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.