Prevalence of Maxillary Sinus Pathology Based on Cone-Beam Computed Tomography Evaluation of Multiethnicity Dental School Population

Diagnostic accuracy of artificial intelligence in the detection of maxillary sinus pathology using computed tomography: A concise systematic review

Purpose

This study was performed to assess the performance and accuracy of artificial intelligence (AI) in the detection and diagnosis of maxillary sinus pathologies using computed tomography (CT)/cone-beam computed tomography (CBCT) imaging.

Materials and Methods

A comprehensive literature search was conducted across 4 databases: Google Scholar, BioMed Central (BMC), ProQuest, and PubMed. Combinations of keywords such as "DCNN," "deep learning," "convolutional neural network," "machine learning," "predictive modeling," and "data mining" were used to identify relevant articles. The study included articles that were published within the last 5 years, written in English, available in full text, and focused on diagnostic accuracy.

Results

Of an initial 530 records, 12 studies with a total of 3,349 patients (7,358 images) were included. All articles employed deep learning methods. The most commonly tested pathologies were maxillary rhinosinusitis and maxillary sinusitis, while the most frequently used AI models were convolutional neural network architectures, including ResNet and DenseNet, YOLO, and U-Net. DenseNet and ResNet architectures have demonstrated superior precision in detecting maxillary sinus pathologies due to their capacity to handle deeper networks without overfitting. The performance in detecting maxillary sinus pathology varied, with an accuracy ranging from 85% to 97%, a sensitivity of 87% to 100%, a specificity of 87.2% to 99.7%, and an area under the curve of 0.80 to 0.91.

Conclusion

AI with various architectures has been used to detect maxillary sinus abnormalities on CT/CBCT images, achieving near-perfect results. However, further improvements are needed to increase accuracy and consistency.

Evaluation of Maxillary Sinus Pathologies in Children and Adolescents with Cleft Lip and Palate Using Cone Beam Computed Tomography: A Retrospective Study

OBJECTIVE

The purpose of this study was to evaluate maxillary sinus (MS) pathologies in children and adolescents with cleft lip and palate (CLP) in comparison to a sex- and age-matched control group using cone beam computed tomography (CBCT), retrospectively.

METHOD

CBCT images obtained between the years 2014 and 2022 from a total of 130 patients aged between 7 and 18 were considered eligible for this study. Age, sex, and the type of MS pathologies in each sinus were recorded in CLP (n = 65) and control (n = 65) groups. The MS pathologies were categorized and recorded for both right and left sinuses separately as: (1) healthy; (2) mucosal thickening >3 mm; (3) polypoidal mucosal thickening; (4) partial opacification; and (5) complete opacification. In the CLP group, the cleft type and side were also recorded. Variations of polypoidal mucosal thickenings were subcategorized as small, large, and multiple.

RESULTS

The mean age of the 130 patients (58 female, 72 male) was calculated as 12.43 ± 3.13. Among the patients in the study and control groups, polypoidal mucosal thickening was found to be the most frequent sinus pathology (25.4%), while total opacification was found to be the least frequent (1.6%). Overall, only the number of sinuses with mucosal thickening greater than 3 mm was statistically significantly higher in the CLP than that of the control group (P < .05). In terms of cleft type and side, the frequency of the pathology based on the sinuses showed no significant difference in any of the pathology groups (P > .05).

CONCLUSION

Incidental findings in the oral and maxillofacial region that are detected on CBCT images of CLP patients may play an important role in the early diagnosis of MS diseases and aid in the referral for further evaluation.

Retrospective analysis of pathological changes in the maxillary sinus with CBCT

The aim of this study is to examine the frequency of maxillary sinus pathologies and their relationship with each other using cone beam computed tomography (CBCT) and to make a new grade according to the number of affected walls. 1000 maxillary sinuses of 500 patients with CBCT images were included in the study. Anatomical variations and pathological formations of the maxillary sinuses were examined. Images were evaluated for the presence of flat, polypoidal, partial and generalized mucosal thickening, partial and total opacification, polyps and mucous retention cysts. Maxillary sinus pathologies were graded according to the number of walls affected. In the examined CBCT images, no pathology was found in 54.2% of the maxillary sinuses, while pathology was observed in 45.8%. The most common sinus pathologies were mucous retention cyst (12.3%) and polypoidal thickening (12.2%). While pneumatization, ostium obstruction, and the presence of sinus-related roots were associated with sinus pathology, no relationship was found with nasal septum deviation and the presence of septa. Before dental implant and sinus surgery applications, the presence of sinus pathologies and their relationship with anatomical variations can be evaluated with CBCT, a three-dimensional technique, and complications such as sinus membrane perforation, infection, failure to break the bone window due to the presence of antral septa, graft loss and oroantral fistula formation can be reduced.

Analysis of risk variables for association with maxillary sinus mucosal thickenings: a cone-beam computed tomography-based retrospective study

PURPOSE

This study aimed to determine which patient-related, anatomical, pathologic, or iatrogenic variables may be directly associated with and which may have a modifying effect on the generation of maxillary sinus (MS) mucosal thickenings.

METHODS

A total of 278 cone-beam computed tomography (CBCT) scans obtained from 114 males and 164 females were evaluated. The protocol included the assessment of 21 candidate variables, of which 18 were bilateral and 3 were unique. The relationship among the study variables and the mucosal thickenings were examined individually and adjusted for confounding using univariate and multivariate binary logistic regression models.

RESULTS

The prevalence of mucosal thickenings was 71.20% at patient level and 53.40% at sinus level. The ostium height > 28.15 mm, the infundibulum length ≤ 9.55 mm, the infundibulum width ≤ 0.50 mm, along the occurrence of periapical lesions and slight-to-severe periodontal bone loss acted as strong/independent risk variables for MS mucosal thickenings. Confounding and interaction relationships between MS height and depth, and between the alveolar process type and the presence of foreign materials with respect to age stratum > 47.50 years might be also associated with the mucosal thickenings.

CONCLUSIONS

While increased ostium height, decreased infundibulum length/width, the presence of periapical lesions and periodontal involvement might be the foremost indicator variables for MS mucosal thickenings, there are synergistic relationships among the increased sinus height and depth as well as aging regarding atrophic/partially atrophic alveolar process status and the presence of foreign materials that may be also associated with a greater proportion of these mucosal abnormalities.

Maxillary Sinus Pathology and its Relationship with Pathology and Dental Treatments. Systematic Review

Introduction and objective: The aim of this review is to evaluate to what extent sinus pathology originates from dental pathology or treatment, and to assess the occurrence frequency of sinus pathology in its different forms using cone beam computed tomography (CBCT). Method: The literature review was conducted using PubMed, Scopus and the Cochrane Library. Forty-two articles were included (25 case series, ten cross- sectional studies, three case-control studies, two cohort studies, one prospective study, and one retrospective study). Results: Forty-two articles involving a total of 13,191 patients and 17,374 CBCTs were included in this review. The most frequent pathological findings were, by a considerable degree, inflammatory diseases, which represented 75.16% of the total findings, followed by infection (12.13%), tumours (6.88%), and high pneumatisation (2.07%). Within dental pathology, there is a direct Pearson correlation with polyps (1) and opacification (0.999), and an almost direct correlation with retention cysts (0.981) and sinus-associated dental elements (0.972). Conclusions: Our results further support the argument that dental modifications and treatments are an important cause of sinus pathology. For this reason, dental aetiologies must be taken into account by both dentists, maxillofacial surgeons and ENT when considering the most appropriate treatment for patients with maxillary sinusitis.

Risk Factors for Maxillary Sinus Pathology after Surgery for Midfacial Fracture: A Multivariate Analysis

This study aimed to determine the incidence of maxillary sinus pathology in patients with a midfacial fracture who underwent osteosynthesis surgery and evaluate the associated risk factors. We conducted a retrospective case-control analysis of patients with midfacial fractures involving a maxillary sinus wall who were treated with open reduction and internal fixation (ORIF) between January 2015 and December 2020. Fracture reduction, the number of screws implanted in the maxillary sinus, and the number of screws penetrating the maxillary sinus, etc., were examined as potential risk factors. Maxillary sinus pathology on postoperative CT was considered the primary outcome for case-control analysis. Binary logistic regression was used to identify variables associated with postoperative maxillary sinus pathology. Thereafter, propensity score matching (PSM) was used to extract confounding factors. A total of 262 patients (totaling 372 maxillary sinuses) were included for analysis. PSM yielded 178, 246, and 70 matched sinuses, respectively, depending on the potential risk factors. Postoperative maxillary sinus pathology was visualized in 218 of the 372 maxillary sinuses (58.60%). The risk factors for postoperative maxillary sinus pathology included the number of screws penetrating the maxillary sinus (odds ratio (OR), 1.124; p = 0.007), an imperfect maxillary sinus wall fracture reduction (OR, 2.901; p = 0.021), and the number of sinus walls involved (OR, 1.383; p = 0.011). After PSM, postoperative maxillary sinus pathology was still more prevalent in sinuses with multiple maxillary sinus wall fractures (64.04% vs. 48.31%, p = 0.034), sinuses with more screws penetrating the maxillary sinus (64.23% vs. 50.41%, p = 0.028), and sinuses with an imperfect reduction (80% vs. 51.43%, p = 0.012). In conclusion, maxillary sinus pathology is common after the ORIF of midfacial fractures. Patients with a fracture of multiple maxillary sinus walls require a close follow-up. Screw penetration of the maxillary sinus should be avoided to prevent maxillary sinus pathology after a midfacial fracture ORIF.

Maxillary Sinusitis of Odontogenic Origin: Prevalence among 3D Imaging—A Retrospective Study

The aim of this study was to investigate the prevalence of maxillary sinus mucosal thickening and compare it to the presence of odontogenic pathology of adjacent teeth. Three hundred and twenty-one full maxilla cone-beam computed tomography scans were examined. The parameters investigated included signs of maxillary sinus mucosal thickening and the diagnosis and proximity of the adjacent teeth. Statistical analysis was conducted using IBM SPSS version-16.0 (SPSS Inc., Chicago, IL, USA). Out of the 2001 teeth examined, 888 (44.4%) were associated with mucosal thickening with a significant difference between the different tooth types (p = 0.04). Mucosal thickening in a maxillary sinus was more likely if the neighboring teeth had apical disease. Interruption of the maxillary sinus floor was noticed more in specific teeth, particularly the first and second molars (p < 0.001). Sinusitis of odontogenic origin can be more prevalent than clinicians expect. The treatment of odontogenic sinusitis should be straightforward, whereby the diseased tooth is root treated or extracted. The sinusitis will then resolve if there are no other etiological factors.

Sinus membrane elevation and implant placement

Sinus Schneiderian membrane elevation surgery is widely performed for dental implant placement in the maxillary posterior region. With regard to sinus elevation surgery, various complications can occur and lead to implant failure. For successful implants in the maxillary posterior region, the clinician must be well acquainted with sinus anatomy and pathology, a variety of bone graft materials, the principles of sinus elevation surgery, and prevention and management of complications.