Is the maxillary sinus volume affected by concha bullosa, nasal septal deviation, and impacted teeth? A CBCT study

The relationship between structures affecting maxillary sinus ventilation and maxillary sinus volume: a CT study

PURPOSE

This study aims to identify anatomical variations inside and outside the maxillary sinus (MS), determine their prevalence and coexistence, and investigate their relationship with MS volume in individuals without MS pathology, using ImFusion Suite software.

METHODS

Analysis of 330 paranasal CT scans obtained from the radiology archive (2018-2021) was performed using the ImFusion Suite program. Anatomical variations, including accessory ostium, Haller cells, ethmomaxillary sinus, concha anomalies, septa, and impacted teeth, were identified and their frequency of coexistence was determined. MS volume and nasal septum deviation (NSD) angle were measured. The relationship between MS volume and gender, as well as the impact of anatomical variations on MS volume, was analyzed. Statistical analyses were conducted using SPSS software.

RESULTS

The most common anatomical variation was NSD (98%), while the least common was ethmomaxillary sinus (9.4%). Middle and inferior concha hypertrophy were more frequent in males, whereas concha bullosa and impacted teeth were more prevalent in females (p < 0.05). A normal anatomical appearance on CT scans was observed in only 2.1% of cases (3.5% in males; 1.1% in females), with a notable coexistence of multiple variations. MS volume was significantly higher in males (right: 16.79 ± 5.23 cm3; left: 16.39 ± 5.61 cm3) than in females (right: 14.44 ± 4.54 cm3; left: 14.59 ± 4.62 cm3) (p < 0.05). MS volume was significantly smaller when the NSD angle was ≥9° and larger in the presence of septa.

CONCLUSION

This study provides a comprehensive analysis of anatomical variations in the MS and their relationship with MS volume. The findings indicate that septa increase MS volume, while a higher NSD angle (≥9°) is associated with reduced MS volume. Other variations, including accessory ostium, Haller cells, and concha anomalies, showed no significant impact on MS volume. These results highlight the importance of detailed radiological evaluation in clinical and surgical planning.

Relationship between maxillary sinus mucosal cyst and sinus ostium 2D area in three-dimensional volumetric paranasal CT ımages

OBJECTIVE

To investigate the relationship between the maxillary sinus ostium 2D area (SOA) and the development of mucosal cysts of the maxillary sinus (MMC).

METHODS

Thirty patients (≥ 18 years) with unilateral MMC who underwent paranasal sinus CT (PNsCT) were included in this single-center retrospective study. Non-MMC sinus was used as the control group. Cyst and air volume of the maxillary sinuses, diameter, and 2-dimensional area of the ostium of the patients were calculated in the 3-dimensional volumetric analysis program. Both correlation and linear regression model analyses were performed for the relationship between MMC and SOA.

RESULTS

Thirty patients were included (mean age of 42.30 ± 17.62 years). A total of 15/30 (50%) were male. The mean SOA in patients with MMC (8.91 ± 1.10 mm2) was lower than in patients without MMC (12.94 ± 1.35 mm2), which was statistically significant (p < 0.001). The mean sinus ostium diameter in patients with MMC (2.12 ± 0.71 mm) was higher than in patients without MMC (1.91 ± 0.82 mm), which was statistically insignificant (p = 0.295). There was a statistically significant, good level of negative linear correlation between SOA and total cyst volume (TCV) [correlation coefficient (r) = - 0.680, p < 0.001]). As a result, the regression model consisting of "Age, Sinus air volume, and TCV" variables is a good model and has statistically significant relations with SOA.

CONCLUSION

In conclusion, small SOAs contribute to the development of MMC. There was a negative correlation between SOA and TCV. In addition, 2D area measurement may be a more accurate method instead of diameter measurement.

Multilevel Modeling Analysis of Odontogenic Risk Factors and Nasal Septum Deviation Associated with Maxillary Sinus Mucosal Thickening: A Cone-Beam Computed Tomography Study

(1) Background: In this study, the impact of odontogenic risk factors with nasal septum deviation on maxillary sinus mucosal thickening was assessed using Cone-beam computed tomography CBCT. (2) Methods: A total of 328 maxillary sinus regions from 164 patients (85 males and 79 females) were examined. Images were interpreted by dental specialists and Otolaryngologists. Coronal and sagittal sections were examined to assess the proximity of the root tips of posterior maxillary teeth (RPMT) to the maxillary sinus. The periodontal bone loss for all maxillary posterior teeth was also assessed. Consequently, maxillary sinus mucosal thickening (MT) was further classified into three gradings. Multilevel modeling regression analysis was used due to the hierarchical structuring of the data. Four models were developed, a null model with no factors, a model with tooth-level factors (RPMT, PBL, tooth condition, and root length), a model with patient-level factors (gender and nasal septum deviation), and a model with combined patient- and tooth-level factors. Regression estimates (AOR) and 95% confidence intervals (CIs) of individual and tooth factors were calculated. (3) Results: Multilevel regression analysis showed that RPMT was significantly associated with MT of maxillary sinus (p < 0.001), where patients who had RPMT > 0 had higher odds of MT of maxillary sinus. Tooth condition was also found to be significantly associated with MT of maxillary sinus, where teeth with failed RCT (p < 0.001) and teeth with restorations (p < 0.008) had higher odds of MT of maxillary sinus (AOR = 2.87, 95%CI 1.65, 4.42, AOR = 1.64, 95%CI 1.14, 2.36, respectively). (4) Conclusions: In order to plan preoperative treatment for maxillary posterior teeth, it is important to assess the anatomical relationship between the sinus floor and the root tips of the maxillary posterior teeth. Additionally, we establish a better understanding of the clinician before surgical intervention is conducted.

Is There a Relationship Between Unilateral/Bilateral Impacted Maxillary Canines and Nasal Septum Deviation?

Introduction A deviated nasal septum may be associated with some dentofacial deformities. The aim of the study was to determine whether there is a relationship between some craniomaxillary features of unilateral and bilateral maxillary impacted canines and nasal septum deviation. Methods This is a retrospective study consisting of cone beam computed tomography (CBCT) images of 51 patients. All patients were divided into three subgroups: unilateral maxillary impacted canines (UMIC) (n=19) bilateral maxillary impacted canines (BMIC) (n=15), and control group (MC) (n=17). The septal deviation angle and some angular and dimensional measurements were performed. Differences in linear and angular measurements between the groups were analyzed using One-way ANOVA and the Kruskal-Wallis test. Pearson's correlation analysis was performed to determine the relationship between the septal deviation angle, septal deviation direction, nasal floor angle, and other parameters, and multivariate linear regression analysis was performed to determine the effect of variables in the septal deviation angle. Results Bilateral or unilateral position of the impacted canines was found to be effective on septal deviation. The septal deviation angle and the nasal floor angle values were found to be significantly higher in the UMIC and BMIC groups (p<0.001) than in the MC group. Maxillary width was found to be significantly lower in the BMIC group compared to the UMIC (p<0.01) and MC group (p<0.001). Septal deviation angle was positively correlated with septal deviation direction and nasal floor angle (p<0.001). Palatal width and nasal floor angle were found to be negatively correlated (p<0.05), and palatal depth and septal deviation direction were found to be positively correlated (p<0.01). Groups and septal deviation angle, septal deviation direction, and nasal floor angle were found to be negatively correlated (p<0.001). The multivariate linear regression analysis revealed an association between septal deviation angle, group (p<0.01), and nasal floor angle (p<0.05). Conclusion Bilateral or unilateral position of the impacted canines was found to be effective on septal deviation. The septal deviation angle values were found to be higher when the maxillary impacted canine was unilateral. Unilateral or bilateral positions of the impacted canine and the nasal floor angle were found to be factors affecting the formation of septal deviation.

Increased risks of maxillary sinus mucosal thickening in Chinese patients with periapical lesions

Objectives

This study aimed to evaluate the effects of factors related to periapical lesions (PALs) on sinus membrane thickening (SMT) in the Chinese population using cone-beam computed tomography (CBCT).

Methods

In this retrospective study, CBCT images (n = 512) of maxillary sinuses of 446 patients were evaluated by two examiners for SMT and PALs, PAL size, and the distance between the maxillary sinus floor (MSF), and the PAL's edge/root apex. The data were analyzed using analysis of variance, the Kruskal-Wallis test, χ²-test, and logistic regression.

Results

A binary logistic regression model showed that the prevalence and severity of SMT > 2 mm were significantly associated with older age (>60 years) (odds ratio [OR]: 4.03, 95% confidence interval [CI]): 2.24-7.72, P < 0.001], male sex (OR: 2.08, 95% CI: 1.21-3.56, P < 0.006), and PALs (OR: 6.89, 95% CI: 3.93-12.08, P < 0.001). The type of contact and penetration between the MSF and PALs or root apex showed a more significant relation with SMT > 2 mm than did distance after adjusting for confounding factors, including age and sex (PALs: OR = 10.17 and 14.57, P < 0.001; root apex: OR = 3.49 and 5.86, P < 0.001).

Conclusions

The prevalence and severity of SMT were significantly associated with older age, male sex, PALs, PAL size, and the distance between the MSF and PALs/root apex. Therefore, communication between dental surgeons and an otolaryngology specialist is important for the timely diagnosis and treatment of SMT of dental origin.

Is There a Relationship Between Maxillary Sinus's Inferior Pneumatisation and Sinonasal Variations? A Retrospective CBCT Study

Objectives

This retrospective study aims to analyse alveolar and palatal process pneumatisation and their relationships with sinonasal variations using cone-beam computed tomography.

Material and Methods

The study included 500 patients aged 18 to 87 years, involving 1000 maxillary sinuses with cone-beam computed tomography scans. We examined the relationship between inferior maxillary pneumatisation and the following anatomic variations: Haller cell, concha bullosa, paradoxical concha, bifid concha, and septal deviation.

Results

Among the 1000 maxillary sinuses assessed, we found 223 (22.3%) with alveolar process pneumatisation (APP), 37 (3.7%) with palatal process pneumatisation (PPP), and 23 (2.3%) with the presence of both APP and PPP. Significant relationships were observed between the Haller cell (P = 0.005), nasal septum deviation (P = 0.000), and middle concha bullosa (P = 0.01) with APP. However, there were no significant relationships between the paradoxical middle concha (P = 0.07), bifid middle concha (P = 0.74), and APP. Similarly, significant relationships were observed between the Haller cell (P = 0.001), paradoxical middle concha (P = 0.009), bifid middle concha (P = 0.000), and PPP. However, there were no significant relationships between concha bullosa (P = 0.799) and PPP. Additionally, we found significant relationships between the Haller cell (P = 0.003) and the presence of both APP and PPP.

Conclusions

This study provides an anatomical basis for imaging diagnosis by investigating the frequency of inferior pneumatisation of the maxillary sinus and its relationship with certain sinonasal variations.

Diagnostic value of CBCT in Chinese children with adenoid hypertrophy

Objective

The main objectives of the study were to investigate the reliability and accuracy of cone-beam computed tomography (CBCT) in the diagnosis of adenoid hypertrophy in Chinese children and to evaluate its value in clinical diagnosis.

Methods

From January 2019 to January 2020, 300 children with sleep snoring in Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University were retrospectively studied. All patients underwent nasopharyngoscopy (NE) and CBCT scanning. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of CBCT were determined according to the diagnostic criteria of NE, and the consistency between CBCT and NE was evaluated.

Results

The clinical study of 300 children patients found that compared with NE, CBCT had a sensitivity of 87.3%, specificity of 89.2%, the positive predictive value of 93.20%, the negative predictive value of 80.5%, the positive likelihood ratio of 8.08, the negative likelihood ratio of 0.14, and Kappa value of .748.

Conclusion

CBCT is a reliable and accurate tool for the diagnosis of adenoid hypertrophy and can be used as an alternative examination method for children with contraindications or intolerance during NE.

Level of Evidence

4.

Maxillary sinus aeration analysis using computational fluid dynamics

The maxillary sinus aeration using the computational fluid dynamics (CFD) method based on individual adult patients’ computed tomography (CT) scans were analyzed. The analysis was based on CT images of 4 patients: one with normal nose anatomy and three with nasal septal deviation (NSD) and concha bullosa (CB). The CFD simulation was performed using the Reynolds-Average Simulation approach and turbulence closure based on linear eddy viscosity supplemented with the two-equation k-\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\omega$$\end{document}ω SST model. As a result, it was found that the lower part of NSD has the most significant impact on the airflow change within the maxillary sinuses compared to CB and the upper part of NSD. In a healthy nose, the airflow in the sinuses is continuous, while NSD and CB change this flow into pulsatile. Multiple changes in the direction of flow during one respiratory phase were observed. The flow intensity within the maxillary sinus opening is lower on the NSD side. The concept of vorticity measure is introduced to evaluate and compare various patients qualitatively. Typically, the lowest values of such measures are obtained for healthy airways and the highest for pathological changes in the nasal cavity.

The effect of anatomical variations of the sinonasal region on maxillary sinus volume and dimensions: a three-dimensional study

INTRODUCTION

Anatomical variations in the sinonasal region are remarkably common and these variations may have an impact on maxillary sinus development due to their close anatomical adjacency.

OBJECTIVE

The aim of this study was to investigate the effect of anatomical variations of the sinonasal region on the width, height, length, and volume of the maxillary sinus.

METHODS

Cone beam computed tomography records of 120 patients were evaluated. Nasal septum deviation angle was measured for each patient and patients were divided into three groups as mild, moderate, and severe. Sinonasal variations such as nasal septum deviation direction, septal spur, concha bullosa, uncinate process pneumatization, middle concha hypertrophy, inferior concha hypertrophy, paradoxical middle concha and presence of septa in the maxillary sinus were registered. Cone beam computed tomography images were transferred to the SimPlant software thus right and left maxillary sinus volumes and dimensions were measured separately.

RESULTS

There was a negative and statistically significant relationship between age and left maxillary sinus width (p = 0.015). The relationships between gender and maxillary sinus volumes and dimensions were statistically significant (p < 0.05). Although there were significant relationships between the nasal septum deviation severity, middle concha hypertrophy, inferior concha hypertrophy, paradoxical middle concha, and presence of septa and maxillary sinus dimensions; there was no significant relationship between septal spur, nasal septum deviation direction, concha bullosa, uncinate process pneumatization, and maxillary sinus dimensions. No statistically significant relationship could be determined between maxillary sinus volume and anatomical variations of the sinonasal region.

CONCLUSION

According to our findings, while certain the variations were found to affect the sinus dimensions; none of the variations was found to be related to the maxillary sinus volume.

Does Nasal Septal Deviation and Concha Bullosa Have Effect on Maxillary Sinus Volume and Maxillary Sinusitis?: A Retrospective Study

Purpose

This study aimed to determine whether nasal septal deviation and concha bullosa affect the maxillary sinus volume, and whether this effect is associated with the prevalence of chronic sinusitis.

Materials and Methods

This study retrospectively reviewed 209 paranasal sinus CT (PNS CT) images of patients with sinonasal symptoms from January 2017 to December 2018. The maxillary sinus volume was measured twice by a radiologist, and statistical analysis was performed using SAS 9.4.

Results

Intersex comparison of the maxillary sinus volume (on left and right sides) revealed that the volume was significantly larger on both the sides (p < 0.0001) in men compared with that in women. Concha bullosa was found to occur mainly in the concave cavity of the septal deviation (p < 0.0001). No significant association was found between nasal septal deviation and maxillary sinusitis (p = 0.8756) as well as between concha bullosa and maxillary sinusitis prevalence (p = 0.3401) or maxillary sinus volume (both: p = 0.6289, Rt.: p = 0.9522, Lt.: p = 0.9201).

Conclusion

Although nasal septal deviation and the location of concha bullosa may affect each other, maxillary sinus volume and maxillary sinusitis were neither associated with nasal septal deviation nor concha bullosa.