Quantitative Assessment of Ethmoidal Air Cell Variations by Age and Gender Using Cone-Bone Computed Tomography

Area of Science:

• Anatomy
• Radiology
• Otolaryngology

Background:

• Ethmoidal air cell variants are key anatomical structures impacting functional endoscopic sinus surgery (FESS) outcomes.
• Understanding the prevalence and distribution of these variants is essential for surgical planning and risk reduction.

Purpose of the Study:

• To evaluate the prevalence and gender-specific distribution of ethmoidal air cell variants.
• To assess the clinical significance of these variants in the context of pre-operative functional endoscopic sinus surgery (FESS) evaluation.

Main Methods:

• Retrospective analysis of 258 cone beam computed tomography (CBCT) scans from Sangli, Maharashtra, India.
• Independent assessment of five defined ethmoidal variations (Agger nasi, Haller, Onodi, uncinate bulla, ethmoid bulla) by two radiologists.
• Chi-square test used to determine statistical significance in gender distribution (P < 0.05).

Main Results:

• Onodi cells (32%) and Haller cells (17.7%) were the most prevalent ethmoidal variants.
• Agger nasi cells (10.3%), uncinate bulla (2.7%), and ethmoid bulla (1.7%) were less common.
• A male predominance was observed for most variants, but these differences were not statistically significant (P > 0.05).

Conclusions:

• High prevalence of Onodi and Haller cells necessitates thorough pre-FESS CBCT evaluation.
• Individual assessment of ethmoidal variations is critical, despite non-significant gender differences.
• Personalized radiological analysis using CBCT can help mitigate surgical risks in FESS.