Prevalence of frontal sinus agenesis in maxillofacial imaging and its forensic relevance - systematic review and meta-analysis

Rhonan Ferreira Silva; Maria Eduarda Ramos Stefanel; Fernanda Thomaz de Aquino Macedo; Ana Bheatriz Souza Oliveira; Thaís Karmen Silva Santos; Solon Diego Mendes; Wahaj Anees; Rizky Merdietio Boedi; Ademir Franco

doi:10.1016/j.jflm.2026.103095

Prevalence of frontal sinus agenesis in maxillofacial imaging and its forensic relevance - systematic review and meta-analysis

J Forensic Leg Med. 2026 Feb:118:103095. doi: 10.1016/j.jflm.2026.103095. Epub 2026 Feb 11.

Authors

Rhonan Ferreira Silva¹, Maria Eduarda Ramos Stefanel², Fernanda Thomaz de Aquino Macedo², Ana Bheatriz Souza Oliveira³, Thaís Karmen Silva Santos³, Solon Diego Mendes⁴, Wahaj Anees², Rizky Merdietio Boedi⁵, Ademir Franco⁶

Affiliations

¹ Department of Dentistry, Federal University of Goiás, Goiânia, Brazil; Department of Forensic Anthropology & Dentistry, Scientific Police of Goiás, Goiânia, Brazil.
² Division of Forensic Dentistry, Faculdade São Leopoldo Mandic, Campinas, Brazil.
³ Department of Dentistry, Federal University of Goiás, Goiânia, Brazil.
⁴ Department of Forensic Anthropology & Dentistry, Scientific Police of Goiás, Goiânia, Brazil; Division of Forensic Dentistry, Faculdade São Leopoldo Mandic, Campinas, Brazil.
⁵ Department of Forensic Medicine and Dentistry, Diponegoro University, Semarang, Indonesia.
⁶ Division of Forensic Dentistry, Faculdade São Leopoldo Mandic, Campinas, Brazil; Department of Therapeutic Stomatology, Institute of Dentistry, Sechenov University, Moscow, Russia. Electronic address: ademir.junior@slmandic.edu.br.

PMID: 41690010
DOI: 10.1016/j.jflm.2026.103095

Abstract

Objectives: the present study aimed to perform a systematic review and meta-analysis on the prevalence of frontal sinus agenesis.

Methods: A systematic review was conducted following PRISMA statement, with a preliminary protocol based on PRISMA-P registered in Open Science Framework and Zenodo. Searches were performed in PubMed/MEDLINE, Scopus, LILACS, SciELO, Open Access Theses and Dissertations and OpenGrey, complemented by additional screening through backward snowballing. Only observational studies reporting prevalence data on frontal sinus agenesis in maxillofacial imaging were selected.

Results: From 3614 records, 48 studies met eligibility criteria, and 47 were included in the quantitative synthesis. The pooled sample comprised 19,453 radiographic examinations spanning 22 countries. Bilateral frontal sinus agenesis showed a prevalence rate of 3,5% (n = 670 observations), while unilateral agenesis rate was 2,7% for the right side and 2,4% for the left side. Subgroup analyses revealed no significant differences based on sex, side, or imaging modality (2D vs. 3D).

Conclusion: The synthesis of eligible studies showed that frontal sinus agenesis is a rare anatomical feature that can be recognized effectively using either 2D (posteroanterior or anteroposterior radiographic projections) or 3D (multislice or cone beam computed tomography) imaging. This consistency across modalities supports its practical value for clinical and diagnostic practice, and for human identification in the forensic routine.

Keywords: Forensic anthropology; Forensic dentistry; Frontal sinus agenesis; Human identification; Maxillofacial radiology; Systematic review and meta-analysis agenesis.

Publication types

Review