Impact of Frontal and Maxillary Sinus Size on the Incidence and Patterns of Facial Fractures: A CT-Based Volumetric Study

The aim of this study is to evaluate the impact of frontal and maxillary sinus size on the incidence and patterns of upper and middle third facial fractures, assessed using computed tomography (CT) volumetric measurements. This retrospective observational study included CT scans from January 2019 to May 2025, analysing two cohorts: patients with frontal sinus fractures (n=47) and maxillary sinus fractures (n=244), compared against matched controls without fractures (frontal controls, n=52; maxillary controls, n=178). Sinus dimensions—height, depth, width, and volume—were measured using CT imaging. Statistical analyses employed unpaired t-tests, Cohen’s d effect size, and multivariate linear regression models to identify associations between sinus size and fracture occurrence. Frontal sinus fracture patients exhibited significantly larger mean sinus volumes compared to controls. Similarly, maxillary sinus fracture patients had notably higher mean sinus volumes. Multivariate regression confirmed sinus height, depth, and width as highly significant predictors of sinus volume (all p< 0.001). After controlling for these dimensions, fracture status alone was not a significant independent predictor of sinus volume, indicating anatomical size primarily influences fracture susceptibility. Individuals with larger frontal and maxillary sinuses are significantly more susceptible to facial fractures in corresponding regions, likely due to increased bone surface area and reduced structural integrity. These findings emphasize the importance of sinus size in fracture risk assessment, surgical planning, and trauma prevention strategies. Future research should prospectively validate sinus size as a predictive risk factor and explore biomechanical implications across diverse populations.