Sinonasal Anatomical Variations: Their Relationship with Chronic Rhinosinusitis and Effect on the Severity of Disease—A Computerized Tomography Assisted Anatomical and Clinical Study

Abstract

The anatomy of the sinonasal area has a very wide rage of anatomical variations. The significance of these anatomical variations in pathogenesis of rhinosinusitis, which is the commonest disease in the region, is still unclear. The aims of the study were to compare the rate of sinonasal anatomical variations with development and severity of chronic rhinosinusitis patients. CT scan of paranasal sinuses images of 99 individuals were retrospectively reviewed. 65 cases of chronic rhinosinusitis (study group) who had undergone endoscopic sinus surgery were compared with 34 cases without chronic rhinosinusitis (control group). Also in study group Lund-Mackay score of the sinus disease were calculated and compared to the rate of related anatomical variations. There were 74 (74.7 %) males and 25 (25.2 %) females with ages ranging from 13 to 70 years (mean 32.2 years). The anatomical variations recorded were: Septal deviation 47 (72.3) in study and 25 (73.5 %) in control group, concha bullosa 27 (41.5 %) in study and 18 (52.9 %) in control group, overpneumatized ethmoid bulla 17 (26.1 %) in study and 14 (41.1 %) in control group, pneumatized uncinate 3 (4.6 %) in study and 3 (8.8 %) in control group, agger nasi 42 (64.6 %) in study and 19 (55.8 %) in control group, paradoxical middle turbinates 9 (13.8 %) in study and 4 (11.7 %) in control group, Onodi cell 6 (9.2 %) in study and 2 (5.8 %) in control group, Haller's cells (infraorbital ethmoid cell) 9 (13.8 %) in study and 7 (20.5 %) in control group. None of these results were statistically significant between study and control group (p [ 0.05). Lund-Mackay score (which was assumed to show the severity of the disease) of the maxillary, ethmoid and frontal sinus were calculated and compared to rate of septal deviation, concha bullosa, agger nasi cells. No significant correlation was conducted (p [ 0.05). The results of study showed no statistically significant correlation between sinonasal anatomical variations and pathologies of the paranasal sinus. Also these anatomical variations did not increase the severity of pre-existing sinusitis significantly. Level of Evidence This is a retrospective cohort study (2b).

Incidence of sinonasal anatomical variations associated with chronic sinusitis by CT scan in Karaikal, South India

“…Other studies have found wide variation (2-83%) in occurrence of agger nasi. [4][5][6]8 Studies demonstrate that their major dimensions are correlated with frontal sinus diseases and lacrimation. 7 All the subjects in the study had discharge in the frontal sinus.…”

“…1,3 Although sinusitis is a clinically diagnosed condition, imaging studies are used to assess the disease and demonstrate the sinonasal anatomy. 4 CT scan and nasal endoscopy are preferred diagnostic modalities to determine the mucosal abnormalities and bony anatomic variations of paranasal sinus and assess the possible pathogenicity of these findings in patients undergoing evaluation for sinusitis. therapy need surgical clearance of infected sinuses and establishment of ventilation and drainage.…”

Prevalence of Variant Anatomy of Paranasal Sinuses in Computed Tomography and its Correlation to Sinusitis:

“…The size of the cell may compensate the frontal recess and also the anterior part of middle meatus (5) . Kaygusuz et al (6) reported a prevalence of 61% in their study but without a significant etiology in frontal sinusitis. In our study the prevalence was 37%.…”

Evaluation of nose and paranasal sinus disease, anatomical variations by computerized tomography

“…1 The anatomy of paranasal sinuses is very complicated. 2 Evaluation of the location, extent of sino nasal diseases by radiologic evaluation of the paranasal sinuses is essential in planning surgical intervention. Plain radiography, computed tomography and magnetic resonance imaging are applied in evaluating the sinuses.…”

“…3 Sinonasal region that possess frequently anatomic variations, plays an important role in the pathogenesis of paranasal sinus diseases. 2 Earlier studies have demonstrated the very high rate of anatomical variations in the sinonasal area especially the osteomeatal complexa small area located in the region between the middle turbinate and lateral nasal wall in the middle meatus representing the area of drainage of anterior ethmoid, maxillary and frontal sinuses and the importance of careful assessment of CT scan in patients with chronic rhinosinusitis, especially in the pre-operative planning prior to endoscopic surgery. [4][5][6][7] Meticulous radiographic delineation of the small structures in this region, coupled with endoscopic evaluation, provides detailed preoperative information regarding morphology and pathology.…”