The sphenoid sinus displays variable pneumatization patterns and complex morphology, situated near vital vascular and neural structures. Understanding its anatomical variations is essential for accurate radiological diagnosis and safe surgical planning in otolaryngology and neurosurgery. Different pneumatization types may influence surgical outcomes and complication risks. This retrospective study analyzed 408 CT scans from patients aged ≥18 years to assess sphenoid sinus pneumatization and morphometry. Pneumatization types were classified as conchal, presellar, incomplete sellar, and complete sellar. Morphometric parameters (width, height, and angle) were measured on sagittal CT images. Intraobserver reliability showed excellent agreement. Statistical analyses included descriptive statistics, ANOVA, t-tests, Pearson correlation, and Chi-square tests.
Incomplete (41.42%) and complete sellar (40.44%) were the most frequent pneumatization types. Males had greater posterior wall width (p = 0.0008), and age positively correlated with width (p = 0.0125), height (p < 0.0001), and angle (p = 0.0068). Pneumatization types differed significantly by gender (p = 0.0439). Posterior wall height varied significantly across sphenoid sinus pathologies (p = 0.0024), with higher values in cases of polypoid tissue and cysts. Significant correlations existed between width and height (p = 0.0251), and width and angle (p = 0.0053). Incomplete sellar pneumatization was most common, with notable gender differences in type prevalence. While sellar morphometry correlated with age and gender, it was not associated with pneumatization types. Variations in posterior wall height across sinus pathologies may reflect anatomical variability, showing the importance of detailed imaging evaluation.
