Multi-detector Computed Tomography Evaluation of Variant Paranasal Sinuses Anatomy and its Pre-operative Impact in Functional Endoscopic Sinus Surgery

Abstract

Introduction: Conventional radiography is beneficial only in providing information about frontal and maxillary sinuses; its role in evaluation of osteomeatal complex, ethmoid, sphenoid, and nasal cavity is very limited. The present study was conducted to evaluate various anatomical variations of paranasal sinuses by multi-detector computed tomography and to correlate pre-operative multi-detector computed tomography (MDCT) findings with intraoperative functional endoscopic sinus surgery (FESS) findings. Methodology: This prospective cross-sectional study consisted of 196 patients of age 8 years and above with symptoms of chronic rhinosinusitis, refractive to medical therapy who underwent MDCT study of paranasal sinuses, and had undergone FESS thereafter. The data were analyzed for the presence of anatomical variants in paranasal sinuses and frequency of occurrence was calculated in percentage. Correlation was inferred by kappa statistics and p value <0.05 was taken as significant. Results: Out of 196 patients, 108 were males and 88 were females. Most of the variants (25%) were seen in the age group of 21-30 years. Deviated nasal septum was the most common anatomical variation in the present study (79.5%) followed by agger nasi (59.1%) and concha bullosa (36.7%). Most patients have sellar pattern of sphenoid sinus pneumatization (84.8%). Minimum of one variation was seen in all the patients. Excellent correlation of agreement between pre-operative multi-detector computed tomography findings with intra-operative endoscopic sinus surgery findings was found. Conclusion: Multi-detector computed tomography plays a vital role in assessing the anatomical variations of paranasal sinuses and nasal cavity. It evaluates the osteomeatal and proved to be a gold standard investigation for the surgeons for proper planning of the surgery.

Keywords

• Functional endoscopic sinus surgery, Multi-detector computed tomography, Paranasal sinuses.