{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T16:32:47Z","timestamp":1785515567419,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korea government (MSIT)","award":["2020R1C1C1014734"],"award-info":[{"award-number":["2020R1C1C1014734"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The accessory maxillary ostium (AMO) can interfere with ventilation and drainage of the maxillary sinus, and therefore the importance of evaluating the anatomical features of the AMO has been emphasized. This study aimed to evaluate anatomical characteristics of the AMO together with the natural ostium (NO) using three-dimensional (3D) analysis and to assess the relationship between the AMO and maxillary sinus pathologies. Materials and Methods: This retrospective study included 394 sinuses in 197 patients. Using 3D computed tomography images, the prevalence of the AMO and concurrent sinus pathologies were examined. For patients with an AMO, 3D spatial positions of the AMO and NO related to adjacent anatomic structures and dimensions of the AMO and NO were evaluated. Results: A total of 84 sinuses showed single or multiple AMO, with a prevalence of 21.3%. The AMO was located superiorly by 30.1 mm from the maxillary sinus floor, inferiorly by 1.3 mm from the orbital floor, and posteriorly by 22.4 mm from the anterior sinus wall. The AMO was located 5.4 mm posteriorly and 0.7 mm inferiorly from the NO. On the same coronal plane as the NO or AMO, height from the maxillary sinus floor to the NO and AMO ranged from 19.4 to 45.8 mm and 14.5 mm to 41.9 mm, respectively. The mean horizontal and vertical dimensions were 5.9 mm and 4.6 mm for the NO and 2.8 mm and 3.0 mm for the AMO. We detected a significant association between the presence of the AMO and the mucosal thickening (p = 0.029). Conclusions: The results of this study suggest that, although the AMO and NO are mostly located in positions that do not limit sinus-related surgeries, such as maxillary sinus floor augmentation, the AMO and NO are also found in lower positions, which may be a detriment to the postoperative physiological function of the maxillary sinus and affect treatment outcomes.<\/jats:p>","DOI":"10.3390\/medicina58091243","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T07:05:56Z","timestamp":1662620756000},"page":"1243","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Anatomical Characteristics of the Accessory Maxillary Ostium in Three-Dimensional Analysis"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0973-8410","authenticated-orcid":false,"given":"Jiwon","family":"Do","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 03080, Korea"},{"name":"Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8975-0198","authenticated-orcid":false,"given":"Jeong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul 03080, Korea"},{"name":"Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1034\/j.1600-0722.2003.00012.x","article-title":"Effects of maxillary sinus floor elevation surgery on maxillary sinus physiology","volume":"111","author":"Timmenga","year":"2003","journal-title":"Eur. J. Oral Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s12070-010-0047-z","article-title":"The Location of Maxillary Sinus Ostium and Its Clinical Application","volume":"62","author":"Prasanna","year":"2010","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4315","DOI":"10.1007\/s00405-016-4129-8","article-title":"The effect of the presence of the accessory maxillary ostium on the maxillary sinus","volume":"273","author":"Yenigun","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_4","first-page":"3","article-title":"Accessory maxillary ostia: Topography and clinical application","volume":"50","author":"Kumar","year":"2001","journal-title":"J. Anat. Soc. India"},{"key":"ref_5","first-page":"121","article-title":"Development of maxillary accessory ostium following sinusitis in rabbits","volume":"46","author":"Genc","year":"2008","journal-title":"Rhinol. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"602","DOI":"10.2500\/ajra.2009.23.3375","article-title":"The Two Holes Syndrome","volume":"23","author":"Mladina","year":"2009","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"163","DOI":"10.2147\/IJGM.S253569","article-title":"Accessory Maxillary Ostia: Prevalence of an Anatomical Variant and Association with Chronic Sinusitis","volume":"13","author":"Aleshawi","year":"2020","journal-title":"Int. J. Gen. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s00276-019-02308-6","article-title":"Frequency, location, and morphology of accessory maxillary sinus ostia: A retrospective study using cone beam computed tomography (CBCT)","volume":"42","author":"Hung","year":"2019","journal-title":"Surg. Radiol. Anat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1017\/S002221510014544X","article-title":"Mucus circulation between accessory ostium and natural ostium of maxillary sinus","volume":"113","author":"Chung","year":"1999","journal-title":"J. Laryngol. Otol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"361","DOI":"10.2500\/105065897781286034","article-title":"Recirculation of Mucus as a Cause of Persistent Sinusitis","volume":"11","author":"Kane","year":"1997","journal-title":"Am. J. Rhinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/014556130308200118","article-title":"Iatrogenic Maxillary Sinus Recirculation and Beyond","volume":"82","author":"Gutman","year":"2003","journal-title":"Ear Nose Throat J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.resp.2012.06.026","article-title":"Effect of accessory ostia on maxillary sinus ventilation: A computational fluid dynamics (CFD) study","volume":"183","author":"Zhu","year":"2012","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1164\/rccm.200207-640OC","article-title":"Reduced Nitric Oxide in Sinus Epithelium of Patients with Radiologic Maxillary Sinusitis and Sepsis","volume":"168","author":"Deja","year":"2003","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"20200575","DOI":"10.1259\/dmfr.20200575","article-title":"Investigation of the accessory maxillary ostium: A congenital variation or acquired defect?","volume":"50","author":"Soylemez","year":"2021","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1288\/00005537-199010000-00002","article-title":"The location of the maxillary Os and its importance to the endoscopic sinus surgeon","volume":"100","author":"May","year":"1990","journal-title":"Laryngoscope"},{"key":"ref_16","first-page":"85","article-title":"Functional anatomy of the paranasal sinuses","volume":"149","author":"Miller","year":"1997","journal-title":"J. La. State Med. Soc. Off. Organ La. State Med. Soc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"327","DOI":"10.5455\/ijmsph.2013.301220131","article-title":"Anatomy of accessory maxillary sinus ostium with clinical application","volume":"3","author":"Singhal","year":"2014","journal-title":"Int. J. Med. Sci. Public Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s40729-020-00233-7","article-title":"Involvement of the maxillary sinus ostium (MSO) in the edematous processes after sinus floor augmentation: A cone-beam computed tomographic study","volume":"6","author":"Sakuma","year":"2020","journal-title":"Int. J. Implant Dent."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13005-021-00284-0","article-title":"A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography","volume":"17","author":"Shetty","year":"2021","journal-title":"Head Face Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.ejrnm.2018.07.009","article-title":"Maxillary sinus ostium assessment: A CT study","volume":"49","author":"Raafat","year":"2018","journal-title":"Egypt. J. Radiol. Nucl. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1007\/s00330-005-0068-2","article-title":"Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses","volume":"16","year":"2006","journal-title":"Eur. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1016\/j.jcms.2015.08.004","article-title":"Three-dimensional analysis of postoperative returning movement of perioperative condylar displacement after bilateral sagittal split ramus osteotomy for mandibular setback with different fixation methods","volume":"43","author":"Han","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Serindere, G., Gunduz, K., and Avsever, H. (2022). The Relationship Between an Accessory Maxillary Ostium and Variations in Structures Adjacent to the Maxillary Sinus without Polyps. Int. Arch. Otorhinolaryngol.","DOI":"10.1055\/s-0042-1742325"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3977","DOI":"10.1007\/s00784-019-02829-9","article-title":"Visibility, location, and morphology of the primary maxillary sinus ostium and presence of accessory ostia: A retrospective analysis using cone beam computed tomography (CBCT)","volume":"23","author":"Yeung","year":"2019","journal-title":"Clin. Oral Investig."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1002\/alr.21610","article-title":"The association between septal deviation and the presence of a maxillary accessory ostium","volume":"5","author":"Ozel","year":"2015","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"443","DOI":"10.18203\/issn.2454-5929.ijohns20180705","article-title":"Incidence of accessory ostia in patients with chronic maxillary sinusitis","volume":"4","author":"Ghosh","year":"2018","journal-title":"Int. J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5624\/isd.2017.47.1.33","article-title":"Cone-beam computed tomography analysis of accessory maxillary ostium and Haller cells: Prevalence and clinical significance","volume":"47","author":"Ali","year":"2017","journal-title":"Imaging Sci. Dent."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3484","DOI":"10.16965\/ijar.2016.504","article-title":"Anatomical variations of accessory maxillary sinus ostium: An endoscopic study","volume":"5","author":"Mahajan","year":"2017","journal-title":"Int. J. Anat. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/cid.12703","article-title":"The potential clinical relevance of anatomical structures and variations of the maxillary sinus for planned sinus floor elevation procedures: A retrospective cone beam computed tomography study","volume":"21","author":"Kaya","year":"2018","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1111\/clr.12655","article-title":"Longitudinal response of membrane thickness and ostium patency following sinus floor elevation: A prospective cohort study","volume":"27","author":"Guo","year":"2015","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"331","DOI":"10.11607\/jomi.4108","article-title":"Changes in Sinus Membrane Thickness after Lateral Sinus Floor Elevation: A Radiographic Study","volume":"31","author":"Makary","year":"2016","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/00008505-200107000-00005","article-title":"Complications after Maxillary Sinus Augmentation: A Case Report","volume":"10","author":"Maksoud","year":"2001","journal-title":"Implant Dent."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1111\/clr.12168","article-title":"Cone-beam computed tomographic analysis of sinus membrane thickness, ostium patency, and residual ridge heights in the posterior maxilla: Implications for sinus floor elevation","volume":"25","author":"Shanbhag","year":"2013","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1002\/alr.22159","article-title":"Accessory maxillary ostium repair using middle turbinate flap: A case series of 116 patients with chronic rhinosinusitis","volume":"8","year":"2018","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_35","first-page":"502","article-title":"CBCT analysis of haller cells: Relationship with accessory maxillary ostium and maxillary sinus pathologies","volume":"37","year":"2020","journal-title":"Oral Radiol."},{"key":"ref_36","first-page":"MC07","article-title":"Radiological Study of Maxillary Sinus using CBCT: Relationship between Mucosal Thickening and Common Anatomic Variants in Chronic Rhinosinusitis","volume":"10","author":"Capelli","year":"2016","journal-title":"J. Clin. Diagn. Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/9\/1243\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:27:22Z","timestamp":1760142442000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/9\/1243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,8]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["medicina58091243"],"URL":"https:\/\/doi.org\/10.3390\/medicina58091243","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,8]]}}}