Bilateral septa in the sphenoid and maxillary sinuses: a cadaveric case report and literature review

A thorough understanding of paranasal sinus anatomy and its variations is essential for accurate diagnosis, effective treatment of sinus-related conditions, and safe surgical intervention. Preoperative assessment of sinus morphology plays a vital role in minimizing intraoperative risks and postoperative complications.

During routine dissection of a 78-year-old female cadaver at the Department of Biomedical Sciences, Mercer University School of Medicine (Columbus, GA), a unique case of bilateral septa in both the sphenoid and maxillary sinuses was observed.

Four accessory septa (AS) were identified in the sphenoid sinuses. On the left, one septum extended from the lateral wall to the internal carotid artery (ICA) prominence. The second arose from the anterolateral wall. On the right, one septum was located on the inferior wall, and another, also attached to the ICA prominence, was located on the posterosuperior wall. In the maxillary sinuses, vertical septa were present on both sides. On the left, a septum extended from the anterior wall to the infraorbital canal (IOC). On the right, a septum connected the anterior wall to the sinus roof.

With the increasing use of functional endoscopic sinus surgery and transsphenoidal approaches, it is important to recognize anatomical variations such as AS. Septa that involve the ICA prominence or IOC present significant surgical risks. Preoperative imaging and careful surgical planning are essential to reduce complications and improve outcomes.