Role of computed tomography in identifying anatomical variations in chronic sinusitis: An observational study

Abstract

Background/Aim: Clear visualization of bony wall, mucosal layer, sinus contents, and compartment by computed tomography (CT) helps to identify the anatomical variations in chronic sinusitis (CS). We describe the clinical and radiological features in CS. Materials and Methods: We included patients of both genders aged ≥15 years, with CS. Unenhanced CT images of the nasal cavity and paranasal region were taken in coronal, complemented by axial and sagittal reconstructions. Analysis of anatomical variants was performed using a soft tissue window and a bone window. Results: Headache (64%), nasal obstruction (53%), and nasal discharge (38%) were common complaints of 100 patients (male = 52) whose mean ± standard deviation age was 32.55 ± 10.9 years. Significant mucosal thickening in at least one of the paranasal sinuses (PNSs) was seen in all except four patients. All had a minimum of one anatomical variant, 72% had >1 variant. Maxillary antra were most commonly involved (62.0%), followed by ethmoid sinuses (36.0%). Deviated nasal septum (60%) was most common, followed by concha bullosa (38%); paradoxical middle turbinate (18%), ethmoidal bulla (20%), agger nasi cells (33%), Haller cells (21%), and onodi cells (10%) were other features. All had optic nerve involvement with Type I (84%) involvement being common. Kero's classification Type I was noted in 71%. None had Type IV. Cribriform plate and carotid canal wall were normal in all while 2% had dehiscence of lamina papyracea. Conclusion: CT plays an important role in visualization of anatomical variations in PNSs, and anatomical variations particularly in the ostiomeatal complex are the key factors in the causation of CS.