Relationship between Anatomical Variations of Sinonasal Area and Maxillary Sinus Pneumatization

Document Type: Original


1 Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Private Practices, Toronto, Canada.

3 Dentistry Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


Maxillary sinuses are among the largest paranasal sinuses with various shapes and volumes. The dimensions and volumes of maxillary sinuses play an important role in the surgical treatment plan. The higher levels of pneumatization of alveolar bone lead to the increase of odontogenic sinusitis which cause problems in dental implantation. Therefore, this study aimed to evaluate the relationship between maxillary sinus volume and pneumatization and anatomical factors.
Materials and Methods:
In this cross-sectional study, computed tomography (CT) images of the healthy maxillary sinuses of 199 adult patients were reviewed.  Amira software was used for the measurement of sinus volume. Sinus pneumatization of the alveolar bone in coronal CT scan images in the posterior teeth areas was measured. Moreover, anatomical variations of the sinonasal region, such as nasal septal deviation, and size of the ostium were measured and recorded. The Kolmogorov-Smirnov test, the t-test, and the Pearson’s and Spearman's correlation coefficients were applied for data analysis.
According to the obtained results, the mean value of the maxillary sinus volume and the alveolar bone pneumatization were 15.54 mm3 and 3.54 mm, respectively. The mean value of the maxillary sinus volume was statistically higher among males than females (P<0.001). The prevalence of nasal septal deviation, concha bullosa, and maxillary sinus septa were 14.6%, 14.6% and 6% respectively. There were no association between anatomical factors, including the nasal septal deviation, the size of the ostium, concha bullosa, and maxillary sinus septa and maxillary sinus volume and pneumatization. P-value less than 0.05 was statistically significant.
No correlation was observed between the anatomical variations of the sinonasal region and maxillary sinus volume and pneumatization.


Main Subjects

1. Sahlstrand-Johnson P, Janert M, Strombeck A, Abul-Kasim K. Computed Tomography Measurments of Different Dimensions of Maxillary and Frontal Sinuses. BMC Medical Imaging 2011; 11:8.

2. Koppe T, Nakatsukasa M, Yamanaka A. Implication of craniofacial morphology for the pneumatization pattern of the human alveolar process. Acta Medica Lituanica 2005; 12(1): 40-6.

3. Rae T, Hill R, Hamada Y, Koppe T. Clinical variation of maxillary sinus volume in Japanese macaques (Macaca fuscata). American journal of primatology 2003; 59(4):153-8.

4. Sharan A, Madjar D. Maxillary sinus Pneumatization following extractions: A Radiographic study. The international J Oral-Maxillofac Implants 2008; 23(1): 8.

5. Hyun Cho S, Kim T, Kim K, Lee J, Lee D, Kim J. Factors for Maxillary Sinus Volume and Craniofacial Anatomical Features in Adults with Chronic Rhinosinusitis. Archives of Otolaryngology- Head and Neck Surgery 2010; 136(6): 610.

6. Fatterpekar GM, Delman BN, Som PM. Imaging the paranasal sinuses: where we are and where we are going. Anat Rec 2008; 291:1564–72.

7. Marquez S. The paranasal sinuses: the last frontier in craniofacial biology. Anat Rec 2008; 261:1350–61.

8. Gosau M, Rink D, Driemel O, Draenert F. Maxillary sinus anatomy: a cadaveric study with clinical implications. The Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology 2009; 292(3): 352-4.

9. Krennmair G, Ulm CW, Lugmayr H, Solar P. The incidence, locations and height of maxillary sinus septa in the edention and dental Maxilla. J Oral Maxillofac Surg 1999; 57:4.

10. Kilic C, Kamburoglu K, Pehlivan Yuksel S, Ozen T. An Assessment of The Relationship between the Maxillary Sinus Floor and the Maxillary Posterior Teeth Root Tips using Dental Cone-Beam Computerized Tomography. Eur J Dent 2010; 4: 462-7.

11. Park I, Song J, Choi H, Kim T, Hoon S, Lee S, et al. Volumetric Study in The Development of Paranasal Sinuses by CT imaging in Asian: A Pilot Study. Int J Pediatric Otorhinolaryngology 2010; 74: 1347-50.

12. Smith K, Edwards P, Saini T, Norton N. The Prevalence of Concha Bullosa and Nasal Septal Deviation and Their Relationship to Maxillary Sinusitis by Volumetric Tomography. Int J of Dentistry 2010; 24.

13. Rae T, Koppe T. Independence of biomechanical forces and craniofacial pneumatization in Cebus. The Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology 2008; 291(11): 1414-9.

14. Ting Liu, Demin Han, Jie Wang, Jie Tan, Hongrui Zang, Tong Wang, et al. Effects of septal deviation on the airflow characteristics: Using computational fluid dynamics models. Acta OtoLaryngologica 2012; 132(3): 290-8.

15. Kapusuz Gencer ZOzkırış MOkur AKaraçavuş SSaydam L. The effect of nasal septal deviation on maxillary sinus volumes and development of maxillary sinusitis. Eur Arch Otorhinolaryngol. 2013; 270(12):3069-73

16.  Hongrui Zang,Yingxi Liu,Demin Han,Luo Zhang,Tong Wang,Xiuzhen Sun ,et al. Airflow and temperature distribution inside the maxillary sinus: A computational fluid dynamics simulation. Acta OtoLaryngologica. 2012; 132(6): 637-44.

17. Ikeda A. Volumetric Measurment of the Maxillary Sinus by Coronal CT. Nihon Jibiinkoka Gakkai Kaiho 1996; 99(8): 1136-43.

18. Kim HYKim MBDhong HJJung YGMin JYChung SK, et al. Changes of maxillary sinus volume and bony thickness of the paranasal sinuses in longstanding pediatric chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol. 2008;72(1):103-8.

19. Ariji Y, Kuroki T, Moriguchi S, Ariji E, Kanda S. Age Changes in The Volume of the Human Maxillary Sinus: A Study Using Computed Tomography. Dentomaxillofacial Radiology 1994; 23(3): 163-8.

20. Velasco-Torres M, Padial-Molina M, Avila-Ortiz G, García-Delgado R, O’Valle F, Catena A, et al. Maxillary Sinus Dimensions Decrease as Age and Tooth Loss Increase. Implant Dentistry. 2017; 26(2): 288-95.

 21. Schriber MBornstein MMSuter VGA. Is the pneumatisation of the maxillary  sinus following tooth loss a reality? A retrospective analysis using cone beam computed tomography and a customised software program. Clin Oral Investig. 2018; 17 [Epub ahead of print]

22. Krennmair G, Ulm C, Lugmayr H. Maxillary sinus septa: incidence, morphology and clinical implications. Journal of Cranio-Maxillofacial Surgery 1997; 25(5): 261-5.

23. Park Y, Jeon H, Shim J, Lee K, Moon H. Analysis of The Maxillary Sinus Septum Using 3-Dimensional Computed Tomography. J oral maxillofac Surg 2011; 69: 1070-8.

24. Bornstein MM, Maestre-Ferrín L, Fodich I, Jacobs R, Buser D, von Arx T. An Analysis of Frequency, Morphology, and Locations of Maxillary Sinus Septa Using Cone Beam Computed Tomography. 2016; 31(2). 280–7.

25. Seluka A, Ritter L, Mischkowski RA, Dreiseidler T, Scherer P, Ketterle M, et al. Variations of Maxillary Sinus and Accompanying Anatomical and Pathological Structures. J Craniofac Surg 2008; 19(1): 159-64.

26.  Naimi M, Bakhshaei M. The major obstructive inflammatory patterns of the sinonasal diseases in 200 candidates of functional endoscopic sinus surgery.  The Iranian Journal of Otorhinolaryngology 2006; 17(42): 9-14.

27. Karataşa D, Yükselb F, Koçc A. Volumetric correlation between concha bullosa and paranasal sinuses. J Anat Soc India 2017;66(2):131-4.

28.  Stallman JS, Lobo JN, Som PM. The incidence of concha büllosa and its relationship to nasal septal deviation and paranasal sinus disease. Am J Neuroradiol. 2004; 25:1613–8.

29. Demir U. L, Akca M. E, Ozpar R, Albayrak C, Hakyemez B. Anatomical correlation between existence of concha bullosa and maxillary sinus volume. Surg Radiol Anat. 2015; 37(9)

30. Göçmen G, Borahan MO, Aktop S, Dumlu A, Pekiner FN, Göker K. Effect of Septal Deviation, Concha Bullosa and Haller’s Cell on Maxillary Sinus’s Inferior Pneumatization; a Retrospective Study. Open Dent J. 2015 Jul 31; 9: 282-6.

31. Zadanfarokh H, Naderian M. Comparison of the anatomic position of the lateral nasal wall in patients with chronic sinusitis and cadavers with endoscopic method. J Iran Univ Med Sci. 2008; 1380: 424–7.

32. Aramani A, Karadi R.N, Kumar S. A Study of Anatomical Variations of Osteomeatal Complex in Chronic Rhinosinusitis Patients-CT Findings. J Clin Diagn Res. 2014; 8(10): KC01–KC04.

33. Ancuta Roman R, Hedeşiu M, Gersak M, Fidan F, Băciuţ G, Băciuţ M. Assessing the prevalence of paranasal sinuses anatomical variants in patients with sinusitis using cone beam computer tomography. Clujul Med. 2016; 89(3): 423–9.