Evaluation of Anatomical Variations Associated with Chronic Rhinosinusitis by Computed Tomography of Paranasal Sinuses

Abstract

Background: Chronic rhinosinusitis (CRS) is a syndrome with multifactorial aetiology. Amongst which, anatomical variations studied by computed tomography of paranasal sinuses (CT PNS) had a high incidence which varied between 64.0% and 99.8%¹⁰. Due to such high incidence, this study is undertaken to assess the various anatomical variations and their significant association in CRS.

Method: A prospective observational study was conducted in 70 CRS patients and were subjected to CT PNS. CT PNS is studied to know the various anatomical variations & other CT findings causing CRS and then findings noted down, tabulated and statistical analysis done.

Results: All 70 CRS patients evaluated by CT PNS had one or more anatomical variations along with other findings like fungal sinusitis in 6 patients, dentigerous cyst and inverted papilloma in 1 case each. The anatomical variations observed in our study were septal deviation(62.8%), concha bullosa(52.8%), agger nasi(51.4%), pneumatized crista galli(47.1%), hyperpneumatized bulla(40%), suprabullar cells(37%), septal spur(34.3%), paradoxically curved middle turbinate(34.2%), supra orbital cells(32.8%), haller cells(31.4%), septal pneumatization(17.1%), pneumatized uncinate(13%), interfrontal septal pneumatization(13%), maxillary septations(10%), maxillary sinus hypoplasia(7.1%), frontal hypoplasia(5.7%), uncinate attached to lamina papyracea(40%), uncinate to middle turbinate(11%), uncinate to skull base(7.9%), free uncinate(41%), frontal cells type 1;2;3;4 (36%);(30%);(20%);(38.5%), onodi cells(27.1%), pneumatized anterior clinoid process(18.5%), lateral recess(15.7%), sphenoid septations attached to optic nerve(10%) and carotid(2.8%), pneumatized superior turbinate(1.4%), Sellar; Pre sellar; Post sellar sphenoid(42.8%);(5.7%);(51.4%). In our study only anatomical variations around the maxillary & Frontal sinus showed significant association with CRS.

Conclusion: Anatomical variations around the anterior group of sinuses have a significant association with CRS.

Keywords: Anatomical Variation; CT Paranasal Sinuses; Chronic Rhinosinusitis; EPOS 2020.

Fig. 1

Anatomical variations of anterior group of sinuses. a-deviated nasal septum, b-concha bullosa, c-agger nasi cell, d-pneumatized crista galli, e-hyperpneumatized bulla, f-suprabullar cell, g-septal spur, h-paradoxical middle turbinate, i-suprabullar cell, j-haller cell, k-nasal septum pneumatized, l-uncinate pneumatized, m-pneumatized interfrontal septum, n-maxillary septation, o-maxillary hypoplasia, p-frontal hypoplasia, q-uncinate attached to lamina papyracea, r-uncinate to middle turbinate, s-uncinate to skull base, t-free uncinate, u;v;w;x-frontal type4,1,2,3 cell

Fig. 2

Anatomical variations of posterior group of sinuses. a-onodi cell, b-lateral recess, pneumatized anterior clinoid process, c-sphenoid septation attached to optic nerve, d-sphenoid septation attached to carotid, e-pneumatized superior turbinate, f-post sellar sphenoid, g-sellar sphenoid, h-pre sellar sphenoid