Introduction: Orthopantomography is the radiological standard for evaluation of teeth and jaws. Though, presentation is limited to two-dimensional data. A three-dimensional demonstration via cone beam tomography is an additional analysis with higher exposure to radiation and costs. Aim of the study was a comparison of visibility and evaluation of pathologies of the maxillary sinus together with possible additional secondary diagnoses via orthopantomography and cone beam tomography. Materials and Methods: Orthopantomographies and cone beam tomographies of patients with pathologies of the maxillary sinus were reviewed. Emphasis was laid on 1) visibility in both imaging physics and 2) number as well as significance of the additional secondary diagnosis. Results: 31 cases (2006-2009) were reviewed. In 15%, the pathology was seen in the orthopantomography. In 85%, additional radiological methods were demanded. In cases of cone beam tomography, 35% new three-dimensional information were seen. 44% of the cone beams were seen to influence therapy and in 6%, cone beam tomography was seen to be mandatory. A mean of one additional secondary diagnose per patient was seen. Discussion: This elucidates the clear and relevant advantages of the cone beam tomography for diagnostics of the maxillary sinus when compared to orthopantomography. The additional information is followed by a higher radiation exposure of the respective patients which is as high as if not less than a computed tomography. Keywords: Cone Beam Tomography, Radiology, Sinus maxillaris, Pathology, Comparison