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The anatomical variations of the lateral wall of nose may create technical difficulties during surgery and increase predisposition for chronic rhinosinusitis (CRS). Various cadaveric and radiological studies have been carried out to identify the variations of critical landmarks in sinonasal anatomy. However, studies analyzing the nasal endoscopic examination of living patients are scarce. Objective: The aim of the study was to compare the anatomical variations in the middle meatus of patients having CRS with that of normal population. Materials and methods: This was a prospective clinical study, where 700 subjects (1,400 middle meatus) were subjected to diagnostic nasal endoscopy, over a period of 2 years. A total of 350 subjects each with CRS and normal population were included in the case and control group, respectively. Endoscopic examination of nasal cavity was done to observe the middle meatus configuration. Results: The anatomical variations in the case group were significantly higher that of control. The most common atypical anatomical presentation in both the case and control group were atypical agger nasi (14 vs 7%, p-value = 0.0001), concha bullosa in middle turbinate (12 vs 9%, p-value = 0.0809), medially projected uncinate process (10 vs 4%, p-value = 0.0001), and sausage shaped ethmoid bulla (18 vs 10%, p-value = 0.0001). Interestingly, opening of ethmoid bulla was also observed in both the groups. Conclusion: The prevalence of anatomic variations is significantly higher in the case group. However, the detection of a single anatomical variant itself does not establish the genesis of pathophysiology of CRS. Familiarity with such anatomy is important to optimize surgical treatment of sinus disease, while avoiding complications.

Study of the Anatomical Variations in the Middle Meatus on Nasal Endoscopy