Background

The incidence and potential disease impact of paranasal sinus anatomic variants in patients with recurrent acute rhinosinusitis (RARS) has important implications for management, including surgery, but is incompletely defined.



Methods

A retrospective review of 26 patients with RARS who had undergone computed tomography (CT) was performed. Patient demographics, RARS severity and comorbidities were reviewed. CT scans were reviewed for the incidence of anatomic variants in all patients. The pattern of inflammatory changes was explored in the subset of patients with acute rhinosinusitis at the time of CT. Potential correlation between the presence of anatomic variants and disease severity were investigated.



Results

In the patient cohort who met inclusion criteria, the most common variants included agger nasi cell (88.5%), concha bullosa (53.8%), infraorbital cell (50%), and deviated nasal septum with middle meatus obstruction (42%). In exploring correlations with RARS severity, type 2 frontal cells correlated with a greater number of years with RARS (0.0363). In the 23 patients who underwent CT at the time of an acute infection, no statistically significant correlation was found between severity or location of inflammatory changes and the presence of anatomic variants.



Conclusion

This study describes the incidence of anatomic variants in a cohort of patients with RARS. A correlation between the presence of anatomic variants and the pattern of inflammatory changes was not identified.

Anatomic variants of the paranasal sinuses in patients with recurrent acute rhinosinusitis

Objective: To determine the incidence of anatomical variants of sinonasal region and its correlation with symptoms of sinusitis.
Methods: The study was conducted from January-June 2020 at Radiology Department of PNS Shifa Hospital, Karachi. The study involved 50 symptomatic subjects of sinusitis with age ranges from 18-60 years which were prepared for computed tomography of paranasal sinuses. The scans were reviewed for nasal-septum, turbinates, uncinate process, ethmoid air-cells along with other anatomical variants and were correlated with symptoms of sinusitis.
Results: Out of 50 subjects, 34 were males and 16 were females with mean age of 42.68±18.22 years. Most common anatomical variants observed were agger nasi cells (64%), deviated nasal septum (56%), and concha-bullosa (46%). Statistically significant correlation existed between bilateral agger nasi cells and nasal obstruction (p=0.017, ρ=-0.336).
Conclusion: The anatomy of sinonasal region is highly complex. However, anatomical variants can disturb the sinus mucociliary drainage pathway resulting in patient suffering. Therefore, considering the variable anatomy of sinonasal region, CT-PNS is recommended for every subject in order to avoid surgical hazards.
doi: https://doi.org/10.12669/pjms.37.1.3260
How to cite this:Qureshi MF, Usmani A. A CT-Scan review of anatomical variants of sinonasal region and its correlation with symptoms of sinusitis (nasal obstruction, facial pain and rhinorrhea). Pak J Med Sci. 2021;37(1):195-200. doi: https://doi.org/10.12669/pjms.37.1.3260
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

/pdf/a-ct-scan-review-of-anatomical-variants-of-sinonasal-region-7swtu6tvzt.pdf

A CT-Scan review of anatomical variants of sinonasal region and its correlation with symptoms of sinusitis (nasal obstruction, facial pain and rhinorrhea).

Background. Nasal septal deviation (NSD) plays a critical role in nasal obstruction symptoms, aesthetic look of the nose, increased nasal resistance, and occasionally snoring. Septoplasty is the most common method for correction of deviated nasal septum (DNS). Therefore, the aim of the present study was to assess the association between initial clinical presentations of patients selected for septoplasty and demographical characteristics in Northern Saudi Arabia. Methodology. Archives related to all patients selected for septoplasty between 2012 and 2017 were retrieved from ENT Department at King Khalid Hospital in Hail, Northern Saudi Arabia. Only adults over 18 years of age were included in this study. Results. With regard to the clinical presentations, almost all patients presented with variable degrees of nasal congestions, nasal blockages, breathing troubles, sleeping troubles, and exercise problems. Conclusion. Nasal obstruction is prevalent in Northern Saudi Arabia with peaks being in the years 2016 and 2014 with the most etiological factor being DNS.

/pdf/the-common-clinical-presentation-of-patients-selected-for-1e1zp2e9g9.pdf

The Common Clinical Presentation of Patients Selected for Septoplasty in Northern Saudi Arabia.

The nasal septum is a crucial supporting factor for the nasal cavity and may develop several anatomical variants including septal deviation, spur and pneumatization. These variants could be associated with a higher incidence of sinusitis due to structural and functional alterations. So, the aim of this study was to assess the prevalence of nasal septal deviation (NSD), nasal septal spur (NSS) and nasal septal pneumatization (NSP) among the Saudi adult population and their links with the incidence of sinusitis by using computed tomography (CT). A retrospective study was achieved over a twenty-two months period on 681 adult Saudi subjects (420 males and 261 females) aged 20 years or older, referred for coronal CT evaluation of the paranasal sinuses. NSD and NSS were significantly more prevalent in males than females (80.0% vs. 67.4% respectively for NSD, and 34.5% vs. 24.9% respectively for NSS), while there was no statistical difference in frequency of NSP regarding gender (P=0.670). The incidence of sinusitis was significantly higher in presence of NSD and/or NSS (P<0.001 for both). On the contrary, NSP was not associated with a significant increase in the prevalence of sinusitis (P=0.131). In conclusion, NSD and NSS are more prevalent in males than females among the Saudi population with no statistical difference between both genders regarding the presence of septal pneumatization. Furthermore, sinusitis is more prevalent with the occurrence of NSD and NSS, and not related to the incidence of NSP.

https://acbjournal.org/journal/download_pdf.php?doi=10.5115/acb.22.110

Nasal septal anatomical variations among Saudi population and their possible coincidence with sinusitis: a computed tomography scan study

Risk of dental malocclusion in children with upper respiratory tract disorders: A case-control study of a nationwide, population-based health claim database.

Objective: To investigate the correlation of nasal septal deviations and chronic rhinosinusitis. Methods: The study was conducted at Department of Otolaryngology, Head and Neck Surgery, Boali Hospital, Sari, Iran from January 2012 to September 2014 and comprised subjects aged from 5 to 68 years who had undergone elective functional endoscopic sinus surgery for chronic rhinosinusitis. SPSS 17 was used for statistical analysis. Results: Of the 60 subjects in the study, 41(68.3%) were males and 19(31.7%) females with overall median age of 27. Nasal septal deviation was found in 49(81.7%) subjects; 11(18.3%) had it in both right and left sides, 16(26.7%) in right alone and 22(36.7%) in the left side. The commonest type of septal deviations in the left side were posteroinferior 10(16.66%) and anteroinferior 7(11.7%). In the right side, the corresponding numbers were 9(15%) and 7(11.7%). Conclusion: Nasal septal deviations are of particular interest in majority of patients with chronic rhinosinusitis.

/pdf/the-incidence-of-nasal-septal-deviation-and-its-relation-5cxettmrw4.pdf

The incidence of nasal septal deviation and its relation with chronic rhinosinusitis in patients undergoing functional endoscopic sinus surgery.

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The incidence of nasal septal deviation and its relation with chronic rhinosinusitis in patients undergoing functional endoscopic sinus surgery.