Racial, Ethnic, and Gender Variations in Sinonasal Anatomy

Abstract

Background: Complications during endoscopic sinus surgery often result from unfavorable anatomy. The prevalence rates of such anatomic findings vary tremendously in the literature, in part due to the small, homogenous populations previously studied. Objective: To characterize the prevalence of sinonasal anatomic variants among ethnic groups and genders seen at an academic medical center. Methods: This is a retrospective cross-sectional study of adult subjects who underwent CT imaging of the sinuses from January 2019 to November 2020 at a tertiary academic setting. CT scans were analyzed systematically by 3 trained study personnel for the presence of critical sinus anatomic variants that endoscopic sinus surgeons typically evaluate for preoperatively. Chi-squared tests and analyses of variance were conducted to detect differences in the prevalence of structural findings between genders and races/ethnicities. Results: A total of 489 subjects (57% female) were included: 44 Asian, 14 Black/African American, 101 Hispanic/Latino, 203 White, 127 Other. The prevalence of the following anatomical variants differed by race/ethnicity: Haller cells, Type 3 optic nerve, Onodi cells, maxillary septations, sphenoid lateral recess, anterior clinoid process pneumatization, and carotid artery dehiscence. Asian subjects had higher rates of Haller cells (48% vs 16%, P < .001) and Type 3 optic nerve (18% vs 4%, P = .022) compared to Hispanic subjects, as well as a higher prevalence of Onodi cells (39% vs 17%, P = .003) compared to White subjects. Males had a higher prevalence of mesenteric anterior ethmoid arteries (62% vs 45%, P < .001) and dehiscent carotid arteries (30% vs 21%, P = .024). Conclusion: Certain sinonasal anatomic variants, which have direct implications for complications during endoscopic sinus surgery, were found to be significantly more prevalent in some demographic groups. Surgeons should be aware of these differences in their review of preoperative imaging for safe surgical planning.

Assessing nasal airway resistance and symmetry: An approach to global perspective through computational fluid dynamics

“…Our focus on resting inspiration, a process shaped by natural selection, elucidates the potential ethnicity and sex independence of R-ϕ estimators. Although the nasopharyngeal tract and nasal region exhibit adaptive shape differences, 16,48 these are identified as ecomorphological adaptations that modify but do not fundamentally alter the respiratory function.…”

“…While Sanmiguel‐Rojas et al's 39 study offered valuable insights, its limited demographic scope, focusing on a sample of 49 Caucasian adults, raised questions about the applicability of its findings across different sexes and ethnic groups. Research by Stocks et al, 43 Crouse and Laine‐Alava, 44 Zhu et al, 45 LoMauro and Aliverti, 11 Molgat‐Seon et al, 46 Shah and Frank‐Ito, 16 Russel and Frank‐Ito, 47 and Kulich et al 48 have explored the influence of ethnicity, sex, age, and anthropometric factors on nasal airflow patterns, respiratory function, and sinonasal anatomy, emphasizing the existing variability and the importance of developing universally applicable assessment methods.…”