The effect of the ethmomaxillary sinus on maxillary sinus volume and chronic maxillary sinusitis

Abstract

Purpose: The ethmomaxillary sinus (EMS) is a posterior ethmoid cell variation located between the posterior part of the maxillary sinus and the orbital floor, draining into the superior meatus. The aim of this study was to investigate the prevalence of EMS variation, to assess the effect of EMS on maxillary sinus volume using paranasal sinus computed tomography (CT), and to evaluate the relationship between EMS and chronic sinusitis. Materials and methods: In this study, paranasal sinus CT scans of 492 patients were evaluated. Forty-two patients (59 sides) with EMS were included in the analysis. The EMS volume, ipsilateral maxillary sinus volume, and contralateral maxillary sinus volume (in patients with unilateral EMS) were measured. The relationship between EMS and chronic maxillary sinusitis was also evaluated. Results: The prevalence of EMS variation was found to be 8.5%, and a negative correlation was identified between EMS volume and ipsilateral maxillary sinus volume (p=0.05). The ipsilateral maxillary sinus volume was statistically significantly lower than the contralateral maxillary sinus volume (p=0.007). In addition, the incidence of chronic maxillary sinusitis was significantly higher on the side with EMS compared to the contralateral side (p<0.001). Conclusion: According to these findings, EMS appears to reduce the volume of the ipsilateral maxillary sinus, and the increased incidence of chronic maxillary sinusitis on the side with EMS suggests that EMS is associated with ipsilateral chronic maxillary sinusitis.

Keywords

• Ethmomaxillary sinüs
• ethmoidal air cells
• maxillary sinus
• paranasal sinuses computerized tomography
• chronic sinusitis

Etmomaksiller sinüsün, maksiller sinüs hacmine ve kronik maksiller sinüzite etkisi

Öz

Amaç: Etmomaksiller sinüs (EMS), maksiller sinüsün arka kısmı ile orbita tabanı arasında yer alan ve üst meatusa drene olan posterior etmoid hücre varyasyonudur. Bu çalışmanın amacı, EMS varyasyonunun sıklığını, Paranazal Sinüs Bilgisayarlı Tomografi’de (BT) EMS’nin maksiller sinüs volümü üzerindeki etkisini araştırmak ve EMS ile kronik sinüzit arasındaki ilişkiyi değerlendirmektir. Gereç ve yöntem: Çalışmada 492 hastanın paranasal sinüs BT taramaları değerlendirildi. EMS’si bulunan 42 hasta (59 taraf) çalışmaya dahil edildi. EMS hacmi, ipsilateral maksiller sinüs hacimi, unilateral EMS’li hastalarda kontralateral maksiller sinüs hacmi ölçüldü. Kronik maksiller sinüzit ile ilişkisi değerlendirildi. Bulgular: EMS varyasyonu sıklığı %8,5 bulunmuş, EMS ile ipsilateral maksiller sinüs volümleri arasında negatif korelasyon tespit edilmiştir (p=0,05). İpsilateral maksiller sinüs volümü, kontralateral maksiller sinüs volümüne göre istatistiksel olarak anlamlı düzeyde düşük bulunmuştur (p=0,007). Ayrıca EMS’li tarafta, karşı tarafa göre kronik maksiller sinüzit gelişimi istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur (p<0,001). Sonuç: Bu bulgulara göre EMS’nin, ipsilateral maksiller sinüs hacmini azalttığı ve EMS’li tarafta artmış kronik maksiller sinüzit gelişiminin, EMS’nin ipsilateral maksiller sinüzit ile ilişkili olduğu düşünülmektedir.

Anahtar Kelimeler

• Etmomaksiller sinüs
• etmoidal hava hücreleri
• maksiller sinüs
• paranazal sinüs bilgisayarlı tomografi
• kronik sinüzit

References

1. Hui L, Hung KF, Yeung AWK, von Arx T, Leung YY, Bornstein MM. Anatomical variations of the ethmoid sinuses and their association with health or pathology of the ethmoid and maxillary sinuses in a Southern Chinese population: An analysis using cone-beam computed tomography. Imaging Sci Dent. 2022;52(1):109-115. doi:10.5624/isd.20210277
2. Lee S, Fernandez J, Mirjalili SA, Kirkpatrick J. Pediatric paranasal sinuses-Development, growth, pathology, & functional endoscopic sinus surgery. Clin Anat. 2022;35(6):745-761. doi:10.1002/ca.23888
3. Zhang L, Han D, Ge W, et al. Computed tomographic and endoscopic analysis of supraorbital ethmoid cells. Otolaryngol Head Neck Surg. 2007;137(4):562-568. doi:10.1016/j.otohns.2007.06.737
4. Wormald PJ. The agger nasi cell: the key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg. 2003;129(5):497-507. doi:10.1016/S0194-59980301581-X
5. Caversaccio M, Boschung U, Mudry A. Historical review of Haller's cells. Ann Anat. 2011;193(3):185-190. doi:10.1016/j.aanat.2011.02.006
6. Jinfeng L, Jinsheng D, Xiaohui W, Yanjun W, Ningyu W. The Pneumatization and Adjacent Structure of the Posterior Superior Maxillary Sinus and Its Effect on Nasal Cavity Morphology. Med Sci Monit. 2017;23:4166-4174. doi:10.12659/msm.903173
7. Sirikçi A, Bayazit YA, Bayram M, Kanlikama M. Ethmomaxillary sinus: a particular anatomic variation of the paranasal sinuses. Eur Radiol. 2004;14(2):281-285. doi:10.1007/s00330-003-1993-6
8. Melnichenko Y, Kabak S, Savrasova N, Iwanaga J. A new CBCT-based classification of posterior extramural ethmoid cells. Surg Radiol Anat. 2025;47(1):173. doi:10.1007/s00276-025-03686-w

9. Kim SJ, Moon JW, Lee HM. Clinical and imaging features of ethmomaxillary sinus compared to Haller's cell. Eur Arch Otorhinolaryngol. 2023;280(12):5401-5406. doi:10.1007/s00405-023-08148-w
10. Zhou F, Cao C, Fan W, et al. The imaging anatomy of ethmomaxillary sinus and its impact on chronic rhinosinusitis. Eur Arch Otorhinolaryngol. 2021;278(3):719-726. doi:10.1007/s00405-020-06322-y
11. Khanobthamchai K, Shankar L, Hawke M, Bingham B. Ethmomaxillary sinus and hypoplasia of maxillary sinus. J Otolaryngol. 1991;20(6):425-427.
12. Ozcan KM, Selcuk A, Oruk V, Sarikaya Y, Dere H. Ethmomaxillary sinus. Eur Arch Otorhinolaryngol. 2008;265(2):185-188. doi:10.1007/s00405-007-0444-4
13. Selcuk A, Ozcan KM, Akdogan O, Bilal N, Dere H. Variations of maxillary sinus and accompanying anatomical and pathological structures. J Craniofac Surg. 2008;19(1):159-164. doi:10.1097/scs.0b013e3181577b01
14. Liu J, Dai J, Wen X, Wang Y, Zhang Y, Wang N. Imaging and anatomical features of ethmomaxillary sinus and its differentiation from surrounding air cells. Surg Radiol Anat. 2018;40(2):207-215. doi:10.1007/s00276-018-1974-8
15. Güven M, Saygin DA, Uysal II, Emlik GD. The relationship between structures affecting maxillary sinus ventilation and maxillary sinus volume: a CT study. Surg Radiol Anat. 2025;47(1):98. doi:10.1007/s00276-025-03607-x
16. Shi MH, Wang M, Li H, Wu YX. The CT image features of ethmomaxillary sinus and their significance in endoscopic surgery. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019;54(11):813-818. doi:10.3760/cma.j.issn.1673-0860.2019.11.003