Three-dimensional variation in maxillary sinus anatomy: Implications for health disparities in sinonasal disease




Kim, Suhhyun


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Sinusitis affects approximately 30 million Americans annually and is associated with negative quality of life, overuse of antibiotics, and high healthcare costs. As the maxillary sinus (MS) is the sinus most commonly involved in sinusitis, MS anatomy has long been of considerable biomedical interest. Moreover, MS anatomy has also elicited the attention of anthropologists, given its relevance to evolutionary hypotheses regarding craniofacial ontogeny and physiological adaptations for respiratory air-conditioning, selective brain cooling, and/or nitric oxide production. Importantly, the vast majority of research into MS morphology has focused on MS volume across ecogeographical populations, despite factors such MS shape, surface area, and the surface area-to-volume (SAV) ratio, factoring heavily in both biomedical and anthropological theories regarding MS form and function. Hence, this dissertation has three objectives: 1) investigate MS volume in conjunction with measures of MS shape, mucosal surface area, and the SAV ratio in modern humans from diverse ecogeographical backgrounds, 2) examine the potential contributions of ancestrybased variation in MS morphology to sinusitis susceptibility, and 3) assess the implications of sex-based differences in MS morphology to sinusitis risk. A total of 167 computed tomography (CT) scans of male and female crania derived from three different ancestral backgrounds (West Africa, East Asia, and Europe) were employed for this study. MS volume, linear measurements, and three-dimensional coordinate landmarks were collected from each CT scan. Multivariate analyses were then performed to evaluate each of the three objectives. This study found 1) that MS volume and MS shape exhibit a significant pattern of allometric scaling that substantially influences both total surface area and the surface area-to-volume ratio, 2) that Asian-ancestry individuals typically exhibit a larger MS size, a more inferiorly positioned MS floor, and a greater distance from the MS floor to the nasal fontanelle (i.e., skeletal ostium), and 3) that both across and within ancestry groups, males typically exhibit larger MS volumes, more inferiorly positioned MS floors, and greater distances from the MS floor to the nasal fontanelle, than females. This study thus sheds light on proposed hypotheses regarding MS form and function, as well as the clinical manifestation and management of sinusitis.