CT Analysis of Variations in the Medial Maxillary Wall Relative to the Medial Orbital Wall: Implications for Surgical Risk Stratification from an Endoscopic Perspective

Functional endoscopic sinus Surgery (FESS) is a form of safe and effective management for chronic rhinosinusitis. Nevertheless, although FESS is minimally invasive, it poses a risk of rare orbital complications. This study aims to investigate the variations in the medial maxillary wall relative to the medial orbital wall, as depicted on computed tomography (CT) scans. We retrospectively included CT scans of the sinuses between November 2022 and April 2023. To maintain consistency, we used the coronal image that delineated the anterior ethmoidal foramen. The attachment site of the inferior turbinate to the medial maxillary wall was categorized into three classes according to its position relative to the inferomedial orbital strut. Class I indicates that the site of attachment is located within 2 mm, either medially or laterally. Class II indicates that it has been medially displaced by more than 2 mm, whereas Class III indicates that it has been laterally displaced by more than 2 mm. We enrolled 183 patients, yielding a total of 363 sides. Classes I, II, and III account for 55.4%, 41.3%, and 3.3% of the cases, respectively. A significant correlation exists between the classification and the dimensions and volume of the maxillary sinus (p < 0.001). The logistic regression model indicates a significant negative correlation between the width of the maxillary sinus and risk classification (p < 0.001), implying a protective effect with increasing width. Knowledge of the variations in the medial wall of the maxillary sinus relative to the medial orbital wall is essential for guidance toward the optimal endoscopic approach, and it demonstrates relevance to risk stratification.