Özge DÖNMEZ TARAKÇI, Gökhan ÖZKAN
Meandros Medical and Dental Journal - 2026;27(1):69-78
Objective: Detailed knowledge of paranasal sinus anatomy and its variations is essential due to their proximity to vital neurovascular structures, including the internal carotid artery, optic nerve, cavernous sinus, and orbit. These variations can significantly affect the outcomes of functional endoscopic sinus surgery, posterior maxillary implant placement, sinus augmentation, and orthognathic procedures. This study presents a cone beam computed tomography (CBCT)-based evaluation of 23 bony anatomical variations in Turkish population and organizes them according to surgical risk to improve clinical decision-making. This study provides practical guidance: for high-risk variants, surgeons might employ modified approaches to sensitive regions to reduce neurovascular injury. Materials and Methods: A total of 180 CBCT images containing all of the paranasal sinuses were evaluated retrospectively in terms of anatomical variation presence or absence. Results: Agger nasi cell (80.6%), concha bullosa (65.6%), and septum pneumatization (60.3%) were the most prevalent variations. Several high-risk variants, including internal carotid artery protrusion and Onodi cells, were identified at clinically relevant frequencies. Conclusion: Present study demonstrates that CBCT not only allows accurate three-dimensional identification of anatomical variations at a lower radiation dose compared to computed tomography (CT). This clinical risk-based classification improves preoperative planning, minimizes iatrogenic complications, and reinforces the role of CBCT in dentomaxillofacial imaging.
