Evaluation of paranasal sinus anatomic variations and mucosal changes with cone beam computed tomography

Abstract

Background/Aim: Anatomical variations of paranasal sinuses are common and play an role in disrupting the drainage of the sinuses, which often causes chronic sinusitis. In this article, anatomical variations of the paranasal sinuses and its relationship with mucosal changes were evaluated retrospectively by cone beam computed tomography (CBCT) which is also known as dental volumetric tomography. Material and Methods: CBCT data of 500 patients who applied to Cukurova University Faculties of Dentistry for any reason were retrospectively evaluated by maxillofacial radiologist. Anatomical variants of paranasal sinuses were included in the study. Mucosal thickening greater than 2 mm in the maxillary sinus was considered pathological. Results: The most common anatomic variation in the study was the nasal septal deviation, found in 302 (60.4%) patients. The least common anatomic variation in the study was lower concha pneumatization found in 3 (0.6%) patients. Mucosal thickening of the maxillary sinus was observed in 271 (54.2%) cases in the right sinus and 260 (52%) cases in the left sinus (p>0.05). Conclusions: Nasal septum deviation was the most common variation in the study. According to the results of our study, concha bullosa, haller cell and the uncinate process had no definite effect on mucosal thickening in the maxillary sinus.

The CBCT Retrospective Study on Underwood Septa and Their Related Factors in Maxillary Sinuses—A Proposal of Classification

“…The presence of Underwood septa might be one of the diagnosed situations in the maxillary sinuses, followed by SSS, accumulation of mucus, formation of a retention cyst, swelling of the mucosa of the maxillary sinus floor, lack of good oroantral drainage, changes in the OMC (osteomeatal complex), or poor sinus ventilation. Each of these findings might impact any further dental procedures, sinus surgery, or other surgical approaches planned in the maxillary sinuses [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. According to Shahidi et al, the amount of maxillary sinus variations in CBCT are common findings, but only their careful radiological evaluation might influence later good clinical and surgical outcome [ 12 ].…”

“…On the other hand, Krennmair et al’s classification distinguishes the primary septa (during maxillary development), and secondary (related to maxillary floor pneumatization and the process of tooth loss) [ 11 ]. Some other maxillary septa classifications and variations can be described according to their thickness, angulation, shape, or other components [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The current proposal on maxillary septa indicates that the sinus septa can be divided into primary septa and secondary septa; the primary septa arise from the development of the maxilla, whereas the secondary septa are said to arise from the irregular pneumatization of the sinus floor following tooth loss [ 13 , 14 , 15 , 16 ].…”

“…Some other maxillary septa classifications and variations can be described according to their thickness, angulation, shape, or other components [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The current proposal on maxillary septa indicates that the sinus septa can be divided into primary septa and secondary septa; the primary septa arise from the development of the maxilla, whereas the secondary septa are said to arise from the irregular pneumatization of the sinus floor following tooth loss [ 13 , 14 , 15 , 16 ]. In other words, primary septa are congenital, and secondary septa are acquired.…”

“…Therefore, it can be said that septa above teeth are primary, while the septa above an edentulous ridge are primary or secondary. Because of the following, it is worth noticing that each maxillary sinus wall can have also anatomical variations, shapes, and volume, which could be related to maxillary sinus septa and their relation towards the floor of the sinus, bony walls, their position regarding the dental roots and scope of sinus pneumatization, or even others [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…In some cases, the scope of bone septa and their proximity to dental roots can mimic a cyst when they are not closely evaluated before any surgery. Any surgery related to those bony septa should be made with caution to protect the infraorbital artery, the posterior lateral nasal artery, and the posterior superior alveolar artery (PSAA) which grants the blood supply to the maxillary sinus [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”