Computed tomography-detected sinonasal anatomical variations in rhinoplasty candidates: a cross-sectional study

Abstract Introduction Rhinoplasty requires precise preoperative evaluation to identify nasal and paranasal sinus variations that may impact surgical outcomes. Computed tomography (CT) is essential for detecting anatomical anomalies, yet data on their frequency in Iranian populations remain limited. This study assessed CT findings in Blindedian rhinoplasty candidates to inform evidence-based planning. Methods This cross-sectional study enrolled 133 patients (mean age 29.44 ± 8.65 years; 70.7% female) scheduled for primary rhinoplasty at Blinded Hospital, Blinded, Blinded, from January 2023 to February 2024. Preoperative paranasal sinus CT scans were retrospectively reviewed by a blinded radiologist for variants including cribriform plate depth (per Keros classification), sinus pneumatization, nasal septal deviation, concha bullosa and ethmoid air cells. Sinonasal symptoms, particularly nasal obstruction, were evaluated using the Nasal Obstruction Symptom Evaluation (NOSE) scale. NOSE scores indicated mild-to-moderate nasal obstruction (mean 42.3 ± 18. 6), with no strong correlations with CT findings ( r < 0.20). Results Nasal septal deviation was prevalent (81.4%; mild 50%, moderate 22.5%, severe 8.8%), with higher severity in males ( p < 0.001). Concha bullosa occurred in 51.9%, Agger nasi cells in 86.5%, Haller cells in 13.5%, and Onodi cells in 20.3%. Keros Type 2 cribriform plate depth (per Keros classification) dominated (> 90% bilaterally). Hyper-pneumatized sinus pneumatization affected ~ 50% of frontal, sphenoid, and maxillary sinuses, with gender differences ( p < 0.05). NOSE scores showed mild symptoms, with no strong CT correlations ( r < 0.20). Conclusions High frequencies of sinonasal variants underscore the value of preoperative CT for personalized rhinoplasty, potentially reducing complications. Ethnic variations highlight the need for localized data; future prospective studies should evaluate postoperative outcomes.