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Depression of the maxillary sinus anterior wall and its influence on panoramic radiography appearance.

OBJECTIVES
To clarify the depression aspect of the maxillary sinus anterior wall and to investigate its relationship with the panoramic image appearance of a diagonal line from the inferior part of the so-called panoramic innominate line to the medial portion of the orbital floor line.


METHODS
Based on CT data, panoramic images were simulated for two typical cases with and without anterior wall depression. Next, on axial CT images of 1689 subjects (3378 sinuses) stored in our image database, the wall depths were measured and analyzed for their relationships with the panoramic appearances of the diagonal line, classified into invisible, obscure and clear patterns.


RESULTS
Based on the simulation study, visualization of the diagonal line was verified to alter depending on the morphology of the anterior wall and the position of the panoramic image layer. In 408 (12.1%) sinuses, the diagonal line (clear and obscure patterns) could be seen on the panoramic image. The incidences of the obscure and clear patterns increased with increasing age groups. The mean wall depths were 2.91, 4.80 and 7.28 mm for the invisible, obscure and clear patterns, respectively. The clear pattern showed the highest value for the wall depth, followed by the obscure pattern.


CONCLUSIONS
The diagonal line on a panoramic image was verified to be related to depression of the maxillary sinus anterior wall, and its panoramic image appearance can be altered depending on the position of the tomographic image layer.