Incidental Paranasal Sinus Findings on Computed Tomography Images of Pediatric Patients: A Cross-sectional Prevalence Study

DISCUSSION

The development of the sinuses begins in the 3rd–4th-month intrauterine period; however, at birth, not all the sinuses are well observed on the radiographic images. The majority of pneumatization in the skeleton is observed postnatally.⁴

In the present study, incidental sinus pathologies were noted in 31.03%, which is in accordance with the past studies done by Diament et al.⁵ and Havas et al.,⁶ which was around 30%. However, CBCT studies have shown a higher incidence of 24–56%.^7,10 This could be attributed to two facts, firstly, the studies for incidental findings on CT are few, and secondly that CBCT studies are primarily done on maxillary sinuses while the CT studies include all paranasal sinuses. A study on incidental findings of sinus comparing CT and MRI showed that MRI had a higher prediction rate of 87%. In the same study, the incidence in the younger population (<19 years) and adult population (>19 years) showed no significant variation and was 33–37% which was again similar to the values in the present study.¹¹

Asymptomatic patients were evaluated in a few studies involving three-dimensional imaging of sinuses, and pathologies were noted in 8.2–57.1%.

In the present study, MT was the most commonly observed pathology in 68 (29%) scans, followed by underdevelopment/ failure to develop in eight cases. Similar MT was observed by Pazera et al.⁹ The incidence of MT in maxillary sinus has been observed between 40 and 60% or sometimes higher in studies involving the general population and implant patients.¹² Bilateral MT in maxillary and ethmoid sinus was higher than unilateral involvement.

Frontal sinus was not appreciated in eight subjects from 6 to 11 years. However, the development of the frontal sinus is seen between 1 and 3 years but is appreciated on radiographs only after 4 years. Thereafter it grows in various phases and ceases at maturity. It is absent at birth.^13,14

The maxillary sinus is the first sinus to develop from the mesoderm of the first brachial arch.⁴ Development begins at 3 weeks of gestation, and at birth, the size is approximately 7–8 × 4–6 × 3–4 mm. The growth of it is faster in the initial 6 months, remains slow, and studies until the age of 8 years; after that, it becomes much slower and grows up to the age of 15–18 years.^2,4 Agenesis of the maxillary sinus is extremely rare.

Maxillary sinus and maxillary premolar, and first molar root apices have close approximation and are known to have a high rate of pathology transmission. Apical periodontitis and periodontal disease are among the major causes of odontogenic sinus disorders.¹⁵ In the contradictory scenario, patients may suffer from referred pain in these teeth by maxillary sinusitis, making them seek dentist consultation.

A few drawbacks of the present study were—no detailed clinical history except for exclusion criteria were considered and the lack of a sample group with symptomatic patients of upper respiratory infection for comparative analysis. Sinus inflammation may often be found in children as upper respiratory tract infection; however, studies have also shown that these findings are not rare in the asymptomatic common population.¹⁶ Our study was in accordance with them as 30% of the children who were subjected to CT for reasons other than upper respiratory infections and sinusitis had shown pathological changes. Literature has shown that maxillary sinus development affects not only the maxilla but also the growth and symmetry of the lower Jaw.¹⁷ Incidental sinus inflammatory diseases and their secondary dental effects may be an impending area of further research.