Relationship between the Sinonasal Anatomical Variations and Maxillary Sinusitis Using Multi-Slice Computed Tomography Scans

Chronic sinusitis has been the most reported chronic and multifactorial disease in the last decades. The relationship between the anatomical diversity of the sinonasal complex and sinusitis is still under discussion. Computed tomography (CT) is the modality of choice for the evaluation of the sinuses and anatomic factors that predispose one to sinusitis. This study aimed to investigate the relationship between the anatomical variations of sinonasal complex and sinusitis of the maxillary sinuses using multi-slice CT scans.

In this study, we evaluated CT scans from the paranasal sinuses of 106 patients (212 maxillary sinuses) referring to the Shahid Kamyab Hospital in Mashhad, Iran, that were prepared by 16-slice spiral CT machine (cutting thickness: 0.75 mm). Normal anatomic variations which included agger nasi cells, ethmoid bulla, concha–bullosa, paradoxical middle concha, and nasal septal deviation, were evaluated and recorded. The samples were divided into a healthy group, that showed no increase in mucosal thickness in the maxillary sinus walls, and a patient group (with sinusitis) that showed an increase of more than 2 mm in mucosal thickness of at least one wall. Chi-squared test and independent t-test were used to determine the association between the anatomic variations with maxillary sinusitis.

Chi-square test showed a statistically significant relationship between the presence of paradoxical middle concha and the deviation of the middle nasal septum with an increase in the thickness of the sinus mucosa (sinusitis) (P≤0.001). Moreover, Student's t-test showed no statistically significant difference between the healthy and patient groups in the dimensions of concha bullosa, agger nasi cell, and ethmoid bulla.

The findings of our study showed a relationship between paradoxical middle concha and deviation of the middle nasal septum with sinusitis of maxillary sinus. However, other sinonasal anatomical variations were not associated with the development of sinusitis.