MORPHOLOGICAL STUDY OF THE PARANASAL SINUSES USING MULTIDETECTOR COMPUTED TOMOGRAPHY AND ITS CLINICAL APPLICATIONS IN PLANNING ENDOSCOPIC SINUS SURGERY PROCEDURE IN UTTAR PRADESH, INDIA

Abstract

Background and Introduction: The paranasal sinuses exhibit considerable anatomical variability that carries direct implications for the safety and success of functional endoscopic sinus surgery (FESS). Preoperative multidetector computed tomography (MDCT) remains the gold standard for identifying sinonasal anatomical variations, assessing disease severity, and guiding individualized surgical planning. Despite the clinical importance of this data, region-specific normative and variation-prevalence information from central India remains limited, creating a significant evidence gap for surgeons practicing in this population.

Methods: A descriptive, observational, cross-sectional study was conducted over twelve months from January 2025 to December 2025 at the Department of Anatomy in collaboration with the Department of Radiology and Imaging, Autonomous State Medical College, Kanpur Dehat, Uttar Pradesh. A total of 50 adult MDCT scans of the paranasal sinuses were evaluated using multiplanar coronal, axial, and sagittal reconstructions. Anatomical variations, sinus dimensions, Keros classification of olfactory fossa depth, and Lund-Mackay disease severity scores were systematically documented using a predesigned proforma. Data were analyzed using IBM SPSS version 23 with descriptive statistics, chi-square testing, and Pearson’s correlation coefficient.

Results: Nasal septal deviation was the most prevalent variation, identified in 62.0 percent of participants, followed by aggernasi cells (54.0%), concha bullosa (42.0%), enlarged inferior turbinate (34.0%), and Haller cells (26.0%). Onodi cells were present in 20.0 percent of cases. Keros Type II olfactory fossa depth was the most common configuration (52.0%), while the surgically high-risk Keros Type III was found in 18.0 percent of participants. Lund-Mackay scoring revealed moderate sinusitis as the predominant disease category (46.0%), with a statistically significant association between anatomical variations and greater disease severity (p = 0.006). Maxillary and frontal sinus dimensions showed statistically significant gender-based differences, with males recording larger measurements.

Conclusion: This study provides clinically relevant, region-specific MDCT data on paranasal sinus morphology and anatomical variations from central India, documenting a high prevalence of surgically significant variants. The findings support the mandatory use of structured preoperative MDCT evaluation incorporating Keros classification and Lund-Mackay scoring to improve surgical safety and outcomes in patients undergoing endoscopic sinus surgery.