A radiological study of anatomical variations in ostiomeatal complex in patients with chronic rhinosinusitis


  • Rajneesh . Shree ENT Clinic, Gulberga, Karnataka, India
  • Rahul S. Department of ENT, ESIC Medical College, Gulberga, Karnataka, India




Chronic rhinosinusitis, Computed tomography, Anatomical variations


Background: In ancient times the paranasal sinuses, without any anatomical differentiation, were thought to be a system of hollow spaces through which mucus produced by the brain was drained. Leonardo da Vinci in Milano in 1489 was the first to prepare and draw anatomical specimens of the paranasal sinuses; the drawings, however, only became accessible to scientific evaluation as late as 1901.

Methods: All adult patients (more than 20 years of age) attending the Outpatient department at ENT, diagnosed to have chronic rhinosinusitis, willing to undergoing Computed Tomographic evaluation were included in this study. Sample of 50 was selected using purposive sampling technique. All CT scans were obtained with GE Brightspeed scanner (16 slice MDCT scanner). Coronal sections were performed with the patients in prone position, with extended neck and the plane perpendicular to the infraorbitomeatal line.

Results: Agger nasi was the most common variation seen in 72% cases followed by dwviated nasal septum in 66% patients. Other variations found were lateral attachment of uncinate process in 54%, uncinate attachment to skull base in 33%, concha bullosa in 32%, overpneumatized bulla ethmoidalis in 21%, medial attachment of unicinate process to middle turbinate in 13%, paradoxical bent middle turbinate in 11%, haller cell seen in 6%. 56% had type I frontoethmoidal cells, 29% had type II, and 15% had type III frontoethmoidal air cells.

Conclusions: The presence of anatomical variants does not indicate a predisposition to sinus pathology but these variations may predispose patients to increased risk of intraoperative complications. The surgeon must pay close attention to anatomical variants in the preoperative evaluation avoid possible complications and improve success of management strategies. 


Shoja MM, Tubbs RS, Loukas M, Shokouhi G, Jerry Oakes W. Emil Zuckerkandl (1849-1910): anatomist and pathologist. Ann Anat. 2008;190(1):33-6.

Messerklinger W. Endoscopy of the Nose. Munich: Urban and Scharzenberg; 1978:52-54.

Stammberger H. Endoscopic endonasal surgery - concept in treatment of recurring rhinosinusitis. Otolaryngol Head Neck Surg. 1986;94:143-56.

Kennedy DW. Functional endoscopic sinus surgery technique. Arch Otolaryngol. 1985;111:643-9.

Wormald PJ. Endoscopic sinus surgery Anatomy, three dimensional reconstruction, and surgical technique. 2nd edition, New York, Thieme; 2008; 3:1.

Kopp W, Stammberger H, Fotter R. Special radiologic image of the paranasal sinuses. European J Radiol. 1998;8:152-6.

Zinreich J, Mattox DE, Kennedy DW, Chisholm HI, Diffey DM, Rosenbaum AE. Concha bullosa: CT evaluation. J Computer Assisted Tomography. 1988;12:778-84.

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.

Perez-Pinas, Sabate J, Carmona A, Catalina-Herrera CJ, Jimenez-castellanos J. Anatomical variations in the human paranasal sinus region studied by CT. J Anat. 2000;197:221-7.

Maru YK, Gupta V. Anatomic variations of the bone in sinonasal CT. Indian J of Otolaryngol Head Neck Surg. 2001;53(2):123-8.

Asruddin, Yadav SPS, Yadav RK, Singh J. Low dose CT in chronic sinusitis. Indian J Otolaryngol Head Neck Surg. 2000;52:17-21.

Mecit K, Mural K, Fatih A, Omer O, Adnan O, Adem K. Remarkable anatomic variations in paranasal sinus region and their clinical importance. European J Radiol. 2004;50(3):296-303.

Zinreich S. Paranasal sinus imaging. Otolaryngol Head Neck Surg. 1990;103:863-8.

Zinreich S. Imaging of inflammatory sinus disease. Otolaryngol Clin North Am. 1993;26:535-47.

Bolger WE, Woodruff W and Parsons DS, CT demonstration of pneumatization of the uncinate process. Am J Neuroradiol. 1990;11:552.

Stammberger H, Wolf G. Headaches and sinus disease: the endoscopic approach. Ann Otol Rhinol Laryngol Suppl. 1988;134:3-23.






Original Research Articles