Computed tomography has become method of the choice for diagnosing and treatment of para nasal sinuses disease and detecting anatomical variation, CT produces a volume of data that can be manipulated through a process known as windowing in order to demonstrate various PNS structures. Protocols should done for PNS are Axial , Coronal, Sagittal. 

This study aimed to characterize the most common PNS anatomical variation in Saudi resident Patients with rhinosinusitis using computed tomography (CT).  The present study was cross-sectional hospital-based study of   392 patients, 272 males, and 120 females, referred for CT scan of PNS was conducted from 2017 to 2019, this study was done in Riyadh Hospitals, Saudi Arabia, mostly from Consultant Radiologists Diagnostic Center selected all complaining from rhinosinusitis using Toshiba Alexion 16 slice. The images were evaluated for the presence of any anatomical variants in paranasal sinuses, data were analyzed using SPSS. The results of this study revealed that the absolute frequency of anatomical variations was 91.3% were deviated nasal septum, concha bullosa seen in 50.77%, Basal lamella pneumatization found in 5.36 %. The superior turbinates were pneumatized in 20.15%, The crista galli was pneumatized in 19.39%. Frontal sinus was hyperpneumatized in 8.67% and nonpneumatized in 4.85%, the middle turbinate found to be paradoxical in shape in 10.71 %. lamina papyrecia dehiscence in 1.79%, inferior turbinate was pneumatized in 1.28%. The frontal air-cell was not present in our studied group. The supraorbital air-cell was present in 16.07% The Onodi air-cell found to be present in 12.24%. The Haller air-cell found to be present in 30.10%. The sphenoid sinus is laterally pneumatized in 7.65%. The depth of cribriform plate (Keros classification) was in 0.51%, The agger cells found to be presented in 51.02%, The infraorbital air-cell was present in 10.20%,nasal septum spur was presented in 29.34%, prominent ethmoidal bulla was presented in 29.85%, uncinate process was pneumatized in 12.76%,sphenoid sinus extension into posterior nasal septum is presented in 36.22%, posterior floor of cellaturcica was pneumatized in 30.87%, the pterygoid process was pneumatized in 7.91%,anterior clinoid process  was pneumatized in 10.97%, hard palate was pneumatized in 9.18% and lastly sphenoid septum change the direction in 8.16%. This study concluded that Anatomical variations of paranasal sinuses are best depicted on MDCT scan of PNS.Deviated nasal septum is the commonest anatomical variation (93.11%) followed by agger nasi cell (51.02) and concha bullosa (50.77%).

Distribution of the anatomical variations

* Anatomical variation of the PNS is very important to be identified preoperatively.

* Anatomical variations found to be different among regions and countries, In our study we found all Pt with rhinosinusitis has one or more than one anatomic variant mentioned. *Anatomical variations of paranasal sinuses are best depicted on MDCT scan of PNS.

*Deviated nasal septum is the commonest anatomical variation (93.11%) followed by agger nasi cell (51.02) and concha bullosa (50.77%).

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Natural home ventilation will save your PNS healthy.

First and above all, thanks and praises to Allah, the almighty for providing me this opportunity and granting me the capability to proceed successfully, and the prayers and peace be upon the merciful prophet Mohamed. I want to express my sincere thanks and deep graduate to my colleagues whom help me in my study. I would also like to pass my special thanks to my supervisors, Sudan University of Science and Technology.