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

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.