Radiological anatomy analysis of uncinate process, concha bullosa, and deviated septum in chronic rhinosinusitis

Background: Risk factors of chronic rhinosinusitis include epithelial disease related to disturbanceof mucociliary transport system, anatomical variations obstructing the ostiomeatal complex anddysfunction of neural regulation. Purpose: To find the prevalence of deviated septum, concha bullosa andlateral deflection of the uncinate process in ipsilateral chronic rhinosinusitis. Methods: A retrospectivestudy of computed tomographic (CT) scans of chronic rhinosinusitis patients who were not cured by6 weeks of maximal medical treatment of rhinosinusitis. Pneumatization of the middle turbinate anddeviation of the septum were evaluated on coronal slices, while lateral deflection of the uncinate processwas also assessed by calculating the angle using Osirix software (Pixmeo, Geneva, Switzerland). Results:One hundred ninety-three CT scans comprising 386 nasal sides were analyzed. The prevalence of thecombination of deviated septum, concha bullosa and lateral deflection of the uncinate process occurringconcurrently with ipsilateral maxillary sinusitis was found to be 32,9% (p=0.01, OR=9.1, 95% CI=1.2-69.7). The prevalence of deviated septum with concha bullosa was found in 40.9% with ipsilateral maxillarysinusitis (p=0.03, OR=3.8, 95% CI=1.1-13.3). One single anatomical variation of lateral deflection ofthe uncinate process had a proportion of 71.5% in ipsilateral maxillary sinusitis (p=0.03, OR=2.7 95%CI=1.1-6.9). Conclusion: Deviated septum, concha bullosa and lateral deflection of the uncinate processwere frequently present in the existence of ipsilateral chronic maxillary rhinosinusitis. It suggested greaterassociation compared to one or a combination of two anatomical variation in the role of local factorscontributing to sinonasal epithelial dysfunction.