Article

Remarkable anatomic variations in paranasal sinus region and their clinical importance

Department of Radiology, Medical School, Atatürk University, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum, Turkey.
European Journal of Radiology (Impact Factor: 2.16). 07/2004; 50(3):296-302. DOI: 10.1016/j.ejrad.2003.08.012
Source: PubMed

ABSTRACT With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the preoperative work-up. To be in the known anatomical variants with some accompanying pathologies, directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. A review of 512 (1024 sides) paranasal sinus tomographic scans was carried out to expose remarkable anatomic variations of this region. We used only coronal sections, but for some cases to clear exact diagnosis, additional axial CT scan, magnetic resonance imaging (MRI) and nasal endoscopy were also performed. In this pictorial essay, rates of remarkable anatomic variations in paranasal region were displayed. The images of some interesting cases were illustrated, such as the Onodi cell in which isolated mucocele caused loss of visual acuity, agger nasi cell, Haller's cell, uncinate bulla, giant superior concha bullosa, inferior concha bullosa, bilateral carotid artery protrusion into sphenoid sinus, maxillary sinus agenesis, bilateral secondary middle turbinate (SMT) and sphenomaxillary plate. The clinical importance of all these variations were discussed under the light of the literature. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in the preoperative evaluation.

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    • "The nasal septum is easily identified on both axial and coronal CT (Laine & Smoker). It is impossible to differentiate the pneumatisation and hypertrophy of the INC without CT (Kantarci et al., 2004; Yang et al.; Dogru et al.; Aydin et al.). CB and SD are frequently present together and there is a relationship between these two issues (Stallman et al., 2004; Keles et al., 2010; Lloyd, 1990; Zinreich et al., 1988; Bolger et al.; 1991; Uygur et al., 2003; Blaugrund, 1989). "
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    • "However, there is controversy regarding the incidence of this variation and more importantly the clinical symptoms associated with it. It has been estimated that the incidence of secondary middle turbinate ranges from 0.8% to 14.3% (Khanobthamchai et al., 1991a; Aykut et al., 1994; Kantarci et al., 2004; Ozcan et al., 2008). This is a bony structure covered by mucosa and originating from the lateral wall of the middle meatus as illustrated in Figure 1C. "
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