Computed Tomography Evaluation of Anatomical Variations and Inflammatory Diseases of the Paranasal Sinuses

Anatomical variants and inflammatory diseases of the paranasal sinuses include a wide spectrum. Plain radiograph is inaccurate and inadequate in the evaluation and diagnosis. Technological advances in CT have provided more precise and greater detail about the anatomical variants and anatomic extent of the disease. These provide sufficient information for diagnosis and surgical planning in the PNS diseases. CT before FESS serves to direct the surgical approach. The aim of the study was to evaluate the anatomical variations and inflammatory diseases of paranasal sinuses by CT. The study was conducted over a period of 2 years (October2015-september2017) in patients referred to Department of Radio-diagnosis, K. S Hegde Medical Hospital for computed tomography scan of paranasal sinuses were evaluated for the presence of anatomical variants and inflammatory diseases of the paranasal sinuses. Patients who met the inclusion criteria were included in the study. Unenhanced CT of the PNS was performed for these patients using GE Bright speed 16 - slice MDCT scanner. In our study deviated nasal septum was the most common variation in 134 (66 %) followed by middle concha bullosa in 97 (47.7 %) patients. Other variations found were Paradoxical middle turbinate in 40 (19.7 %), curved uncinate process in 32 (15.7 %), overpneumatized ethmoidal bulla or giant bulla 35 (17.2 %), superior concha bullosa in 27 (13.3 %), prominent Agger Nasi cells in 27 (13.3 %), haller cells in 20 (9.8 %), onodi cells in 15 (7.3 %), maxillary sinus septae in 15 (7.3 %) and pneumatization of uncinate process in 12 (5.9 %) patients. In our study 146 (72 %) patients had PNS mucosal abnormalities and 57 (28 %) patients had no mucosal abnormalities. Anatomical variation were seen in 125 (85.6 %) out of 146 patients with PNS mucosal abnormalities and 15 (26.3 %) out of 57 patients without PNS mucosal abnormalities. The presence of anatomical variants does not mean a predisposition to sinus pathology, but may predispose patients to increased risk of intra-operative complications, if not known to the surgeon before procedure.