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Introduction: Maxillary sinus pathology, particularly its association with odontogenic infections, is a significant concern in dentistry. This retrospective study explored the prevalence of maxillary sinus pathologies and their association with odontogenic infections in Saudi Arabia. Methods: This retrospective study included 411 patients aged 20–80 years. Cone-beam computed tomography was performed to identify the presence, location, and characteristics of odontogenic infections and maxillary sinus pathologies. Patients’ age and sex were also recorded. Results: Sinusitis was prevalent in 50.6 % of the cases, with no significant sex or age differences in the pathology distribution. A notable association was found between odontogenic and sinus pathologies, particularly on the left side. Conclusion: A significant prevalence of sinus pathologies, particularly sinusitis, was observed, with an association between odontogenic and sinus pathologies, notably on the left side. While acknowledging the limitations of the study, these findings underscore the need for integrated dental and sinus health assessments.