Frontal sinus morphology and maturation determination

AIM: To determine the relationship between frontal sinus morphometric measurements and established maturation indicators obtained from hand-wrist and lateral cephalometric radiographs, and to evaluate the diagnostic performance of frontal sinus morphometric measurements in discriminating growth and developmental stages. MATERIALS AND METHODS: This retrospective study analysed radiographs of 240 patients aged 9-19 years who underwent simultaneous hand-wrist and cephalometric imaging. Patients were categorized into six cervical vertebral maturation stages (CVS), with 20 females and 20 males in each stage. Hand-wrist (HWS), cervical vertebra (CVS), and dental maturation (DS) stages were assessed. Frontal sinus measurements included maximum height (FSHeight), maximum width (FSWidth), frontal sinus index (FSIndex), area (FSArea), and perimeter (FSPerimeter). Spearman's Rho assessed correlations, and ROC analysis evaluated diagnostic performance with cut-off-based accuracy rates. Reliability was examined using the Kappa coefficient, Kendall's tau-b, and intraclass correlation coefficient (ICC). RESULTS: After Benjamini-Hochberg false discovery rate (FDR) correction, no significant correlations were found between HWS or DS stages and FSHeight in male patients, or between CVS or DS stages and FSIndex. In females, FSArea showed the highest discriminatory performance for classifying the transition from pre-pubertal to pubertal stage (AUC = 0.794; P < 0.001). In males, FSWidth showed the strongest discriminatory performance (AUC = 0.817; P < 0.001). For the transition from the pubertal to post-pubertal stage, FSWidth showed the highest discriminatory performance (AUC = 0.846; P < 0.001), and all frontal sinus measurements were statistically significant in both sexes. CONCLUSION: Frontal sinus morphometry showed high reliability and meaningful associations with age and maturation indicators. However, as AUC values ranged from moderate to good (0.655-0.846) and diagnostic performance varied by sex, maturation system, and transition stage, frontal sinus morphometry should be regarded as a supplementary rather than a standalone or definitive indicator of skeletal maturation, pending longitudinal validation.