Introducing a simple method of maxillary sinus volume assessment based on linear dimensions

Internal structural analysis of the nasomaxillary complex in patients with skeletal class III asymmetry: A study on asymmetry patterns

OBJECTIVES

To investigate the internal structure of the nasomaxillary complex, including the maxillary sinus, nasal cavity and nasal septum according to the facial asymmetry pattern and to evaluate its correlation with external maxillomandibular asymmetry in Class III patients based on cone-beam computerized tomography (CBCT) images.

MATERIALS AND METHODS

Facial asymmetry was analysed in a total of 100 Class III patients aged 16 years or older using CBCT scans. Patients were categorized into subgroups based on asymmetry pattern. Measurements of the nasomaxillary complex were obtained from the CBCT scans, including the volume and width of the maxillary sinuses and nasal cavities on deviated and non-deviated sides, as well as the displacement of the nasal septum. Statistical analysis was performed to compare the internal nasomaxillary variables within and between groups, and regression analysis was conducted to evaluate the correlation between facial asymmetry and the internal nasomaxillary variables.

RESULTS

Group comparisons showed that there were no significant differences in the volume of the maxillary sinus and nasal cavity. However, the direction and extent of nasal septum deviation, as well as the width of the nasal cavity, varied depending on the maxillary asymmetry pattern. Regression analysis indicated a correlation between nasal septum deviation and the difference in maxillary height, while the difference in nasal cavity width was correlated with the difference in maxillary width.

CONCLUSION

A comprehensive evaluation of the internal nasal anatomy is vital for understanding the intricate relationship between nasal structure and maxillary growth.

Anatomical study of the maxillary sinus: which characteristics can influence its volume?

PURPOSE

To investigate whether there is a relationship between the volume of the maxillary sinus and individual parameters such as gender, side, posterior tooth absence, sinus membrane thickening, bony septa, vertical and sagittal skeletal patterns.

METHODS

The tomographic volume of the maxillary sinus from 211 individuals (422 sides) was evaluated using Horos DICOM Viewer Software. Bony septa and sinus membrane thickening were classified as absent or present. At the same time, loss of one or more teeth in the posterior region of the maxilla (except for the third molars) was considered. The t test was applied to analyze maxillary sinus volume according to gender, age, side, posterior tooth absence, sinus membrane thickening and bony septa. A one-way analysis of variance (ANOVA) with Tukey's post-hoc test was applied to compare sagittal and vertical patterns. Pearson's correlation coefficient was also used to verify the association between maxillary sinus volume, age and skeletal patterns.

RESULTS

Concerning the sagittal skeletal pattern, a statistically significant difference was observed between Classes II and III (p = 0.05) and it was confirmed by the Pearson's correlation coefficient (r = - 0.107/p = 0.029). No statistically significant differences were observed between the maxillary sinus volume according to gender (p = 0.06), side (p = 0.37), posterior tooth absence (p = 0.92), sinus membrane thickening (p = 0.47), bony septa (0.89) and vertical skeletal pattern (p = 0.67). No significant differences were observed with age (r = - 0.076/p = 0.109) and the vertical skeletal pattern (r = - 0.078/p = 0.108).

CONCLUSION

Maxillary sinus volume was influenced by the sagittal skeletal pattern and was higher in Class III individuals.

[Automated system of the determination of maxillary sinus morphometric parameters]

THE AIM OF THE STUDY

Was to compare manual, semi-automatic and automatic methods for determining the maxillary sinus volume using cone beam computed tomography (CBCT).

MATERIAL AND METHODS

CBCT images from 48 patients (96 maxillary sinuses) with no history of sinus and alveolar bone surgery, who were presented to Minsk medical centers, were used in this study. Neural network training was performed on CBCT scans of 42 patients (84 maxillary sinuses).The height, depth and width of the sinus were measured manually on CBCT scans of 6 patients (12 maxillary sinuses). Maxillary sinus volume (V) was calculated by the formula: V=height´depth´1/3 width. Semi-automatic segmentation was carried out by an expert radiologist. The convolutional neural network technology was applied for maxillary sinus automatic segmentation.

RESULTS

The largest values were revealed by using the automatic method for sinus volume measurement. These values were within the 95% confidence interval (±4.29 cm³) of the average sinus volume obtained from semi-automatic method.

CONCLUSION

The data obtained using the convolutional neural network technique (artificial intelligence) has a high correlation with the results of sinus morphometric analysis acquired through manual and semi-automatic methods. Automatic maxillary sinus segmentation technique does not require special user knowledge. This method is reproducible and it is implemented in a short time interval.

Volumetric study of the maxillary sinus in patients with sinus pathology

Objectives

The aim of this study is 1) to obtain the area and volumes of the maxillary sinuses in patients affected by clinically unilateral sinus pathology by comparing the results to the contralateral sinus and 2) to determine the importance of the volumetric measures when diagnosing the percentage of sinus obliteration.

Materials and methods

A single-centre observational retrospective clinical study was conducted in 214 patients with clinically unilateral sinus pathologies. Linear (mm), area (mm2) and volume (mm3) measurements were taken from Cone Beam Computed Tomography (CBCT) images of the affected sinus as well as from the contralateral ones. Histopathological study was performed using haematoxylin/eosin and PAS or Groccot stains. The lesions were classified into non-specific sinusitis, polyps, inverted papilloma, fungal sinusitis, cysts, mucocele and other lesions. Chi-squared test, ANOVA for independent samples and Pearson test were used for the statistical analysis.

Results

A total of 100 sinuses were measured in 50 patients (28 men and 22 women, with an age of 43.6 years (SD = 18.3), 50 pathological and 50 healthy contralateral sinuses. The three-dimensional occupation volume of the affected sinuses was 97.1 mm³ (62.5%) vs. 40.6 mm³ (22.8%) in the healthy ones (p<0.0001). The medial-lateral width of the sinus in the frontal plane was significantly higher in the cysts group (32.4 mm, CI: 23–41.8 mm).

Conclusion

In medical terms, the global percentage of occupation determined using the classic manual determination method does not differ from the three-dimensional percentage calculated using specific complex software.

The maxillary sinus: physiology, development and imaging anatomy

OBJECTIVES

The maxillary sinus is of paramount importance for otolaryngologists, rhinologists, oral and maxillofacial surgeons, head and neck and dental and maxillofacial radiologists. A comprehensive review article concerning the physiology, development and imaging anatomy was undertaken.

METHODS

Relevant literature pertaining to the physiology of the sinonasal cavity, development of the paranasal sinuses and imaging anatomy of the maxilla and maxillary sinus from 2000 to 2019 was reviewed. Emphasis was placed on literature from the last 5 years.

RESULTS

Extensive recent research using imaging has provided new insights into the development of the maxillary sinus, the other paranasal sinuses and the midface. The fundamental physiological concept of mucociliary clearance and its role in sinus health is emphasized. The paranasal sinuses are an integral part of a common mucosal organ formed by the upper and lower airway.An in-depth understanding of the soft-tissue and neurovascular relationships of the maxillary sinus to the deep fascial spaces and branches of the trigeminal nerve and external carotid artery respectively is required to evaluate and report imaging involving the maxillary sinus.Sinusitis of rhinogenic, rather than odontogenic origin, originates from nasal inflammation followed by anterior ethmoid disease and secondary obstruction of the ostiomeatal unit. The role of anatomical variants that predispose to this pattern of disease is discussed in detail with illustrative examples.The maxillary sinus is intimately related to the roots of the posterior maxillary teeth; the high frequency of mucosal disease and sinusitis of odontogenic aetiology is now well recognized. In addition, an understanding of the anatomy of the alveolar process, morphology of the alveolar recess of the maxillary sinus and neurovascular supply are essential both for deliberate surgical intervention of the sinus and complications related to oral surgical procedures.

CONCLUSIONS

An understanding of the fundamental principles of the development, physiology, anatomy and relationships of the maxillary sinus as depicted by multi-modality imaging is essential for radiologists reporting imaging involving the paranasal sinuses and midface.

Sexual dimorphism of maxillary sinuses in children and adolescents - A retrospective CT study

BACKGROUND

In the postnatal period, some sexual dimorphism is observed from the moment of birth, but it is most pronounced from puberty. The aim of the study based on CT images was to assess possible sexual dimorphism of the maxillary sinus in children aged 0-18.

METHODS

The retrospective analysis of CT images of the head (assessed as normal by radiologists) of 170 patients aged 0-18 (85 females and 85 males) was performed. The maxillary sinuses of every patient were bilaterally measured in three planes. Three diameters were obtained: maximum transverse (horizontal) diameter (the maxillary sinus width, MSW); maximum vertical diameter (the maxillary sinus height, MSH) and maximum antero-posterior diameter (maxillary sinus length, MSL). The automatic CT image segmentation algorithm was used (Syngo Via for Oncology, Siemens) to establish maxilla retrospective analysis of CT images of the head (assessed as normal by radiologists) of 170 patients aged 0-18 (85 females and 85 males) was performed. The maxillary sinuses of every patient were bilaterally measured in three planes. Three diameters were obtained: maximum transverse (horizontal) diameter (the maxillary sinus width, MSW); maximum vertical diameter (the maxillary sinus height, MSH) and maximum antero-posterior diameter (maxillary sinus length, MSL). The automatic CT image segmentation algorithm was used (Syngo Via for Oncology, Siemens) to establish maxillary sinus volume (MSV). The coefficient of variation used in the study allowed the biological variation between sexes to be observed.

RESULTS AND CONCLUSIONS

The sexual dimorphism of maxillary sinus parameters is variable and depends on the phase of ontogenesis. All investigated parameters of maxillary sinuses are larger in males at 2-3 years (except for the length, which is larger in females by the end of three years, between six and nine years and after 15 years). The sexual dimorphism is less evident during the first year of age, and the most evident between 15 and 16 years. During the first two years, females are dominant with all parameters being larger than in males. The maxillary sinus length is developmentally the most stable parameter of maxillary sinuses, because throughout the investigated ontogenesis, the sexual differences are very similar. The most evident sexual dimorphism is observed in the volume of the maxillary sinus.

Virtual reconstruction of paranasal sinuses from CT data: A feasibility study for forensic application

PURPOSE

The purpose of this study was to report the feasibility of computed modelization and reconstitution of the paranasal sinuses, before and after trauma, from CT data.

MATERIALS AND METHODS

We modeled and reconstructed the paranasal sinuses of two patients (A and B), before and after trauma, using two different softwares (3DSlicer^® and Blender^®). Both patients had different numbers and locations of fractures. The 3DSlicer^® software was used to create a 3D model from CT data. We then imported the 3D data into the Blender^® software, to reconstruct and compare the dimensions of the paranasal sinuses before and after trauma.

RESULTS

The 3 fragments of patient A and the 7 fragments of patient B could be repositioned in the pre-traumatic configuration. Distance measurements proved to be similar between pre- and post-traumatic 3D volumes.

CONCLUSION

After simple trauma, bone facial anatomy reconstruction is manually feasible. The whole procedure could benefit from automatization through machine learning. However, this feasibility must be confirmed on more severely fractured paranasal sinuses, to consider an application in forensic identification.

The Association between Maxillary Sinus Dimensions and Midface Parameters during Human Postnatal Growth

Objective

The aim of the study based on CT images was to assess the age-related changes in maxillary sinus diameters in relation to diameters of the facial skeleton.

Materials and Methods

The retrospective analysis of CT images of the head of 170 patients aged 0-18 years (85 females and 85 males) was performed. Specific orientation points (zy, zm, pr, ns, n, and P) were identified in every patient and the following distances were measured: zy-zy, maximum facial width; zm-zm, midfacial width; n-pr, upper facial height; ns-pr, alveolar facial height; and ns-P, distance not indicated in craniometry.

Results

The maxillary sinuses of every patient were bilaterally measured in three planes. Three diameters were obtained: maximum transverse (horizontal) diameter called MSW, maximum vertical diameter called MSH, and maximum anteroposterior diameter (length) called MSL. In females, the correlation of MSW, MSH, and MSL and zy-zy, as well as n-pr distances, is very strong. Moreover, the significant correlation was found between all measurements of maxillary sinus and ns-pr as well as ns-P distances in females. The correlation between MSL and all measurements of midface as well as MSH and MSW and all measurements except ns-P is stronger in females than in males. In males, all measurements of maxillary sinus correlate with ns-P distance very strongly.

Conclusions

The statistical analysis (correlation and determination coefficient) showed that all measurements of maxillary sinuses correlate with midface dimensions.