Prevalence of Zygomatic Air Cell Defects in the Tunisian Population: A Retrospective Study

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Published Mar 10, 2026
https://doi.org/10.62438/tunismed.v104i01.6051
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Vol. 104 No. 01 (2026): Tunis Med Jan 2026

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Nawres Ghadhab
Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia
Rym Kammoun
Department of Radiology, University Dental Clinic, Monastir, Laboratory of Histology and Embryology,ABCDF Laboratory for Biological Clinical and Dento-Facial Approach LR12ES10, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, 5000, Tunisia
Rawia Jaziri
Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia
Manel Gharbi
Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia
Olfa Zaghden
Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia
Imen Chaabani
Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia
Touhami Ben Alaya
Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia

Abstract

Objectives: Zygomatic Air Cell Defect (ZACD) is an anatomical variation that may complicate surgical procedures involving the temporomandibular joint. This retrospective study aimed to determine the prevalence, location, and morphological characteristics of ZACD in a Tunisian population and to compare the findings with previously reported data.


Methods: A total of 3,988 digital panoramic radiographs from patients aged 4–94 years were independently assessed by three oral and maxillofacial radiologists. Demographic characteristics, ZACD laterality (unilateral/bilateral), and morphology (unilocular/multilocular) were recorded. Statistical analysis was performed using the Chi-Squared test, and the results were contextualized through a comprehensive literature review.


Results: ZACD was detected in 2.28% of cases, with a mean age of 37.4 years (range: 7–67). Most cases were unilateral (69/92), predominantly on the left side, while bilateral involvement was noted in 23 patients. Unilocular (56.5%) and multilocular (43.5%) patterns were almost equally distributed. No significant associations were observed between ZACD presence and patients’ age, sex, laterality, or locularity.


Conclusion: The prevalence of ZACD in the Tunisian population is comparable to that of other populations, but it tends to occur in younger individuals. Recognizing ZACD on panoramic radiographs is clinically relevant, as its presence may pose challenges during surgical or endoscopic procedures of the temporomandibular joint. Awareness of this variation can therefore help clinicians anticipate potential complications and improve preoperative planning.

Keywords:

Cone-Beam Computed Tomography, Radiography, Panoramic, Retrospective Studies, Temporomandibular Joint

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Author Biographies

Rym Kammoun, Department of Radiology, University Dental Clinic, Monastir, Laboratory of Histology and Embryology,ABCDF Laboratory for Biological Clinical and Dento-Facial Approach LR12ES10, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, 5000, Tunisia

1- Department of Radiology, University Dental Clinic, Monastir 5000, Tunisia

Rawia Jaziri, Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia

Department of Radiology, University Dental Clinic, Monastir 5000, Tunisia

Manel Gharbi, Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia

Department of Radiology, University Dental Clinic, Monastir 5000, Tunisia

Olfa Zaghden, Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia

Department of Radiology, University Dental Clinic, Monastir 5000, Tunisia

Imen Chaabani, Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia

Department of Radiology, University Dental Clinic, Monastir 5000, Tunisia

Touhami Ben Alaya, Department of Radiology, University Dental Clinic, Monastir , The research Laboratory of Bioactive Natural Substances and Biotechnology LR24ES14, Faculty of Dental Medicine, University of Monastir, Monastir 5000, Tunisia

Department of Radiology, University Dental Clinic, Monastir 5000, Tunisia

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