Computed tomographic analysis of sinonasal anatomical variations and their role in the pathogenesis of chronic rhinosinusitis

Abstract

Abstract Background Chronic rhinosinusitis (CRS) is a prevalent inflammatory disorder of the nose and paranasal sinuses that significantly affects quality of life. Although multiple anatomical variations of the sinonasal region—particularly involving the uncinate process and osteomeatal complex—have been implicated in CRS pathogenesis, their exact role remains controversial. Objectives To evaluate anatomical variations of the uncinate process and related sinonasal structures on computed tomography (CT) and to analyze their association with chronic rhinosinusitis. Materials and methods This prospective comparative cross-sectional study included 200 adult patients who underwent non-contrast CT of the paranasal sinuses between March 2024 and February 2025. The study population comprised 100 patients diagnosed with CRS (Group 2) and 100 asymptomatic individuals undergoing CT for non-sinonasal indications (Group 1). CT scans were evaluated for uncinate process morphology, angulation, orientation, superior attachment (Landsberg and Friedman classification), pneumatization, concha bullosa, nasal septal deviation, osteomeatal complex variations, frontal recess cells (frontoethmoidal classification), supraorbital cells, Haller cells, and maxillary sinus volumes. Statistical comparisons were made between the two groups. Results The two groups were comparable in age and sex distribution. Most anatomical variations, including nasal septal deviation, uncinate process angulation, orientation, pneumatization, concha bullosa, osteomeatal complex configuration, Haller cells, and maxillary sinus volumes, showed no statistically significant difference between CRS and asymptomatic groups ( p > 0.05). A significant difference was observed in the right-sided frontoethmoidal classification ( p = 0.049) and in the presence of supraorbital cells on both sides ( p < 0.001), with a higher prevalence noted in asymptomatic individuals. Conclusion Anatomical variations of the uncinate process and adjacent sinonasal structures are common findings on CT and occur with similar frequency in individuals with and without chronic rhinosinusitis. These results support the concept that CRS is primarily a multifactorial inflammatory condition, and that anatomical variations alone are insufficient to explain disease pathogenesis or to justify surgical intervention in the absence of correlating clinical and inflammatory factors.