A clinico-radiological study of anatomical variations of nose and para-nasal sinuses in chronic rhinosinusitis patients
Keywords:Anatomical variations, Paranasal sinuses, Chronic rhinosinusitis, CT scan, Nasal endoscopy
Background: There are a lot of anatomical variations in para-nasal sinuses that are responsible for various sinus pathologies. CT scan of paranasal sinuses prior to functional endoscopic sinus surgery has become extremely important to know the anatomy and its variations to avoid complications during surgery.
Methods: This study was performed in 100 patients at King George’s Medical University, Lucknow UP, India to compare the anatomical variations between nasal endoscopy and CT scan findings. The outcome measures were deviated nasal septum, paradoxical middle turbinate, concha bullosa, medialized/lateralised uncinate process, pneumatized uncinate process, large ethmoid bulla, accessory ostium, Agger nasii cells, Haller’s cells and Onodi cells.
Results: In this study the age of the patients were 30.00±9.56 yrs. with male to female ratio 1.9:1. Deviated nasal septum was the most common anatomical abnormality (70%) followed by large bulla ethmoidalis 17%. Occurrence of different types of special cells were studied which are better visualized on coronal CT scan images. Among these cells Agger nasi was the most common variety (15%) followed by Haller’s cells (11%) and Onodi cell (3%). Concha bullosa was present in 8%.
Conclusions: The importance of CT and nasal endoscopy can be seen in patients with persistent symptoms to identify the anatomical variations that may responsible for the development of chronic sinus disease. In cases of sinusitis patients all the para-nasal sinus should be properly investigated to avoid complications.
Adeel M, Muhammad S, Akhter S, Mubasher I, Arain A, Khattak Y. Anatomical variations of Nose and paranasal sinuses; CT scan review. JPMA. 2013;63(3):317-9.
Bradoo R. Endoscopic anatomy. In: Anatomic principles of Endoscopic sinus surgery: A step by step approach Edn. New Delhi: Jaypee Bros; 2005:59-70.
Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, et al. Adult chronic rhinosinusitis: Definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg. 2003;129(3):1-32.
Scribano E, Ascenti G, Loria G, Cascio F, Gaeta M. The role of the ostiomeatal unit anatomic variations in inflammatory disease of the maxillary sinuses. Eur J Radiol. 1997;24:172-4.
Perez P, 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.
Dua K, Chopra H, Khurans AS, Munjal M. CT scan variations in chronic sinusitis. Ind J Radio Imag. 2005;15:315-20.
Dutra DL, Marchiori E. Helical CT of the paranasal sinuses in children: evaluation of inflammatory sinus disease. Radiol Bras. 2002;35:161-6.
Llyod GA, Lund VJ, Scadding GK. CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients. J Lar Oto. 1991;105:181-5.
Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and Mucosal abnormalities. CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101:56-4.
Saxena R, Kanodia V, Srivastava M. Role of CT paranasal sinuses and diagnostic nasal endoscopy in the treatment modification of chronic rhinosinusitis. Gujarat J Otorhinolar Head Neck Surg. 2010;7(1):7-11.
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(4):244-51.
Krzeski A, Tomaszewska E, Jakubczyk I. Anatomic variations of the lateral nasal wall in the chronic rhinosinusitis. Am J Rhinol. 2001;15:3715.
Van Alyea OE. Ethmoid labyrinth: anatomic study, with consideration of the clinical significance of itsstructural characteristics. Arch Otolaryngol Head Neck Surg. 1939;29:881-01.
Nouraei SAR, Elisay AR, Dimarco A. Variations in paranasal sinus anatomy: implications for the pathophysiology of chronic rhinosinusitis and safety of endoscopic sinus surgery. J Otolaryngology Head Neck Surg. 2009;38:32–7.