diagnosis should be confirmed by objective measures like radiography and nasal endoscopy. Though anatomical variations in sinonasal region are rare, they have significant impact in the causation of sinonasal diseases and pose difficulties during surgery.
Methods: This was a prospective study conducted on 60 patients who attended to the Department of ENT and HNS, Konaseema Institute of Medical Science, Amalapuram between December 2017 to July 2019. By considering AAO-HNS criteria patients were selected and subjected to high resolution computerized tomography para nasal sinuses and diagnostic nasal endoscopy.
Results: As per study, 60% patients are having deviated nasal septum, followed by aggar nasi in 58.3%, concha bullosa in 26.8%, Haller cells in 11.7%, paradoxical middle turbinate in 11.7%, uncinate pneumatisation in 5%, and onodi cells in 5% of cases.
Conclusions: Anatomical variations in sinonasal cavity predispose to chronic rhinosinusitis and hence require correction. Also, detecting these variations preoperatively by computed tomography of paranasal sinus helps in avoiding complications during functional endoscopic sinus surgery.
References
Kantarci M, Karasen RM, Alper F, Onbas O, Okur A, Karaman A, et al. Remarkable anatomic variations in paranasal sinus region and their clinical importance. Eur J Radiol. 2004;50:296-302.
Sivasli E, Sirikçi A, Bayazýt YA, Gümüsburun E, Erbagci H, Bayram M, et al. Anatomic variations of the paranasal sinus area in pediatric patients with chronic sinusitis. Surg Radiol Anat. 2003;24:400-5.
Azila A, Irfan M, Rohaizan Y, Shamim AK. The prevalence of anatomical variations in osteomeatal unit in patients with chronic rhinosinusitis. Med J Malaysia. 2011;66:191-4.
Stallman JS, Lobo JN, Som PM. The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR. 2004;25:1613-8.
Fadda GL, Rosso S, Aversa S, Petrelli A, Ondolo C, Succo G. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis. Acta Otorhinolaryngol Ital. 2012;32:244-51.
Beale TJ, Madani G, Morley SJ. Imaging of the paranasal sinuses and nasal cavity: normal anatomy and clinically relevant anatomical variants. Semin Ultrasound CT MR. 2009;30:2-16.
Smith KD, Edwards PC, Saini TS, Norton NS. The prevalence of concha bullosa and nasal septal deviation and their relationship to maxillary sinusitis by volumetric tomography. Int J Dent. 2010;2010:404982.
Schaefer SD, Manning S, Close LG. Endoscopic paranasal sinus surgery: indications and considerations. Laryngoscope. 1989;99(1):1-5.
Van Alyea OE. Ethmoid labyrinth: anatomic study, with consideration of the clinical significance of its structural characteristics. Arch Otolaryngol Head Neck Surg. 1939;29(6):881-902.
Rao PBK, Ramesh S. An analytical study of anatomical variations in clinical rhinosinusitis. J Evol Med Dent Sci. 2018;7(35):3863-7,
Kennedy DW, Zinreich SJ. Functional endoscopic approach to inflammatory sinus disease: current perspectives and technique modifications. Am J Rhinol. 1988;2:89-96.
Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991;101:56-64.
Jones NS, Strobl A, Holland I. CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol. 1997;22:47-51.
Arslan H, Aydinlioglu A, Bozkurt M, Egeli E. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx. 1999;26:39-48.
Laine FJ, Smoker WR. The ostiomeatal unit and endoscopic surgery: Anatomy, variations and imaging findings in inflammatory disease. Am J Roentgenol. 1992;159:846-57.
Zinreich SJ, Kennedy DW, Chisholm HL, Diffley DM, Rosenbaum AE. Concha Bullosa CT evaluation. J Comput Assist Tomogr. 1988;12:778-84.
Joe JK, Steven YH, Yanagisawa E. Documentation of variation in sinonasal anatomy by intraoperative nasal endoscopy. Laryngoscope. 2000;110:229-35.
Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg. 1991;104:480-3.
