- Original article
- Open Access
Anatomic variations of the nose and paranasal sinuses in saudi population: computed tomography scan analysis
The Egyptian Journal of Otolaryngology volume 34, pages234–241(2018)
Knowledge of the anatomy constitutes an integral part in the total management of patients with sinonasal diseases. The aim of this study was to obtain the prevalence of sinonasal anatomic variations in Saudi population and to understand their importance and impact on the disease process, as well as their influence on surgical management and outcome.
Materials and methods
This study is prospective review of retrospectively performed normal computed tomography (CT) scans of the nose and paranasal sinuses in adult Saudi population at Dammam Medical Complex. The scans were reviewed by two independent observers.
Of all CT scans that were reviewed, 48.4% were of female patients and 51.6% were of male patients. The mean age of the study sample was 38.5±26.5 years. The most common anatomic variation after excluding agger nasi cell was pneumatized crista galli, which was seen in 73% of the scans. However, the least common variation seen in this series was hypoplasia of the maxillary sinus, which was encountered in 5% of the cases. We did not detect a single pneumatized inferior turbinate among the studied scans.
A wide range of regional differences in the prevalence of each anatomic variation exists. Understanding the preoperative CT scan is substantially important because it is the road map for the sinus surgeon. Detection of anatomic variations is vital for surgical planning and prevention of complications.
Güler C, Uysal IÖ, Polat K, Salk I, Müderris T, Koşar MI. Analysis of ethmoid roof and skull base with coronal section paranasal sinus computed tomography. J Craniofac Surg. 2012; 23:1460–1464.
Zinreich SJ. Rhinosinusitis: radiologic diagnosis. Otolaryngol Head Neck Surg 1997; 117:S27–S34.
Aygun N, Zinreich SJ. Imaging for functional endoscopic sinus surgery. Otolaryngol Clin North Am 2006; 39:403–416.
Midilli R, Aladağ G, Erginöz E, Karci B, Savaş R. Anatomic variations of the paranasal sinuses detected by computed tomography and the relationship between variations and sex. Kulak Burun Bogaz Ihtis Derg 2005; 14:49–56.
Jaworek JK, Troć P, Chrzan R, Sztuk S, Urbanik A, Walocha J. Anatomic variations of the septation within the sphenoid sinus on CT scan images – an initial report. Przegl Lek 2010; 67:279–283.
Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991; 101(Pt 1):56–64.
Zinrech SJ. Functional anatomy and computed tomography imaging of the paranasal sinuses. Am J Med Sci 1998; 316:2–12.
Simmen D, Schuknecht B. Computerized tomography of paranasal sinuses – a preoperative check list. Laryngorhinootologie 1997; 76:8–13.
Prescher A. Clinical anatomy of the paranasal sinuses. Descriptive anatomy, topography and important variations. HNO. 2009; 57:1039–1050.
Becker SS. Preoperative computed tomography evaluation in sinus surgery: a template-driven approach. Otolaryngol Clin North Am 2010; 43:731–751.
Badia L, Lund VJ, Wei W, Ho WK. Ethnic variation in sinonasal anatomy on CT-scanning. Rhinology 2005; 43:210–214.
Silva LC, Zoppa AL, Fernandes WR, Baccarin RY, Machado TS. Bilateral sinus cysts in a filly treated by endoscopic sinus surgery. Can Vet J 2009; 50:417–420.
Adeel M, Rajput MS, Akhter S, Ikram M, Arain A, Khattak YJ. Anatomical variations of nose and para-nasal sinuses; CT scan review. J Pak Med Assoc 2013; 63:317–319.
Kantarci M, Karasen RM, Alper F, Onbas O, Okur A, Karaman A. Remarkable anatomic variations in paranasal sinus region and their clinical importance. Eur J Radiol 2004; 50:296–302.
Fadda GL, Rosso S, Aversa S, Petrelli A, Ondolo C, Succo G. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis. Acta Otorhinolaryngol Ital 2012; 32:244–251.
Cho JH, Citardi MJ, Lee WT, Sautter NB, Lee HM, Yoon JH, et al. Comparison of frontal pneumatization patterns between Koreans and Caucasians. Otolaryngol Head Neck Surg 2006; 135:780–786.
Pérez-Piñas I, Sabaté J, Carmona A, Catalina-Herrera CJ, Jiménez-Castellanos J. Anatomical variations in the human paranasal sinus region studied by CT. J Anat 2000; 197(Pt 2):221–227.
Zinreich J. Imaging of inflammatory sinus disease. Otolaryngol Clin North Am 1993; 4:533–545.
Earwaker J. Anatomic variants in sinonasal CT. Radiographics 1993; 13:381–415.
Al-Abri R, Bhargava D, Al-Bassam W, Al-Badaai Y, Sawhney S. Clinically significant anatomical variants of the paranasal sinuses. Oman Med J 2014; 29:110–113.
Kayalioglu G, Oyar O, Govsa F. Nasal cavity and paranasal sinus bony variations; a computed tomographic study. Rhinology 2000; 38:108–113.
Basić N, Basić V, Jukić T, Basić M, Jelić M, Hat J. Computed tomographic imaging to determine the frequency of anatomical variations in pneumatization of the ethmoid bone. Eur Arch Otorhinolaryngol 1999; 256:69–71.
Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg 1991; 104:480–483.
Blaugrund SM. Nasal obstruction. The nasal septum and concha bullosa. Otolaryngol Clin North Am 1989; 22:291–306.
Goldman JL. The principles and practice of rhinology: a text on the diseases and surgery of the nose and paranasal sinuses. New York: Wiley 1987. 89–95
Takanishi R. The formation of the nasal septum and the etiology of septal deformity. Acta Otolaryngol Suppl 1987; 443:1–154.
Ritter FR. The paranasal sinuses: anatomy and surgical technique. St. Louis: Mosby 1973. 24–36
Mazza D, Bontempi E, Guerrisi A, Del Monte S, Cipolla G, Perrone A, et al. Paranasal sinuses anatomic variants: 64-slice CT evaluation. Minerva Stomatol 2007; 56:311–318.
Selcuk A, Ozcan KM, Akdogan O, Bilal N, Dere H. Variations of maxillary sinus and accompanying anatomical and pathological structures. J Craniofac Surg 2008; 19:159–164.
Jensen OT, Shulman LB, Block MS, Iacono VJ. Report of the sinus consensus conference of 1996. Int J Oral Maxillofac Implants 1998; 13:11.
Schaefer SD. Endoscopic total sphenoethmoidectomy. Otolaryngol Clin North Am 1989; 22:727–732.
Kennedy DW, Zinreich SJ. The functional endoscopic approach to inflammatory sinus disease: current perspectives and technique modifications. Am J Rhinol 1988; 2:89–96.
Laine FJ, Smoker WR. The ostiomeatal unit and endoscopic surgery: anatomy, variations, and imaging findings in inflammatory diseases. AJR Am J Roentgenol 1992; 159:849–857.
Tonai I, Baba S. Anatomic variations of the bone in sinunasal CT. Acta Otolaryngol Suppl 1996; 525:9–13.
Maru YK, Gupta Y. Concha bullosa: frequency and appearances on sinonasal CT. Indian J Otolaryngol Head Neck Surg 1999; 52:40–44.
Shihada R, Luntz M. A concha bullosa mucopyocele manifesting as migraine headaches: a case report and literature review. Ear Nose Throat J 2012; 91:E16–E18.
Lloyd GA, Lund VJ, Scadding GK. CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients. J Laryngol Otol 1991; 105:181–185.
Stammberger H, Wolf G. Headaches and sinus disease: the endoscopic approach. Ann Otol Rhinol Laryngol Suppl 1988; 9:3–23.
Onodi A. The optic nerve and accessory sinuses of the nose: a contribution to the study of canalicular neuritis and atrophy of the optic nerve of nasal origin. New York: Wood; 1910. 80–81.
Stammberger HR, Kennedy DW Anatomic terminology group. Paranasal sinuses:anatomic terminology and nomenclature. Ann Otol Rhinol Laryngol Suppl 1995; 167:7–16.
Khanduri S, Agrawal S, Chhabra S, Goyal S. Bilateral maxillary sinus hypoplasia. Case Rep Radiol 2014; 2014:148940.
Bolger WE, Woodruff WW Jr, Morehead J, Parsons DS. Maxillary sinus hypoplasia: classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg 1990; 103(Pt 1):759–765.
Sirikci A, Bayazit Y, Gumusburun E, Bayram M, Kanlikana M. A new approach to the classification of maxillary sinus hypoplasia with relevant clinical implications. Surg Radiol Anat 2000; 22:243–247.
Chanavaz M. Sinus grafting related to implantology. Statistical analysis of 15 years of surgical experience. J Oral Implantol 1996; 22:119–130.
Vinter I, Krmpotić-Nemanić J, Hat J, Jalsovec D. Does the alveolar process of the maxilla always disappear after tooth loss. Laryngorhinootologie 1993; 72:605–607.
Kennedy DW, Zinreich SJ, Rosenbaum AE, Johns ME. Functional endoscopic sinus surgery: theory and diagnostic evaluation. Arch Otolaryngol 1985; 111:576–582.
Stammberger H. Endoscopic endonasal surgery – concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg 1986; 94:143–147.
Ozgursoy OB, Comert A, Yorulmaz I, Tekdemir I, Elhan A, Kucuk B. Hidden unilateral agenesis of the frontal sinus: human cadaver study of a potential surgical pitfall. Am J Otolaryngol 2010; 31:231–234.
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
About this article
Cite this article
Alshaikh, N., Aldhurais, A. Anatomic variations of the nose and paranasal sinuses in saudi population: computed tomography scan analysis. Egypt J Otolaryngol 34, 234–241 (2018). https://doi.org/10.4103/1012-5574.244904
- agger nasi
- anatomic variations
- computed tomography scan
- concha bullosa
- cristal galli
- haller cell
- middle turbinate
- nasal septum
- nose and paranasal sinuses
- onodi cell