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

Abstract

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.