Prevalence and imaging features of temporal bone pneumatization on cone-beam computed tomography: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to estimate the prevalence of temporal bone pneumatization (TBP), including pneumatization of the articular tubercle (PAT) and glenoid fossa (PGF), based on cone-beam computed tomography (CBCT) studies. The laterality, pattern, and extension of the TBP, as well as the sex distribution and age range of the patients are also described. A systematic search was performed in the PubMed, Embase, Scopus, Web of Science, and Google Scholar databases up to May 2025 . Studies reporting TBP prevalence on CBCT were included. The data extraction followed the PRISMA guidelines, and risk of bias was assessed using the JBI checklist for prevalence studies. Meta-analyses were performed using a random-effects model to calculate pooled prevalence rates. The pooled prevalence of TBP was 62.5% (95% confidence interval (CI) 53.6-70.7%), while the prevalence rates of PAT and PGF were 26.1% (95% CI 15.4-40.6%) and 28.6% (95% CI 18.7-41.2%), respectively. Multilocular patterns predominated over unilocular, and grade 2 extension (pneumatization between the glenoid fossa and crest of the articular eminence) was the most frequent extension type in PAT. In conclusion, due to the anatomical risks associated with TBP, CBCT assessment is recommended before surgical procedures involving the temporomandibular joint to reduce the risk of complications, such as perforation of the middle cranial fossa.