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Background <p>The olfactory fossa (OF) depth and Keros classification are crucial anatomical parameters in functional endoscopic sinus surgery (FESS). A deeper OF increases the risk of skull base injury during ethmoidectomy, particularly in patients with chronic rhinosinusitis (CRS). Population-based variations highlight the importance of preoperative radiological assessment.</p> Aim <p>To evaluate olfactory fossa depth and classify it according to Keros types in patients with CRS undergoing FESS, and to correlate these findings with laterality, sex, and age.</p> Methods <p>A prospective observational study was conducted on 100 patients with CRS who underwent paranasal sinus computed tomography (CT) at a tertiary care centre. Coronal CT Sect.&#xa0;(1.0&#xa0;mm slice thickness) in bone window settings were analyzed. The depth of the OF was measured bilaterally from the cribriform plate to the lateral lamella of the cribriform plate (LLCP). Measurements were independently verified by two radiologists to ensure interobserver reliability. Data were analyzed using SPSS v25 with chi-square and t-tests where appropriate.</p> Results <p>Keros type II was the most common configuration (63%), followed by type I (25%) and type III (12%). Bilateral symmetry was observed in 82% of cases. No significant sex- or age-related variations were noted. Type III configurations were associated with deeper ethmoid roof recesses, posing higher surgical risk.</p> Conclusion <p>Keros type II predominates among CRS patients in this Indian cohort. Preoperative CT evaluation of OF depth is essential for minimizing iatrogenic skull base injury during FESS. Population-specific anatomical awareness improves surgical safety and planning.</p>

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CT-Based Evaluation of Olfactory Fossa Variations and Their Surgical Significance in Chronic Rhinosinusitis: a Prospective Study

  • 期刊论文

  • 发表日期：

    2026年1月6日

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  • Paramita Debnath,
  • Manwinder Singh,
  • Misbahul Haque

摘要

Background

The olfactory fossa (OF) depth and Keros classification are crucial anatomical parameters in functional endoscopic sinus surgery (FESS). A deeper OF increases the risk of skull base injury during ethmoidectomy, particularly in patients with chronic rhinosinusitis (CRS). Population-based variations highlight the importance of preoperative radiological assessment.

Aim

To evaluate olfactory fossa depth and classify it according to Keros types in patients with CRS undergoing FESS, and to correlate these findings with laterality, sex, and age.

Methods

A prospective observational study was conducted on 100 patients with CRS who underwent paranasal sinus computed tomography (CT) at a tertiary care centre. Coronal CT Sect. (1.0 mm slice thickness) in bone window settings were analyzed. The depth of the OF was measured bilaterally from the cribriform plate to the lateral lamella of the cribriform plate (LLCP). Measurements were independently verified by two radiologists to ensure interobserver reliability. Data were analyzed using SPSS v25 with chi-square and t-tests where appropriate.

Results

Keros type II was the most common configuration (63%), followed by type I (25%) and type III (12%). Bilateral symmetry was observed in 82% of cases. No significant sex- or age-related variations were noted. Type III configurations were associated with deeper ethmoid roof recesses, posing higher surgical risk.

Conclusion

Keros type II predominates among CRS patients in this Indian cohort. Preoperative CT evaluation of OF depth is essential for minimizing iatrogenic skull base injury during FESS. Population-specific anatomical awareness improves surgical safety and planning.