PARANASAL SINUS ANATOMICAL DIFFERENCES IN ELDERLY PATIENTS

Introduction: Endonasal endoscopic sinus surgeries performed on elderly patients can be challenging due to anatomical variations, and can be studied using preoperative computed tomography. The aim of the present study was to evaluate paranasal sinus anatomical differences in elderly patients compared to a younger control group. Materials and Methods: We retrospectively evaluated paranasal computed tomography scans of 47 elderly patients (>65 years old) (Elderly group) and 47 younger patients (Control group) for midfacial skeletal size (interzygomatic buttress distance, nasion-basion distance), anatomical variations, dimensions, and paranasal sinus volumes. Results: The mean age of the Elderly group was 69.89 years (65-81 years) and the mean age of the Control group was 33.15 years (20-49 years). There was no significant difference in midfacial size between the two groups. The prevalence of Keros Type III olfactory fossa was significantly higher in the Elderly group than in the Control group (p<0.05). The Elderly group had a significantly lower mean maxillary sinus volume (p<0.01) and mean anteroposterior diameter of the sphenoid sinus (p<0.01) compared to the Control group. Furthermore, there was no significant difference in the maxillary sinus volume between the elderly edentulous and dentulous patients(p>0.05). Conclusion: Elderly patients have more Keros Type III olfactory fossa, which confers a higher risk of iatrogenic cerebrospinal fluid leakage during endoscopic sinus surgery. The preoperative detailed evaluation of computed tomography scans of elderly patients should include, but not be limited to, the ethmoid roof for deep olfactory fossa, and the sphenoid sinus for its narrow anterioposterior dimention.