Cone Beam CT Is Superior at Diagnosing Maxillary Sinus Pathology

Objectives: Approximately 40 million cases of sinusitis are reported in the United States each year. According to the center for disease control, patients get radiographs of the jaws with panoramic imaging that includes the maxillary sinuses more often than any other part of the body. While panoramic radiographs show sinus pathology to a certain extent, they do not depict the entire sinus in detail. The objective of this study was to compare the diagnostic ability of panoramic imaging and a cone beam CT (CBCT) that provides three dimensional information of the imaged area with a reasonably low radiation dose.
Methods: A total of 32 maxillary sinuses from 16 dry skulls were used to simulate a variety of maxillary sinus pathologies. Mucous retention cysts and mucous thickening were randomly simulated on the floor, medial wall, lateral wall and roof of the sinus by using dental inlay wax. Some of the simulations were done more anteriorly in the sinus and some were randomly simulated on the posterior aspect. A preoperative panoramic radiograph and a CBCT was done for all the skulls. A post-operative Panoramic and CBCT were done after the sinus pathology was simulated. The images were evaluated to compare the diagnostic efficacy of both the modalities in diagnosing sinus pathology.
Results: Interim data analyses showed that mucus retention cysts and marked mucosal thickening, specifically in the anterior plane were detectable equally on both modalities. Panoramic radiographs could not show simulated pathology on the medial wall, lateral wall and the roof of the sinus. CBCT was able to detect the simulated pathology at all locations.
Conclusions: Cone Beam CT is superior at diagnosing sinus pathology when compared to panoramic imaging.