Clinical Diagnostic Performance of Panoramic Radiography and the Complementary Role of Cone Beam Computed Tomography in Maxillary Sinus Pathology

Abstract

The maxillary sinus is closely related to the posterior maxillary teeth, making accurate radiographic evaluation essential for diagnosing odontogenic and non-odontogenic sinus pathologies and guiding appropriate treatment planning. This study aimed to evaluate the diagnostic performance of panoramic radiography (OPG) compared with cone beam computed tomography (CBCT) and to identify the maxillary sinus lesions that can be reliably detected on panoramic imaging. A retrospective cross-sectional study was conducted using 437 panoramic radiographs obtained from patients attending public dental clinics in Misurata, Libya. Among these, 316 patients underwent CBCT on the same day, allowing direct paired comparison between imaging modalities. CBCT served as the reference standard. Evaluated pathologies included mucosal thickening, odontogenic and non-odontogenic sinusitis, mucous retention cysts, mucosal polyps, foreign bodies, mucoceles, oroantral fistulas, fluid accumulation, and tumors. Statistical analysis was performed using the chi-square test and McNemar's test, with statistical significance set at P < 0.05. Mucosal thickening was the most common finding (26%), followed by non-odontogenic sinusitis (18%), odontogenic sinusitis (13%), mucosal polyps (10%), mucous retention cysts (8%), and foreign bodies (2%). OPG detection varied significantly according to lesion type (χ² = 71.38, P < 0.001). Compared with CBCT, panoramic radiography demonstrated significantly lower sensitivity for subtle inflammatory lesions, whereas well-defined lesions, including mucous retention cysts and mucosal polyps, were reliably identified. CBCT provided superior assessment of lesion morphology, disease extent, and tooth–sinus anatomical relationships. Panoramic radiography remains a valuable, accessible first-line imaging modality for the initial evaluation of maxillary sinus pathology. However, CBCT should be considered when subtle inflammatory disease, odontogenic extension, or detailed anatomical assessment is required. A stepwise imaging approach integrating both modalities may improve diagnostic accuracy and clinical decision-making.