Objective: To find the the incidence of Anatomical abnormalities in the osteomeatal complex among chronic rhinosinusitis patients (CRS).

Methods: This was a cross sectional observational study. All the patients having clinical findings of CRS referred from ENT department for CT PNS were included in the study. Patients with malignancy/ history of trauma and not giving consent/Pregnancy were excluded from the study. All these patient were submitted to detailed clinical examination, routine investigation & subsequently submitted for CT scan of PNS.

Results: Bilateral osteomeatal complex abnormality was seen in 58.7% and unilateral was in 41.3% patients. Deviated nasal septum was found to be most common anatomical variation (78.3%) followed by  inferior turbinate hypertrophy (58.7%), septal spur (38%), concha ballosa (32.6%), Retention cyst (29.3%), AggerNasi cells (28.3%) and Paradoxical Middle Turbinate (19.6%). The percentage of other anatomical variations was less than 15%.

Conclusion: This study emphasizes on identification of specific anatomical variations of ostiomeatal complex and its importance when considering as an etiological factor for CRS. Hence, the importance of CT scan and nasal endoscopy is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease.

Keywords: Chronic rhinosinusitis, Ostiomeatal complex, Anatomical abnormalities.

1. Deepthi NV, Menon UK, Madhumita K. Chronic Rhinosinusitis–An Overview. Amrita J Med. 2012:8(1):1-44
2. Sandring S, Ellis H, Healy JC, Johnson D, Williams A. Gray’s Anatomy 39th ed. Edinburgh. London. New York; 2005: 567-579.
3. Riello APL, Boasquesvisque EM. Anatomical variants of the ostiomeatal complex: tomographic findings in 200 patients. Radiol Bras J. 2008;41:149-54.
4. Aramani A, Karadi RN, Kumar S. A Study of Anatomical Variations of Osteomeatal Complex in Chronic Rhinosinusitis Patients-CT Findings. J Clin Diag Res. 2014;8:1-4.
5. Shpilberg KA, Daniel SC, Doshi AH, Lawson W, Som PM. CT of Anatomic Variants of the Paranasal Sinuses and Nasal Cavity - poor Correlation With Radiologically Significant Rhinosinusitis but Importance in Surgical Planning. Neuroradiology/Head and Neck Imaging AJR. 2015;204:1255-60
6. Senniappan S, Raja K, Tomy AL, Kumar CS, Panicker AM, Radhakrishnan S. Study of anatomical variations of ostiomeatal complex in chronic rhinosinusitis patients. Int J Otorhinolaryngol Head Neck Surg 2018;4:1281-6.
7. Earwaker J. Anatomic variants in sinonasal CT. Radiographics. 1993; 13(1):381–415.
8. Fadda GL, Rossa S, Aversa S, Petrelli A, Ondolo C, Succo G. Multiparametric statistical correlations between paranasal sinus anatomic variations and chronic rhinosinusitis. Acta Otorhinolarygologica Italica. 2012;32:244-51
9. Chakraborty Priyanko, Jain Rajiv Kumar. Radiologic Variations of Nose and Paranasal Sinuses: A Ct Based Study. JMSCR 2016; 4 (5).
10. Mamatha H, Shamasundar NM, Bharathi M, Prasanna L. Variations of ostiomeatal complex and its applied anatomy: a CT scan study. Indian J Sci Technol 2010; 3: 904-7.
11. Pinas IP, Sabate J, Carmona A, Herrera CJ and Castellanos J. Anatomical variations in the human paranasal sinus region studied by CT. J. Anat.2000; 197, 221-227.
12. Zinreich SJ. Rhinosinusitis: radiologic diagnosis. Otolaryngol Head Neck Surg.1997;117(part 2):27-34.
13. Shroff MM, Shetty PG, Kirstane MV. Coronal screening sinus CT in inflammatory sino-nasal disease. Indian Journal of Radiology and Imaging 1996; 6: 3-17.
14. Wani AA, Kanotra S, Lateef M, Ahmad R, Qazi SM, Ahmad S. CT scan evaluation of the anatomical variations of the ostiomeatal complex. Indian j Otolaryngol Head Neck Surg 2009; 61(3):163-8
15. Vincent TE, Gendeh BS. The association of concha bullosa and deviated nasal septum with chronic rhinosinusitis in functional endoscopic sinus surgery patients. Med J Malaysia. 2010;65(2):108-11.
16. Adeel Mohammad, Rajput Muhammad Shaheryar Ahmed, Akhter Shabbir, Ikram Mubasher, Arain Asif, Khattak Yasir Jameel.. Anatomical variations of nose and para-nasal sinuses; CT scan review. JPMA 2013; 63.
17. Stamberger H, Wolf G. Headache and sinus disease the endoscopic approach. Ann Otol Rhinol Laryngol 1988; 34: 2-23.
18. Lloyd GA. CT of the paranasal sinuses: study of a coronal series in relation toendoscopic sinus surgery. J Laryngol Otol 1990; 104 (6): 477-81.
19. Asruddin ,Yadav SPS, Yadav RK, Singh J. Low dose CT in chronic sinusitis. Indian Journal of Otolaryngology and Head Neck Surgery 2000; 52: 17-21.
20. Bolger et al. PNS Surgery: Anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991; 101: 56-64.
21. Lloyd et al. CT of paranasal sinuses and Functional endoscopic sinus Surgery: A critical analysis of 100 symptomatic patients. J Laryngol Otol 1991;105: 181-5.
22. Mafee MF. Preoperative imaging anatomy of nasal-ethmoid complex for functional endoscopic sinus surgery. Radiology Clinics of North America 1993; 31: 1-19.
23. Maru YK, Gupta Y. Concha Bullosa: Frequency and appearance on Sinonasal on Sinonasal CT. Indian Journal of Otolaryngology and Head &Neck Surgery 2000; 1:40-4.
24. Benjaporn Nitinavakarn, Sanguansak Thanaviratananich, Nilubon Sangsilp Anatomical Variations of the Lateral Nasal Wall and Paranasal Sinuses: A CT Study for Endoscopic Sinus Surgery (ESS) in Thai Patients. J Med Assoc Thai 2005;88 (6):763-768.

Dr Ashish Chaturvedi

Assistant Professor, Department of Radiodiagnosis, Varun Arjun Rohilkhand Medical College & Rohilkhand Hospital, Shahjahanpur, UP, India