Presence Of Anatomical Variations Research Articles

Multi-institutional experimental validation of online adaptive proton therapy workflows

Objective. To experimentally validate two online adaptive proton therapy (APT) workflows using Gafchromic EBT3 films and optically stimulated luminescent dosimeters (OSLDs) in an anthropomorphic head-and-neck phantom. Approach. A three-field proton plan was optimized on the planning CT of the head-and-neck phantom with 2.0 Gy(RBE) per fraction prescribed to the clinical target volume. Four fractions were simulated by varying the internal anatomy of the phantom. Three distinct methods were delivered: daily APT researched by the Paul Scherrer Institute (DAPTPSI), online adaptation researched by the Massachusetts General Hospital (OAMGH), and a non-adaptive (NA) workflow. All methods were implemented and measured at PSI. DAPTPSI performed full online replanning based on analytical dose calculation, optimizing to the same objectives as the initial treatment plan. OAMGH performed Monte-Carlo-based online plan adaptation by only changing the fluences of a subset of proton beamlets, mimicking the planned dose distribution. NA delivered the initial plan with a couch-shift correction based on in-room imaging. For all 12 deliveries, two films and two sets of OSLDs were placed at different locations in the phantom. Main results. Both adaptive methods showed improved dosimetric results compared to NA. For film measurements in the presence of anatomical variations, the [min-max] gamma pass rates (3%/3 mm) between measured and clinically approved doses were [91.5%–96.1%], [94.0%–95.8%], and [67.2%–93.1%] for DAPTPSI, OAMGH, and NA, respectively. The OSLDs confirmed the dose calculations in terms of absolute dosimetry. Between the two adaptive workflows, OAMGH showed improved target coverage, while DAPTPSI showed improved normal tissue sparing, particularly relevant for the brainstem. Significance. This is the first multi-institutional study to experimentally validate two different concepts with respect to online APT workflows. It highlights their respective dosimetric advantages, particularly in managing interfractional variations in patient anatomy that cannot be addressed by non-adaptive methods, such as internal anatomy changes.

Empirical analysis of a plan-of-the-day strategy to approximate daily online reoptimization for prostate CBCT-guided adaptive radiotherapy.

Adaptive radiotherapy (ART) can improve the dose delivered to the patient in the presence of anatomic variations. However, the required time, effort, and clinical resources are intensive. This work analyzed a plan-of-the-day (POD) approach on clinical patients treated with online ART to explore implementations that balance dosimetric benefit and clinical resource cost. Eight patients treated to the prostate and proximal seminal vesicles with 26 fractions of CBCT-guided, daily online ART were retrospectively analyzed. With a plan library composed of daily adaptive plans from the initial week of treatment and the original plan, the effect of a POD approach starting the following week was investigated by simulating use of these previously generated plans under 3- and 6-degree-of-freedom patient alignment. The plan selected for each treatment was that from the library that maximized the Dice similarity coefficient of the clinical target volume with that of the current treatment fraction. The resulting distribution of several target coverage and organ-at-risk dose metrics are described relative to those achieved with the daily online reoptimized adaptive technique. The values of target coverage and organ-at-risk dose metrics varied across patients and metrics. The POD schemas closely approximated the reference values from a fully reoptimized adaptive plan yet required less than 20% of the reoptimization effort. The POD schemas also had a much greater effect on target coverage metrics than 6-degree-of-freedom registration did. Organ-at-risk dose metrics also varied considerably across patients but did not exhibit a consistent dependence on the particular schema. POD schemas were able to achieve the vast majority of the dosimetric benefit of daily online ART with a small fraction of the online reoptimization effort. Strategies like this might allow for more practical and strategic implementation of ART so as to benefit a greater number of patients.

In vivo endoscopic study of the variations of anatomical structures in the hidden spaces of the middle ear during endoscopic ear surgery

ObjectiveThe middle ear has compartments with the presence of anatomic variations. Transcanal endoscopic middle ear surgery facilitates the exploration of every single compartment with the least possible tissue dissection.MethodsThis study was conducted on 250 middle ears of patients who had endoscopic ear surgery (tympanoplasty and stapedotomy) at the period of the study with endoscopic recording of the data. Intraoperative examination of the pro, retro, and hypotympanum was performed with 0, 30, and 45° endoscopes and data was collected, processed, and analyzed with Statistical Package for Social Sciences (SPSS).ResultsQuadrangular conformation (64%), type B (shallow subtensor recess) (64.8%), and type A protinuculum (ridge) were the commonest in the protympanum. Type A jugular bulb which lies below the level of the bony annulus was the commonest finding (75.6%) in the hypotympanum. Type A (ridge) variant was the commonest finding of ponticulus, subiculum, and finiculus 88.4%, 64.8%, and 72.8% respectively in the retrotympanum. Type B (deep) ST 53.6% was the commonest regarding sinus tympani. Type A (present) subcochlear canaliculus, type B (oblique) fustis and type B (absent) RW membrane were the most common regarding the round window region.ConclusionGood knowledge of the anatomical variations of the middle ear has great surgical importance. The study showed variations of the known structures from other studies that can be attributed to being an in vivo study, racial differences, and a larger sample size.

Mandibular İnterforaminal Bölgede İmplant Cerrahisinde Karşılaşılabilecek Vasküler Komplikasyonlar ve Yönetimi

Mandibular interforaminal bölge, birçok ağız ,diş ve çene cerrahisi protokolünde özellikle de dental implant uygulamalarında tercih edilen bir alandır. Son yıllardaki vaka raporları, mandibular interforaminal bölgede birçok komplikasyonla karşılaşılabileceğini göstermektedir. Bunlardan en tehlikeli ve yaşamı tehdit edeni de üst solunum yolu obstrüksüyonuna kadar varabilen lingual arter yaralanmalarıdır. Tecrübeye bağlı olmaksızın karşılaşılabilecek bu komplikasyondan kaçınmak ancak mandibular interforaminal bölgenin vasküler anatomisine hakim olmak, işlem öncesi gerekli radyografik tetkik ve incelemeleri yapmış olmaktan geçmektedir. Hastayla ilgili yetersiz radyografik tetkik bulunması ya da anatomik varyasyon varlığı gibi durumlarda bu şekilde bir kanama komplikasyonuyla karşı karşıya kalındığındaysa, hekimin süreci ve komplikasyonu yönetebilecek bilgi ve donanımda olması gereklidir. Bu çalışmada mandibular interforaminal bölgesinin anatomik vasküler anatomisi, lingual foramenler ve bulunma sıklıklarıyla birlikte komplikasyondan kaçınma ve başa çıkma yöntemleriyle ilgili literatür özetlenmiştir. Böylece diş hekimlerinin bu ciddi komplikasyonla ilgili bilgilerini tazelemek amaçlanmaktadır.

Fenestration of the Mandibular Buccal Cortex by the Inferior Alveolar Bundle: A Case Report

A precise knowledge of the anatomy of the Mandibular Canal is essential while performing oral surgical procedures in order to avoid any risk of injury to the inferior alveolar neurovascular bundle. The presence of anatomical variations associated with the mandibular canal has great clinical implications during such surgical procedures.
 Various anatomical variations may not be well appreciated entirely in two-dimensional images like Orthopantomograph (OPG). In such cases, Cone Beam Computed Tomography (CBCT) plays a crucial role in facilitating the localization of anatomic structures, their significant variations and provides data concerning bone morphology.
 In this case report, A 27 year old male patient reported with the chief complaint of intermittent pain in left lower back region of the mouth. Clinical and radiographic examination (OPG) revealed impacted lower third molar in the left back region of the jaw. While raising a full thickness mucoperiosteal flap, we encountered fenestration of the left mandibular buccal cortex by the inferior alveolar nerve which is a 6th reported case without pathology.
 The aim of this article is to add on a rare anatomical variation in the existing literature i.e. fenestration of the mandibular buccal cortex by the inferior alveolar bundle, encountered accidently during exposing mandibular third molar and confirmed by cone beam computed tomography (CBCT).

Image-guided, surgical robot-assisted percutaneous puncture of the foramen ovale and foramina stylomastoideum: a cadaveric study.

Image-guided, surgical robot-assisted percutaneous puncture of the foramen ovale and foramina stylomastoideum: a cadaveric study.

Mono-Radicular mandibular canine with complex canal anatomy — A unique case report

A comprehensive knowledge of the root canal anatomy is essential for successful endodontic treatment. However, presence of anatomic variation in the tooth can be diagnostically and technically challenging and hence may pose difficulties during endodontic therapy. The anatomical variations associated with permanent mandibular canines have been reported by several investigators. Mandibular canines are recognized as usually having one root with one root canal in majority of cases. The occurrence of two root canals in single-rooted mandibular canine is considered unusual in Indian population. This case report describes non-surgical endodontic management of right permanent mandibular canine having one root with two canals and one apical foramen (Vertucci Type II).

Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries

Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P= 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P= 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P= 0.001) presented a statistically significant association with the rupture. Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.

Radiological anatomy of the intracranial vertebral artery in a select South African cohort of patients

The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and Caucasian) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Understanding the patterns of anatomical variations of the VAs will contribute significantly to the interpretation of ischemic areas and diagnosis of various diseases in the posterior circulatory territory.

An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population

IntroductionThe most common type of vascular complication during cervical spine surgery is the vertebral artery (VA) injury. The presence of anatomical variation in the artery's morphology has been a significant factor for arterial injury during surgery. Therefore, physicians planning interventions in the craniospinal region need to be aware of the extents of variations. In addition to vascular injury, anatomical variations can predispose to some pathologies in the posterior circulation territory. To provide useful data to interventional radiologists, anatomists, and surgeons, we evaluated the anatomical features of the V1 and V2 segments of the VA in a South African population.Materials and methodsThe study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian and White) who had undergone computed tomography angiography (CTA) from January 2009 to September 2019.ResultsThe VA exhibited morphological variation in its course. We report the incidence of variant origin of the left VA, all from the aortic arch. Variation in the level of entry into the transverse foramen ranged between C7 and C3. A left dominant pattern was observed; we also report on hypoplasia of the VA. In addition, we report incidence of VA tortuosity at V1, V2 to be 76.6% and 32.1%, respectively.ConclusionsThe baseline data established in this study regarding the diameter, variant origin, and level of entry into the transverse foramen will assist neurosurgeons and interventional radiologists in interpreting, diagnosing, and planning and executing various vascular procedures and treatment of pathology in the vicinity of the VA.

Thoracic aortic size in Brazilian smokers: measures using low-dose chest computed tomography anatomical and epidemiological assessment

OBJECTIVES:Thoracic aortic aneurysms (TAAs) represent one-third of the hospitalizations for aortic diseases. The prevalence rate depends on the definition of the normal size of the aorta, which is quite variable, depending on the population studied. The aim of this study was to evaluate the characteristics of the thoracic aorta of Brazilian smokers, identifying the normal size of the aorta, presence of anatomical variations, and prevalence of TAA.MATERIALS AND METHODS:A total of 711 patients underwent radiological evaluation with low-dose computed tomography (CT) from January 2013 to July 2014 with the initial objective of lung nodule tracking. Two examiners evaluated these images, and measurements of maximum and serial diameters were performed manually in true orthogonal planes. Serial diameter measurements were taken every 2 cm in the ascending aorta and 5 cm in the descending segment. We searched for anatomical variations, aortic arch type, and correlations between anatomical characteristics, sex, body mass index, and body surface area (BSA).RESULTS:The maximum diameters were 33.61 (standard deviation [SD] 3.88), 28.66 (SD 2.89), and 28.36 mm (SD 3.09) for the ascending segment, aortic arch, and descending segment, respectively. A positive correlation was found between male sex, age, and BSA and aorta diameter. The bovine arch was the most common variation of the aortic arch type, and we found one (0.14%) case of TAA.CONCLUSIONS:This study with low-dose CT allowed the determination of the mean diameters of the ascending aorta, aortic arch, and descending aorta in Brazilian smokers and TAA prevalence.

Management of anatomical challenges during laparoscopic cephalic duodenopancreatectomies

Introduction: Laparoscopic cephalic duodenopancreatectomy (LCDP) is considered a surgery of high technical complexity. It has a long learning curve because of the need of high laparoscopic technical skills, especially in the presence of anatomical variations. The aim of this video is to present three cases of LDCP (pure and hybrid) with difficult anatomical challenges and how to approach them. Case 1: A 76 years old woman presents with painless jaundice and workup reveals an infiltrating 20 mm adenocarcinoma of the Vater´s ampulla. During LCDP, a right posterior bile duct draining independently distal to the common bile duct is found, so two-separated laparoscopic bilio-enteric anastomosis are performed. Case 2: A 70 years old men presents with painless jaundice and workup reveals a 30 mm dysplastic adenoma of the Vater´s ampulla. He had a surgical history of an open gastric antral resection due to a perforated peptic ulcer 40 years ago. During LCDP, multiple lysis adhesions of the hepatic hilium are required and a right hepatic artery arising from the superior mesenteric artery is identified and preserved. Case 3: A 70 years old men with Child-B cirrhosis presents with jaundice and workup reveals an adenocarcinoma of the Vater´s ampulla not suitable for endoscopic resection. Hepatic venous gradient pressure (HVGP) measurement is 7 mmHg, so after multidisciplinary discussion a hybrid LCDP is performed with no complications. Conclusion: anatomical challenges can be safely approached under laparoscopic surgery during LCDP.

Variantes anatómicas del círculo arterial cerebral en un anfiteatro universitario en Bogotá (Colombia)

Introducción: el cerebro es un órgano altamente irrigado, y esta irrigación es suministrada por el círculo arterial cerebral: una red arterial anastomótica con frecuentes variaciones anatómicas, algunas asociadas con patologías. El objetivo es describir las características antropométricas y variaciones anatómicas del círculo arterial cerebral en una muestra de especímenes cadavéricos humanos. Materiales y métodos: se revisaron 50 encéfalos, de los cuales 24 cumplieron con los criterios de inclusión. Se realizaron medidas de diámetro y longitud y también se describieron variaciones anatómicas y variaciones morfométricas. Resultados: siete especímenes evidenciaron variaciones anatómicas (29.1%); 3 (12.5%), arteria cerebral anterior (ACA) ácigos; uno (4.1%), doble ACA en el segmento A1; uno (4.1%), triple ACA en el segmento A2 y doble arteria comunicante anterior (AcomA); uno (4.1%), agenesia de la arteria comunicante posterior (AComP) derecha; uno (4.1%), de la AComP izquierda. El 29.1% presentó variaciones antropométricas; el 12.5 %, hipoplasia de la AComP derecha; el 12.5 %, de la AComP izquierda, y el 4.1 %, hipoplasia bilateral de la AComP. Conclusión: la presencia de variaciones anatómicas fue inferior a la hallada en otros estudios, con predominio de variantes de la circulación anterior. Se describe la presencia de triple aca en el segmento A2 y doble arteria comunicante anterior.

Comparative evaluation of mastoid pneumatization pattern using X-ray mastoid and high-resolution computed tomography temporal bone in unilateral squamosal chronic otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media (COM) affects 0.5-30% of individuals in any community and over 20 million people are estimated to suffer from this condition worldwide. COM often evolves in a continuum. Squamosal disease is more commonly found in poorly pneumatized bones, but whether the sclerosis is relevant to the etiology of the disease or is caused by it, has not been fully resolved. Our study aimed at comparing the mastoid pneumatization patterns obtained using X-ray mastoid and high-resolution computed tomography (HRCT) temporal bone. It was an interventional study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixty patients of unilateral squamosal COM, aged more than 8 years, underwent X-ray mastoid Schuller’s view and HRCT temporal bone, using Philips extended brilliance 48 slice CT. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Upon analysis, in diseased and healthy ears, the coincidence of X-ray and HRCT findings was 63.33% and 80% respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; HRCT temporal bone should be done in all cases of squamosal COM to know the extent of the disease, pneumatization patterns and the presence of anatomical variations. &lt;/p&gt;

Anatomical Variation of the Thyroid Gland - Levator glandulae thyroideae: A Case Report

Surgical procedures on the thyroid are usually complicated by damage to the parathyroid glands, the external branch of superior laryngeal nerves, inferior laryngeal nerves, and hematoma due to vascular injury and the chance of residual thyroid tissue being left in case of cancer and Graves' disease, and the presence of anatomical variations. In this study, we describe the presence of a levator glandulae thyroideae that could misguide surgeons during surgical procedures.

A Hospital based study of High Resolution Computed Tomography and Conventional Radiography for Evaluation of Pathologies of Temporal Bone

Background: Many imaging modalities have been in use for the evaluation of temporal bone lesions. Plain X-rays are cost-effective however; they provide limited details and hence sometimes may result in an inaccurate diagnosis. With the advent of HRCT, the method of imaging of temporal bone has evolved with special algorithms and multiplanar formats. In the present study, we tried to evaluate the different pathologies of the temporal bone with X-ray and HRCT. Methods: The study was conducted in the Departments of Otorhinolaryngology and Radiology, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. A total of n=40 patients were identified and selected based on their symptoms and clinical findings suggestive of a lesion involving the temporal bone such as Otalgia, Otorrhoea, And Sensorineuronal deafness, pulsatile tinnitus, vertigo, and giddiness. These patients were subjected to high resolution computed tomography of the temporal bone on the 128 Slice CT Scanner (PHILIPS INGENUITY). The patients also underwent plain Radiography of temporal bone (CARESTREAM DRX-1 System). Results: Of the total n=40 patients studied the most common temporal bone disease was due to inflammation 85% and tumors were found in 15% of the patients. The common site of involvement of middle ear and mastoid air cells in chronic otitis media was epitympanum in n=30(90%) of cases, Mesotympanum in n=20(60%) of cases. In diseased ears, radiographs of the mastoids revealed pneumatised mastoid in 6(15%), diploic in 6(15%), and sclerosed mastoid in 28(70%) cases. HRCT temporal bone revealed pneumatised mastoid in 9(22.5%), diploic in 5(12.5%) and sclerosed mastoid in 26(65%) cases. Conclusion: The role of plain radiography is found to be limited to know the type of mastoid pneumatisation. It can also as Original Article detect bony erosion in few cases. Because of the ability to see temporal bone structures with great clarity, HRCT can be recommended not only in cases suspected with potential complications but also in all cases of temporal bone pathologies to know the extent of disease, inter-relationships of the tympanomastoid compartment with adjacent neurovascular structures, varied pneumatisation and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.

Positioning errors of dental implants and their associations with adjacent structures and anatomical variations: A CBCT-based study.

PurposeThe objective of the present study was to evaluate the prevalence of dental implants positioning errors and their associations with adjacent structures and anatomical variations by means of cone-beam computed tomography (CBCT).Materials and MethodsCBCT images of 207 patients (584 dental implants) were evaluated by 2 oral radiologists. The distance between the implant and the adjacent teeth/implants was measured and classified as adequate (≥1.5 mm and ≥3 mm, respectively) or inadequate. The presence of thread exposure, cortical perforation, implant dehiscence, implant penetration into adjacent structures, and anatomical variations was also recorded. The incisor canal diameter and the depth of the concavity of the submandibular fossa were measured in order to evaluate their correlations with the frequency of implant penetration in these structures. Descriptive analyses, the Fisher exact test, and Spearman correlation analysis were performed (α=0.05).ResultsThe overall prevalence of positioning errors was 82.9%. The most common error was the inadequate distance between the implant and the adjacent teeth/implants. The presence of anatomical variations did not significantly influence the overall prevalence of errors (P>0.05). There was a positive correlation between the diameter of the incisor canal and the frequency of implant penetration in this structure (r=0.232, P<0.05).ConclusionThere was a high prevalence of dental implant positioning errors, and positioning errors were not associated with the presence of anatomical variations. Professionals should be aware of the space available for implant placement during the preoperative planning stage.

Anatomic Variations of Paranasal Region in Migraine.

To assess the incidence of anatomical variations of the paranasal region on computed tomography in migraine patients compared with control subjects. Paranasal computed tomography scans of 2 groups consisting of 50 migraine patients and 50 control subjects were evaluated, retrospectively. The presence of anatomic variations and the unilateral or bilateral presence of these variations were noted. Appropriate statistical tests were performed to compare the migraine and control groups, using a threshold P value of 0.05 for statistical significance. The migraine group included 39 female and 11 male patients with mean age of 39.9 (range: 18-65) years. The control subject group included 29 female and 21 male patients with mean age of 41.9 (range: 18-73) years. Anatomic variations noted included nasal septal deviation and spur, paradoxical curvature of middle concha, agger nasi cell, infraorbital ethmoidal (Haller) cells, sphenoethmoidal (Onodi) cells, supraorbital ethmoidal air cells, concha bullosa, uncinate bulla, and pneumatized crista galli. Of these variations, only the presence of Haller cells was statistically significantly higher in the migraine group compared with controls (P = 0.007). The unilateral presence of Onodi (P < 0.001), unilateral presence of supraorbital ethmoidal air cells (P = 0.012), and bilateral presence of concha bullosa (P = 0.016) were statistically significantly higher in the migraine group. There was no statistically significant difference between the unilateral or bilateral presence of Haller cells in migraine patients compared with controls (P > 0.05). Radiographic assessment of the paranasal sinuses is useful to elucidate potential points of pathology in migraine patients. The specific contribution of Haller cells to migraine headache symptoms and safe methods for surgical decompression warrant further study.

Correlations between anatomical variations of the nasal cavity and ethmoidal sinuses on cone-beam computed tomography scans.

PurposeAnatomical variations of the external nasal wall are highly important, since they play a role in obstruction or drainage of the ostiomeatal complex and ventilation and can consequently elevate the risk of pathological sinus conditions. This study aimed to assess anatomical variations of the nasal cavity and ethmoidal sinuses and their correlations on cone-beam computed tomography (CBCT) scans.Materials and MethodsThis cross-sectional study evaluated CBCT scans of 250 patients, including 107 males and 143 females, to determine the prevalence of anatomical variations of the nasal cavity and ethmoidal sinuses. All images were taken using a New Tom 3G scanner. Data were analyzed using the chi-square test, Kruskal-Wallis test, and the Mann-Whitney test.ResultsThe most common anatomical variations were found to be nasal septal deviation (90.4%), agger nasi air cell (53.6%), superior orbital cell (47.6%), pneumatized nasal septum (40%), and Onodi air cell (37.2%). Correlations were found between nasal septal deviation and the presence of a pneumatized nasal septum, nasal spur, and Haller cell. No significant associations were noted between the age or sex of patients and the presence of anatomical variations (P>0.05).ConclusionRadiologists and surgeons must pay close attention to the anatomical variations of the sinonasal region in the preoperative assessment to prevent perioperative complications.

Anatomical variations in patients with chronic sinusitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;C&lt;/span&gt;&lt;span lang="EN-IN"&gt;hronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process.&lt;strong&gt; &lt;/strong&gt;Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.&lt;/span&gt;&lt;/p&gt;