Volumetric analysis of maxillary sinus and assessment of various sinonasal anatomic variants on multi-detector computed tomography (MDCT) and their association with chronic rhinosinusitis

Objectives: The study aimed to evaluate the relationship between maxillary sinus volume and various sinonasal anatomical variants, as detected by multi-detector computed tomography, and their associations with chronic rhinosinusitis (CRS).

Material and methods: A case-control study was conducted with 103 patients presenting with chronic sinonasal symptoms (cases) and 50 asymptomatic individuals (controls). A 128-slice computed tomography scanner was used to measure maxillary sinus volume and assess anatomical variants, such as a deviated nasal septum (DNS), concha bullosa (CB), and agger nasi cells. Exclusion criteria included previous sinonasal surgery, malignancy, craniofacial trauma, and lack of consent. Statistical analysis was performed using t-tests for continuous variables and Chi-square tests for categorical data. Receiver operating characteristic curve analysis was utilized to determine a DNS angle cutoff for predicting CRS.

Results: Anatomical variants were significantly more frequent in cases than in controls. The left-sided DNS was predominant in cases, while the right-sided DNS was more common in controls. The mean DNS deviation angle was notably larger in cases (10.84° ± 7.87) than in controls (5.55° ± 5.02). Maxillary sinus volume was significantly smaller in cases (9.69 cc on the left side and 10.23 cc on the right side) compared to controls (18.57 cc and 18.46 cc, respectively), with female patients exhibiting smaller volumes than males. Agger nasi cells were detected in 51.5% of cases versus 8.0% of controls. A strong association was found between CB and contralateral DNS. The optimal DNS deviation angle cutoff for predicting CRS was identified as 12.7°.

Conclusion: This study shows that CRS is linked to smaller maxillary sinus volumes, with males having larger sinus volumes than females. A DNS and larger deviation angles were associated with a higher risk of sinus inflammation, with angles over 12.7° predicting the onset of the condition. The presence of CB and agger nasi cells also contributed to the development of CRS.