Radiographic Variants Associated With Allergic Fungal Rhinosinusitis: Key Differences for Pre-Operative Planning

Area of Science:

• Otolaryngology
• Neurosurgery
• Anatomy

Background:

• Allergic fungal rhinosinusitis (AFRS) can extend beyond paranasal sinuses, risking injury to critical structures like the anterior ethmoid artery (AEA) during endoscopic sinus surgery (ESS).
• Understanding anatomical variations is vital for surgical safety in sinonasal diseases.

Purpose of the Study:

• To compare anterior ethmoid artery to skull base (AEA-SB) length in patients with AFRS versus chronic rhinosinusitis with nasal polyps (CRSwNP).
• To evaluate other anatomical variants in these patient groups to assess surgical risks.

Main Methods:

• Retrospective chart review of patients undergoing ESS for AFRS and CRSwNP.
• Comparison of AEA-SB length and other anatomical variants (Keros classification, ethmoid air cells, concha bullosa) between the two groups.

Main Results:

• The AFRS group was younger and demonstrated significantly longer AEA-SB length compared to the CRSwNP group.
• No significant differences were found in Keros measurement, concha bullosa, or ethmoid air cell variations between the groups.
• No association was observed between AEA-SB length and Keros class in either cohort.

Conclusions:

• AFRS is associated with distinct anatomical features, specifically a longer AEA-SB length, compared to CRSwNP.
• This anatomical difference necessitates careful preoperative planning to mitigate the risk of AEA injury during ESS for AFRS patients.