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Original Article

A study of morphometric evaluation of the maxillary

sinuses in normal subjects using computer
tomography images
Lakshmi N. Kiruba, Chandni Gupta, Sandeep Kumar1, Antony S. D’Souza
Departments of Anatomy and 1Radiodiagnosis, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

ABSTRACT
Objectives: The paranasal sinuses are complex anatomical structures with a significant inter-individual variation. The dimensions
of maxillary sinuses are particularly significant when considering endoscopic sinus surgery. The aims of this study were to estimate
different dimensions of the maxillary sinuses measured on head CT, and their relations to sex of the individuals. Materials and Methods:
Cranial computerized tomographic images (CT) of 200 normal subjects between the age groups of 18 and 80 years were observed in
this study. The height, width, and depth of the maxillary sinuses were measured with a Philips Brilliance 64 CT. The statistical analysis
for sex and age comparison for all the parameters was done. Results: The mean width, height, and depth of maxillary sinus in male
on both right and left side were 27.8, 28.2, 39.9, 39.6, and 40.0, 39.7 mm but in females were 26.6, 26.7, 36.8, 37.1, and 36.6, 37.4
mm. The discriminative analysis showed that the accuracy of maxillary sinus measurements i.e. the ability of the maxillary sinus size
to identify gender was 55% in females and 69.5% in males. Conclusion: This study on CT dimensions of maxillary sinuses may be
beneficial for the ENT surgeons when planning for endoscopic sinus surgery and to support gender determination.

Key Words: CT scan, maxillary sinus, measurements

Introduction canines may raise the sinuses or may pierce their base.[1] It
drains into the middle meatus (hiatus semilunaris) of nose.[2]
Maxillary sinuses are two spaces, which are occupied with
The maxillary sinuses appear at the end of the second
air, situated in the maxillary bone, and can be in several
embryonic month. They extend to the roof of the permanent
sizes and shapes. Their walls are thin. The tip of the sinuses
teeth when deciduous teeth fall off. The maxillary sinuses
can extend into the zygomatic process and can occupy the
originate as invagination of the nasal mucosa into maxilla
zygomatic bone. The base formed by the alveolar process, the
bone. This unique development describes the massive
first, the second, and the third molars, and the roots of the
quantity of anatomical variation.[3]

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Website:
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DOI:
10.4103/2321-4848.133782
Computed tomography (CT) is an outstanding means of
providing anatomical information of this area; thus, it has
been used to determine the anatomic variations of the nose
and paranasal sinuses.[3]
It has been reported that maxillary sinuses stay intact
though the skull and other bones may be severely disfigured

Corresponding Author:
Dr. Chandni Gupta, Department of Anatomy, Kasturba Medical College, Manipal - 576 104, Karnataka, India.
E-mail: chandnipalimar@gmail.com

12 Archives of Medicine and Health Sciences / Jan-Jun 2014 / Vol 2 | Issue 1

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Kiruba, et al.: Morphometric study of maxillary sinuses in CT images

in victims who are incinerated and hence, that maxillary
sinuses can be used for identification.[1]
The aim of this study was to investigate whether the width,
the depth, and the height of maxillary sinuses can be used
for determination of gender.
Materials and Methods
A significant difference was found in the width, the height,
and the depth of the sinuses between males and females,
except the width of the right maxillary sinus which is not
significant.
This formula can be used for gender determination from
measurements of the left (Lt) and the right (Rt) maxillary
sinuses together:

This study included cranial computerized tomographic Gender = –8.424 – 0.118 X height of Rt MS – 0.120 X depth
images (CT) of 200 (M = 120, F = 80) normal subjects of Rt MS – 0.039 X width Lt MS + 0.088 X height Lt MS +
between the age groups of 18 and 80 years, for which ethical 0.096 X depth Lt MS.
clearance has been taken from the local ethical committee.
The accuracy rate of gender identification from the right
The Width, height, and depth measurements were made
and left maxillary sinus measurements together was 55% in
where the maxillary sinus was in its widest position with
females and 69.5% in males, with a mean of 63.6% [Table 2].
the help of the measurement equipment on Philips Brilliance
64 CT scan, as the measurement technique. Whereas width
Discussion
is measured in axial section [Figure 1] and height, depth in
sagittal section [Figure 2]. Identification from remnants of human skeletons is
a significant forensic procedure. Determination of age
The statistical analysis for sex and age comparison for all and gender is an essential part of identification. Gender
parameters was done using t-test for independent samples determination is certainly significant for identification. It has
to compare these values in two groups. Discriminative been stated that the precision rate of gender determination
analysis was done to detect gender by using data obtained is 100% from a skeleton, 98% from both the pelvis and the
from CT scans. The analyses were performed by using the
SPSS 14 package program. Table 1: Distribution of linear measurements of maxillary sinuses on CT
and their standard deviations
Results Maxillary Male (n=120) Female (n=80) P value
sinus Mean Std. Mean Std.
In the current study, the size of the maxillary sinuses of the deviation deviation
Width (right ) 27.858 4.0461 26.693 3.5395 0.143
female was found to be smaller than those of men. Table 1 Width (left) 28.212 3.9571 26.787 3.6837 0.074
shows the distribution of the mean width, depth, and height Height (right) 39.951 7.2192 36.825 5.5054 0.023
Height (left) 39.683 7.2653 37.125 5.0588 0.056
of maxillary sinuses with their standard deviations according Depth (right) 40.053 4.4942 36.675 6.7740 0.004
to gender. Depth (left ) 39.736 4.3857 37.433 3.8448 0.008

Figure 1: Showing the width of maxillary sinus as measured on CT Figure 2: Showing the height and depth of maxillary sinus as measured
images on CT images

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Kiruba, et al.: Morphometric study of maxillary sinuses in CT images
Table 2: Gender determination from measurements of both maxillary
sinuses together
Gender (real) Gender (predicted)
Male Female
Male (120) 84 (69.5%) 36(30.5%)
Female (80) 36 (45%) 44 (55%)
Total 120 80
skull, 95% from the pelvis only or the pelvis and the long
bones, 90-95% from both the skull and the long bones, and
80-90% from the long bones only.[4-6]
It has been reported that the maxillary sinuses are
significantly larger in males than in females.[7-9] The left
maxillary sinus has been reported to be larger than the right
sinus in both genders.[10]
In study of Lee Fernandes, (2004) about gender determination
from measurement of the maxillary sinuses, it has been
noted that maxillary sinuses was larger in males than in
females and that the accuracy rate was 79.0%.[7]
According to Hacer Yasar T et al. (2007), the determination of
gender based on measurements of maxillary sinus was found
to be accurate in 69.4% in females and 69.2% in males.[1]
In the present study, the measurements of the maxillary
sinuses of females were lower than those of males. The
estimation rate of gender was detected in male 69.5% and
female 55% whereas mean 63.6%.
Johnson PS et al. (2011) found the depth and width of
maxillary sinus in males on right and left side as 36, 35 and
25, 25 mm while in females as 35, 34 and 23, 23 mm while
in our study, we got 40, 39.7 and 27.8, 28.2 in males and in
females 36.6, 37.4 and 26.6, 26.7 mm.[11]
Shahbazian M et al. (2010) have done the CT measurements
of maxillary sinus in dentate patients and on edentulous
patients. They found the depth and width of maxillary sinus
on right and left side in dentate patient as 37.4, 37 and
24.8, 25.1 mm while in edentulous patients as 38, 36.8 and
25.5, 23.5 mm.[12]
Hacer Yasar T et al. (2007) has got the following formula, which
can be used for gender determination from measurements
of the left and the right maxillary sinuses together.[1]
Gender = –5.616 + 0.133· the width of the right maxillary
sinus –0.020· the height of the right maxillary sinus –0.078·
the length of the right maxillary sinus–0.114· the width of the
left maxillary sinus + 0.148· the height of the left maxillary
sinus + 0.077· the length of the left maxillary sinus.
14
While in our study, we got the formula as- Gender =
–8.424 – 0.118 X height of right maxillary sinus – 0.120
X depth of right maxillary sinus –0.039 X width left
maxillary sinus + 0.088 X height left maxillary sinus +
0.096 X depth left maxillary sinus. This may be due to
racial differences in the population in which the studies
were done.
Uthman AT et al. (2011) found that the maxillary sinus
height was the best discriminant parameter that could be
used to study sexual dimorphism with an overall accuracy
of 71.6%. They found using multivariate analysis, 74.4%
of male sinuses and 73.3% of female sinuses were sexed
correctly and the overall percentage for sexing maxillary
sinuses correctly was 73.9%.[13]
Fernandes CL gender determination from measurement of
the maxillary sinuses was 79.0% while in our study, it was
63.6%.[14]
CT measurements of maxillary sinuses may be beneficial to
support gender determination in forensic medicine; however,
with fairly low-accuracy rate (less than 70%). We advise
that the depth, the width, and the height of the maxillary
sinuses together with other bones can be used for gender
determination when the complete skeleton is not available.
This information can also be useful for ENT surgeons while
performing surgery in this region.
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How to cite this article: Kiruba LN, Gupta C, Kumar S, D’Souza AS.
A study of morphometric evaluation of the maxillary sinuses in normal
subjects using computer tomography images. Arch Med Health Sci
2014;2:12-5.
Source of Support: Nil, Conflict of Interest: None declared.

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