A Study of Anatomical Variation ofParanasal Sinusesamong AdultsResiding in Saudi Arabia with Rhinosinusitis using Computed Tomography

Abstract

Anatomical variations are very important to be identified when planning a paranasal sinus (PNS) surgery. Conventional radiology does not permit a detailed study of anatomical variations of the nose and paranasal sinuses; there is lack of studies in Saudi Arabia resident in this entity to Study Anatomical Variations of Para nasal sinus (PNS) using Multi slice Computed Tomography (CT) in Rhino sinusitis. A cross-sectional hospital-based study of 392 patients (272 males, and 120 females) referred for CT scan of PNS was conducted from 2017 to 2020 in Riyadh Hospitals, Saudi Arabia, mostly from Consultant Radiologists Diagnostic Center. All subjects complaining from rhino sinusitis and scanned with GE high speed CTE dual CT scanner. The images were evaluated for the presence of any anatomical variants in paranasal sinuses, Candidates those have rhino sinusitis were selected and those who have, trauma or surgery that disturbed their normal anatomy were excluded. The results of this study revealed that the absolute frequency of anatomical variations among 392 were as follows; 91.3% were deviated nasal septum, concha bullosa seen in 50.77%, Basal lamella pneumatization found in 5.36 %. The superior turbinates were pneumatized in 20.15%, The crista galli was pneumatized in 19.39%. Frontal sinus was hyperpneumatized in 8.67% and non-pneumatized in 4.85%, the middle turbinate found to be paradoxical in shape in 10.71 %, lamina papyrecia dehiscence in 1.79%, inferior turbinate was pneumatized in 1.28%. The frontal air-cell was not present in our studied group. The supraorbital air-cell was present in 16.07%,the Onodi air-cell found to be present in 12.24%, the Haller air-cell found to be present in 30.10%, the sphenoid sinus is laterally pneumatized in 7.65%, the depth of cribriform plate (Keros classification) was in 0.51%, the agger cells found to be presented in 51.02%, the infraorbital air-cell was present in 10.20%,nasal septum spur was presented in 29.34%, prominent ethmoidal bulla was presented in 29.85%, uncinate process was pneumatized in 12.76%,sphenoid sinus extension into posterior nasal septum is presented in 36.22%, posterior floor of cellaturcica was pneumatized in 30.87%, the pterygoid process was pneumatized in 7.91%,anterior clinoid process was pneumatized in 10.97%, hard palate was pneumatized in 9.18% and lastly sphenoid septum change the direction in 8.16%.and we compared our results with previous study. Anatomical variations of paranasal sinuses are best depicted on MDCT scan of PNS. The deviated nasal septum was the commonest anatomical variation (93.11%) followed by agger cell (51.02%) and Concha bullosa(50.77%).