Interpretation of anatomic variations of computed tomography scans of the sinuses: a surgeon's perspective

Four hundred computed tomography (CT) scans of patients undergoing endoscopic sinus surgery were studied with particular attention to anatomic variations. Six specific variations were identified that may predispose the surgeon to inadvertent penetration of the orbit or anterior cranial cavity. These anatomic variants are: 1. lamina papyracea lies medial to the maxillary sinus ostium; 2. maxillary sinus hypoplasia; 3. fovea ethmoidalis abnormalities, such as low or sloping fovea and encephaloceles; 4. lamina papyracea dehiscence resulting in herniation of orbital content into the ethmoids; 5. sphenoid sinus wall variations such as septa attached to the carotid covering, and penetration of the sphenoid by the internal carotid artery or optic nerve; 6. sphenoethmoid cells (Onodi cells), the most posterior ethmoid cells pneumatizing lateral and superior to the sphenoid and intimately associated with the optic nerve.