Discussion
CRSwNP is known to have a great impact on pediatric patients and often needs surgical intervention. The knowledge of anatomic variations has great significance in the treatment of CRSwNP. However, most previous studies concentrated on pediatric CRS due to the very low prevalence of CRSwNP.
For pediatric CRS, the prevalence of involved sinus has been inconsistent. The incidence of maxillary sinusitis ranged from 51-89%; anterior ethmoid sinusitis, from 15-85%; posterior ethmoid sinusitis, from 16-57%; frontal sinusitis, from 2-63%; and sphenoid sinusitis, from 13-37%.10,11,12 Most studies suggested that the maxillary sinus was the most commonly involved sinus in pediatric CRS.10 In our study, the incidence of sinusitis was significantly higher compared with previous data on CRS reported by Mohannad, 13, implying that CRSwNP was the one disease entity with more severe inflammation compared with CRS.
The frequencies of anatomical variations in CRS varied in different studies. Al-Qudah13 and Kim14reported that the Agger nasi cell was the most common anatomical variation,13,14 followed by septal deviation, Haller cell, concha bullosa, paradoxical middle turbinate, and Onodi cell. In van der Veken’s study15, anatomic variations in 196 CRS children were determined as concha bullosa in 8%, Haller’s cell in 3%, and septal deformity in 46% of the children. The study by April et al.16 found that the incidence of anatomic variations in CRS children was 19% of the concha, 18% of Haller’s cell, 13% of septal deformity, 7% of the paradoxical middle turbinate. The study by Balak et al. 17 found concha bullosa in 28%, septal deviation in 23%, over pneumatized ethmoidal bulla in 17%, Haller’s cell in 14%, paradoxical middle turbinate in 9%, and uncinate process variations in 9% of CRS children. In our study, Agger nasi cells were found in 96% of cases, followed by inferior turbinate hypertrophy, septal deviation, concha bullosa, Onodi cells, Haller cells, and paradoxical middle turbinate, which was significantly higher compared with previous data on pediatric CRS.
When the population was divided into 6-12 and 13-18 age groups, we found that septal deviation and concha bullosa were more common in the older children group. Previous studies also showed that the prevalence of septal deviation and Concha bullosa increased with age.
Despite the high prevalence of anatomic variations in CRSwNP, we found no correlation between anatomic variation and the corresponding onset of sinusitis. Consistently, Al-Qudah13 and Kim14 showed no correlation between rhinosinusitis and anatomical variations in pediatric chronic rhinosinusitis.
Our study had the following limitations. First, the number of cases was small due to the very low prevalence of pediatric CRSwNP. Second, the lack of CRS and normal control weakened our conclusion. However, we found that the prevalence of anatomical variations in CRS children was far lower than that of our CRSwNP children by searching previous studies. Third, the direct correlation between NP and anatomical variations needs further exploration.
Thus, our results found no correlation between anatomic variations and sinusitis in pediatric CRSwNP. The occurrence of pediatric CRSwNP was largely attributed to immunological, infection, or other factors rather than anatomic variations. Therefore, surgery for pediatric CRSwNP should concentrate on the removal of the polyp and pathological tissue. The removal of anatomic variations should be avoided to reduce the possibility of abnormal facial bony growth.