Visibility, location, and morphology of the primary maxillary sinus ostium and presence of accessory ostia: a retrospective analysis using cone beam computed tomography (CBCT)

  • Andy Wai Kan Yeung
  • Nicolas Colsoul
  • Carla Montalvao
  • Kuofeng Hung
  • Reinhilde Jacobs
  • Michael M. BornsteinEmail author
Original Article



This retrospective study evaluated the visibility, location, and morphology of the primary maxillary ostium (PMO), as well as the presence and number of accessory maxillary ostia (AMO) in the maxillary sinus using cone beam computed tomography (CBCT).

Materials and methods

CBCT scans with a large field of view with both maxillary sinuses entirely visible, acquired from February 2016 to February 2018, were initially screened. Patients were included if there was no history of surgical intervention/trauma in the sinus region. Two observers evaluated the CBCTs for PMO and AMOs independently. PMO and AMOs were evaluated in axial, coronal, and sagittal CBCT views. In case of disagreement, a third observer served as a referee. The findings were correlated with age, gender, condition of the sinus mucosa, and status of the dentition to assess for potential influencing factors.


A total of 184 patients (368 maxillary sinuses) were included. PMO was present and patent in 346 (94.0%) of the 368 analyzed sinuses. Most of the PMOs were located above the attachment of and in the middle third of the inferior turbinate (76.1%) and exhibited a slit shape (71.1%). An AMO was present in 167 (45.5%) of the 368 analyzed sinuses, and 66 (17.9%) sinuses had multiple AMOs. Gender and sinus mucosa morphology were found to be influencing factors for the patency of the PMO. Furthermore, gender seems to be influencing the presence of an AMO.


Most of the analyzed maxillary sinus cavities in the present population had a patent PMO. Being male and having morphological changes of the sinus mucosa were factors associated with a reduced prevalence of a patent PMO.

Clinical relevance

A maxillary sinus with pathological findings of the mucosa seems to have a reduced prevalence of patent PMOs. Therefore, clinicians should take care to assess any clinical and radiographical sign indicating a potential maxillary sinusitis prior to surgical interventions in this region, especially in cases with planned sinus floor elevation.


Maxillary sinus Ostium Cone beam computed tomography Visibility Location Patency 



The authors are grateful to Ms. Kar Yan Li, Centralised Research Lab, Faculty of Dentistry, The University of Hong Kong, for her valuable assistance regarding the statistical analysis.


This study has been funded by departmental funds only. No external funding has been received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki (2013). The study protocol was submitted to and approved by the local institutional review board (IRB) of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (approval number UW 18-227).

Informed consent

For this type of study (retrospective study) formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Oral and Maxillofacial Radiology, Applied Oral Sciences, Faculty of DentistryThe University of Hong KongHong Kong SARChina
  2. 2.OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral and Maxillofacial SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  3. 3.Department Dental MedicineKarolinska InstitutetStockholmSweden

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