Sinonasal Anatomical Variants: CT and Endoscopy Study and Its Correlation with Extent of Disease

Abstract

To evaluate the incidence of anatomical variations in sinonasal area by nasal endoscopy and CT scan paranasal sinuses and to correlate the anatomical variations in sinonasal area with extent of disease. The present study was conducted on 40 patients of chronic sinusitis. All the patients underwent CT scan paranasal sinus axial and coronal view and nasal endoscopy. The most common anatomical variations were agger nasi cells (80 %), deviated nasal septum (72.5 %) and concha bullosa (47.5 %). Other anatomical variations seen in sinonasal region were uncinate process variations, paradoxical middle turbinate, haller cells, accessory ostia of maxillary sinus, multiseptated sphenoid. Osteomeatal unit (87.5 %) and maxillary sinuses (87.5 %) were the most commonly involved which was followed by anterior ethmoids (70 %), posterior ethmoids (50 %), frontal sinuses (32.5 %) and the sphenoids (20 %). Considering the results obtained, we believe that anatomical variations may increase the risk of sinus mucosal disease. We therefore, emphasize the importance of a careful evaluation of CT study in patients with persistent symptoms of chronic rhinosinusitis.

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

“…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. [15][16][17] However, a number of other studies did not show a significant association between these anatomic variants and rhinosinusitis.…”

“Radiologicalassessment of Osteomeatal Unit Variations in Chronic Rhinosinusitis and Nasal Polyposis– A Study in a Tertiary Care Hospital”.

“…But if there is an anatomical variation narrowing this key area, then even a minimal amount of mucosal oedema may predispose the patient to recurrent infection, resulting in chronic inammatory changes in the mucosa. (2) Over the past few decades, both CT scan and nasal endoscopy are being used as diagnostic modalities forsinonasal diseases. The aim of these is to determine the mucosal abnormalities and bony anatomic variations of osteomeatal unit and assess the possible pathogenicity of chronic rhinosinusitis with nasal polyposis in these patients.…”

“…The coronal plane in CT scan is optimal for the assessment of osteomeatal unit, skull base, ethmoid roof and the relationship of orbits to the paranasal sinuses. (2) Since the approach to patients with chronic rhinosinusitis is endoscopic sinus surgery, which aims at removing the obstruction of the main drainage pathway, which in turn requires the surgeons to have detailed knowledge of the anatomy of the lateral nasal wall, paranasal sinuses and surrounding vital structures and of the anatomic variations in this region.…”

Correlation between diagnostic endoscopy, computed tomography and operative findings in patients with chronic rhinosinusitis

“…1 Nasal endoscopy provides the ability to accurately access these areas for the evidence of localized disease, or for anatomical defects that compromise ventilation and mucociliary clearance. 2 Diagnostic endoscopy and systematic understanding of the lateral nasal wall with computed tomography (CT) in the coronal plane has become the corner stone in the evaluation of the para nasal sinus (PNS) disease. 3 Thus, this precise knowledge of the existing anatomical variations, pathological changes and the relative position of the neighboring vital structures like the orbit, optic nerve, cranial cavity, internal carotid artery etc.…”