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Background <p>Anatomical variations of the paranasal sinuses, particularly those involving the lamina papyracea (LP), internal carotid artery (ICA), and optic canal (OC), may significantly increase the risk of complications during functional endoscopic sinus surgery (FESS). High-resolution computed tomography (CT) plays a critical role in identifying these variations preoperatively. In this context, the objective of the present study is to determine the prevalence and radiological characteristics of LP dehiscence, ICA protrusion/dehiscence, and optic canal protrusion/dehiscence in a large CT cohort.</p> Methods <p>This retrospective study included 3052 patients who underwent paranasal CT between June 2020 and October 2025. Patients younger than 18 years, those with maxillofacial trauma, or with prior sinonasal surgery were excluded. All CT scans were acquired using a 128-slice multidetector system. Two blinded radiologists evaluated LP, ICA, and OC variations; LP dehiscence was classified into three grades. ICA and optic canal protrusion were graded as &lt; 50% or ≥ 50% based on the extent of canal invagination into the sphenoid sinus cavity. Statistical analyses were performed with a significance level of <i>p</i> &lt; 0.05.</p> Results <p>LP dehiscence was identified in 70 patients (2.3%), more common in males (<i>p</i> = 0.046). Most cases were unilateral (95.7%) and located in the anterior ethmoid cells (75.7%). Grade 1 was the most common type (70%). ICA protrusion was detected in 241 patients (7.9%), with 50.6% being bilateral. ICA dehiscence occurred in 24 patients (0.8%), with no significant right–left difference. OC protrusion was present in 544 patients (17.8%), nearly half bilateral (46.3%). OC dehiscence was identified in 101 patients (3.3%). Sex-related differences were observed in the laterality distribution of lamina papyracea dehiscence and optic canal variants, whereas ICA laterality did not differ significantly.</p> Conclusions <p>LP dehiscence, ICA protrusion/dehiscence, and OC protrusion/dehiscence are clinically relevant variations that must be recognized prior to FESS. Their detection on CT is essential for surgical planning, as failure to identify these high-risk anatomical features may lead to serious complications such as optic nerve injury or ICA hemorrhage. Routine and systematic CT evaluation should therefore be considered mandatory in all sinonasal surgical candidates.</p> Trial registration <p>Not applicable.</p>

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Anatomical variations of lamina papyracea, internal carotid artery, and optic canal dehiscence and protrusion: a computed tomography retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月9日

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  • Ozan Tuysuz,
  • Semih Tekin,
  • Ali Dablan,
  • Sude Zeynep Mutlu,
  • Mehmet Karagulle

摘要

Background

Anatomical variations of the paranasal sinuses, particularly those involving the lamina papyracea (LP), internal carotid artery (ICA), and optic canal (OC), may significantly increase the risk of complications during functional endoscopic sinus surgery (FESS). High-resolution computed tomography (CT) plays a critical role in identifying these variations preoperatively. In this context, the objective of the present study is to determine the prevalence and radiological characteristics of LP dehiscence, ICA protrusion/dehiscence, and optic canal protrusion/dehiscence in a large CT cohort.

Methods

This retrospective study included 3052 patients who underwent paranasal CT between June 2020 and October 2025. Patients younger than 18 years, those with maxillofacial trauma, or with prior sinonasal surgery were excluded. All CT scans were acquired using a 128-slice multidetector system. Two blinded radiologists evaluated LP, ICA, and OC variations; LP dehiscence was classified into three grades. ICA and optic canal protrusion were graded as < 50% or ≥ 50% based on the extent of canal invagination into the sphenoid sinus cavity. Statistical analyses were performed with a significance level of p < 0.05.

Results

LP dehiscence was identified in 70 patients (2.3%), more common in males (p = 0.046). Most cases were unilateral (95.7%) and located in the anterior ethmoid cells (75.7%). Grade 1 was the most common type (70%). ICA protrusion was detected in 241 patients (7.9%), with 50.6% being bilateral. ICA dehiscence occurred in 24 patients (0.8%), with no significant right–left difference. OC protrusion was present in 544 patients (17.8%), nearly half bilateral (46.3%). OC dehiscence was identified in 101 patients (3.3%). Sex-related differences were observed in the laterality distribution of lamina papyracea dehiscence and optic canal variants, whereas ICA laterality did not differ significantly.

Conclusions

LP dehiscence, ICA protrusion/dehiscence, and OC protrusion/dehiscence are clinically relevant variations that must be recognized prior to FESS. Their detection on CT is essential for surgical planning, as failure to identify these high-risk anatomical features may lead to serious complications such as optic nerve injury or ICA hemorrhage. Routine and systematic CT evaluation should therefore be considered mandatory in all sinonasal surgical candidates.

Trial registration

Not applicable.