Common Sinonasal Variants Did Not Track With Jaw Growth Pattern in Orthodontic Patients
A retrospective cone-beam computed tomography study in growing orthodontic patients found that sinonasal anatomical variations and adenoid hypertrophy were common, but neither showed a significant association with sagittal or vertical skeletal pattern. The cohort included 125 patients aged 9 to 15 years, a period when craniofacial growth, airway caliber, and dental development can all move in parallel. In that setting, it would be reasonable to suspect that nasal obstruction or nasopharyngeal crowding might be reflected in the skeletal pattern. The CBCT data did not support that assumption in this sample.
Nasal septum deviation emerged as the most frequent anatomical variant, present in 68% of patients. Accessory maxillary ostium followed at 54.4%, and middle concha bullosa at 43.2%. Grade 2 adenoid hypertrophy was the most common adenoid category, appearing in 60.8% of the cohort. These are not rare incidental findings in children and adolescents; they are structural observations that can influence airflow, sinus drainage, and clinical evaluation. Yet prevalence alone does not establish a developmental relationship with jaw pattern.
The investigators classified sagittal skeletal relationships using the ANB angle and divided vertical skeletal patterns into normal, hyperdivergent, and hypodivergent groups. Thirteen sinonasal anatomical variations were assessed on CBCT images alongside adenoid grade, then compared with skeletal categories. No significant associations were identified between the sinonasal findings and either sagittal or vertical skeletal pattern, and adjustment for age and sex did not change the result. The statistical signal remained absent, with p values above 0.05.
Airway Findings Are Common, But Not a Skeletal Signature
This negative association matters because orthodontic practice often sits at the intersection of facial growth and airway assessment. A crowded nasopharynx, a deviated septum, or enlarged adenoids can alter breathing mechanics, mouth posture, and patient symptoms. Those downstream effects may influence how a child presents in clinic, but this study suggests they do not map neatly onto sagittal or vertical skeletal pattern as measured here. Craniofacial growth is shaped by genetics, environment, and function, and no single airway feature should be expected to serve as a surrogate marker for skeletal classification.
The biology is plausible in both directions. Chronic nasal obstruction can encourage oral breathing, which may alter tongue posture and muscle balance during growth. At the same time, skeletal pattern itself can influence airway dimensions and facial proportions, making cause and effect hard to separate in observational work. A cross-sectional or retrospective design can detect coexistence, but it cannot prove whether a nasal variant changes facial growth, whether facial growth changes airway anatomy, or whether both arise from shared developmental pathways.
The CBCT method strengthens anatomic assessment because it offers three-dimensional detail that conventional two-dimensional imaging cannot provide. It also raises a familiar caution: detailed imaging can reveal many incidental anatomic variants that may look clinically important without actually carrying predictive value for skeletal morphology. In this cohort, the imaging platform detected a high burden of sinonasal findings, yet those findings did not translate into measurable differences in sagittal or vertical skeletal grouping.
What the Numbers Mean for Orthodontic Assessment
For orthodontists and maxillofacial radiologists, the practical message is narrower than it first appears. Common sinonasal variations should remain on the differential when children present with airway complaints, congestion, or suspected obstruction. They should not be used as a stand-alone explanation for sagittal malocclusion or vertical growth pattern based on this dataset. Facial pattern assessment still belongs to the standard orthodontic workup, and airway anatomy should be interpreted as a separate clinical domain unless stronger evidence connects the two.
The study’s age range, 9 to 15 years, is clinically important because this is a dynamic growth window rather than a static anatomical state. Even so, no association emerged after accounting for age and sex. That finding argues against a simple developmental shortcut in which common sinonasal changes predict craniofacial class. It also suggests that if airway factors contribute to skeletal pattern, the relationship is probably more indirect, more heterogeneous, or more dependent on timing and duration than a one-time CBCT snapshot can capture.
A single sentence captures the core result plainly: the most common sinonasal findings in this cohort were frequent, but they did not identify children with a distinct sagittal or vertical skeletal pattern.
Retrospective Design Limits Causal Inference
Because the study was retrospective, the findings should be read as an association check rather than a causal test. The sample size was 125 patients, which is adequate for an exploratory imaging study but not large enough to exclude subtle subgroup effects. The article does not provide evidence that all sinonasal variants are biologically irrelevant; it only shows that, in this sample, they were not statistically linked to the skeletal categories under study.
A second limitation sits in the nature of the endpoints themselves. ANB-based sagittal grouping and vertical pattern categorization are familiar orthodontic tools, but they compress complex craniofacial growth into a limited classification system. Likewise, adenoid hypertrophy grading on CBCT can describe tissue prominence, yet it may not fully reflect functional obstruction, symptom burden, or dynamic nasal airflow during wakefulness and sleep.
No funding was received from public or private bodies, and the authors reported no competing interests. The work was carried out by teams in oral and maxillofacial radiology and orthodontics at Selçuk University in Konya, Turkey. The open-access format makes the data accessible for further comparison with other CBCT cohorts, especially studies that examine whether airway anatomy relates more strongly to maxillary sinus volume, malocclusion subtype, or longer-term growth trajectories than to skeletal pattern alone.
The most defensible interpretation is restrained: these sinonasal findings are common in growth-period orthodontic patients, but they were not a reliable marker of sagittal or vertical skeletal pattern in this retrospective sample. Future work will need larger cohorts, functional airway measures, and longitudinal follow-up before any stronger developmental claim can be made.