Is palatal cavity volume affected by maxillary sinus pathologies? A CBCT study.

AIM: This study uses cone beam computed tomography (CBCT) to determine whether pathology in the maxillary sinus (MS) affects the volume of the palatal cavity. METHODS: 188 individuals, 95 women and 93 men, aged between 17 and 63, were included in the study. MS pathology in the patients and the open-closed status of the maxillary sinus ostium (MSO) were recorded. Palatal volume measurements were performed using open-access ITK-SNAP via CBCT images. Statistical analysis of the study was conducted using SPSS v.21 software (IBM. Chicago. IL. USA), and p<0.05 was considered statistically significant. RESULTS: The average palatal volume was 1375.29±313.38 mm3 in male patients and 1235.33±250.40 mm3 in females, and it was found to be statistically significant between genders (p=0.001). MS pathology was detected in 114 (60.6%) of the patients. It was determined that the most frequently observed pathology in both the right (n = 58, 30.9%) and left (n = 65, 34.6%) side MS of individuals was mucosal hypertrophy. It was determined that the mean palatal volume was higher when the MSO was closed (p = 0.000). As a result of the correlation analysis, it was shown that the presence of MS pathology had a positive effect in explaining palate volume by 38.6% (R2 = 0.386). CONCLUSION: Palatal cavity volume was affected by maxillary sinus pathologies. Palatal cavity volume increases in the presence of MS pathologies and when MSOs are closed.

Transcrestal maxillary sinus floor elevation with injectable xenogeneic bone substitute in gel form: A clinical, radiological and histological analysis.

PURPOSE: This retrospective study measured the increase in bone tissue using the transcrestal maxillary sinus floor elevation with injectable xenogeneic bone substitute in gel form with simultaneous implant placement. This procedure allows elevation of the sinus floor atraumatically, reducing the risk of perforation of the Schneiderian membrane. METHODS: 52 subjects needing unilateral sinus floor elevation, with a residual crestal height from 2 mm to 5 mm, and a request for at least one implant-prosthetic rehabilitation in the posterior maxillary area were enrolled. Transcrestal maxillary sinus floor elevation was performed with injectable xenogeneic bone substitute in gel form. The sinus elevation was measured after the surgery and 6 months later with a CBCT. Average values were calculated for each measure. RESULTS: 46 implants were simultaneously placed; six implants were placed after 4 months because of the lack of primary stability. All the placed implants, with a follow-up varying from 3 to 5 years after loading, osseointegrated successfully resulting in a survival rate of 100%. Average pre-operative bone height was 4.2 mm while after the surgery the average value reached was 10.1 mm with an average value of new bone gain of 6.43 mm. Histological analysis revealed the presence of 33.2% of vital bone. CLINICAL SIGNIFICANCE: Transcrestal sinus floor elevation with injectable xenogenic bone substitute in gel form is a minimally invasive technique that can reduce the incidence of Schneider membrane perforations, making a widely used method, such as sinus floor elevation, safer and less operator dependent.

Development of maxillary sinuses in relation to the development of cranium in children on computed tomography imaging.

There are available studies assessing the development of maxillary sinuses in relation to the viscerocranium. However, there are no publications analyzing the development of maxillary sinuses in relation to the development of the cranium, i.e. both the viscerocranium and the neurocranium. The aim of the study was to analyze the correlation between the dimensions of maxillary sinuses and anthropometric measurements of the cranium in children. The study was retrospective and was conducted at the based on the results of head computed tomography investigation. The study group included 180 girls and 180 boys, aged from birth to 18 years. To assess the correlation between the degree of development of the paranasal sinuses and the growth of the cranium, standard anthropometric points on the skull and strictly defined dimensions of the height, length, width, and volume of right and left maxillary sinuses were used. In the study group, both in girls and boys, a statistically significant positive correlation was found at the significance level of p < 0.0001 between: the height, length, width and volume of right and left maxillary sinuses, and cranial maximum length (glabella-opisthocranion), its maximum width (euryon-euryon), height (basion-bregma) and the length of the cranial base (basion-nasion) and the dimension of the subspinale-opisthocranion in children. Our study showed a statistically significant positive correlation between the development of maxillary sinuses and the growth of the cranium in children.

Predictive value of tooth and sinuses radiological characteristics in managing odontogenic sinusitis of endodontic origin.

BACKGROUND: One of the most common causes of bacterial odontogenic sinusitis (ODS) is endodontic disease with periapical lesions (PAL). Referrals between otolaryngologists and dental specialists are indispensable for proper diagnosis and treatment. If the disease does not resolve after medical and root-canal treatment (RCT), tooth extraction, endoscopic sinus surgery (ESS) or both are the ways of management.The aim was to clarify the predictive value of disease's radiological characteristics for the further surgical intervention. METHODOLOGY: 68 symptomatic patients evaluated by an otolaryngologist and dental specialist were included to this prospective observational cohort study. Patients who failed medical treatment of sinusitis (intranasal steroids, saline rinses and antibiotics) and RCT were treated either with ESS, tooth extraction or both at the same time. RESULTS: 87% of patients required surgical intervention. 12% improved after tooth extraction alone, 47% after ESS and 31% required both procedures. The degree of maxillary sinus' (MS) opacification was not correlated with the need of invasive procedures implementation, as opposed to ostiomeatal complex' patency (p<0.001). Cortical bone destruction towards the MS and multiple tooth roots involvement suggested ODS resolution only after combined surgical approach (p=0.041). CONCLUSIONS: Radiological characteristics of causative tooth and patency of ostiomeatal unit correlate with the evolution of ODS and need for either ESS and/or tooth extraction. Patients with multiple roots affected, shorter distance to the MS floor and PAL's with visible bone destruction may require tooth extraction and ESS to resolve ODS completely. CLINICAL IMPLICATIONS: Radiological data may help in earlier diagnosis and treatment of ODS with PALs for both otolaryngologists and dental specialists.

Analysis of bone quality formation in sinus lifts with immediate implants.

Sinus lift surgeries are part of the daily practice of dentists. This study evaluates the long-term structure of the bone placed in sinus lifts through the fractal dimension. We conducted a retrospective study on a sample of 35 patients with 51 sinus lifts performed using a lateral window approach and filling material placement. We radiologically analyzed the graft bone to observe its evolution up to one and a half years after the surgical procedure. The obtained results were the average area of the sinuses analyzed was 1401.96 mm2, with a mean area occupied by the filling material of 297.75 mm2. Significant differences are observed when comparing the fractal dimension values obtained on the initial day and one year after prosthesis loading. Similarly, when comparing the values of the area occupied by the biomaterial at the start day and one year after prosthesis loading, significant differences are also obtained (p-value < 0.001). In conclusion, the filling material used in the lateral window sinus lift procedure undergoes significant resorption and shows changes in the fractal dimension.

Automatic maxillary sinus segmentation and pathology classification on cone-beam computed tomographic images using deep learning.

BACKGROUND: Maxillofacial complex automated segmentation could alternative traditional segmentation methods to increase the effectiveness of virtual workloads. The use of DL systems in the detection of maxillary sinus and pathologies will both facilitate the work of physicians and be a support mechanism before the planned surgeries. OBJECTIVE: The aim was to use a modified You Only Look Oncev5x (YOLOv5x) architecture with transfer learning capabilities to segment both maxillary sinuses and maxillary sinus diseases on Cone-Beam Computed Tomographic (CBCT) images. METHODS: Data set consists of 307 anonymised CBCT images of patients (173 women and 134 males) obtained from the radiology archive of the Department of Oral and Maxillofacial Radiology. Bilateral maxillary sinuses CBCT scans were used to identify mucous retention cysts (MRC), mucosal thickenings (MT), total and partial opacifications, and healthy maxillary sinuses without any radiological features. RESULTS: Recall, precision and F1 score values for total maxillary sinus segmentation were 1, 0.985 and 0.992, respectively; 1, 0.931 and 0.964 for healthy maxillary sinus segmentation; 0.858, 0.923 and 0.889 for MT segmentation; 0.977, 0.877 and 0.924 for MRC segmentation; 1, 0.942 and 0.970 for sinusitis segmentation. CONCLUSION: This study demonstrates that maxillary sinuses can be segmented, and maxillary sinus diseases can be accurately detected using the AI model.

Analysis on the relationship between Schneiderian membrane thickening in the posterior maxillary region and periapical lesions by cone beam computed tomography.

OBJECTIVES: This study aimed to evaluate the thickening of sinus membrane, which is also named Schneiderian membrane (SM), in patients and its relationship with periapical lesions (PAL) in the posterior maxillary region to provide reference for the prevention and treatment of odontogenic maxillary sinusitis. METHODS: A retrospective analysis was conducted on 554 cone beam computed tomography (CBCT) imaging data of maxillary sinuses from 301 patients who met the inclusion criteria to determine the correlation between PAL and SM thickening in the posterior maxillary region. Cases of pathological SM were recorded and classified on the basis of the degree and type of SM thickening. The correlation between SM thickening and the diameter of PAL, the relationship between the upper edge of PAL and the maxillary sinus floor, and its relationship with whether affected teeth with PAL undergo root canal treatment were evaluated. RESULTS: The detection rate of SM thickening in patients with PAL was significantly higher than in those without PAL, so PAL was correlated with SM thickening. Analysis on the correlation between PAL detection indicators and SM thickening degree showed that SM thickening degree was positively correlated with PAL diameter (cone beam computed tomography-periapical index) and not correlated with the three spread effects between the upper edge of PAL and the maxillary sinus floor, as well as whether the teeth with PAL undergo root canal treatment. The correlation analysis between PAL detection indicators and SM thickening types showed that whether the teeth with PAL undergo root canal treatment was not correlated with SM thickening types, and the diameter of PAL, the three spread effects between the upper edge of PAL, and the maxillary sinus floor were not correlated with SM thickening types. CONCLUSIONS: The PAL of posterior maxillary teeth is closely related to SM thickening, and the diameter of PAL is positively correlated with the degree of SM thickening. Patients with PAL who have undergone root canal treatment often exhibit SM polyp thickening. In addition, the relationship between the upper edge of PAL and the maxillary sinus floor does not affect the possibility of SM development.

Maxillary sinus actinomycosis: a diagnostic and therapeutic challenge.

The authors present a case of maxillary sinus actinomycosis in a young adult woman.This is a rare condition whose unspecific clinical presentation makes its diagnosis challenging. In this case, the diagnosis was given by the identification of Actinomyces colonies in samples of infected tissue.Treatment consisted of a combined medical and surgical approach. Endoscopic sinus surgery was performed to remove diseased mucosa and to aerate the involved sinuses, followed by long-term antibiotic therapy. No recurrence of the disease was observed during follow-up.

Cholesterol granuloma of the maxillary sinus: a case report.

BACKGROUND: Cholesterol granuloma is not a common entity in the paranasal sinuses. It is a foreign body reaction to the cholesterol crystal deposition. Mostly associated with chronic middle ear diseases. CASE PRESENTATION: This article reports a case of cholesterol granuloma in the maxillary sinus. A 23-year-old Asian man presented with cough, nasal obstruction, and postnasal discharge. On endoscopy, there was a mass protruding from the right maxillary ostium. On computed tomograpy imaging, there was a polypoidal mass in the right maxillary sinus. Endoscopic sinus surgery was performed, the cholesterol granuloma was removed from the right maxillary sinus, and the tissue was submitted for histopathological examination, which showed foreign body giant cell reaction to cholesterol crystals. CONCLUSION: Cholesterol granuloma of maxillary sinus is not common and often missed by clinicians. It is necessary to consider the cholesterol granuloma of maxillary sinus in the differential diagnosis sinonasal lesions. Histopathological analysis is required for confirmation and should be removed surgically. This case may help as a reference for clinician to approach these kinds of cases.

Treatment outcome of modified endoscopic assisted sinus surgery for treating maxillary sinus diseases with three dimensional volumetric analysis.

This retrospective study aimed to analyze volumetric changes of the maxillary sinus after modified endoscopic-assisted sinus surgery (MESS) and to assess short-term treatment outcomes. The volumes of the total maxillary sinus, aeration, and sinus pathology were calculated using computed tomography data obtained prior to surgery and six months after surgery. Postoperative radiological improvement was assessed using the Lund-Mackay score. Bone regeneration around the bony window was evaluated during plate removal. A total of 32 patients were evaluated. Compared with before surgery, air and sinus pathology volumes improved significantly (air, increase by 6.0 cm3, p < 0.001; sinus pathology, decrease by 6.4 cm3, p < 0.001). However, there was no statistically significant change in the total maxillary sinus volume after surgery. The preoperative Lund-Mackay score was 2.9, decreasing to 0.4 six months after surgery (p < 0.001). The only predictors of postoperative aeration rate and Lund-Mackay score were preoperative sinus pathology volume (p = 0.049) and Lund-Mackay score (p = 0.015), respectively. The continuity between the bony window and surrounding sinus wall was restored in all patients. The results of this study suggest that MESS can be a successful, effective, and minimally invasive surgical treatment option for treating maxillary sinus diseases.

The relation between Schneiderian membrane thickening and radiodiagnostic features of periapical pathology.

This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor.

Large Rhinolith in Nasal Cavity and Extension to Maxillary Sinus in a Cocaine User.

Although rhinoliths are rare, they deserve attention and should be considered in the differential diagnoses of calcified lesions that can affect the nasal cavity and maxillary sinus region. This article reports a case of a large rhinolith in the nasal cavity caused by cocaine use. Initially, the patient denied drug use, leaving several uncertainties regarding the diagnosis, including recurrent sinusitis. However, after the histopathologic results, the patient admitted to previous cocaine use, emphasizing the importance of honesty in the medical history to guide diagnostic hypotheses, as well as the awareness of the diagnostic possibility of a rhinolith to assist in treatment.

Anatomical relationship between maxillary posterior teeth and the maxillary sinus in an Indonesian population: a CT scan study.

BACKGROUND: The anatomical proximity between the root apex of the maxillary posterior teeth and the maxillary sinus can lead to complications, including odontogenic maxillary sinusitis. While several studies have investigated similar variables in different populations, there is limited research on the Indonesian population. This study aimed to describe the anatomical position of the maxillary posterior teeth in relation to the floor of the maxillary sinus using CT scans. METHODS: A total of 122 patients (432 maxillary premolars and 1,282 maxillary molars) underwent CT scans to evaluate 1,711 roots. The vertical relationship between the root apex of the maxillary posterior teeth and the maxillary sinus was classified into three types: IS (inside sinus), CO (sinus contact), and OS (outside sinus). RESULTS: The IS type was predominantly found in the palatal roots of the first molars, accounting for 20% of the total roots in this type. The CO type was most frequently observed in the mesiobuccal roots of the second molars, representing 18% of the total roots in this type. The OS type was most commonly found in the first premolar, comprising 20% of the total roots in this type. CONCLUSIONS: The palatal roots of the first molars exhibited the highest frequency of proximity to the maxillary sinus. CT scans can effectively assess the relationship between the root apex of the posterior teeth and the maxillary sinus. CLINICAL RELEVANCE: Clinicians should consider this information comprehensively when planning treatments for maxillary molars.

Comprehensive sinus contour classification and its characteristics from radiographic examination: a cross-sectional study.

OBJECTIVE: The aim of this study was to propose a comprehensive maxillary sinus (MS) contour classification system based on the evaluation of anatomical characteristics from cone beam computed tomography (CBCT) examination and investigate the relationship between sinus contours and sinus floor elevation (SFE). METHODS: A total of 283 CBCT scans from patients who had single tooth loss in the posterior maxilla and underwent SFE were analyzed. The MS was classified at each tooth position. For buccal-palatal evaluation, the classification from Type A to E was narrow-taper, taper, ovoid, square, and irregular, respectively. For mesial-distal evaluation, the classification from Type 1 to 4 was flat, slope, concave, and septa, respectively. The major anatomical parameters evaluated were (1) residual bone height (RBH), (2) sinus width (SW), (3) maxillary sinus angle (MSA), (4) buccal dip angle (BDA), (5) palatonasal recess (PNR), and (6) sinus depth. RESULTS: Eleven groups of MS contour were classified after detailed calculation. Differences in the RBH, MSA, BDA, and SW among different groups were statistically significant. The narrow-taper and slope MS (A2) group had the highest RBH (8.66 ± 0.77 mm), largest BDA (79.9° ± 3.18°), smallest MSA (19.8° ± 2.01°), and narrowest SW (6.30 ± 1.23 mm). The lowest RBH was in the square and concave sinus (D3) group (5.11 ± 2.70 mm). The ovoid and concave sinus (C3) group had the smallest BDA (50.64 ± 8.73 mm) and largest MSA (74.11° ± 11.52°). The square and flat MS (D1) group had the widest SW (19.13 ± 3.69 mm). A strongly significant positive correlation was observed between the SW and MSA (r = 0.67) and a strongly negative correlation between the SW and BDA (r = - 0.65). The prevalence of PNR (mean angle: 104.06° ± 16.83°, mean height: 14.72 ± 11.78 mm) was 38% and frequently observed in the ovoid and slope MS (C2) group. CONCLUSION: Despite certain characteristics at different tooth sites, the same tooth position was categorized differently using different classification systems, indicating large anatomical variations in the MS. The classification system proposed herein allows for classification based on general characteristics at a single tooth site, aiming to help surgeons in improving presurgical evaluation.

Antral membrane balloon technique versus Densah bur in crestal sinus lift with simultaneous implant placement: a randomized clinical trial.

BACKGROUND: The posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement. MATERIALS AND METHODS: This randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed. RESULTS: All dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P < 0.0001), and significant reduction in vertical bone height after 6 months (P < 0.0001). Densah group showed significant increase in bone density (P ≤ 0.05). CONCLUSION: Both techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density. TRIAL REGISTRATION: This study was registered in Clinical-Trials.gov PRS ( https://register. CLINICALTRIALS: gov ) under identification number NCT05922592 on 28/06/2023.

Association between sinus septa and lateral wall thickness with risk of perforation during maxillary sinus lift surgery: A systematic review and meta-analysis.

OBJECTIVE: Sinus membrane perforation is a common complication of sinus lift surgery. This review aimed to examine if anatomical factors such as the presence of septa and lateral wall thickness influence the risk of membrane perforation. METHODS: This study was registered on PROSPERO (CRD42023488259). PubMed, Embase, and Web of Science were searched for relevant studies published up to 26th June 2024. The outcome of interest was the risk of perforation based on presence of septa and lateral wall thickness. Random-effects meta-analysis was conducted with dichotomous data to obtain the odds ratio (OR) of perforation using Review Manager. RESULTS: Ten studies with 1865 patients undergoing 2168 "lateral" sinus lift procedures were included. The total incidence of Schneiderian membrane perforations was 19% (405 cases). Schneiderian membrane perforation was present in 169/425 cases (39.76%) with sinus septa and 184/1492 cases (12.33%) without septa. Meta-analysis showed that septa were significantly associated with an increased risk of perforation (OR: 4.03 95% CI: 1.77, 9.19) with high heterogeneity (I2 = 87%). The certainty of the evidence was very low. Data on lateral wall thickness and risk of perforation was too heterogeneous for a meta-analysis. Studies reported mixed results on the risk of perforation based on lateral wall thickness. CONCLUSIONS: Our results show, with very low-quality evidence, that the presence of septa significantly increases the risk of perforations during maxillary sinus lift surgery. Evidence on the association between lateral wall thickness and a risk of perforations during sinus lift surgery is conflicting, and no clear conclusions can be derived at this stage.

VARIANT ANATOMY OF THE MAXILLARY SINUS BASED ON MULTISPIRAL COMPUTED TOMOGRAPHY DATA.

The structural features of the paranasal sinuses play a key role in the development of pathological processes within them. The aim of our study was to examine the variations in the anatomical structure of the maxillary sinus based on Multispiral Computed Tomography (MSCT) data. MATERIAL AND METHODS: The study involved 400 individuals aged 18 to 44 years, both male and female. During the study, attention was given to the following topographical and structural indicators: linear dimensions of the maxillary sinus2. The position relative to the nasal cavity, which is also important for reconstructive surgeries and cosmetic procedures. For planning surgical interventions in plastic surgery, the location and prevalence in height of the sinuses were also parameters studied in this work; pneumatization features, which deserve special attention from both researchers and practicing physicians; the average volume, wall thickness, and density, measured as key structural indicators of the sinus. Additionally, these data can indirectly indicate potential risks of complications; the study also determined the dependence of the calculated indicators on gender and age. RESULTS AND DISCUSSION: The maximum average sinus volume was found in men aged 60-74 years and women aged 18-44 years. This measure was 19.05±2.33 x10⁻6m³ and 19.3±2.9 x10⁻6m³, respectively. The minimum average volume was observed in men aged 45-59 years, where it was 13.02±2.3 x10⁻6m³. In the corresponding age group of women, the minimum average volume was slightly higher, at 11.9±2.1 x10⁻6m³. In other groups studied, the average volume values were intermediate between the maximum and minimum values. CONCLUSIONS: The results of this study provide insights into the variations in the structure of the human maxillary sinus based on MSCT data. The average sinus volume indicators were calculated, with a maximum of 19.05±2.33 x10⁻6m³ and a minimum of 11.9±2.1 x10⁻6m³. Additionally, the study identified features of the topographical location of the maxillary sinuses in relation to the external nose.

Imaging of Odontogenic Sinusitis.

Odontogenic sinusitis (ODS) has been shown to be the most common cause of unilateral maxillary sinus opacification on computed tomography scans. Review of the maxillary alveolar ridge and maxillary tooth roots, and their relationships to the maxillary sinus floor is essential when interpreting paranasal sinus imaging. In recent years, ODS has received increased attention in the recent otolaryngologic and dental literature. This article will discuss technical considerations to optimize imaging of the paranasal sinuses and maxillary dentition, as well as both classic and nuanced radiologic findings of ODS.

Unilateral Sinus Disease: What Is, and Is Not Odontogenic Sinusitis?

The differential diagnosis of unilateral sinus disease (USD) is broad, and while concerning etiologies like sinonasal neoplasia, invasive fungal sinusitis, and cerebrospinal fluid rhinorrhea should always be considered, most cases are due to noninvasive inflammatory or infectious conditions. To diagnose USD appropriately, clinicians must integrate the clinical history and examination, nasal endoscopy, computed tomography (CT), and possibly MRI. Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification on CT, with 45% to 75% of such cases being odontogenic in nature. This study provides USD diagnostic considerations and reinforces the diagnostic approach to ODS.

Can human sex be estimated based on the dimensions of the maxillary sinuses? A systematic review of the literature on cone-beam and multi-slice computed tomography.

PURPOSE: To critically appraise and summarize the potential of linear and/or volumetric dimensions of the maxillary sinuses obtained with cone-beam and multi-slice computed tomography. METHODS: A bibliographic search was conducted in seven databases in August 2023. Cross-sectional retrospective studies using linear and volumetric measurements of the maxillary sinuses obtained with cone-beam and multi-slice computed tomography for sex estimation and presenting numerical estimation data were included. Narrative or systematic reviews, letters to the editor, case reports, laboratory studies in animals, and experimental studies were excluded. The critical appraisal and certainty of evidence were assessed using the guidelines described by Fowkes and Fulton and GRADE, respectively. RESULTS: A total of 656 studies were found, 32 of which were included. A total of 3631 individuals were analyzed and the overall sex estimation rate ranged from 54.9 % to 95 %. When compared with isolated measurements, combined linear measurements of the right and left maxillary sinuses, such as width, length, and height, provided a higher rate of sex estimation (54.9-95 %). In most of the studies (62.5 %), all measurements were higher in men than in women. Multiple methodological problems were found in the studies, especially distorting influences in 84.4 % of the answers. The certainty of evidence varied from very low to low. CONCLUSIONS: The combination of height, width, and length measurements of the right and left maxillary sinuses from cone-beam and multi-slice computed tomography can be useful in the estimation of sex of humans. Further primary studies are needed to increase the certainty of evidence. PROSPERO REGISTER: CRD42020161922.