Variations in Paranasal Sinus Anatomy: Implications for the Pathophysiology of Chronic Rhinosinusitis and Safety of Endoscopic Sinus Surgery

Nouraei, S. A. R.; Elisay, A. R.; DiMarco, A.; Abdi, R.; Majidi, H.; Madani, S. A.; Andrews, P. J.
February 2009
Journal of Otolaryngology -- Head & Neck Surgery;Feb2009, Vol. 38 Issue 1, p32
Academic Journal
Objectives: To study the radiologic anatomy of the paranasal sinuses in patients with and without chronic rhinosinusitis to assess whether anatomic variations are associated with disease pathology, and to identify those variants that may impact operative safety. Setting: Tertiary referral otolaryngology unit. Main Outcome Measures: incidence and nature of anatomic variants with potential impact on operative safety, and the presence or absence of sinus mucosal disease and its correlation with anatomic variants with a potential impact on mucociliary clearance. Methods: We reviewed 276 computed tomographic scans from patients with rhinosinusitis symptoms to investigate anatomic variations that may predispose to sinusitis or impact on operative safety. The incidence of variants with potential impact on sinus drainage was compared between patients with and without sinus mucosal disease with logistic regression. Results: A closed osteomeatal complex was identified in 148 patients (53%), followed by concha bullosa in 98 patients (35%). Closed osteomeatal complex and nasal polyposis were independent risk factors for sinus mucosal disease. Anatomic variants with a potential impact on operative safety included anterior clinoid process pneumatization (18%), infraorbital ethmoid cell (12%), sphenomaxillary plate {11%), and supraorbital recess (6%). In 92% of patients, the level difference between the roof of the ethmoid cavity and the cribriform plate was Keros I. Conclusions: Bony anatomic variants do not increase the risk of sinus mucosal disease. However, anatomic variants with a potential impact on operative safety occur frequently and need to be specifically sought as part of preoperative evaluation.


Related Articles

  • Diagnosis and endoscopic surgery of chronic invasive fungal rhinosinusitis. Yongqi Li; Yuan Li; Peng Li; Gehua Zhang // American Journal of Rhinology & Allergy;Nov2009, Vol. 23 Issue 6, p622 

    Background: Chronic invasive fungal rhinosinusitis (CIFRS) was thought to be a rare fungal disease of the sinus but is becoming increasingly common. Methods for the early diagnosis of CIFRS and treatment efficacy have not been thoroughly explored. This study was designed to summarize the...

  • Endoscopic Sinus Surgery: Indications and Complications. Alnori, Haitham Abdul-Malik // Tikrit Medical Journal;2013, Vol. 19 Issue 1, p89 

    Objectives: The aim of the present study is to assess the spectrum of paranasal sinus diseases which can be treated by endoscopic sinus surgery and to determine the complications of this surgery. Aims of the study: The aims of this study is to assess the spectrum of paranasal sinus diseases...

  • New bone formation in unilateral rhinosinusitis. Seok Hyun Cho; Su Young Kim; Keun Young Lee; Hyun Chang Lee // American Journal of Rhinology;Jan/Feb2007, Vol. 21 Issue 1, p37 

    Background: Computed tomography (CT) frequently shows abnormal bone thickening in patients with chronic rhinosinusitis. The sinus bone may be not in a static state, and remodeling occurs in response to chronic inflammation. Methods: Ostiomeatal unit CT scans were reviewed in 29 patients with...

  • Tomografia computadorizada das c�lulas etmoidais intra e extramurais: ensaio iconogr�fico. Gon�alves, Fabr�cio Guimar�es; Jovem, C�ssio Lemos; de Oliveira Moura, Leonardo // Radiologia Brasileira;set/out2011, Vol. 44 Issue 5, p321 

    The development of the paranasal sinuses is an intricate process that begins in the intrauterine life and terminates in early adulthood. Among the paranasal sinuses, the ethmoid cells or labyrinth are probably the most complex structures, being associated with the highest number of normal...

  • ANTERIOR SKULL BASE: HIGH RISK AREAS IN ENDOSCOPIC SINUS SURGERY IN CHRONIC RHINOSINUSITIS: A COMPUTED TOMOGRAPHIC ANALYSIS. Ali, Arif; Kurien, Mary; Shyamkumar, N. K.; Selvaraj // Indian Journal of Otolaryngology & Head & Neck Surgery;Jan-Mar2005, Vol. 57 Issue 1, p5 

    Computed Tomography (CT) scan of nose and paranasal sinuses play a key role in preoperative evaluation of patients undergoing endoscopic sinus surgeries (ESS) for chronic rhinosinusitis. The asymmetry of ethmoid fovea, olfactory fossa, anatomical variations of lateral lamella and course of...

  • Evolution of Medical Management of Chronic Rhinosinusitis. Vining, Eugenia M. // Annals of Otology, Rhinology & Laryngology;Sep2006 Supplement, Vol. 115, p54 

    Chronic rhinosinusitis (CRS) is a surprisingly common, poorly defined, and notoriously difficult-to-treat disease. It has a complex pathophysiology that often, but not always, involves nasal or paranasal sinus infection. Anatomic variations that predispose the sinuses to obstruction may play a...

  • Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery. Jui-Chung Lai; Hong-Shen Lee; Mu-Kuan Chen; Yao-Lung Tsai // European Archives of Oto-Rhino-Laryngology;Feb2011, Vol. 268 Issue 2, p227 

    Fungal rhinosinusitis is an important clinical problem with diverse manifestations. Although many literatures had found low recurrence rate after surgical treatment of fungus ball rhinosinusitis, patient satisfaction and treatment outcomes (symptom-free and symptom improvement rate, etc.) for...

  • Endoscopic Turbinoplasty of Concha Bullosa: Long Term Results. Mehta, Rahul; Kaluskar, S. // Indian Journal of Otolaryngology & Head & Neck Surgery;Aug2013 Supplement, Vol. 65, p251 

    The aim of this study is to assess the long-term results of our endoscopic turbinoplasty technique for concha bullosa. Thirty-six patients of chronic or recurrent sinusitis who had concha bullosa on CT scan along with mucosal disease in sinuses and underwent turbinoplasty with functional...

  • Abordajes endoscópicos al receso frontal. Martínez, José Luis Sanjurjo; Cadena, Mauricio Morales // Anales de Otorrinolaringología Mexicana;mar2008, Vol. 53 Issue 2, p87 

    Most patients with frontal sinusitis may be treated with drugs. When ostium stenosis and infection persist, surgery is required. Surgical treatment of this disease keeps evolutioning. All techniques are directed to restaure drainage and ventilation of sinus or to obliterate it. This paper...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics