Common Anatomic Variant Research Articles

THE INCIDENCE OF CONCHA BULLOSA: A RETROSPECTIVE RADIOLOGIC STUDY

Background: Middle nasal concha hypertrophy known as concha bullosa is caused by its pneumatization. Although it is the most common anatomical variation of the ostiomeatal complex, research on it in different populations is limited. It is uncertain whether concha bullosa prevalence varies across populations throughout the world.
 Objective: The purpose of study was to determine the prevalence of (superior, middle and inferior turbinate concha bullosa) in patients who visited an ENT clinic with various ENT symptoms.
 Methods: The duration of this retrospective descriptive study was six month. The study was carried out between the period from June 2022 to November 2022 at Department of ENT and Head & Neck Surgery. We examined the axial and coronal planes of patients' computed tomography (CT) scans of nose as well as paranasal sinuses who reported headaches or nasal obstruction symptoms in addition to symptoms of chronic sinusitis.
 Results: Concha bullosa was seen in 14% of the 100 scans examined. Six (42.8%) individuals had bilateral concha bullosa, whereas eight (57.1%) had unilateral concha bullosa. Out of the eight conchae, two (25%) were found on the right side while six (75%) on the left side.
 Conclusion: Study concluded that concha bullosa is the most common anatomic variation. During the preoperative evaluation, the radiologist must pay close attention to anatomical variants. It is critical for surgeons to be aware of this variation.

Variations of the popliteal artery in human fetuses: preliminary study

IntroductionThis paper provides an in-depth analysis of the anatomical and morphometrical attributes of the popliteal artery (PA) in human fetuses. Additionally, it showcases significant interindividual variation in branching patterns, which are of great clinical importance in the context of vascular surgery and interventional radiology.AimThe purpose of this research was to systematically examine and categorize the anatomical and morphometrical diversities observed in the PA among a 166 sample of human fetuses at various gestational stages, spanning from 16 to 30 weeks of pregnancy.Material and methodsThe latex was injected into the 166 PA within the fetal specimens to visually analyze their anatomical features, and high-resolution digital images were captured at 24-bit color depth for detailed analysis.Results and DiscussionThe PAs were systematically classified into three distinct categories, further subcategorized into specific types. The classification system employed was based on the framework established initially by Lippert and Pabst, with modifications by Kim. The results of the analysis revealed the following distribution: Category I – it was mainly detected in the majority of specimens, comprising 144 cases (86.7%) of the sample population, and represented the most common anatomical configuration; Category II – it was found in 19 specimens (11.4%) of the total sample population (this category represented a less common anatomical variation within the PA); Category III – the rarest anatomical configuration observed in only 3 specimens (1.8%) from the sample population.ConclusionsThe frequent occurrence of short tibiofibular trunks in PA may be due to incidental lesions or postnatal developmental changes, highlighting the need for further research.

Abstract 17786: Transcatheter Atrial Septal Defect With Deficient Retro-Aortic Rim Closure Success Rate and Complication is Similar to Other Anatomical Variants: Meta-Analysis

Introduction: Atrial septal defect (ASD) is a common congenital cardiac malformation resulting from incomplete fusion of one of the multiple embryological structures. Though surgical repair when indicated had been the norm, technological advances over the years have led to the current availability of transcatheter closure of the ASD. This alternative approach has been associated with lower complications and mortality but the procedural success and outcome are variable dependent upon anatomical features. Hypothesis: Several reports have linked deficiency of retro-aortic rim to higher complications, particularly aortic erosion in patients undergoing transcatheter ASD closure. Recent retrospective studies have however suggested otherwise. We herein performed meta-analysis of existing data on the success rate and adverse events following transcatheter closure of ASDs in patients with deficient retro-aortic rims (DRAR) in an attempt to provide general recommendations on the optimal approach for this common anatomic variant. Methods: Twelve relevant studies of ASD with DRAR were identified utilizing PubMed. Each of the twelve studies was closely reviewed for major adverse events including cardiovascular mortality, mortality from non-cardiovascular causes, device erosions, device embolization, residual shunting post-ASD repair, and other complications. The incident of each major adverse events was subsequently tabulated. Five of these reports directly compared the failure rates of ASD closure between patients with and without DRAR. A Mantel-Haenszel random effect meta-analysis was performed on these five publications. Results: Of the total 4,621 transcatheter-based approach ASD closures included, the rate of major adverse events was 5.14%. There was no significant difference in the procedural failure rate between those with and without DRAR ( relative risk =1.14, 95% CI[0.39 3.35], p=0.811 ), (heterogeneity, I 2 =74.75%). Conclusions: Our meta-analysis suggests that transcatheter ASD closure could be performed in patients with deficient retro-aortic rim ASD with expected similar rates of adverse events and success rates as in other anatomical variants.

Imaging of the Craniocervical Junction: A Pictorial Review.

The craniocervical junction (CCJ) is a complex anatomical structure comprising the occiput, the atlas, and the axis. The CCJ plays an important role in maintaining stability, providing protection, and supporting neurovascular structures. The CCJ can be affected by a wide range of congenital variants and traumatic, degenerative, inflammatory, and tumoral pathologies. This pictorial review the normal anatomy of the CCJ and presents the most common anatomical variants and pathologic conditions affecting the CCJ.

Evaluation of Second Canals in Mandibular Incisors using Magnification: A Cross-Sectional Study

Background: It is essential to have a thorough understanding of the typical anatomy of the root canal system, as well as the various common and uncommon anatomical variations, in order to achieve successful treatment outcomes.Objective: To determine the frequency and pattern of two canals in mandibular incisors using magnifying loupe Material and Methods: This study at Saidu College of Dentistry in Swat included 385 participants selected consecutively. Inclusion criteria were males and females aged 20-60 years with mandibular incisor-related dental conditions. Exclusion criteria were local anesthesia allergies, internal root resorption, calcified canals, and pregnancy. The number of canals was recorded radiographically using the SLOBE technique. Canals were classified using Vertucci's system. Canal frequencies were analyzed by gender and tooth types using chi-square tests (p<0.05).Results: The mean age was 33.97±11.10 years. Of the participants, 215 (55.84%) were males. The highest numbers of tooth types were found among the left lateral incisors (n=148, 38.44%) and left central incisors (n=122, 31.69%). Second canal was found 139 participants (36.10%). Among these, Type I (n=84, 21.82%) was the most common two-canal pattern, followed by Type III (n=36, 9.35%). When analyzing the canal types within the single canal group, Type I was the most prevalent in both males (23.26%) and females (20.00%). The frequencies of Types II, III, and IV were similar between genders and did not exhibit significant differences (p=0.865). The distribution of canal types varied across tooth types, with Type I being the most common, but not statistically significant (p=0.652).Conclusion: The presence of a second canal in the mandibular incisors is quite common. The most common pattern of two canals, according to the Vertucci classification, was Type I, followed by Type III.Keywords: Magnification, Mandibular incisors, Second canals, Vertucci classification

Common but lesser-known anatomical variation of the mandibular canal: Bifid mandibular canal

Günümüz diş hekimliğinde mandibulada yapılacak cerrahi işlemler öncesi mandibular kanala ilişkin varyasyonların değerlendirmesi ve belirlenmesi posterior bölgeye yapılacak oral cerrahi işlemlere yönelik cerrahi esnasında ve sonrasında meydana gelebilecek komplikasyonların önlemesinde önem taşımaktadır. Bifid mandibular kanal mandibulada izlenen anatomik varyasyonlar arasında en sık bildirilen tür olmakla birlikte, tanımlanmasına ve yaygınlığının bilinirliğine yönelik bilgi düzeyinin düşük olduğu tahmin edilmektedir. Bu teknik notta yaygın görülmekle birlikte hakkındaki bilgi düzeyinin eksik olduğu bilinen bifid mandibular kanal varyasyonlarının görünümlerine ilişkin bilgi verilmesi amaçlanmaktadır.

Comparison between CT-Scan Finding and Operative Finding of Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery

Background: Chronic rhinosinusitis is a group of disorders characterized by inflammation of the mucosa of the nose and Paranasal sinuses for at least 12 consecutive weeks. It is a common clinical problem that has a significant impact on quality of life. CT-scan has become the modality of choice for assessment of CRS and Endoscopic sinus surgery is a minimally invasive technique and the surgical management of choice for chronic rhinosinusitis.
 The Aim of this Study: To verify the agreement and associations between preoperative CT-scan and intraoperative ESS findings in patients with CRS and to evaluate the types and frequency of anatomical variants in the nasal fossa and paranasal sinuses as well as their clinical correlations in chronic rhinosinusitis.
 Patients and Methods: This study is experimental study in which 50 subjects were collected by simple randomization technique as they visited our department in a period from January to December 2015. All the participants were guided to conduct a coronal, axial, and sagittal CT scan of the nose and paranasal sinuses before functional endoscopic sinus surgery. The anatomical variations and mucosal abnormalities on CT Scan & ESS were studied and analyzed.
 Results: Septal deviation is the most common anatomical abnormality, 37(74%) of the participants have these abnormalities. The presence of agar nasi cells 34(68%), and chonca bullosa 28(56%) are the second and third most common anatomical variants found on CT-scan images. There is a high level of agreement between both the diagnostic tools at the high numbers of both positive and negative results for each abnormal finding.
 Conclusions: There was a good correlation between CT and ESS findings and there was a slight difference between the diagnostic characteristics of these different tools.

Characteristic of Anatomical Variations in Paranasal Sinus CT-Scan of Chronic Rhinosinusitis Patients at the ENT Clinic Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar in 2021

Background: Anatomical variations and pathological processes in the nose and paranasal sinuses have been widely studied by experts. Many anatomical variations cause chronic sinusitis by causing obstruction of the osteomeatal complex (OMC) and influencing mucociliary transport patterns. Methods: This is a retrospective study based on radiology data of all rhinosinusitis cases that performed a computed tomography scan of the paranasal sinuses at Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar for one year (January 2021 to December 2021). The sample of this study was all rhinosinusitis patients undergoing surgery, both male and female, from January 1 to December 31, 2021. Results: Based on the results of the research data, the highest anatomical variation was concha hypertrophy in as many as 26 people (38.2%). Conclusion: The most common anatomic variation is concha hypertrophy. Preoperative CT scan examination is essential because it can be helpful as navigation for sinus surgeons. Early detection of anatomic variations is the key for surgical planning and the prevention of complications.

Association among Orthodontic Malocclusions, Paranasal Sinuses Anatomic Variations and Adenoid Vegetation in Children Using CBCT.

The aim of this study is to evaluate the relationship between orthodontic malocclusion, paranasal sinus (PS) variations, and adenoid vegetation in a group of pediatric patients with chronic rhinosinusitis. Clinical and radiographical data were retrospectively evaluated and 58 patients were diagnosed as having chronic sinus disease. Cone-beam computed tomography (CBCT) images were acquired with Newtom-3G. Anatomical variations of the PS were assessed on every section. Additionally, for cephalometric analysis, the images were imported into the InVivoDental software program. A total of 252 anatomical variations, which encompassed 19 different types, were detected in the current study. Concha bullosa was the most common anatomical variation, at 72.4%. Septum deviation was the second most common one, at 67.2%. The Class III group exhibited a significantly higher prevalence of concha bullosa and secondary middle turbinate than the other groups. While adenoid vegetation was most common in the Class III group, sinusitis and antral disease were most common in the Class II group. Overall, Class III subjects exhibited fewer PS variations. In conclusion, concha bullosa emerged as the most prevalent anatomical variation, with distinctive patterns observed across different malocclusion groups. Therefore, CBCT is useful, especially in pediatric patients, due to its low dose advantage.

Identification of Anatomical Variations in the Nose and Paranasal Sinuses to Ensure Safe and Complete Endoscopic Sinus and Skull Base Surgery in the North Indian Population

Introduction: The surgical sciences are changing from open to minimum invasive so thats why we were interested in getting the knowledge of anatomy again, so that MIS can become easier with minimum technical difficulties. Objective: The identification of anatomical variations in the nose and paranasal sinuses, which are important to ensure safe and complete endoscopic sinus and skull base surgery. Materials and Methods: Prospective study was conducted for 1 year with 90 patients. All the patients who presented to the outpatient department with complaints of nasal and cranial symptoms were subjected to the computed tomography nose and paranasal sinus. Results: Our results were comparable to other older studies; some variables were noted that are important doing endoscopic surgeries. Conclusion: The most common anatomical variant studied was deviated nasal septum, followed by inferior turbinate concha bullosa, maxillary sinusitis, and anterior ethmoid sinusitis.

A Cadaveric Study of Two Uncommon Cases of Sural Nerve Complex Variation

Abstract Introduction The sural nerve is a sensitive nerve whose function is to provide sensory supply for the posterolateral aspect of the distal third of the leg and the lateral side of the dorsum of the foot. This nerve is formed in the upper third of the calf from the terminal branches of the tibial and common peroneal nerves and the communicating branch of the sural nerve. Objectives The aim of our study is to showcase two anatomical variants of the sural nerve. Materials and methods Two formalin-preserved cadavers, one male and one female, embalmed using formalin 4% were dissected with the intent of being used as teaching materials for the students attending anatomy classes at the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania. Results In both cases, less common anatomical variations of the formation of sural nerve were discovered. On the male cadaver, we identified the sural nerve as a continuation of the medial sural cutaneous nerve. The lateral sural cutaneous nerve and the communicating branch of the sural nerve were both absent. On the female cadaver, we identified both the medial sural cutaneous nerve and the lateral sural cutaneous nerve. The sural nerve was, however, a continuation of only the lateral sural cutaneous nerve, with the medial sural cutaneous nerve as an independent branch. Conclusions We described two anatomical variants of the sural nerve, which are less common than those documented in the literature.

Anatomical variations of the Paranasal sinuses in Javanese patients with Chronic Rhinosinuitis

Variations in paranasal sinuses anatomy are common and vary among populations. Having clear picture of paranasal sinuses anatomy of a chronic rhinosinusitis patients is essential in surgical planning. This study was done to know paranasal sinuses anatomical variations of chronic rhinosinusitis in Javanese patients by Ct-scan. Retrospective chart survey from medical record of the ORL-HNS outpatient unit at Dr. Soetomo hospital Surabaya during the period January 2019 to December 2020. The data of age, gender, anatomical variations of paranasal sinuses and Keros classification of 55 patients who met the inclusion and exclusion criteria were obtained and recorded. The most common paranasal sinuses anatomical variations were deviated nasal septum (71%), concha bullosa (27%) and ager nasi (22%). Genderwise, anatomical variations were seen more in males. Based on Keros classification, type II(47%) is the most frequently found. The high incidence of paranasal sinuses anatomical variations, emphasize the need for proper preoperative assessment for safe and effective endoscopic sinus surgery.

Sonographic imaging and assessment of the sural nerve

AbstractThe sural nerve is a sensory nerve which innervates the posterolateral distal calf and lateral foot. It can be demonstrated using high resolution ultrasound and travels near the small saphenous vein throughout most of its course. There are variations in its origin and relative position through the posterior distal calf, lateral ankle, and foot. To allow this nerve and any potential pathology or injury to be sonographically demonstrated, a good understanding of the sonographic relative anatomy, course, and common anatomical variations, as well as the sonographic normal appearances throughout need to be appreciated and these are reviewed in this paper.

Assessing the risk of re-fracture related to the percentage of partial union in scaphoid waist fractures.

There is ambiguity surrounding the degree of scaphoid union required to safely allow mobilization following scaphoid waist fracture. Premature mobilization could lead to refracture, but late mobilization may cause stiffness and delay return to normal function. This study aims to explore the risk of refracture at different stages of scaphoid waist fracture union in three common fracture patterns, using a novel finite element method. The most common anatomical variant of the scaphoid was modelled from a CT scan of a healthy hand and wrist using 3D Slicer freeware. This model was uploaded into COMSOL Multiphysics software to enable the application of physiological enhancements. Three common waist fracture patterns were produced following the Russe classification. Each fracture had differing stages of healing, ranging from 10% to 90% partial union, with increments of 10% union assessed. A physiological force of 100 N acting on the distal pole was applied, with the risk of refracture assessed using the Von Mises stress. Overall, 90% to 30% fracture unions demonstrated a small, gradual increase in the Von Mises stress of all fracture patterns (16.0 MPa to 240.5 MPa). All fracture patterns showed a greater increase in Von Mises stress from 30% to 10% partial union (680.8 MPa to 6,288.6 MPa). Previous studies have suggested 25%, 50%, and 75% partial union as sufficient for resuming hand and wrist mobilization. This study shows that 30% union is sufficient to return to normal hand and wrist function in all three fracture patterns. Both 50% and 75% union are unnecessary and increase the risk of post-fracture stiffness. This study has also demonstrated the feasibility of finite element analysis (FEA) in scaphoid waist fracture research. FEA is a sustainable method which does not require the use of finite scaphoid cadavers, hence increasing accessibility into future scaphoid waist fracture-related research.

SPLENULE FREQUENCY ON COMPUTED TOMOGRAPHY SCANS IN CHILDREN, PRESENTING TO THE EMERGENCY DEPARTMENT

Objectives: Accessory spleen, also known as “splenule”, is the presence of splenic tissue in ectopic localisations. The presence of splenule is important, especially in patients planned for splenectomy, as it may cause refractory symptoms. The aim of the present study is to define the frequency of splenule(s) in children (0-17 years) who received non-contrast and contrast enhanced computed tomography (NECT and CECT) protocols in the emergency department.
 Material and methods: 748 children (aged 0 to 17 years) who were admitted to the emergency department between May 2015 – September 2022 and had NECT and CECT abdominal scans were included in the study. Patients whose CT protocols were incomplete and cases with traumatic splenic injury and / or cases with poor image quality and patients with a history of splenectomy or hematologic pathology were excluded from the study (n: 100). A total of 648 patients were included in the cohort. NECT and CECT scans of all patients were assessed; the localisation of splenules as well as the antero-posterior (AP), medio-lateral (ML) and cranio-caudal (CC) dimensions of each splenule were measured.
 Results: A total of 648 cases with 467 males (72.1%) and 181 females (27.9%) were included in the study. Splenules were observed in 131 (20.2%) cases. More than one splenule was observed in 21 of these 131 cases. A total number of 159 splenules were observed in total, with a mean volume of 0,72 ±0,95 ml. The most common location was found to be the splenic hilus (n=55, 41.9%). 
 Conclusion: Our study have stated that splenules are common anatomical variants, seen at a rate of 20,2% in this age cohort. A cross-sectional imaging should be performed to determine the presence, location, and number of the splenules before a planned splenectomy.

Anatomical variations of the sternum: sternal foramen and variant xiphoid morphology in dried adult human sternum in Ethiopia.

Background: The sternum exhibits unique anatomical variations with major clinical and forensic implications. This study is devoted to providing baseline epidemiological information about the sternal foramen and variant xiphoid morphology in Ethiopia. Two extremely interesting and unusual variations of the sternal foramen are also discussed. Methods: This observational study was carried out using dried adult human sternum obtained from skeletal remains samples brought for medicolegal examination over a period of 4 years. A total of 94 dried adult human sternums (66 males (70.2%) and 28 females (29.8%)) were obtained with an age range of 21 to 57 years and a mean age at death of 38.383 ± 11.3480 years. Dried human sternum specimens were morphologically examined, and morphometric parameters were recorded and photographed. Results: A sternal foramen was found in 18 specimens (19.1%); 17 were male and one was female. A single sternal foramen was observed in 83.3% (n=15/18) of the sternal bodies and 11.1% (n=2/18) of the xiphoid processes (both males). In addition, a double sternal foramen was observed in a single male specimen on the mesosternum and xiphoid process. The most common sternal foramen site was at the fifth costochondral junction level. The xiphoid process was present in 77 samples and ended as a single process in 83.1% (n=64/77) of samples. In 15.6% (n=12/77) of the samples, the xiphoid process was bifurcated and trifurcated in a single male (1.3%) specimen. Conclusions: The sternal foramen and variation in xiphoid morphology are common anatomical variations in Ethiopia. The findings of the current study highlight the necessity of strict precautionary measures during sternal procedures in this study population. In addition, such incidental findings during radiologic and autopsy procedures should be properly evaluated to avoid misdiagnosis and misinterpretation of such findings as traumatic or pathologic conditions.

The Superior Cerebellar Artery: Variability and Clinical Significance.

The superior cerebellar artery (SCA) arises from the distal part of the basilar artery and passes by the oculomotor, trochlear, and trigeminal nerves. SCA is known to play a crucial role in the development of trigeminal neuralgia. However, due to its anatomical variability, it may also trigger other neurovascular compression (NVC), including hemifacial spasm, oculomotor nerve palsy, and ocular neuromyotonia. Additionally, it may be associated with ischemic syndromes and aneurysm development, highlighting its clinical significance. The most common anatomical variations of the SCA include duplication, a single vessel origin from the posterior cerebral artery (PCA), and a common trunk with PCA. Rarely observed variants include bifurcation and origin from the internal carotid artery. Certain anatomical variants such as early bifurcation and caudal course of duplicated SCA trunk may increase the risk of NVC. In this narrative review, we aimed to examine the impact of the anatomical variations of SCA on the NVCs based on papers published in Pubmed, Scopus, and Web of Science databases with a snowballing approach. Our review emphasizes the importance of a thorough understanding of the anatomical variability of SCA to optimize the management of patients with NVCs associated with this artery.

Symptomatology and Radiologic Features of Isolated Sphenoid Sinusitis

Background: Isolated sphenoid sinusitis has a potentially dangerous clinical course with nonspecific presentations leading to delayed diagnosis. Aim: To assess the presenting symptoms and CT findings of isolated sphenoid sinusitis. Method: From the period of November 2015 to November 2022, 19 patients who were diagnosed with isolated sphenoid sinusitis was identified. The presenting symptoms and radiological studies were retrospectively reviewed and analysed. Results: The most common presenting symptom was headache, which was present in 17 out of 19 patients. 11 patients complained of nasal symptoms. Blurring of vision was present in 2 patients. CT PNS showed sinus wall sclerosis in 11 and intra-sinus calcification in 10 patients. The most common anatomical variation observed was inferior turbinate hypertrophy in 10 patients. Conclusion: With headache being the only dependable finding, CT imaging remains a valuable tool for the diagnosis of isolated sphenoid sinusitis. Keywords: sphenoid sinusitis, paranasal sinus diseases, headache

Sinonasal Anatomy Variations on CT Scans of a Sample of Filipino Adults With Chronic Rhinosinusitis

ABSTRACT
 Objective: To determine the prevalence of sinonasal anatomic variations seen on paranasal sinus (PNS) CT scans of a sample of Filipino adults with chronic rhinosinusitis.Methods: Design: Cross-sectional study Setting: Tertiary Government Training Hospital Participants: The PNS CT scans of 51 Filipino patients with chronic rhinosinusitis with and without nasal polyposis diagnosed at our outpatien Department of Otorhinolaryngology-Head and Neck Surgery between October 2015 to December 2020 were reviewed for the presence of sinonasal anatomic variants. The prevalence of the identified variants was calculated.
 Results: The CT scans of 51 patients, 41 (80.4%) men and 10 (19.6%) women, were included. The median age was 48 years (Q25: 35, Q75: 56, IQR:21). The median Lund Mackay Score (LMS) was 15 (Q25: 12, Q75: 20, IQR:8). Majority (94%) had an LMS of ≥5. The most common anatomic variant in the study population was agger nasi (n=46/51, 90.2% present bilaterally) followed by uncinate process attachment to the lamina papyracea (n=90/102, 88.24%). The third to sixth most common findings were Keros type II classification (n=76/102, 74.51%), nasal septal deviation (n=35/51, 68.62%), optic nerve canal type 1 (n=67/102, 65.69%) and anterior ethmoid artery grade 1 (n=46/102, 45.1%), respectively. Less common variants were Onodi cell (n=13/51, 25.49% unilateral and n=10/51, 19.61% bilateral), Haller cell (n=8/51, 15.69% unilateral and n=1/51, 1.96% bilateral), supraorbital cell (n=4/51, 7.84% unilateral and n=4/51, 7.84% bilateral), middle turbinate concha bullosa (n=3/51, 5.88% unilateral and n=6/51, 11.76% bilateral), superior turbinate concha bullosa (n=2/51, 3.92% unilateral and n=1/51, 1.96% bilateral), pneumatized crista galli (n=2/51, 3.92%) and optic nerve dehiscence (n=1/51, 1.96% bilateral). 
 Conclusion: In the adult Filipino population with CRS sampled in this study, the six most common sinonasal anatomic variants were agger nasi, superior attachment of the uncinate process to the lamina papyracea, Keros type II classification, septal deviation, optic nerve canal type 1 and anterior ethmoid artery grade 1. Pre-operatively, the PNS CT scan of every patient must be meticulously evaluated for the sinonasal anatomic variants to avoid surgical complications.

Combined Radiological and Endoscopic Evaluation of Sino Nasal Anatomical Variations in Patients of Chronic Rhinosinusitis: A North Indian Study.

To determine the prevalence of anatomical variations of nasal cavity and paranasal sinuses of patients with chronic rhinosinusitis (CRS) on CT scan imaging. To correlate the Anatomical variations with the extent of CRS. 100 patients attending the ENT outpatient department with clinically diagnosed CRS were selected for study based on inclusion and exclusion criteria. Patients were subjected to CT scan and diagnostic nasal endoscopy. The correlation of anatomical variation with severity of CRS based on radiological score and endoscopic score was observed. Deviated nasal septum was the most common anatomical variation observed in 71% cases. Followed by Agger nasi (68%), concha bullosa (55%), Onodi cell (25%), Haller cell (14%), frontal sinus hypoplasia (2%) and uncinate bulla (1%) respectively. Statistically significant relationship of radiological score with left side Bullous Concha Bullosa and highly statistically significant relationship with Haller Cell was observed. While statistically significant relationship between Deviated Nasal Septum on left side with endoscopic score was also observed. Correlation of anatomical variation with CRS concludes on the notethat some variations cause impaired sinus drainage and ventilation leading to recurrent sinusitis. Also, incidence of these variations was comparable to other studies done in asymptomatic population therefore, simply detection of a solitary anatomical variant itself does not determine predisposition to disease or the pathogenesis of the CRS and that we should have a critical look out for these anatomical variations from point of view of surgical management.