Assessing the prevalence of paranasal sinuses anatomical variants in patients with sinusitis using Cone Beam Computer Tomography

Abstract

Background and aimsTo asses, by using the Cone Beam CT (CBCT) reformatted images, the presence of anatomical variants of the sinonasal cavities and to determine the correlation of these variations with the onset of maxillary sinus inflammations.MethodThe study is a retrospective one and consists of the investigation of 130 patients with CBCT imaging, patients that were referred to the Maxillo-Facial Clinic, Radiology Department of the Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca, for clinical symptoms of sinusitis within a period of 24 months. The images were analyzed for the presence of different anatomical variations and sinus inflammation. The CBCT images were obtained using a NewTom 3G scanner and the data acquired were statistically analyzed using Chi-square test, Odds ratio data and confidence intervals, with a determined p<0.05 considered to be statistically significant.ResultsThe anatomical variants were detected both in the inflammation and control group. From the spectrum of variations concha bullosa, deviation of uncinate process and asymmetrical ethmoid roof presented significant association with sinusitis. The deviated position of the uncinate process appeared in more than 50% of patients in the positive group [OR=2.55] compared with a third of the control group. Concha bullosa was observed in 31% cases, 23% in the control group and 34% in the positive group [OR=1.73]. Haller cells showed a small difference between groups [OR=1.14] whereas the ethmoid roof asymmetry was evidently more prevalent in the inflammation group.ConclusionThe anatomical variants of the paranasal sinuses are not incidental, being found in a large number of patients and may be a predisposing factor in the onset and recurrence of sinuses inflammation. The CBCT technique, due to the finest multiplanar reconstruction, permits a very good pre-therapeutic assessment of these predisposing conditions.

Normal anatomic variants of paranasal sinus region studied by computed tomography

“…6,29,33 Haller cells (Figure 1 b) are ethmoid air cells that extend laterally over the medial aspect of the roof of the maxillary sinus; they may cause narrowing of the infundibulum. 27 In the present study, Haller cells were frequent variants and found in 70.5% of the scans (Figure), but other authors have reported a wide variation in the prevalence rates such as 25%, 1 9.1%, 33 8%, 34 and 33%. 31,35 Onodi cell was found in 44.7% of the scans in the current study.…”

“…In the present study, 57 patients were found with paradoxical middle turbinates (19%) near to a study done in India 18%. 31 Roman et al 1 have found this variant in 8% of their cases, Adeel et al 2 in 14.3% and Kaya et al 6 in 4.3%. The uncinate process (UP) is a structure that has multiple variations between individuals.…”

“…The most common ones are Agger nasi cells, infraorbital ethmoidal (Haller) cells, sphenoethmoidal (Onodi) cells, nasal septal deviation (NSD), septal bony spur, concha bullosa (CB) and paradoxical middle turbinate. [1][2][3][4][5][6][7][8][9][10] Less common anatomic variants of the PNS region include pneumatization of the uncinate process, large ethmoidal bulla, superior turbinate pneumatization, and pneumatized crista galli. 3,5,[11][12][13][14] Some of the anatomic variants have been reported to be associated with chronic rhinosinusitis, possibly leading to inflammation by obstructing drainage pathways from the sinuses and nasal cavity.…”

“…[2][3][4][5] However, a number of other studies did not show a significant association between t h e s e a n a t o m i c v a r i a n t s a n d rhinosinusitis. 1,4,9,10,15,16 Moreover, it has been reported that failure to recognize certain anatomic variants such as asymmetry of the ethmoidal roof, Onodi cells, pneumatization of anterior clinoid processes, supraorbital cells, Haller cells, pneumatization of the dorsum sella and dehiscence of the lamina papyracea may lead to complications during surgery due to proximity of blood vessels, nerves, brain, https://doi.org/10.15218/zjms.2020.022…”

Assessment of Sinonasal Anatomical Variants using 128-Slice MDCT in Patients with Chronic Rhinosinusitis

“…The paranasal sinuses include maxillary, ethmoid, frontal and sphenoid sinuses. 1,2 The main functions of paranasal sinuses include lightening of skull, air humidification and voice resonance. [3][4][5] There are various imaging modalities available for the evaluation of the paranasal sinuses.…”