Anatomic Variations of the Paranasal Sinus Region: Evaluation with Multidetector CT

Objective: In this study, we aimed to evaluate the frequency of anatomic variations of the paranasal sinus region by using multidetector computerized tomography (MDCT). Methods: Between November 2009 and February 2012, 5832 adult patients (2980 females, 2852 males) with a mean age of 39.1±15.4 years (range; 19-85), who underwent MDCT imaging of the paranasal sinus region, were retrospectively evaluated by using the picture archiving and communication system (PACS). All the images were evaluated by three radiologists. Frequency distribution and descriptive statistics of the variants were analysed. Results: Nasal septal deviation was the most commonly detected variation (59.1%) and most were rightward (26.5%). Middle concha pneumatization was the second most commonly encountered variation (57.2%), whereas nasal septum pneumatization was the third most common one (34.8%). Maxillary sinus aplasia was detected in one patient and it was the least common variation (0.05%). Dehiscence of the maxillary nerve (0.4%) and internal carotid artery (0.5%) and sphenoid sinus aplasia (0.5%) were infrequently encountered variations in our study. Conclusion: It is important for the radiologist to know the anatomical variations of the paranasal sinus region in order to consider their possible pathological consequences. Guiding the surgeon in the preoperative period is essential to avoid potential complications.

[1]  Jun Pan,et al.  Pneumatization of the sphenoid sinus in Chinese: the differences from Caucasian and its application in the extended transsphenoidal approach , 2011, Journal of anatomy.

[2]  G. Madani,et al.  Imaging of the paranasal sinuses and nasal cavity: normal anatomy and clinically relevant anatomical variants. , 2009, Seminars in ultrasound, CT, and MR.

[3]  P. Hudgins,et al.  Failed endoscopic sinus surgery: spectrum of CT findings in the frontal recess. , 2009, Radiographics : a review publication of the Radiological Society of North America, Inc.

[4]  R. Sindwani Crista Galli Pneumatization Is an Extension of the Adjacent Frontal Sinuses , 2009 .

[5]  P. Dawes,et al.  Anatomical variations of the paranasal sinuses in Polynesian and New Zealand European computerized tomography scans , 2008, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[6]  Z. C. Wang,et al.  CT appearance of pneumatized inferior turbinate. , 2008, Clinical radiology.

[7]  Y. Bilgili,et al.  Risky anatomic variations of sphenoid sinus for surgery , 2006, Surgical and Radiologic Anatomy.

[8]  B. Değirmenci,et al.  Combined sphenoid and frontal sinus aplasia accompanied by bilateral maxillary and ethmoid sinus hypoplasia. , 2005, The British journal of radiology.

[9]  H. Hatipoğlu,et al.  Concha bullosa types: their relationship with sinusitis, ostiomeatal and frontal recess disease. , 2005, Diagnostic and interventional radiology.

[10]  M. Kazkayası,et al.  Anatomic variations of the sphenoid sinus on computed tomography. , 2005, Rhinology.

[11]  N. Alatas,et al.  Pneumatization of the Inferior Turbinates: Incidence and Radiologic Appearance , 2005, Journal of computer assisted tomography.

[12]  Ting‐Kuang Chao Uncommon anatomic variations in patients with chronic paranasal sinusitis , 2005, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[13]  S. Kountakis,et al.  The Role of Agger Nasi Air Cells in Patients Requiring Revision Endoscopic Frontal Sinus Surgery , 2004, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[14]  J. Lobo,et al.  The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. , 2004, AJNR. American journal of neuroradiology.

[15]  O. Onbas,et al.  Remarkable anatomic variations in paranasal sinus region and their clinical importance. , 2004, European journal of radiology.

[16]  B. Saydam,et al.  The relationship between the sphenoid and the posterior ethmoid sinuses and the optic nerves in Turkish patients. , 2004, Rhinology.

[17]  M. Kantarci,et al.  A massive superior concha bullosa: case report and literature review. , 2004, Rhinology.

[18]  R. Mladina A morphometric consideration of nasal septal deviations by people with paranasal complaints; a computed tomography study. , 2003, Rhinology.

[19]  N. Erdoğan,et al.  Maxillary Sinus Aplasia , 2002 .

[20]  R. Holliday,et al.  Asymmetry of the Ethmoid Roof: Analysis Using Coronal Computed Tomography , 2001, The Laryngoscope.

[21]  I. PÉREZ‐PIÑAS,et al.  Anatomical variations in the human paranasal sinus region studied by CT , 2000, Journal of anatomy.

[22]  Y. Bayazıt,et al.  Variations of sphenoid and related structures , 2000, European Radiology.

[23]  T. Jukić,et al.  Computed tomographic imaging to determine the frequency of anatomical variations in pneumatization of the ethmoid bone , 1999, European Archives of Oto-Rhino-Laryngology.

[24]  M. McDermott,et al.  Mucocele involving the anterior clinoid process: MR and CT findings. , 1999, AJNR. American journal of neuroradiology.

[25]  J. Triglia,et al.  Difference in the height of the right and left ethmoidal roofs: a possible risk factor for ethmoidal surgery. Prospective study of 150 CT scans , 1994, The Journal of Laryngology & Otology.

[26]  J. Earwaker Anatomic variants in sinonasal CT. , 1993, Radiographics : a review publication of the Radiological Society of North America, Inc.

[27]  W. Smoker,et al.  The ostiomeatal unit and endoscopic surgery: anatomy, variations, and imaging findings in inflammatory diseases. , 1992, AJR. American journal of roentgenology.

[28]  David S. Parsons,et al.  Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery , 1991, The Laryngoscope.