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Anatomical Changes Related to Age in Maxillary Sinus   
 

Vol 13 No 1 (2025)    DOI 10.5195/d3000.2025.772 

 h#p://den*stry3000.pi#.edu 

Anatomical Changes Related to Age in Maxillary Sinus 

Noor Ghazi Saab 

College of Dentistry, University of Tikrit, Iraq 

Abstract 

Objec&ve: The paranasal sinuses consist of four paired cavi=es: maxillary, ethmoid, frontal, and 
sphenoid, which are air-filled, mucosa-lined spaces within the maxillofacial region, connected to the 
nasal cavity. The maxillary sinus, the largest of these, occupies the body of the maxilla and has a 
pyramidal shape. 
Methods: In this study, CBCT scans from 35 subjects (18 males and 17 females) who visited the University 
Dental Hospital in Tikrit and a private CBCT center in Samarra were analyzed. Subjects were categorized 
into four groups (A, B, C, and D). Measurements focused on determining the dimensions of the right 
maxillary sinus, including height (distance from the superior wall to the inferior wall in the coronal plane), 
width (distance from the lateral to the medial wall), and depth (antero-posterior distance in the axial 
plane). Mean values for each dimension were calculated.  

Results: The study results revealed that the length and height of the right maxillary sinus (RMS) increased 
up to Group C and then began to decline in Group D. Male subjects showed larger sinus dimensions 
compared to females. In females, the maxillary sinus length and height were variable across Groups A 
and B, with an increase in Group C followed by a decrease in Group D, while width showed an ini=al fill 

in Group A and then a gradual decline through 
Groups B, C, and D. In males, length, width, 
and height of the sinus increased in Groups A 
and B, peaked in Group C, and declined in 
Group D. 

Keywords: Maxillary sinus age changes, CBCT 
maxillary sinus measurements, Maxillary sinus 
dimensions by age, Gender differences in 
sinus size 

Cita9on: Saab NG. (2025) Anatomical changes related to 
age in maxillary sinus. Den9stry 3000. 1:a001 
doi:10,5195/d3000.2025.772 
Received: November 14, 2024 
Accepted: December 20, 2024 
Published: February 10, 2025 
Copyright: ©2025 Saab NG. This is an open access ar9cle 
licensed under a Crea9ve Commons ASribu9on Work 
4.0 United States License. 
Email:Noor.gsaab@tu.edu.iq 

 

 

Introduction 

The paranasal sinuses, comprising 
maxillary, ethmoid, frontal, and 
sphenoid sinuses, are air-filled, 
mucosa-lined cavities in the 
maxillofacial region that 
communicate with the nasal cavity 
[1,2]. Initially illustrated by 
Leonardo da Vinci in 1489 and later 
detailed by anatomist Nathaniel 
Highmore in 1651, the maxillary 
sinus—or antrum of Highmore—is 
the largest and earliest to develop 
among the paranasal sinuses [3]. It 
occupies the maxilla, with its floor 
formed by the alveolar process, 
which supports the dentition, 

particularly the second premolar 
and first molar roots [4]. 

Anatomically, the maxillary sinus 
has a pyramidal shape with a 
medial base adjacent to the nasal 
cavity, an apex extending into the 
zygomatic process, and a capacity 
of approximately 15 mL in adults, 
making it the largest paranasal 
sinus [5]. Bone expansion during 
paranasal sinus development 
occurs at varying rates and can 
result in significant variability in 
sinus shape and size [6,7]. With 
age, sinus volume increases until 
around 20 years of age before 
gradually declining, a process 

further influenced by tooth loss 
and aging [8]. The purpose of this 
study was to investigate the age-
related changes in dimensions of 
the maxillary sinus, a study using 
computed tomography [9].   

Material and Methods 

Subjects 

CBCT scans were analyzed from 93 
subjects, comprising 49 males and 
44 females, who presented to the 
University Dental Hospital in 
Sharjah. The CBCT images were 
acquired using the Galileos, Sirona 
CBCT Dental System (Bensheim, 
Germany) with an SIDEXIS 
operating system set at 85 kVp and 



Anatomical Changes Related to Age in Maxillary Sinus   
 

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7 mA. Assessment was conducted 
directly on a 1920 x 1080 pixel, 23-
inch DELL monitor. This dataset, 
obtained from the University 
Dental Hospital at the University of 
Sharjah, included measurements 
of six specific features of the 
paranasal sinuses for both male 
and female subjects [10,11]. The 
study encompassed patients aged 
20 to 70 years. CBCT scans from 
edentulous subjects, those with a 
history of mid-facial trauma, 
maxillary sinus cysts or tumors, or 
scans with incomplete coverage of 
the maxillary sinus area, were 
excluded [12].   

To minimize observer bias, two 
experienced maxillofacial 
radiologists, each with 10 years of 
clinical practice, evaluated the 
sinus dimensions. Mean values for 
each measurement were 
calculated, with assessments 
repeated after 15 days to control 
for intra-observer variability. 

Additionally, CBCT scans from 35 
subjects (18 males and 17 females) 
who presented to the University 
Dental Hospital in Tikrit and a 
private CBCT center in Samarra 
were reviewed. These scans were 
acquired using the CS 8200 3D (12 
x 10 Edition) and assessed on the 
same DELL monitor specifications 
as in Sharjah. This subset included 
subjects aged 20 to 60 years and 
followed similar exclusion criteria. 

Sample Grouping 

Only data from the right maxillary 
sinus were included in this study 
due to incomplete data for the left 

maxillary sinus, which led to its 
exclusion. Data collection was 
organized using a chart (refer to 
Figure 2). Subjects were 
categorized into age-based groups, 
with each group comprising both 
male and female participants, as 
follows: 

- Group (A): Ages 20-29 years 

- Group (B): Ages 30-39 years 

- Group (C): Ages 40-49 years 

- Group (D): Ages 50-59 years 

Statistical Analysis 

The mean value for each 
measurement was calculated. For 
statistical analysis, an independent 
samples t-test was employed to 
compare means between males 
and females, while an ANOVA test 
was used to evaluate mean 
differences across age groups. In all 
tests, a P-value of less than 0.05 
was considered statistically 
significant. Data organization was 
conducted in Microsoft Excel 2020, 
with subsequent analysis in SPSS 
version 27[13]. 

Exclusion Criteria 

1. Patients with a history of mid-
facial trauma. 

2. Presence of tumors or cysts in 
the maxillary sinus. 

3. CBCT scans lacking complete 
coverage of the maxillary sinus 
area were excluded from the study. 

 

 

Figure 1. X-ray computed 
tomography. 

 

Figure 2. Chart for data collection. 

Measurements 

The measurements of the right 
maxillary sinus were conducted on 
CBCT sections to ensure precision 
and consistency, with 
measurements taken parallel or 



Anatomical Changes Related to Age in Maxillary Sinus   
 

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perpendicular to the hard palate as 
specified. 

1. Height: The height of the 
maxillary sinus was measured in 
the coronal CBCT section, 
perpendicular to the hard palate. 
This distance extended from the 
uppermost point of the superior 
wall to the lowest point of the 
inferior wall, as illustrated in Figure 
3A. 

2. Width: The width of the 
right maxillary sinus was assessed 
in the coronal CBCT section, also 
parallel to the hard palate. This 
measurement spanned from the 
outermost point on the lateral wall 
to the medial wall of the maxillary 
sinus, as shown in Figure 3A. 

3. Depth: The depth of the 
sinus was measured on the axial 
CBCT section as the longest antero-
posterior distance, as depicted in 
Figure 3B. 

 

 

Figure 3. Measurements on CBCT 
images. 

• A: Measurement of the 
height and width of the maxillary 
sinus on the coronal CBCT section. 

• B: Measurement of the 
depth (length) of the maxillary 
sinus on the axial CBCT section. 

Results 

The distance from the uppermost 
point of the superior wall to the 
lowest point of the inferior wall of 
the maxillary sinus was measured 
in the coronal section, oriented 
perpendicular to the hard palate. 
The width of the right maxillary 
sinus was also assessed in the 
coronal CBCT section, parallel to 
the hard palate, spanning from the 
outermost point on the lateral 
wall to the medial wall. Depth was 
measured in the axial CBCT section 
as the longest antero-posterior 
distance. Mean values for each 
measurement were calculated for 
each age group, separately for 
males and females, with 

measurements taken exclusively 
from the right side. 

MS Measurements in Different 
Age Groups 

          Mean and standard 
deviation for the length, width and 
height in both sexes of different 
age groups are shown in Table 1.  

Table 1. Average measurements of 
right maxillary sinus parameters 
between age groups (N=35) in 
(mm). 



Anatomical Changes Related to Age in Maxillary Sinus   
 

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Figure 4. Length of MS by age 
groups. 

 

Figure 5. Width of MS by age 
groups. 

 

Figure 6. Height of MS by age 
groups. 

MSM in Both Sexes Related to 
Aging 

           Table 2 revealed that 
maxillary sinus length of females 
in GA was (35.3+2.4), GB was (34.0 
+ 2.5), GC was (36.2+4.1), and 
finally GD was (35.4+ 3.0). 

The present study showed that all 
the dimensions of MS in males 
were larger than in females. There 
was no significant difference 
between groups of males and 
females (P>0.05). 

Table2. Average measurements (in 
mm) of right maxillary sinus 
parameters between sex and age 
groups (N=35).  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Variable 

GA 

20-29 

GB 

30-39 

GC 

40-49 

GD 

50-59 

 

P-value 

Mean SD Mean SD Mean SD Mean SD 

Length 37.1 3.8 37.0 5.5 38.8 4.7 36.2 3.2 >0.05 

Width 23.9 4.5 24.2 3.7 23.6 2.8 24.2 2.6 >0.05 

Height 33.3 5.5 33.2 5.9 34.2 7.2 31.2 6.8 >0.05 



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Discussion  

          In this study, CBCT scans of 
100 patients (72 males and 28 
females) aged 1 to 90 years were 
examined at the Radiology 
Department of Vydehi Institute of 
Medical Science & Research 
Centre, Bangalore, focusing on 
coronal and axial sections of the 
maxillary sinuses [14,15]. Volume 
and dimensions, along with 

anatomical variations, were 
assessed, with mean values, 
standard deviations (SD), and 
significant differences across age 
and gender calculated. Notably, 
the greatest sinus growth in males 
occurred in the 11-20 and 41-50 
age groups for height, width, and 
volume, while depth peaked in the 

21-30 and 31-40 age groups. 
Growth generally decreased after 
61-70 years in height and further in 
81-90 years across depth, width, 
and volume. These findings align 
partially with the current study, 
where maxillary sinus (MS) length, 
width, and height in males peaked 
in Group C (40-49 years) before 
decreasing in Group D (50-59 
years). In females, the highest 

growth was observed in the 21-30 
and 51-70 age ranges for height, 
depth, and volume, with width 
peaking in the 11-20 and 51-60 age 
groups, followed by a decrease in 
all dimensions post-61 years, which 
also partially corresponds to our 
findings showing height and length 
increases in Group A (20-29 years) 

and declines by 
Group D. 

A retrospective 
observational 

study at Royal 
Care Hospital, 
Khartoum, Sudan 
[16,17]. evaluated 
CT scans of 
Sudanese adults 
(ages 17-78 years, 
46 males and 35 
females) with 
normal paranasal 
sinuses (PNS). The 
study found a 

negative 
correlation 

between age and 
maxillary sinus volume, with sinus 
dimensions decreasing in both 
genders as age advanced. This 
aligns with our findings, where the 
right maxillary sinus (RMS) length 
and height peaked in Group C and 
decreased in Group D. However, 
the Sudanese study noted no 
significant gender differences in 
sinus volume, a contrast to the 
present study where all maxillary 

Variable 

Age group 

P-value 
GA 

29 

GB 

30-39 

GC 

40-49 

GD 

50-59 

Mean SD Mean SD Mean SD Mean SD 

Sex 

Female 

(n=17) 

Length 35.3 2.4 34.0 2.5 36.2 4.1 35.4 3.0 >0.05 

Width 23.6 4.9 23.1 5.4 22.5 2.0 22.1 1.9 >0.05 

Height 29.6 3.8 29.5 3.0 32.5 7.5 27.6 2.5 >0.05 

Male 

(n=18) 

Length 38.4 4.3 39.3 6.3 42.7 2.0 37.4 3.7 >0.05 

Width 24.1 4.6 25.0 1.7 25.2 3.7 23.1 3.3 >0.05 

Height 36.0 5.0 36.2 6.1 36.7 8.5 35.9 8.3 >0.05 



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sinus dimensions were larger in 
males than females [18]. 

Another study of 200 patients at 
Dicle University, Faculty of 
Dentistry, Department of Oral and 
Maxillofacial Radiology, involved 
CBCT images analyzed via MIMICS 
software, categorizing patients 
into five age groups [19]. Results 
revealed a significant male-female 
difference in maxillary sinus 
volume, with volumes diminishing 
with age—findings that align with 
the current study’s conclusions 
[20]. 

Finally, an analysis of 133 
individuals (84 females, 49 males) 
aged 8 to 51 years assessed 
maxillary sinus volume (MSV) via 
MIMICS 21.0 software, with SPSS 
21.0 used for statistical analysis. 
While this study found no 
significant relationship between 
gender, age, and maxillary sinus 
volume, differing from our results, 
which show male measurements 
consistently larger and RMS length 
and height peaking in Group C 
before declining in Group D 
[21,23]. 

Recommendations 

1. Increase the interval of samples 
to study younger and older age 
groups. 

2. Using longitudinal study by 
taking groups of childes and take 

their morphometric 
measurements then after a period 
take the measurements of the 
same people and study their aging 
changes.   

Conflicts of interest 

The authors declare no competing 
interest. 

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