CT scan evaluation of the anatomical variations of the ostiomeatal complex

Functional endoscopic sinus surgery (FESS) has revolutionized the approach and treatment of chronic rhinosinusitis. Certain anatomical variations are thought to be predisposing factors for the development of sinus disease and it is necessary, for the surgeon to be aware of these variations, especially if the patient is a candidate for FESS.

The aim of the present study was to identify the various anatomical variations of the ostiomeatal complex in patients of chronic rhinosinusitis who underwent FESS.

A total of 150 patients of chronic rhinosinusitis (medical treatment failures) who were subjected to FESS were CT scanned preoperatively to find any bony anatomic variation and the extent of mucosal disease.

Concha bullosa was the commonest anatomic variation and was seen in 45 (30%) patients. The other anatomic variations noted included: paradoxical middle turbinate in 9.33% patients, uncinate process variations in 25% patients, agger nasi cells in 9.33%, Haller cells in 8.66% and posterior septal deviations in 25.33% patients. The mucosal disease was most commonly seen in anterior ethmoids (87.33% ), followed by maxillary sinus ostial area (70%), maxillary sinus disease (65.33%), posterior ethmoidal disease (38%), frontal sinus disease (15%) and sphenoid sinus mucosal disease (8.66%) patients.

A thorough preoperative CT evaluation of the patients undergoing FESS is necessary to detect various anatomical variations in the ostiomeatal complex.