Skip to main content

Radioanatomic study of maxillary sinus palatal process pneumatization



To perform a detailed analysis of palatal process pneumatization (PPP) on cone beam computed tomography (CBCT) images.


This study consisted of 376 maxillary sinuses of 188 patients aged 22–88 years who had maxillary CBCT scans. The radioanatomy of the PPP was evaluated at distances 4, 8, 16, and 24 mm posterior to incisive foramen. The types of PPP were classified as follows: type I: maxillary sinus palatal process non-gasified; type II: palatal process gasification into the nasal floor, but not more than half of the width of the nasal floor; and type III: palatal process gasification into the nasal floor more than half of the width of nasal floor. Sinus opening angle (SOA), palatonasal recess angle (PNRA), palatal junction angle (PJA), and palatal depth measurement (PDM) were the evaluated parameters.


Among the identified 1315 PPPs, type I PPP (880, 66.92%) was the most frequently observed, followed by type II (426, 32.4%), and the least observed was type III PPP (9, 0.68%). There was no significant difference between SOA and PJA according to the types of PPP (p > 0.05). The difference between PNRA and PDM of type I and type II PPP showed a statistically significant difference (p < 0.05). Type I PPP was the most encountered with the highest PDM, and PNRA was narrower in type III than in type II PPP.


Physicians must be aware of these variations to prevent possible complications during surgery because 33.08% of the maxillary sinuses showed extensive pneumatization through the palatal process.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Yoon A, Guilleminault C, Zaghi S, Liu SY. Distraction Osteogenesis Maxillary Expansion (DOME) for adult obstructive sleep apnea patients with narrow maxilla and nasal floor. Sleep Med. 2020;65:172–6.

    Article  Google Scholar 

  2. Sánchez-Pérez A, Boracchia AC, López-Jornet P, Boix-García P. Characterization of the Maxillary Sinus Using Cone Beam Computed Tomography. A Retro Radiograph Study Implant Dent. 2016;25(6):762–9.

    Article  Google Scholar 

  3. Lana JP, Carneiro PM, Machado Vde C, de Souza PE, Manzi FR, Horta MC. Anatomic variations and lesions of the maxillary sinus detected in cone beam computed tomography for dental implants. Clin Oral Implants Res. 2012;23(12):1398–403.

    Article  Google Scholar 

  4. Cavalcanti MC, Guirado TE, Sapata VM, Costa C, Pannuti CM, Jung RE, César Neto JB. Maxillary sinus floor pneumatization and alveolar ridge resorption after tooth loss: a cross-sectional study. Braz Oral Res. 2018.

    Article  PubMed  Google Scholar 

  5. Wagner F, Dvorak G, Nemec S, Pietschmann P, Traxler H, Schicho K, Seemann R. Morphometric analysis of sinus depth in the posterior maxilla and proposal of a novel classification. Sci Rep. 2017;7(1):1–7.

    Article  Google Scholar 

  6. Marin S, Kirnbauer B, Rugani P, Payer M, Jakse N. Potential risk factors for maxillary sinus membrane perforation and treatment outcome analysis. Clin Implant Dent Relat Res. 2019;21(1):66–72.

    Article  Google Scholar 

  7. Nunes LS, Bornstein MM, Sendi P, Buser D. Anatomical characteristics and dimensions of edentulous sites in the posterior maxillae of patients referred for implant therapy. Int J Periodontics Restorative Dent. 2013;33(3):337–45.

    Article  Google Scholar 

  8. Velloso GR, Vidigal GM Jr, de Freitas MM, Garcia de Brito OF, Manso MC, Groisman M. Tridimensional analysis of maxillary sinus anatomy related to sinus lift procedure. Implant Dent. 2006;15(2):192–6.

    Article  Google Scholar 

  9. Chan HL, Monje A, Suarez F, Benavides E, Wang HL. Palatonasal recess on medial wall of the maxillary sinus and clinical implications for sinus augmentation via lateral window approach. J Periodontol. 2013;84(8):1087–93.

    Article  Google Scholar 

  10. Niu L, Wang J, Yu H, Qiu L. New classification of maxillary sinus contours and its relation to sinus floor elevation surgery. Clin Implant Dent Relat Res. 2018;20(4):493–500.

    Article  Google Scholar 

  11. King KS, Lam EW, Faulkner MG, Heo G, Major PW. Vertical bone volume in the paramedian palate of adolescents: a computed tomography study. Am J Orthod Dentofacial Orthop. 2007;132(6):783–8.

    Article  Google Scholar 

  12. Yilmaz HG, Ayali A. Evaluation of the neurovascular bundle position at the palate with cone-beam computed tomography: an observational study. Head Face Med. 2015;11(1):1–5.

    Article  Google Scholar 

  13. Liu JF, Dai JS, Zhou M, He PP, Liu QT, Wang NY. The CT observation and clinical significance of pneumatization of the anterior maxillary sinus Lin Chuang er bi yan hou tou Jing wai ke za zhi. J Clin Otorhinolaryngol Head Neck Surg. 2016;30(16):1447–54.

    Google Scholar 

  14. Monje A, Urban IA, Miron RJ, Caballe-Serrano J, Buser D, Wang HL. Morphologic patterns of the atrophic posterior maxilla and clinical implications for bone regenerative therapy. Int J Periodontics Restorative Dent. 2017;37(5):e279–89.

    Article  Google Scholar 

  15. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  Google Scholar 

  16. Garcia-Denche JT, Abbushi A, Hernández G, Fernández-Tresguerres I, Lopez-Cabarcos E, Tamimi F. Nasal floor elevation for implant treatment in the atrophic premaxilla: a within-patient comparative study. Clin Implant Dent Relat Res. 2015;17:e520–30.

    Article  Google Scholar 

  17. Bauer RE, Ochs MW. Maxillary orthognathic surgery. Oral Maxillofac Surg Clin North Am. 2014;26(4):523–37.

    Article  Google Scholar 

  18. Lozano-Carrascal N, Salomó-Coll O, Gehrke SA, Calvo-Guirado JL, Hernández-Alfaro F, Gargallo-Albiol J. Radiological evaluation of maxillary sinus anatomy: aA cross-sectional study of 300 patients. Ann Anat. 2017;214:1–8.

    Article  Google Scholar 

Download references


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations



DNG: conceptualization, resources, writing—original draft, TEK resources, writing—original draft, BA and EZA: writing—review and editing.

Corresponding author

Correspondence to Dilara Nil Günaçar.

Ethics declarations

Conflict of interest

The authors deny any conflicts of interest related to this study.

Ethical approval

The study design was approved by the Ethics Committee of the Recep Tayyip Erdogan University Faculty of Medicine (2021/62).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Patients signed informed consent regarding publishing their data and photographs.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Günaçar, D.N., Köse, T.E., Arsan, B. et al. Radioanatomic study of maxillary sinus palatal process pneumatization. Oral Radiol 38, 398–404 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Cone beam computed tomography
  • Diagnostic imaging
  • Maxillary sinus
  • Palate