Anatomical Variations of Rhinogenic Headache and Its Relation with Sinusitis: A Computerized Tomography (CT) Scan Study

Background: Variable anatomy, hallmark of sinonasal region is the reason for the etiology of sinonasal symptoms such as rhinogenic headache. This study aimed to investigate the incidence of anatomical variations of the nasal cavity and paranasal sinuses in sinusitis patients with complaint of rhinogenic headache on computed tomography of paranasal sinuses, and the correlation of these variants with a rhinogenic headache. Methods: A prospective cross-sectional study (n=50) of 18-60 years having sinusitis with rhinogenic headache was steered at the Department of Radiology in the PNS Shifa Hospital of Karachi, Pakistan, between June-December 2021. After obtaining written informed consent, all subjects were investigated for various anatomical variants of the sinonasal region detected on computed tomographic scans of paranasal sinuses and were correlated with a rhinogenic headache. The Chi-square test and Pearson correlation were applied for statistical analysis and the level of significance was set at p≤ 0.05. Results:  The most common anatomical variant of sinonasal region detected was agger nasi cells 32(64%) (Right: r/r -0.24, p =0.09; Left: r/r -0.28, p = 0.04), followed by deviated nasal septum 28(56%) (r/r 0.04, p= 0.75), concha bullosa 23(46%) (r/r 0.07, p=0.59), deviated nasal septum with bony spur (r/r 0.07, p=0.62) and other variants. The overall, study found male (68%) predominance. Significant association existed between rhinogenic headache and some of the anatomical variants along with sinus mucosal thickening (p<0.05). Conclusion: The significant association (p<0.05) was found between rhinogenic headache and different anatomical variants like agger nasi cells, left-sided agger nasi cells, right-sided Haller’s cells, left-sided maxillary and ethmoid sinusitis. Keywords: Rhinogenic Headache; CT-PNS; Sinonasal Region; Anatomical Variants

Use of Computed Tomography for Nasal and Paranasal Anatomic Variants

Augmentations and improvements in sinus surgical methods and computed tomography (CT) have concurrently elaborated interest in variable anatomical features of the nasal cavity and paranasal sinuses (PNS). Anatomical variations are normal morphological structures that are present in humans. The presence of these anatomical variations can affect nearby anatomical relations resulting in structural modifications. By the broad perspective of anatomical features in the sinonasal area, certain anatomical characteristics are supposed to be a risk factor for the advancement of sinus pathological conditions and hence it should be essential for the radiologist to be conscious of the variable anatomical structures residing within the nasal and PNS area, significantly if the treatment plan includes surgical procedures. The sinonasal tomographic imaging is required in symptomatic subjects of sinusitis to evaluate the mysterious sinonasal anatomy including morphology, variations, detailed bony visualization, and pathologies within the sinonasal region and surroundings. This review includes studies from 2013-2023 which were extracted from searching databases like Google Scholar, Internet sources, PubMed, Scopus, and Medline to establish a critical review of hidden anatomy of nasal and paranasal sinus region, detected by computed tomography and highlight the operative significance to enhance the surgical outcomes globally