Mapping the Hidden Air Spaces: What CBCT Scans Reveal About Maxillary Sinus Anatomy in Saudis
How Our Sinuses Shape Dental and Surgical Decisions
The maxillary sinus — the largest of the paranasal sinuses located above the upper jaw — is far more than an empty air pocket. Its size, shape, and internal structures vary greatly between people and can significantly influence dental treatments, implant placement, and even forensic identification.
A recent study published in BMC Oral Health (Madfa et al., 2025) offers one of the most comprehensive looks yet at this hidden structure in a Saudi population, using cone-beam computed tomography (CBCT) — a 3D imaging method widely used in modern dentistry.
Why Study the Maxillary Sinus?
Because the sinus lies close to the upper teeth and nasal cavity, any dental or surgical procedure in that area requires precise anatomical knowledge. Differences in sinus size or internal walls (called septa) can affect how safely and effectively implants are placed or sinus-lift surgeries are performed.
Moreover, variations in sinus dimensions can reveal biological and even forensic clues — helping experts estimate a person’s sex or age from skeletal remains.
The Study: Over a Thousand Scans, One Goal
Researchers from the University of Ha’il examined 1,018 CBCT scans (2,036 sinuses) taken between January 2024 and January 2025. Each scan belonged to a healthy adult aged 18 years or older.
They measured several sinus features — including width, length, area, perimeter, septa, mucosal thickening, and sinus fluid — and compared them across sex, age, and right/left sides.
Key Findings: Sex, Age, and Symmetry Matter
Men have larger sinuses.
Across all dimensions — width, length, area, and perimeter — men showed significantly larger measurements than women (p < 0.001). This reflects general craniofacial differences and could be vital for both surgical and forensic applications.
Sinuses shrink with age.
Sinus size decreased gradually after the fifth decade of life, likely due to bone remodeling and reduced air-space expansion (pneumatization).
Sinus fluid increases with age — and in men.
Fluid accumulation was the most common abnormality, found in roughly one-fifth of sinuses. It appeared more often in older adults and men, suggesting age-related or environmental influences such as tobacco exposure or chronic inflammation.
Bilateral symmetry is strong.
The right and left sinuses were highly correlated (correlation coefficients > 0.55), confirming that most individuals have symmetrical sinus structures.
Sinus septa and membrane thickening were less common.
These variations occurred but showed no significant difference by sex or age, supporting the idea that septa are mainly congenital.
Clinical and Forensic Implications
For dentists and surgeons, these findings underline the importance of personalized treatment planning. Recognizing that male and younger patients tend to have larger sinuses — while older patients are more prone to fluid and mucosal changes — can guide safer implant and sinus-lift procedures.
For forensic experts, the study reinforces the maxillary sinus as a reliable marker for sex estimation, especially when other skeletal parts are damaged or missing.
Looking Ahead
The authors emphasize that CBCT imaging should be a standard preoperative tool for maxillary procedures. They also call for larger, multi-regional studies to refine population-specific anatomical databases — crucial for both clinical practice and forensic science.
Reference
Madfa, A. A., Alshammari, A. F., Alenezi, Y. E., Alshammari, B. B., Al-Haddad, A., Aledaili, E. A., Abobaker, S. H., & Alkurdi, K. A. (2025). Comprehensive analysis of maxillary sinus anatomical features and associated characteristics: a CBCT-based study in a Saudi subpopulation. BMC Oral Health, 25, 1755. https://doi.org/10.1186/s12903-025-07152-2