Adjacent Maxillary Bone Microarchitecture in Patients with Asymmetric Bilateral Lund-Mackay Scores: A Pilot...

Background/Objectives: The study aims to investigate whether lateral asymmetry in the inflammatory burden of the maxillary sinus is associated with measurable differences in adjacent non-alveolar maxillary bone structure, as observed on cone-beam computed tomography (CBCT) images. Additionally, this study aims to examine the relationship between sinus inflammation severity and trabecular bone characteristics using microarchitectural parameters. Methods: A total of 100 patients with asymmetric bilateral Lund-Mackay scores were included, yielding 200 maxillary sinuses and exceeding an a priori power requirement of 184 sinuses. Standardized cubic volumes of interest were sampled from the zygomatic process of the maxilla, outside the alveolar process, and analyzed using ImageJ 1.54p and BoneJ+ 0.0.12. Evaluated parameters were trabecular thickness, trabecular separation, bone volume fraction, connectivity, connectivity density, degree of anisotropy, cortical porosity, cortical thickness, and ellipsoid factor. Paired comparisons were performed between the less severe and more severe sinus sides. Generalized estimating equation models were used to assess associations with LM score, age, sex, and etiology of the inflammation as odontogenic or rhinosinusitis. Results: Compared to the less severe side, the more severe side showed significantly lower Tb.Th, BV/TV, Cort.Th, and EF and significantly higher Tb.Sp and cortical porosity (all p ≤ 0.05). However, Conn., Conn.D, and DA did not differ significantly. An increasing LM score was associated with lower Tb.Th, BV/TV, DA, and EF, as well as higher cortical porosity. Odontogenic and non-odontogenic inflammatory patterns were both associated with less favorable bone characteristics compared to non-inflamed sides. However, the magnitude and distribution of the effects differed across parameters. Conclusions: Greater sinus inflammatory burden was associated with measurable alterations in adjacent non-alveolar maxillary bone architecture across multiple morphometric domains. Although not a validated index, the cortical porosity score may reflect the resorptive effects of maxillary sinusitis on the adjacent cortex. The findings support the idea that sinus inflammation may have an osseous correlate beyond the sinus cavity. Further validation in larger, clinically phenotyped cohorts is warranted.