Copyright © 2016 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Anatomic Variations in Paranasal Sinuses of Patients With Sinonasal Polyposis: Radiological Evaluation Bilge Tu¨rk, MD,  Meltem Akpinar,  Abdullah Soydan Mahmutog˘lu, MD, y Irmak Uc¸ak, MD,  and Berna Uslu Cos¸kun, MD  Objective: Although sinonasal anatomic variations have been postulated as a risk factor for sinus disease, the role of anatomic abnormalities in the pathogenesis of nasal polyps is still unclear. This study was conducted to examine the association of sinonasal polyposis with anatomic variations. Methods: The paranasal sinus computerized tomography scans of 155 patients with sinonasal polyposis were examined retrospectively from January 2012 to 2014 in a tertiary care hospital. Paranasal sinus computerized tomography of 100 patients without complaints and signs of sinus disease were also included to serve as control group. The incidence of anatomic variations was evaluated. The sinonasal polyposis and control group data was compared statistically. Results: The incidence of the septal deviation, concha bullosa, Agger nasi, frontal sinus hypoplasiaand accessory sinus ostium in healthy subjects, and sinonasal polyposis patients revealed statistically significant difference. The mentioned variations were found significantly higher in sinonasal polyposis patients (P ¼ 0.000, P ¼ 0.000, P ¼ 0.001, P ¼ 0.002, and P ¼ 0.035 respectively) and may be predisposing for this pathology. Conclusion: Considering the results obtained, the presence of septal deviation, concha bullosa, Agger nasi cell, frontal sinus hypoplasiaand accessory sinus ostium may play role in pathogenesis of sinonasal polyposis. Key Words: Anatomic variations, computed tomography, nasal polyposis, paranasal sinuses (J Craniofac Surg 2016;27: 1336–1339) N asal polyps are idiopathic perennial, reactive, inflammatory condition of mucous membranes of nose and paranasal sinuses. Nasal polyposis increases with age and occurs more frequently in men than women. They affect up to 4% of the population. The etiology remains unclear, but there is a known association with allergy, asthma, infection, cystic fibrosis, and aspirin sensitivity. Other causes of nasal polys include nonallergic rhinitis, vasomotor rhinitis. Most patients originate in the lateral aspect of the middle meatus. Polyp epithelium contains a large number of mast cells, eosinophils, and high histamine concen- trations. Eosinophil-dominated diffuse nasal polyposis behaves differently from the noneosinophil-dominated nasal polyposis. The eosinophil-dominated polyp has a close relationship with asthma and analgesic intolerance. 1–3 Computerized tomography (CT) is a significant technique for the evaluation of paranasal sinuses, as it provides an applied anatomic view of the paranasal sinuses, and reveals the extent of nasal polyps and chronic rhinosinusitis, as well as frequently encountered anatomic variations. 4 There is a close agreement between those data obtained from CT scans and those provided by anatomic dissection. 5 The anatomic variations in the middle meatus may indicate a predisposition to contact with opposing mucosal surfaces. The congenital anomalies and anatomic vari- ations observed in this region are important, as they may have pathological consequences or may be associated with surgical challenges. 6 The present study was conducted to reveal the radio- logical incidence of anatomical variations and their potential relationship with sinonasal polyposis. METHODS The paranasal CT scans of 155 patients with sinonasal polyposis and 100 healthy subjects were retrospectively analyzed over a 2- year period from January 2012 to 2014. The diffuse sinonasal polyposis patients without active sinus infection and with an age range of 18 to 78-year old (mean, 44  14) were included to the study group (n: 155; 110 men, 45 women). The diagnosis of sinonasal polyposis was based on history, radiological imaging, and endoscopic findings. The subjects without signs of sinus disease on CT were enrolled to the control group (n: 100; 57 men, 43 women; age range 19 – 76 years, with a mean of 43  13 years). The subjects who had prior sinus surgery, evidence of bony or soft tissue trauma, invasive fungal sinusitis, mucocele, other benign or malign neoplasms of the paranasal sinuses were excluded from the study. Nasal endoscopic findings were graded according to Meltzer criteria (Table 1). 7 The study protocol was approved by the Institutional Review Board of the Sisli Hamidiye Etfal Training and Research Hospital. All aspects of the study were conducted according to the Declara- tion of Helsinki. The radiological examination of the paranasal sinuses was performed through coronal and axial CT (Somatom Plus 4; Sie- mens, Erlangen, Germany) with 3-mm sections. The standard bone and soft tissue windows were available. All CT studies were evaluated retrospectively by the same radiologist in the hospital. The parameters searched for were evaluated as ‘‘present’’ or ‘‘absent.’’ The anatomic variations of the nose and paranasal sinuses were evaluated, including septal deviation, concha bullosa, para- doxical middle concha, uncinate pneumatization, Agger nasi cells, infraorbital ethmoid cells (Haller cells), sphenoethmoid cells From the  ENT Clinic; and y Radiology Clinic, S¸is¸li Hamidiye Etfal Training and Research Hospital, S¸is¸li, Istanbul, Turkey. Received December 22, 2015. Accepted for publication March 8, 2016. Address correspondence and reprint requests to Bilge Tu¨rk, MD, ENT specialist, S¸is¸li Hamidiye Etfal Training and Research Hospital, Halasgargazi Street, Etfal Road, 34371 S¸is¸li, Istanbul, Turkey; E-mail: drbilgeturk@hotmail.com This study was carried out at S¸is¸li Hamidiye Etfal Training and Research Hospital in Istanbul. The authors report no conflicts of interest. Copyright # 2016 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000002731 ANATOMICAL STUDY 1336 The Journal of Craniofacial Surgery  Volume 27, Number 5, July 2016