Evaluation and comparison of the paranasal sinus anatomic variations between pediatric patients with orbital complications of acute rhinosinusitis and the general pediatric population by computed tomography and evaluation of its effect on the clinical course

Objective and hypothesis : The aim of this study was to evaluate and compare the nasal and paranasal sinus anatomic variations between the pediatric patients with orbital complications of acute rhinosinusitis (ARS) and the general pediatric population without nasal and paranasal sinus diseases. In addition, the variables related to the patient, disease and treatment process that may affect the course of the clinic were planned to analyze in the patient group. In this way, it is aimed to determine whether paranasal sinus anatomical variations are risk factors for the development of complications, whether they affect the course of the clinic, and to reveal the other parameters that may affect the clinical course. Materials and Method : Fifty-two pediatric patients who were hospitalized for orbital complications of ARS in the Department of Otorhinolaryngology, Dokuz Eylül University, between January 2010 and June 2020 and underwent computed tomography (CT) imaging were identified as case group and their medical charts were reviewed retrospectively. As for the control group, 52 cases selected by simple random sampling from the one-to-one matched group in terms of age and gender among the pediatric maxillofacial CTs taken at the Radiology Department of Dokuz Eylül University between January 2017 and June 2020, were included. The nasal and paranasal sinus anatomical variations (septum deviation, septal spur, concha bullosa, paradoxical middle turbinate, hypoplasic middle turbinate, Haller cell, Agger Nasi cell, Onodi cell) on CT were evaluated in both groups and compared usign the Chi-Square test. The difference of the patients' clinical variables (age, gender, treatment method, hospitalization time, time between the onset of complaints and admission to the institution, recurrence, choise of antibiotherapy, treatment and type before admission to the institution, affected sinuses, complication side, sociocultural level, smoking in the family, number of siblings, time between onset of rhinosinusitis and the development of ocular findings, intraorbital air, season, endoscopic adenoid examination, otoscopic examination findings, use of nasal steroids and topical decongestants, tonsil and adenoid surgery, fever, laboratory data (C-Reactive protein (CRP), white blood cell (WBC), erythrocyte sedimentation rate (ESR) hemoglobin level, control CRP, control WBC, control laboratory day) between the Chandler classification groups and the correlation of them with these groups were analyzed with the Kruskall-Wallis and Kendall correlation tests. Clinical data were evaluated by specialist ENT physicians and radiological data were evaluated by specialist radiologists. Results : All nasal and paranasal sinus anatomic variations were found to be statistically similar in both groups in the evaluation performed regardless of the side in the case and control groups (p>0.05). Considering the anatomical variations on the complication side in the case group, it was demostrated that septum deviation (p=0.006), concha bullosa (p=0.001), Haller cell (p=0.028), Agger nasi cell (p=0.01) and Onodi cell (p=0.031) in the control group were significantly higher than the case group. No statistically significant difference was observed between the two groups in favor of the case group in any anatomical variation. When the clinical data were evaluated, a significant difference and correlation was observed between the groups in terms of treatment method (p=0.007, Kendall correlation coefficient=0.363), treatment received before admission to the institution (p=0.014, Kendall correlation coefficient=0.319), ocular findings (p<0.001, Kendall correlation coefficient=0.611), recurrence (p=0.025, Kendall correlation coefficient=0.302), fever (p=0.034, and hospitalization time (p<0.001,) according to Chandler classification, while other parameters were found to be statistically similar (p> 0.05). Conclusion : The nasal and paranasal sinus anatomical variations are found not to be as a risk factor for the development of ARS orbital complications in the pediatric age group. In pediatric ARS orbital complications, treatment method, treatment received before admission to the institution, ocular findings, recurrence, fever, and hospitalization time were demostrated to affect the clinical course. Although we did not detect a relationship between ARS orbital complications in the pediatric age group and anatomic variations of the nose and paranasal sinus in our study, we suppose that further studies on this issue particularly those including pediatric ARS patients without complications are needed, as well.