An in vitro parametric study of maxillary sinus ventilation using transparent 3D-printed sinonasal models

Impaired maxillary sinus ventilation promotes secretion stasis and infection risk. How anatomical parameters (ostial diameter (D), length (L), and sinus volume (V)) interact with breathing pattern to shape ventilation has not been systematically studied in anatomically realistic settings.

Fifteen transparent sinonasal casts were 3D printed spanning three levels of D, L, and V (D1-D3, L1-L3, V1-V3). E-vapor was used to visualize and quantity sinus ventilation under three conditions: breath-hold, quiet breathing, and panting. Two time metrics were quantified: (i) total vapor escape-settling time; and (ii) escape time for the vapor cloud to reach a reference line. Full factorial ANOVA assessed the main effects of anatomical factors and breathing modes and their interactions.

Breathing mode was the strongest determinant of total clearance (p < 0.001), with panting markedly reducing the ventilation time than quiet breathing and breath-hold (by > two-thirds). Longer canals and larger sinus volumes prolonged retention. For early-stage transport (time to reference line), ostial length had the most influential main effect (p < 0.001), followed by breathing mode, ostial diameter, and sinus volume. Significant two-way interactions were observed, whereas higher-order interactions were limited. Visualizations and pooled distributions (violin plots) corroborated these hierarchies across the parametric space.

Maxillary sinus ventilation reflects coupled anatomical and physiological constraints. Breathing mode dominates sinus ventilation, whereas ostial canal length most strongly governs early escape near the ostium. These results have implications for surgical planning to increase ostial patency and for optimizing breathing maneuvers to promote sinus aeration and clearance.