Morphometric thresholds of the ostiomeatal complex and their psychological correlates in sinus ventilation impairment

Abstract

The ostiomeatal complex (OMC) is a critical anatomical region ensuring ventilation and drainage of the anterior paranasal sinuses. Variability in its morphology can lead to functional impairment and predispose individuals to chronic rhinosinusitis. Objective: To determine quantitative morphometric thresholds associated with inadequate sinus ventilation based on OMC structure and semilunar hiatus dimensions using CT data and computational modeling. Methods: Morphometric analysis was performed on 400 spiral CT scans. OMC parameters were measured manually and automatically, and 3D models were constructed. Pressure and flow simulations were conducted using the IMED system. Subjects were divided into three groups based on the width of the semilunar hiatus: narrow, moderate, and wide. Parameters such as sinus wall thickness, OMC component density, and estimated ventilation pressure were analyzed. Results: Both excessively narrow (<1.8 mm) and overly wide (>3.5 mm) semilunar hiatuses were associated with impaired ventilation. Optimal airflow occurred in the intermediate range (2.1–3.2 mm). A pressure gradient of <2.5 Pa between the maxillary sinus and nasal cavity was associated with stasis in 73% of cases. Strong correlations were observed between sinus ventilation efficiency and the thickness of the uncinate process (r = –0.75, p < 0.01), as well as medial maxillary sinus wall thickness (r = –0.72, p < 0.05). Conclusion: Functional ventilation of the maxillary sinus requires a semilunar hiatus width between 2.1 and 3.2 mm and a pressure differential above 2.5 Pa. Both morphological extremes are associated with physiological dysfunction, highlighting the importance of patient-specific anatomical assessment in surgical planning