Objectives: This study investigates the canine fossa (CF) topography relative to the maxillary sinus and nasal fossa and examines its association with facial types, focusing on side and gender. Methods: One hundred CBCT scans were analysed bilaterally at the first (PM1) and second (PM2) premolar levels. The CF was classified according to its anatomical relationship with adjacent structures: type 1, where the CF lies predominantly lateral to the maxillary sinus; type 2, where it is lateral to the nasal fossa; and type 3, where the CF is positioned lateral to the nasal fossa inferiorly and to the maxillary sinus superiorly. Facial measurements (height and width) were used to calculate the facial index, classifying individuals into five facial types: hypereuroprosopic, euryprosopic, mesoprosopic, leptoprosopic, and hyperleptoprosopic. A statistical analysis assessed the correlation between CF types and facial morphology. Results: Types 1 and 3 were the most prevalent CF types, while type 2 was observed only at the PM1 site. The PM2 level showed a predominance of type 1, indicating a consistent anatomical association of the CF with the maxillary sinus. In contrast, the PM1 level demonstrated a higher prevalence of type 3, reflecting the presence of the CF in the walls of both the nasal fossa and maxillary sinus. Leptoprosopic facial type was strongly associated with type 3, while no significant associations of CF types were found for other facial types. The sample lacked hypereuroprosopic individuals (facial index < 79.9), while hyperleptoprosopic faces (facial index > 95) were present in 23% of cases. Conclusions: The CF topography varies significantly by premolar site and is influenced by facial proportions. Type-3 CFs correlate strongly with elongated (leptoprosopic) facial configurations; broader facial types were underrepresented in this sample.

Background and Objectives: The upper posterior teeth are typically regarded as being exclusively inferior to the maxillary sinus (MS). The expansion of the nasal fossa above the maxillary alveolar base (MAB) needs better investigation. The hypothesis was raised that the MAB in the upper premolar region, which is usually addressed by surgeons for the elevation of the antral floor, is not exclusively beneath the MS. Therefore, we aimed to document the possible upper relations of the MAB as antral, nasal, or both. Materials and Methods: A total of 145 CBCT scans were used to study four types of MAB: type 1—antral; type 2—antral with a palatal recess; type 3—antral and nasal; type 4—nasal. In type 2, the orthoradial width of the alveolar bone, the rectilinear width of the antral floor, and the maximum depth of the palatal recess were measured. For type 3, the MAB width and the straight widths of the antral and nasal segments of the MAB were measured. Results: Type 1 was found in 67.24%, type 2 in 13.45%, type 3 in 16.21%, and type 4 in 3.1% of the 290 MSs investigated. Palatal recesses were found in 11.72% of the MSs on the right side and 15.17% of the MSs on the left side. Types 1 and 2 exhibited strongly statistically significant bilateral symmetry (Pearson’s Chi2 = 86.42, p < 0.001). Type 3 correlated equally with contralateral types 1 and 3. The bilateral symmetry for types 1–3 was stronger in the males (Pearson’s Chi2 = 47.83, p < 0.001) than in the females (Pearson’s Chi2 = 56.96, p < 0.001). There were no statistically significant associations between sex and the unilateral anatomical type. Conclusions: The MAB in the upper second premolar area should not be considered to be exclusively antral during surgeries or in anatomical teaching.

Mugurel Constantin Rusu, Alexandru Nicolae Mureşan, Carol Antonio Dandoczi, Alexandra Diana Vrapciu. Anat Cell Biol -0001;0:. https://doi.org/10.5115/acb.24.023

This review aims to provide an applied surgical–anatomical synthesis of the buccal fat pad, harmonise the commonly used extension nomenclatures, and summarise the principal neurovascular structures at risk, major clinical applications, and representative pathologies relevant to current surgical practice. A narrative, anatomy-oriented review was conducted using cadaveric, imaging-based (CT/MRI), and surgical literature. The evidence was organised thematically around extension anatomy, fascial boundary planes, neurovascular relationships, and procedure-related surgical risk. Two main extension frameworks, the 4-extension and 6-extension models, were identified, and their correlation improves anatomical orientation and comparability across studies. Key structures at risk include the parotid (Stensen’s) duct, buccal branches of the facial nerve, and the buccal and transverse facial vessels, all of which show variable relationships to the buccal fat pad. Safer surgery depends on accurate plane selection, limited dissection, and gentle mobilisation rather than forceful traction to reduce haemorrhagic and neural complications. The review also outlines clinically relevant pathology, including traumatic herniation or pseudoherniation and tumour or tumour-like lesions involving the buccal fat pad. An integrated applied-anatomical framework of the buccal fat pad, combining extension mapping with neurovascular risk awareness, may improve operative planning and support safer, more predictable aesthetic and reconstructive procedures.

Background/Objectives: A marked anteroposterior gradient of nasal fossa pneumatisation over the posterior maxillary alveolar base has been documented at the second premolar level, yet whether this gradient extends to the second upper molar (M2)—the primary site for posterior implant rehabilitation—remains uncharacterised. We aimed to quantify this gradient by classifying pneumatisation patterns above the maxillary alveolar base at M2 (Type 1: pure antral; Type 2: antral with palatine recess; Type 3: Big Nose pattern with combined antral and nasal involvement), assess bilateral symmetry and sex distribution, and compare findings with published second premolar data. Methods: A retrospective study was conducted on 165 cone-beam computed tomography scans (330 sides) from a Romanian population. Patterns were classified as Type 1 (pure antral), Type 2 (antral with palatine recess), or Type 3 (Big Nose pattern). Bilateral symmetry was assessed using Cohen’s kappa, and sex differences using Fisher’s exact test. Results: Type 1 was observed in 93.3% of sides, Type 2 in 4.2%, and Type 3 in 2.4%. Bilateral symmetry was 98.8% (kappa = 0.904), with all Type 3 cases occurring bilaterally. No significant sex difference was found (p = 0.363), although Type 3 showed a non-significant male predominance (OR = 4.55; p = 0.305). The Big Nose pattern was 6.8-fold less prevalent at M2 than at the second premolar level. Conclusions: A 6.8-fold reduction in Big Nose prevalence from the second premolar (16.2%) to M2 (2.4%) confirms a pronounced anteroposterior gradient in nasal fossa involvement over the posterior maxillary alveolar base—the central finding of this study. At M2, the maxillary sinus dominates exclusively in 97.6% of sides, rendering standard sinus floor elevation highly predictable. The invariable bilaterality of the Big Nose pattern at M2 supports contralaterally symmetrical surgical planning. These findings provide a gradient-based clinical framework: nasal-floor-aware augmentation planning is essential anteriorly (premolar region), whereas standard sinus augmentation protocols are reliably applicable at M2.