Anatomical Variations in Superior Attachment of Uncinate Process on CT Nose and Paranasal Sinus

BACKGROUND: Uncinate process is considered as one of the most important surgical landmarks. Its superior attachment shows great anatomic variability. During endoscopic sinus surgeries, the uppermost segment of unicinate process is a blind spot for the surgeons. Thus, the aim of this study was to observe the superior attachment and presence of any other variation in uncinate process, knowledge of which may reduce the rate of complications during endoscopic sinus surgery.

MATERIAL AND METHOD: This cross sectional observational study was conducted by Postgraduate Department of Anatomy in collaboration with Department of Radio-diagnosis and Imaging, Government Medical College, Srinagar . This study was done on 200 cases. Non-contrast CT scan Nose and Paranasal sinuses (NCCT Nose &PNS) was done. The superior attachment of uncinate process was noted in 400 sides and categorized. Besides  any variations in uncinate process were also studied.

RESULTS: In our study of 200 cases (400 sides), in majority i.e. 317 (79.25%) sides uncinate process was superiorly attached to Lamina papyracea (type 1), in 61 (15.25%) attached to skull base(type 2) and in 22 (5.50%) sides uncinate process was attached to middle turbinate(type 3). Our study makes trend of type 1>type2>type3.Also,In 200 cases, pneumatized UP was found in 4 (2.00%) cases, 3 (1.50%) on left side and 1 (0.50%) on right side while only in 1(0.50%) case hypertrophied UP was found on left side.

CONCLUSION: It is necessary for the surgeon to be cognisant of any of the uncinate process variations in the patient undergoing functional endoscopic sinus surgery especially when an uncinatectomy is planned.