Evaluation of Paranasal Sinus Anatomic Variations: Otolaryngologist versus Radiologist

Öz

Objective: This study aimed to investigate whether or not there is a difference between clinical branches in the determination of anatomic variations, through the evaluation of Paranasal sinus computed tomography (PCT) images by an otolaryngology specialist and a radiology specialist. Material and Method: The axial and coronal PCT images were evaluated separately by an otolaryngology and radiology specialist. The anatomical variations found were compared. Results: A statistically significant difference was determined between the otolaryngology specialist and the radiology specialist in respect of the evaluations of septal deviation, concha bullosa, paradoxical middle concha, accessory maxillary sinus ostium, Haller cell, agger nasi cell, asymmetric olfactory fossa, and onodi cell (p<0.001). No statistically significant difference was determined between the two observers in respect of the evaluation of the anatomic variations of maxillary sinus pneumatization and pneumatized anterior clinoid process (ACP), and of the optic nerve sphenoid sinus relationship (p > 0.05). Conclusion: PCT has an important role in the diagnosis of sinonasal diseases and in the evaluation of the extremely variable anatomic structures. A detailed consensus on this subject would provide both standardizations in evaluations and allow real and comparable rates in the determination of variations to be made in the future.

Anahtar Kelimeler

• Paranasal sinuses
• Tomography
• Otolaryngology
• Radiology

Paranazal Sinüs Anatomik Varyasyonlarının Değerlendirilmesi: Kulak Burun Boğaz Uzmanı ve Radyolog Karşılaştırması

Öz

Amaç: : Bu çalışmanın amacı, bir kulak burun boğaz uzmanı ve bir radyoloji uzmanı tarafından yapılan paranazal bilgisayarlı tomografi (PBT) görüntülemeleri aracılığıyla anatomik varyasyonların belirlenmesinde klinik branşlar arasında fark olup olmadığını araştırmaktır. Gereç ve Yöntem: Aksiyel ve koronal PBT görüntüleri, bir kulak burun boğaz uzmanı ve bir radyoloji uzmanı tarafından ayrı ayrı değerlendirildi. Tespit edilen anatomik varyasyonlar karşılaştırıldı. Bulgular: Septal deviasyon, konka bülloza, paradoksal orta konka, aksesuar maksiller sinüs ostiumu, Haller hücresi, agger nasi hücresi, asimetrik olfaktör fossa ve Onodi hücresi değerlendirmelerinde kulak burun boğaz ve radyoloji uzmanları arasında istatistiksel olarak anlamlı fark bulundu (p<0.001). Maksiller sinüs pnömatizasyonu, pnömatize anterior klinoid çıkıntı ve optik sinir–sfenoid sinüs ilişkisi değerlendirmelerinde ise iki gözlemci arasında istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Sonuç: PBT, sinonazal hastalıkların tanısında ve oldukça değişken anatomik yapıların değerlendirilmesinde önemli bir rol oynamaktadır. Bu konuda sağlanacak detaylı bir fikir birliği, hem değerlendirmelerde standardizasyonu sağlayacak hem de gelecekte varyasyonların belirlenmesinde daha gerçekçi ve karşılaştırılabilir oranların elde edilmesine olanak tanıyacaktır.

Anahtar Kelimeler

• Paranazal Sinüsler
• Tomografi
• Otolaringoloji
• Radyoloji

Kaynakça

1. Ernst BP, Reissig MR, Strieth S, Eckrich J, Hagemann JH, Doge J, et.al. The role of structured reporting and structured operation planning in functional endoscopic sinus surgery. PLoS One. 2020;15(11):e0242804.
2. Ali A, Kurien M, Shyamkumar NK, Selveraj S. Anterior skull base: High risk areas in endoscopic sinus surgery in chronic rhinosinusitis: A computed tomographic analysis. Indian J Otolaryngol Head Neck Surg. 2005;57(1):5-8.
3. Adeel M, Rajput MS, Akhter S, Ikram M, Arain A, Khattak YJ. Anatomical variations of nose and paranasal sinuses; CT scan review. J Pak Med Assoc. 2013;63(3):317-319.
4. DeLano MC, Fun FY, Zinreich J. Relationship of the optic nerve to the posterior paranasal sinuses: a CT anatomic study. Am J Neuroradiol. 1996;17(4):669-675.
5. Reiner BI, Knight N, Siegel EL. Radiology reporting, past, present, and future: the radiologist’s perspective. J Am Coll Radiol. 2007;4(5):313-319.
6. Papadopoulou AM, Chyrsikos D, Samolis A, Tsakatos G, Troupis T. Anatomical Variations of the Nasal Cavities and Paranasal Sinuses: A Systematic Review. Cureus 2021 Jan 15;13(1):e12727.
7. Devaraja K, Doreswamy SM, Pujary K, Ramaswamy B, Pillai S. Anatomical variations of the nose and paranasal sinuses: a computed tomographic study. Indian J Otolaryngol Head Neck Surg. 2019;71(3):2231-2240.
8. Mladina R, Cujić E, Subarić M, Vuković K. Nasal septal deformities in ear, nose, and throat patients: an international study. Am J Otolaryngol. 2008;29(2):75-82.

9. Koo SK, Kim JD, Moon JS, Jung SH, Lee SH. The incidence of concha bullosa, unusual anatomic variation and its relationship nasal septal deviation: A retrospective radiologic study. Auris Nasus Larynx. 2017;44(5):561-570.
10. Tiwari R, Goyal R. Study of anatomical variations on CT in chronic sinusitis. Indian J Otolaryngol Head Neck Surg. 2015;67(1):18-20.
11. Alsowey AM, Abdulmonaem G, Elsammak A, Fouad Y. Diagnostic performance of multidetector computed tomography (MDCT) in diagnosis of sinus variations. Pol J Radiol. 2017;82:713-725.
12. Bolger WE, Woodruff JWW, Morehead J, Parsons DS. Maxillary sinus hypoplasia: classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg. 1990;103(5(Pt 1)):759-765.
13. Erdem T, Aktas D, Erdem G, Miman MC, Ozturan O. Maxillary sinus hypoplasia. Rhinology. 2002;40(3):150-153.
14. Ali IK, Sansare K, Karjodkar F, Saalim M. Imaging analysis of Onodi cells on cone-beam computed tomography. Int Arch Otorhinolaryngol. 2020;24(3):e319-e322.
15. Driben JS, Bolger WE, Robles HA, Cable B, Zinreich SJ. The reliability of computerized tomographic detection of the Onodi (sphenoethmoid) cell. Am J Rhinol. 1998;12(2):105-111.
16. Tomovic S, Esmaeili A, Chan NJ, Choudhry OJ, Shukla PA, Liu JK, et.al. High-resolution computed tomography analysis of the prevalence of Onodi cells. Laryngoscope. 2012;122(7):1470-1473.
17. Chmielik LP, Chmielik A. The prevalence of the Onodi cell: most suitable method of CT evaluation in its detection. Int J Pediatr Otorhinolaryngol. 2017;97:202-205.
18. Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101(1Pt1):56-64.
19. Keast A, Yelavic S, Dawes P, Lyons B. Anatomical variations of the paranasal sinuses in Polynesian and New Zealand European computerized tomography scans. Otolaryngol Head Neck Surg. 2008;139(2):16-21.
20. Kaya M, Çankal F, Gumusok M, Apaydin N, Tekdemir I. Role of anatomic variations of paranasal sinuses on the prevalence of sinusitis: Computed tomography findings of 350 patients. Niger J Clin Pract. 2017;20(11):1481-1488.
21. Hung K, Montalvao C, Yeung AWK, Li G, Borstein MM. Frequency, location, and morphology of accessory maxillary sinus ostia: a retrospective study using cone beam computed tomography (CBCT). Surg Radiol Anat. 2020;42(2):219-228.
22. Kaplanoglu H, Kaplanoglu V, Dilli A, Toprak U, Hekimoğlu B. An analysis of the anatomic variations of the paranasal sinuses and ethmoid roof using computed tomography. Eurasian J Med. 2013;45(2):115-125.
23. Itagi RM, Adiga CP, Kalenahalli K, Goolahaly L, Gyanchandani M. Optic nerve canal relation to posterior paranasal sinuses in Indian ethnics: Review and objective classification. J Clin Diagn Res. 2017;11(4):TC01-TC03.
24. Abozed M, Alsulaiti G, Almannaei F, Raza A, El Beltagi A, Ayyad A. Anterior clinoid mucocele causing optic neuropathy: A case report and review of literature. eNeurologicalSci. 2017;7:57-59.
25. Abuzayed B, Tanriover N, Biceroglu H, Yuksel O, Tanriover O, Albayram S, et.al. Pneumatization degree of the anterior clinoid process: a new classification. Neurosurg Rev. 2010;33(3):367-373.
26. Murthy A, Santosh B. A study of clinical significance of the depth of olfactory fossa in patients undergoing endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg. 2017;69(4):514-522.