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Anatomic variations of the paranasal sinus area in pediatric patients with chronic sinusitis
E Sivasli1, A Sirikçi, Y A Bayazýt
1Department of Pediatrics, Faculty of Medicine, Gaziantep University, Kolejtepe, Gaziantep, Turkey.
Insights
Anatomic variations of the lateral nasal wall are common in children undergoing endoscopic endonasal surgery. However, these variations show no significant link to chronic sinusitis, suggesting other factors are more critical.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Imaging
Background:
- Endoscopic endonasal surgery in children requires precise anatomical knowledge.
- Understanding lateral nasal wall anatomy and variations is crucial for surgical success and complication avoidance.
- The relationship between sinonasal anatomical variations and disease in pediatric patients needs clarification.
Purpose of the Study:
- To assess anatomical variations of the lateral nasal wall in children.
- To investigate the association between these variations and chronic sinusitis in pediatric patients.
Main Methods:
- Retrospective analysis of coronal and axial computed tomographic (CT) scans.
- Inclusion of 47 children (25 female, 22 male; ages 2-16 years) with chronic sinus disease.
- Assessment of lateral nasal wall anatomical variations and sinusitis prevalence.
Main Results:
- Pneumatized middle concha (MC) was the most frequent variation, followed by superior concha (SC) pneumatization, Haller cell, and agger nasi cell.
- Rare variations included secondary MC, large ethmoidal bulla, maxillary sinus hypoplasia, Onodi cell, and uncinate process pneumatization.
- Maxillary sinusitis was most common, with no significant relationship found between anatomical variations and sinusitis, except for minor associations.
Conclusions:
- Anatomical variations of the lateral nasal wall are prevalent in children.
- Factors beyond anatomical variations, such as local, systemic, or environmental influences, are more significant in pediatric sinusitis.
- Avoidance of aggressive surgical intervention is recommended in pediatric endonasal endoscopic surgery due to the lack of a definitive link between variations and disease.
Abstract:
Endoscopic endonasal surgery has been performed in children. Therefore, we need to know the precise anatomy and anatomic variations of the lateral nasal wall. This is important in order to achieve better surgical results and avoid complications. We also need to know the relationship between the anatomic variations and sinonasal disease. For the purpose of this study we assessed the anatomic variations of the lateral nasal wall and the association of these variations with chronic sinusitis in children. Forty-seven children with chronic sinus disease were included in the study. There were 25 female and 22 male patients with ages ranging from 2 to 16 years (mean 10.5+/-3.8 years). On coronal and axial computed tomographic (CT) scans, the anatomic variations of the lateral nasal wall and sinusitis were assessed. A pneumatized middle concha (MC) was the most common anatomic variation, followed by pneumatization of the superior concha (SC), Haller cell and agger nasi cell. Secondary MC, large ethmoidal bulla, maxillary sinus hypoplasia, Onodi cell, and uncinate process pneumatization were relatively rare. Maxillary sinusitis was the most common sinus infection, followed by ethmoidal, sphenoidal and frontal sinusitis in that order. There was no significant relationship between the sinusitis and anatomic variations except for some minor associations. In conclusion, anatomic variations in the lateral nasal wall are common in children. Local, systemic or environmental factors appear to be more important in pediatric sinusitis than the anatomic variations. Due to the absence of a definitive relationship between the anatomic variations and sinus disease, aggressive surgical interventions should be avoided while performing endonasal endoscopic surgery in the children.