To determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology.
Data Sources
Medline (1996-present) and Embase (1974-present) were searched on March 14, 2020, to identify articles that reported radiological sinus mucosal findings in asymptomatic population groups. Bibliographic search of included studies was conducted to identify additional articles.
Review Methods
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search strategy was formulated and articles screened to extract data reporting Lund-Mackay (LM) score, presence of mucous retention cysts, and maxillary mucosal thickening. A random-effects model was used in meta-analysis.
Results
A total of 950 articles were identified, of which 33 manuscripts met the inclusion criteria. The included studies involved 16,966 sinonasally asymptomatic subjects. The mean LM score was 2.24 (95% CI, 1.61-2.87), and an LM score of ≥4 in 14.71% (95% CI, 6.86-24.82%) was present across all general asymptomatic population groups. Mucous retention cysts were noted in 13% (95% CI, 8.33-18.55%) and maxillary mucosal thickening of ≥2 mm in 17.73% (95% CI, 8.67-29.08%).
Conclusion
The prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis.
FokkensWJLundVJHopkinsC, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(suppl S29):1-464.
2.
GraysonJWCavadaMHarveyRJ.Clinically relevant phenotypes in chronic rhinosinusitis. J Otolaryngol Head Neck Surg. 2019;48(1):23.
3.
European Academy of Allergology and Clinical Immunology. European position paper on rhinosinusitis and nasal polyps. Rhinol Suppl. 2005;18:1-87.
4.
LimWKRamBFasulakisSKaneKJ.Incidental magnetic resonance image sinus abnormalities in asymptomatic Australian children. J Laryngol Otol. 2003;117(12):969-972.
5.
BhattacharyyaTPiccirilloJWippoldFJII. Relationship between patient-based descriptions of sinusitis and paranasal sinus computed tomographic findings. Arch Otolaryngol Head Neck Surg. 1997;123(11):1189-1192.
6.
LundVJMackayIS.Staging in rhinosinusitus. Rhinology. 1993;31(4):183-184.
7.
KimSHOhJSJangYJ.Incidence and radiological findings of incidental sinus opacifications in patients undergoing septoplasty or septorhinoplasty. Ann Otol Rhinol Laryngol. 2020;129(2):122-127.
8.
AshrafNBhattacharyyaN.Determination of the “incidental” Lund score for the staging of chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2001;125(5):483-486.
9.
del RioATrostNTartagliaCO’LearySJMichaelP.Seasonality and incidental sinus abnormality reporting on MRI in an Australian climate. Rhinology. 2012;50(3):319-324.
10.
HillMBhattacharyyaNHallTRLufkinRShapiroNL.Incidental paranasal sinus imaging abnormalities and the normal Lund score in children. Otolaryngol Head Neck Surg. 2004;130(2):171-175.
11.
JainRStowNDouglasR.Comparison of anatomical abnormalities in patients with limited and diffuse chronic rhinosinusitis. Int Forum Allergy Rhinol. 2013;3(6):493-496.
12.
NazriMBuxSITengku-KamaldenTFNgKHSunZ.Incidental detection of sinus mucosal abnormalities on CT and MRI imaging of the head. Quant Imaging Med Surg. 2013;3(2):82-88.
13.
MoherDLiberatiATetzlaffJAltmanDGGroupP.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med. 2009;6(7):e1000097.
14.
HigginsJPThomasJChandlerJ, et al. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley; 2019.
15.
BaxL.MIX 2.0—Professional Software for Meta-Analysis in Excel. BiostatXL; 2017.
16.
MaYChuHMazumdarM.Meta-analysis of proportions of rare events: a comparison of exact likelihood methods with robust variance estimation. Commun Stat Simul Comput. 2016;45(8):3036-3052.
17.
MarciniakAMielnik-NiedzielskaG.Asymptomatic radiological changes in computer tomography in children with head trauma. Otolaryngol Pol. 2019;73(5):5-11.
18.
Cesur-AydinKBalli-AkgolBDelilbasiBCGurlerG.Evaluation of maxillary sinus findings in children using CBCT. J Intern Med Pharmacol. 2019;178(6):386-391.
19.
De Araujo-NetoSABaracatECE.Clinical progression of incidental tomographic findings in paranasal sinuses of asymptomatic individuals: cohort study. J Pediatr (Rio J). 2011;87(5):433-438.
20.
KristoAAlhoOPLuotonenJKoivunenPTervonenOUhariM.Cross-sectional survey of paranasal sinus magnetic resonance imaging findings in schoolchildren. Acta Paediatr. 2003;92(1):34-36.
21.
OliveiraRSPerettoJTPanzarellaFKRaitzR.Evaluation of incidental findings on cone beam computed tomography. Braz Res Pediatr Dent Integrat Clin. 2019;19(1):e4340.
22.
KawaiTTanakaRYeungAWKvon ArxTBornsteinMM.Frequency and type of incidentally detected radiodensities in the maxillary sinus: a retrospective analysis using cone beam computed tomography (CBCT). Clin Oral Investig. 2019;23(3):1091-1099.
23.
KamioTYakushijiTTakakiTShibaharaTImotoKWakohM.Incidental findings during head and neck MRI screening in 1717 patients with temporomandibular disorders. Oral Radiol. 2019;35(2):135-142.
24.
Zain-AlabdeenEHEl KhateebSM.Incidental cone beam computed tomographic findings among Taibah University patients, KSA: a retrospective study. J Taibah Univ Med Sci. 2017;12(2):131-138.
25.
ToganBGanderTLanzerMMartinRLubbersHT.Incidence and frequency of nondental incidental findings on cone-beam computed tomography. J Craniomaxillofac Surg. 2016;44(9):1373-1380.
26.
ShokriAMortazaviHBaharvandMFalah-KooshkiSOstovarradFKarimiA.Prevalence of incidental findings in paranasal sinuses using CBCT. Dent Med Problems. 2014;51(4):431-438.
27.
EdwardsRAlsufyaniNHeoGFlores-MirC.The frequency and nature of incidental findings in large-field cone beam computed tomography scans of an orthodontic sample. Prog Orthod. 2014;15(1):37.
28.
PazeraPBornsteinMMPazeraASendiPKatsarosC.Incidental maxillary sinus findings in orthodontic patients: a radiographic analysis using cone-beam computed tomography (CBCT). Orthod Craniofac Res. 2011;14(1):17-24.
29.
RakKMNewellIJDYakesWFDamianoMALuethkeJM.Paranasal sinuses on MR images of the brain: significance of mucosal thickening. AJR Am J Roentgenol. 1991;156(2):381-384.
30.
WittkopfMLBeddowPARussellPTDuncavageJABeckerSS.Revisiting the interpretation of positive sinus CT findings: a radiological and symptom-based review. Otolaryngol Head Neck Surg. 2009;140(3):306-311.
31.
CalhounKHWaggenspackGASimpsonCBHokansonJABaileyBJ.CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg. 1991;104(4):480-483.
32.
Da SilvaAFFroesGRJrTakeshitaWMDa FonteJBDe MeloMFSousa MeloSL.Prevalence of pathologic findings in the floor of the maxillary sinuses on cone beam computed tomography images. Gen Dent. 2017;65(2):28-32.
33.
JonesNSStroblAHollandI.A study of the CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol Allied Sci. 1997;22(1):47-51.
34.
MoserFGPanushDRubinJSHonigsbergRMSprayregenSEisigSB.Incidental paranasal sinus abnormalities on MRI of the brain. Clin Radiol. 1991;43(4):252-254.
35.
IwabuchiYHanamureYUenoKFukudaKFurutaS.Clinical significance of asymptomatic sinus abnormalities on magnetic resonance imaging. Arch Otolaryngol Head Neck Surg. 1997;123(6):602-604.
36.
TaherMMSHaddadOS.CT scan findings of occult sinus pathology in asymptomatic individuals. Ann Saudi Med. 1992;12(5):456-458.
37.
WilsonPSGrocuttM.Mucosal thickening on sinus X-rays and its significance. J Laryngol Otol. 1990;104(9):694-695.
38.
HavasTEMotbeyJAGullanePJ.Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Arch Otolaryngol Head Neck Surg. 1988;114(8):856-859.
39.
BaughKAWeireterLJCollinsJN.The trauma pan scan: what else do you find?Am Surg. 2014;80(9):855-859.
40.
MakdissiJPawarRRRadonMHolmesSB.Incidental findings on MRI of the temporomandibular joint. Dentomaxillofac Radiol. 2013;42(10):20130175.
41.
BolgerWEButzinCAParsonsDS.Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101(1, pt 1):56-64.
SimasekMBlandinoDA.Treatment of the common cold. Am Fam Physician. 2007;75(4):515-520.
44.
WangJHJangYJLeeBJ.Natural course of retention cysts of the maxillary sinus: long-term follow-up results. Laryngoscope. 2007;117(2):341-344.
45.
RodriguesCDFreireGFSilvaLBFonsecadaSilveiraMMEstrelaC.Prevalence and risk factors of mucous retention cysts in a Brazilian population. Dentomaxillofac Radiol. 2009;38(7):480-483.
46.
HararRPChadhaNKRogersG.Are maxillary mucosal cysts a manifestation of inflammatory sinus disease?J Laryngol Otol. 2007;121(8):751-754.
47.
BergOCarenfeltCSobinA.On the diagnosis and pathogenesis of intramural maxillary cysts. Acta Otolaryngol. 1989;108(5-6):464-468.
48.
HeikkinenTJarvinenA.The common cold. Lancet. 2003;361(9351):51-59.
49.
Marcal VieiraEMde MoraisSde MusisCR, et al. Frequency of maxillary sinus mucous retention cysts in a central Brazilian population. J Dent (Shiraz). 2015;16(3):169-174.
50.
CarterLCCalamelAHallerAAguirreA.Seasonal variation in maxillary antral pseudocysts in a general clinic population. Dentomaxillofac Radiol. 1998;27(1):22-24.
51.
CasamassimoPSLillyGE.Mucosal cysts of the maxillary sinus: a clinical and radiographic study. Oral Surg Oral Med Oral Pathol. 1980;50(3):282-286.
52.
RegeICSousaTOLelesCRMendoncaEF.Occurrence of maxillary sinus abnormalities detected by cone beam CT in asymptomatic patients. BMC Oral Health. 2012;12:30.
53.
RitterARozendornNAvishaiGRosenfeldEKorenISoudryE.Preoperative maxillary sinus imaging and the outcome of sinus floor augmentation and dental implants in asymptomatic patients. Ann Otol Rhinol Laryngol. 2020;129(3):209-215.
54.
Sanchez-PerezABoracchiaACLopez-JornetPBoix-GarciaP.Characterization of the maxillary sinus using cone beam computed tomography: a retrospective radiographic study. Implant Dent. 2016;25(6):762-769.
55.
ValloJSuominen-TaipaleLHuumonenSSoikkonenKNorbladA.Prevalence of mucosal abnormalities of the maxillary sinus and their relationship to dental disease in panoramic radiography: results from the Health 2000 Health Examination Survey. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(3):e80-e87.
56.
KurtulduEAlkisHTYesiltepeSSumbulluMA.Incidental findings in patients who underwent cone beam computed tomography for implant treatment planning. Niger J Clin Pract. 2020;23(3):329-336.
57.
DraganERusaONemtoiAMelianGMihaiCHabaD.Maxillary sinus anatomic and pathologic CT findings in edentulous patients scheduled for sinus augmentation. Rev Med Chir Soc Med Nat Iasi. 2014;118(4):1114-1121.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
