Infraorbital Ethmoid Cells and Sinonasal Opacification: A Multicenter Cross-Sectional Radiological Evaluation

Background: Infraorbital ethmoid cells, also known as Haller’s cells (HCs), are anatomical variants whose impact on sinus drainage and ventilation remains uncertain. The purpose of this study was to assess the prevalence of HCs and their correlation with sinus and ostiomeatal complex opacification in a large cohort of patients, thus settling the debate raised by previous studies’ conflicting results. Methods: A multicenter cross-sectional radiological analysis was conducted on adult patients who underwent maxillofacial computed tomography scans from January 2019 to December 2020. A radiological database containing 2332 scans were reviewed, selecting 1853 suitable patients. Evaluations of the presence of unilateral or bilateral HCs, septal deviation, and the extent of sinus opacifications were conducted independently on radiographic images. Results: Haller’s cells were present in 12.25% of cases. The occurrence of this anatomical variation did not significantly correlate with either the presence or the degree of maxillary, anterior/posterior ethmoid, and ostiomeatal complex opacifications. However, patients with HCs were generally younger at diagnosis and exhibited a higher incidence of septal deviation than those without infraorbital ethmoid cells. Conclusion: The findings reaffirm the prevalence of HCs as previously documented. Thanks to the selection of a large sample of patients, the investigation concluded that the presence of HCs on radiographic images cannot be considered a determinant for sinus disease.