4. INTRODUCTION
2nd largest bone of face
2 maxillae forms whole of upper jaw
Each maxilla contributes in formation of –
1. Face
2. Nose
3. Mouth
4. Orbit
5. Infratemporal fossa
6. Pterygopalatine fossa
5. FEATURES OF MAXILLA
Each maxilla has –
1. A body
2. 4 processes – frontal
zygomatic
alveolar
palatine
6. BODY OF MAXILLA
Shape – pyramidal
It has –
1. Base – directed medially at nasal surface
2. Apex - directed laterally at zygomatic process
3. 4 surfaces – anterior / facial
posterior / infratemporal
medial / nasal
superior / orbital
Encloses a cavity – maxillary sinus
9. POSTERIOR / INFRATEMPORAL SURFACE
Concave
Directed – backward & laterally
Forms – anterior wall of infratemporal
fossa
Separated from anterior surface
2-3 alveolar canals for – posterior superior
alveolar nerve
Posteroinferiorly – maxillary tuberosity &
superficial head of medial pterygoid
muscle
Above maxillary tuberosity -anterior wall
of infratemporal fossa, grooved by
maxillary nerve
10. SUPERIOR / ORBITAL SURFACE
Smooth, triangular & slightly concave
Forms – Greater Part Of Floor Of Orbit
Anterior border forms – part of inferior orbital margin
continues with lacrymal crest of frontal process
11. Posterior border –
smooth & rounded
Forms most anterior margin of
inferior orbital fissure
In middle – infraorbital groove
Medial border –
Anteriorly lacrymal notch, converted into nasolacrymal canal
Behind the notch, articulation with -
Lacrymal
Labrynth of ethmoid
Orbital process of palatine bone
12. The superior surface presents –
Infraorbital groove & canal
Canalis sinosus
Inferior oblique muscles
13. THE MEDIAL /NASAL SURFACE
Part of lateral wall of nose
Posterosuperiorly – maxillary hiatus
Above the hiatus – air sinuses
Below the hiatus – anterior part of inferior meatus
Behind the hiatus –
articulates with
perpendicular plate of
palatine bone
&
encloses greater
& lesser palatine canals
14. THE MEDIAL /NASAL SURFACE
Infront of the hiatus – nasolacrymal groove articulates with
descending process of lacrymal bone & lacrymal process of
inferior nasal concha to forms nasolacrymal canal
15. THE MEDIAL /NASAL SURFACE
More anteriorly – conchal creast for articulation with inferior
nasal concha.
Above the conchal crest – atrium of middle meatus.
17. FRONTAL PROCESS
Projects upward & backwards to articulate
above – nasal margin of frontal bone
infront – nasal bone
behind – lacrymal bone
Lateral surface – divided by anterior lacrymal crest into
anterior smooth & posterior grooved
anterior lacrymal crest
gives attachment to
lacrymal fascia &
medial palpebral ligament
18. FRONTAL PROCESS
Medial surface – forms lateral wall of nose
from above downwards –
1. Uppermost roughened area for articulation with ethmoid
2. Ethmoidal crest – a horizontal ridge, articulates with middle nasal
concha
3. Below the ethmoidal crest
– atrium of middle meatus
conchal crest
inferior meatus
19. Pyramidal lateral projection
Anterior, posterior & superior surfaces converge here
Superiorly – rough, to articulate with zygomatic bone
ZYGOMATIC PROCESS
20. Forms half of alveolar arch
Bears socket for maxillary teeth
In adults = 8 sockets
Buccinator arises from posterior part of its outer surface upto
1st molar tooth.
Maxillay torus (occasionally)
ALVEOLAR PROCESS
21. Thick horizontal plate
Projecting medially
Forms largest part of roof & floor
Inferior surface – concave & forms anterior 3/4th of bony hard
palate.
PALATINE PROCESS
22. Various foramina & pits
Posterolaterally –
greater & lesser
palatine foremen
Superior surface –concave
from side to side & forms
floor of nasal cavity.
23. Medial border –
Thicker anteriorly
Groove between
nasal crest of 2 maxilla receives lower border vomer
Anterior part of ridge – incisal crest & anterior nasal spine, Incisive canal
Posterior border articulates with horizontal plate of palatine bone
Lateral border is continuous with alvolar process
24. ARTICULATIONS OF MAXILLA
Superiorly – 3 bones
1. Frontal
2. Nasal
3. Lacrymal
Laterally – 1 bone
1. Zygomatic bone
26. AGE CHANGES IN MAXILLA
AT BIRTH –
1. Transverse & anterioposterior diameter > vertical diameter
2. Well marked frontal process
3. Body consists of little more than alveolar process
4. Tooth sockets – close to orbit
5. Maxillary sinus is a mere furrow on the lateral wall of nose
IN ADULTS –
Vertical Diameter Is More due to –
1. Developed alveolar process
2. Increased size of maxillary sinus
IN OLD –
1. Infantile condition
2. Resorption of alveolar bone
27. DEVELOPMENT OF MAXILLA
MAXILLA develops from ossification in mesenchyme of maxillary process
of 1st arch.
No arch cartilage / primary cartilage
Center of ossification – close to the cartilage of nasal capsule
Center of ossification – in angle between division of infraorbital nerve
From this center the bone formation spreads –
Bony trough for infraorbital canal is formed .
Posteriorly – below the orbit toward the developing maxilla
Anteriorly – toward the future incisor region
Superiorly – to form frontal process
Medially – to form palate
28. From this trough a downward extension of bone forms the lateral alveolar
plate.
Medial alveolar plate – from junction of palatal process & main body of
forming maxilla.
These plates forms a trough of bone around the maxillary tooth germ.
There is contribution of secondary cartilage.
Zygomatic / malar cartilage adds in development of maxilla.
29. According to B.D. Chaurassia’s human anatomy 4th edition vol. 3 The
Head & Neck
MAXILLA ossifies from 3 centers in the membrane –
1. 1 center for maxilla proper – 6th week of IUL, above the canine fossa
2. 2 centers for premaxilla
Of 2 premaxillary centers-
o Main center above the incisive fossa - 7th week of IUL
o Second center – ventral margin of nasal septum - 10th week of IUL
soon fuses with palatal process of maxilla.
Premaxilla begin to fuse with alveolar process almost immediately after the
ossification begins.
32. Major structures
are labeled in the
picture.
Nasofrontal suture
Zygomaticofrontal
suture
Zygomaticotemporal
suture
SOF = Superior orbital fissure
IOF = Inferior orbital fissure
Orbital ‘rim’
3D CT
Anterior View
34. Axial view
Key structures
A = Frontal sinus, anterior wall
B = Frontal sinus, posterior wall
*Note: The right frontal sinus is not
pneumatized in this case.
Posterior wall of frontal sinus fracture may coexist
with brain injury
35. • Do not confuse the suture between nasal bone and
frontal process of maxilla for a fracture
• Look for a piece of fracture in the optic foramen, it is
the true emergency of facial fracture
Key structures
D = Orbit, medial wall
E = Orbit, lateral wall
F = Suture between
sphenoid and
zygomatic bones
= Nasomaxillary
suture
1 = Globe
2 = Ethmoid sinus
3 = Sphenoid sinus
4 = Nasal bone
5 = Maxilla, frontal
process
6 = Orbit, lateral rim
7 = Sphenoid bone
8 = Optic foramen
Axial view
36. Clear maxillary sinuses can almost
rules out certain fractures such as
ZMC, LeFort, blowout fractures
Key structures
F = Groove for
infraorbital nerve
G = Maxillary sinus,
posterolateral wall
5 = Maxilla, frontal process
9 = Maxillary sinus
10 = Zygomatic arch
11 = Pterygoid bone
12 = Nasolacrimal duct
13 = Mandible, condyle
Axial view
37. Key structures
H = Maxillary sinus,
anterior wall
I = Maxillary sinus,
medial wall
J = Medial pterygoid
plate
K = Lateral pterygoid
plate
9 = Maxillary sinus
14 = Mandible, ramus
Fracture of the pterygoid plates may represent
LeFort fracture
Axial view
38. Lucency in midline of the maxilla is a
normal finding seen occasionally
Key structures
J = Medial pterygoid plate
K = Lateral pterygoid plate
L = Maxilla, spine
14 = Mandible, ramus
15 = Maxilla bone/ hard palate
Axial view
39. Coronal
section
• Remind yourself that CT can miss subtle
tooth fracture, although with the coronal
and sagittal reformation. Obtain
orthopanthogram or dedicated tooth film
when in doubt
Key structures
L = Maxilla, spine
* = Nasomaxillary suture
4 = Nasal bone
5 = Maxilla, frontal process
40. Key structures
D = Orbit, medial wall
M = Nasal septum
5 = Maxilla, frontal process
15 = Maxilla bone/ hard palate
16 = Frontal sinus
17 = Mandible, body
Coronal section
41. Key structures
M = Nasal septum
N = Ethmoid bone,
perpendicular plate
O = Orbit, roof
P = Orbit, floor
Q = Maxillary sinus,
posterolateral wall
**= Zygomaticofrontal
suture
1 = Globe
2 = Ethmoid sinus
6 = Orbit, lateral rim
Coronal section
43. Key structures
P = Orbit, floor
7 = Pterygoid bone
9 = Maxillary sinus
15 = Maxilla bone /hard
Palate
• Orbital blowout fracture
is best seen in sagittal
and coronal images
• Facial CT is not
completed without image
reconstruction
Sagittal section
44. Key structures
3 = Sphenoid sinus
4 = Nasal bone
15 = Maxilla bone/ hard palate
Mid saggital section
45. WATER’S VIEW
The most comprehensive single
projection display Excellent view of
Maxilla
Maxillary sinuses
Zygoma
Zygomatic arches
Rims of orbits,
esp. floor
Nasal bones
46. WATER’S VIEW
Rule:
smooth, nondisrupted,
same contour on both sides
Key structures
1 = Frontal sinus
2 = Maxillary sinus
3 = Frontal process of
Zygoma
4 = Body of Zygoma (malar
eminence)
5 = Temporal process of
Zygoma
Dotted line = zygomaticofrontal
suture
Dolan’s lines of reference
Line A, B, C
47. Line A
Begins at inner surface of
Zygomaticofrontal suture, follows
orbital surface of
zygoma, maxilla, frontal
process of maxilla and arch
of nasal bone
If drawn to both sides, the
line is similar to lazy ‘W’ or
half frame of reading
glasses
Line B
Begins at lateral and
inferior margin of maxilla
and extends along lateral
wall of maxillary sinus and
inferior surface of zygomatic
Arch Ends at glenoid fossa
48. Line C
Begins
at lateral and
inferior margins of maxilla,
extends along lateral wall of
maxillary sinus and inferior
surface of zygomatic arch
Ends at glenoid fossa
“Friendly Line”
Medial half of Line C is the
anterolateral wall of the
maxillary sinus.
If it is disrupted, the
possibilities of fracture include
1) Isolated maxillary
antrum
2) Zygomaticomaxillary
complex (ZMC)
3) LeFort
50. Caldwell’s View
Excellent view of
Entire rim of orbit, esp.
superomedial rim
Ethmoid sinus
Floor of orbit may be well
seen in petrous bones are
projected below the inferior
orbital rim (not in this
example)
51. Key structures
1 = Ethmoid sinuses
2 = Orbit
Line A, B, C, D = superior,
lateral, inferior and medial
walls of the orbit,
respectively
Line E = midline nasal
septum and vomer
Rule:
Ethmoid
sinuses density
should be equal, darker
than orbit
Smooth
nondisrupted
orbital walls
2
52. Lateral cephalogram
Excellent view of
1. Frontal sinus: anterior wall
2. Maxillary sinus: anterior and posterior
wall
3. Sphenoid sinus
4. Pterygoid plate, hard palate
5. Floor of anterior cranial fossa,
53. Key structures
1 = Frontal sinus
2 = Maxillary sinus
3 = Sphenoid sinus
4 = Hard palate
5 = Anterior wall of temporal fossa
Between green arrows =
Pterygoid plate
Line A = Anterior wall of
frontal sinus
Line B = Anterior cranial
fossa
Line C = Anterior wall of
maxillary sinus
Line D = Posterior wall of
maxillary sinus
54. TOWN’S VIEW
Key structures
1 = Zygomatic arch
Line A = Posterolateral wall of maxillary
sinus
Rule:
Smooth, nondisrupted line
Excellent view of Maxillary sinus:
posterolateral wall Zygomatic arch
56. Maxillary Fractures
Types of maxillary fractures -
Maxillary sagittal fracture (maxillary sinus fracture)
Palate fracture
Alveolar process fracture
LeFort fractures
LeFort I fracture
LeFort II fracture
LeFort III fracture
Combination (bilateral, hemi-)
57. Maxillary sagittal fracture
Maxillary sinus fracture
Fracture of a maxilla in sagittal plane, involving anterior-lateral wall
of a maxillary sinus (LeFort fractures represent bilateral maxillary
fractures)
Due to direct blow to either right or left midface
Plain film shows opacified maxillary sinus, however it is usually
inadequate for diagnosis
58. 68-year-old man was found
down.
There is a sagittal plane
fracture of the left maxillary
sinus (red arrow) with
hemosinus (H)
59. Isolated alveolar process
fracture
Fracture of any portion of the alveolar process
Clinically evident by malalignment and displacement of teeth
contained within fractured segment
Even on CT, fracture may be subtle and easily overlooked
Further imaging may be needed when the diagnosis is made
X-ray of the teeth or a panoramic view (look for dental injuries)
Chest radiograph (look for aspirated teeth)
60. Middle age women fell onto her mouth.
Red arrows show the comminuted fractures of the maxillary alveolar process
on the right side. These fractures are considered ‘open’ as they are connected
to the oral cavity.
61. LeFort Fractures
Among the most severe fractures seen in face and associated with
high-energy trauma
Named after René LeFort, a French physician, who studied facial
fractures in cadavers. Result was published in 1901
Key facts -
In each type, there is a partial or complete separation of maxilla from the
remainder of the facial skeleton
All LeFort fractures must extend through posterior face, transects the
pterygoid processes
Any combination of LeFort I, II, and III patterns can occur
62. LeFort I fracture
Definition: transmaxillary fracture
Transverse (horizontal) fracture of inferior maxillae, involving maxillary
sinuses (all except superior walls), lateral margin of nasal fossa, nasal
septum and pterygoid plates
Clinical: free floating and movable hard palate with maxillary teeth
Imaging findings
Opacified bilateral maxillary sinuses
Transverse fracture through the inferior maxillae above hard palate
Best shown and confirmed by coronal and sagittal reformatted CT images
63. 48-year-old man was kicked by a horse.
LeFort I fracture line along bilateral maxillary sinuses (red arrows). Pterygoid plate
fractures are not shown
H = Hemosinus, Blue arrow = Mandibular fracture
64. LeFort II fracture
Pyramid-shaped maxillary fracture, involving maxillary
sinuses (anterior-lateral walls), inferior orbital rim, orbital
floor and nasofrontal suture
Clinical: free floating, movable midface including
maxillary teeth, hard palate and nose
Imaging findings:
Opacified bilateral maxillary sinuses and orbital emphysema
Fractures of anterior/lateral walls of maxillary sinuses, inferior orbital
rims/floors and disruption of nasofrontal suture
Best seen and confirmed by coronal reformatted CT images
65. Middle age man in motor vehicle accident.
Fracture lines are demonstrated in red arrows.
Fracture of pterygoid plates are present in all
type of LeFort fractures.
H = Hemosinus
66. LeFort III fracture
Craniofacial disjunction
This fracture separates calvaria (skull) from the facial
bones. Most severe of all LeFort fractures
Definition: separation of facial bones from the skull
Zygomas separated from sphenoid at zygomatico-sphenoid sutures
Nasal bones and medial orbital walls separated from frontal bone at nasofrontal sutures
Best seen in coronal images
Clinical: movement of face relative to the skull
Imaging findings:
Plain film will underestimate degree of injuryto severe soft tissue swelling
obscuring the bony details. CT is recommended due
67. 32-year-old man, unrestrained
driver in a motor vehicle
accident.
Blue arrows define LeFort II fracture.
Red arrows define the LeFort III fracture.
68. malar fractures-Trauma to infraorbital margin may cause sensory
loss of infraorbital skin.
Sometimes injury to nasolacrymal duct – epiphora.
69. Imaging Approach - Plain Film
Friendly line (anterolateral
antral wall of maxillary sinus)
Both intact
NO ZMC or LeFort fractures
Blowout fracture
Isolated fractures of lateral orbital
wall, zygomatic arch
One disrupted
ZMC fractures
Maxillary sagittal fracture (isolated sinus
fracture)
Both disrupted
LeFort fractures
70. Clear sinus sign (= all sinuses and mastoid are clear of fluid), there are
three possible facial fractures:
Nasal bone fractures
Isolated zygomatic arch fractures
Mandible fractures
Bloody sinuses
Pterygoid plate fracture present - probable LeFort fracture
Maxillary wall fractures
Orbital floors, NOE region fractures
ZMC fractures
With fracture of lateral margin of nasal fossa
= LeFort I
With fracture of inferior orbital rim = LeFort II
With fracture of zygomatic arch = LeFort III
71. TRAJECTORIES OF MAXILLA
According to Bennignhoff –
Vertical trajectories
1. Frontonassal buttress
2. Malarzgomatic buttress
3. Pterygoid buttress
horizontal trajectories
1. Hard palate
2. Orbital margin
3. Zygomatic arches
4. Palatal bone
5. Lesser wing of sphenoid
72. Maxilla is spongy bone & houses paranasal sinuses
- absorbs the energy of blunt trauma
Articulation with frontal process & zygoma – stability.
Porous – ample blood supply – prevents spread of
infection.
Boney defect > 5 mm = grafting.
74. ECTOPIC INFRAORBITAL NERVE
IN A MAXILLARY SINUS SEPTUM:
ANOTHER POTENTIALLY
DANGEROUS VARIANT FOR
SINUS SURGERY
P. Mailleux1, O. Desgain2, M.I. Ingabire1
Evidence in Health and Social Care
(Online journal)
www.rbrs.org/dbfiles/journalarticle_0814.pdf
World Neurosurg. 2011 Sep-Oct;7 2010, 93:
308-309 ; discussion 266-7
75.
76. POSITION OF INFRAORBITAL
FORAMEN
Sárka Bejdová a,*, Václav Krajícek b, Miroslav
Peterka a,c, Pavel Trefný a,d, Jana Velemínská
a Variability in palatal shape and size in
patients with bilateral complete cleft lip and
palate assessed using dense surface model
construction and 3D geometric
Morphometrics, Journal of Cranio-Maxillo-
Facial Surgery 40 (2012) 201e208
100Skulls
196 sides
77. Majority –
Oval in male skull (54.7%) & on left side (52.8%)
Round on right side (34) & oval in left side (23)
Directed inferomedially – 65.8 % in males
- 67.8 % in females
Present in vertical line with 1st premolar = 70/196 sides
no gender predilection
Mean distance between infraorbital margine & infraorbital foramen =
7.39 1.63 mm
4/ 100 skulls – accessory foramina
1 accessory foramina – 2 male & 1 female
2 accessory foramina – 1 male skull
mostly on left side & oval in shape.
78. Variability in palatal shape and size in
patients with bilateral complete cleft lip
and palate
Sárka Bejdová a,*, Václav Krajícek , Miroslav Peterka , Pavel Trefný ,Jana
Velemínská ; Variability in palatal shape and size in patients with bilateral
complete cleft lip and palate assessed using dense surface model
construction and 3D geometric morphometrics; Journal of Cranio-Maxillo-
Facial Surgery 40 (2012) 201e208.
79. Flatter & narrower in bilateral cleft lip & palate cases.
Most notable size difference is in area in between maxilla & maxilla, even
premaxilla can remain separate from rest of the palate.
Mean Palatal configuration of premaxilla & adjacent palatal area in lateral
projection is –
concave in normal individuals
clefted in bilateral cleft lip & palate cases
Palate of clefted patient is more conical anteriorly than posteriorly.
80. Anatomical variation and morphology in the
position of the palatine foramina in adult
Maria Piagkou , Theodore Xanthos , Sophia Anagnostopoulou
, Theano Demesticha , Evangelos Kotsiomitis, Giannoulis
Piagkos, Vassilis Protogerou , Dimitrios Lappas , Panayiotis
Skandalakis , Elizabeth O. Johnson ; Anatomical variation and
morphology in the position of the palatine foramina in adult
human skulls from Greece; Journal of Cranio-Maxillo-Facial
Surgery 40 (2012) e206ee210
81. The study was conducted on 71, Greek dry, adult human
skulls of the twentieth century available in the Anatomical
Museum of the Department of Anatomy, Faculty of
Medicine, Athenian University.
The investigated normal skulls with fully erupted 3rd
maxillary molars were evaluated to describe the intraoral
landmarks of the GPF and related structures.
82. High tuberosity block – for maxillary anesthesia.
Control hemorrhage in cases of repair of nasal septum
(septorhinoplasty).
Greater palatine artery can damage in fracture of –
1. Medial wall of maxillary sinus
2. Lateral wall of maxillary sinus
3. Pterygomaxillary dysjunction
4. Downfracturing of maxilla
Greater palatine foramen is also important in closure of
oroantral communication with palatal flap.
83. Mean distance of greater & lesser palatine foramina from
midsagittal suture
greater palatine foramina = 1.53 cm
lesser palatine foramina = 1.46 ± 0.22 cm (rt),
1.47 ± 0.17 cm (lt)
84. Mean distance of greater palatine foramina from posterior border of
maxilla
Rt side = 0.46 ± 0.10 cm Lt side = 0.47 ± 0.11 cm
85. Mean distance of greater & lesser palatine foramina from alveolar
ridge
Rt side = 0.31 ± 0.17 cm Lt side = 0.29 ± 0.16 cmAvarage = 0.3 cm
Rt side = 0.41 ± 0.19 cm
Lt side = 0.38 ± 0.02 cm
86. Average anteroposterior diameter =
Average transverse diameter =
76.2% cases = between proximal distal surface of maxillary 3rd molars
71.9 % cases = at the junction of palatine bone & inner lamella of pterygoid
plate
Rt side = 0.53 ± 0.09 cm Lt side = 0.54 ± 0.09 cm
Lt side = 0.27 ± 0.05 cmRt side = 0.26 ± 0.06 cm
105. MECHANISM OF INJURY
Middle third of face is a complex of bones & cartilages organized in a system
of buttresses. In adults it is extensively pneumatized.
The maxilla a box like bone has been harder to assess as an entity;
NAHUM (1975) tested the thin anterior wall of maxilla & found that this
shattered at quite low force loadings in the range 150-300 lbs (0.67-1.34kN).
208- 475 lb for zygoma
> 75 lb for nasal bone
106. STANLEY & NOWARK (1985) did cephalometric study about the
cadaver facial impacts where they stresses on importance of angle of impact
in relation to the horizontal buttress of the facial skeleton.
Impact on the nasion at 30-60o
above the horizontal = Le Fort III
fracture (craniofacial disjunction)
107. 2. Horizontal impacts along the Frankfort plane = Le Fort II fracture
pyramidal fracture
108. 3. Direct horizontal or angular blow at the level of upper teeth but below the
anterior nasal spine = Le Fort I or horizontal maxillary fracture.
109. Riu et al 1960
Blanton & Biggs 1969 proposed that –
when force is transmitted from
below the honeycomb (Blanton &
Biggs) pyramidal (Riu et al)
configuration of paranasal sinuses ,
with maxillary sinus forming the
base & sphenoid sinus forming the
apex, forms an architectural
structure that is particularly well
suited to a protective energy
absorbing role.
110. GEOMATRIC CONCEPT
OF
THE CRANIOFACIAL SKELETON
These models represents simplified interpretations of the
complex anatomy of the bony structural pillars that
transmits the forces of mastication, devised to further
understanding of fracture patterns .
111. Rowe & Killey (1955) emphasized the mechanical strength of 3 paired
girders in transmission of force evenly to the skull base –
1. Alveoli & transpalatal arch
2. Palatine-pterygoid buttress posteriorly
3. Zygomaic complex laterally
Additionl support in the central buttress of
vomer & ethmoid vertical plate
The arched palate & infraorbital rim join the
anterior & lateral girders.
112. In a functional analysis of the facial skeleton Sicher & Du Brul 1975
considered that the facial structures are anchored to the skull base by 3 pairs
of curved vertical pillars –
1. Canine pillar
2. Zygomatic pillar
3. Pterygoid pillar
These authors gave greater importance to the
horizontal pillars connecting the curved vertical
pillars, specially the supraorbital bar.
113. Sturla et al 1980
performed cadaver
impaction studies &
proposed a lattice
shaped structure of
facial skeleton.
They emphasized on the
importance of vertical pillars &
transverse plateforms – the hard
palate below & frontal sphenoid
bone above.
114. Manson et al 1983 and Gruss & Mackinnon 1986
advised that anterior vertical buttress are reconstituted to
preserve the facial height, in case of trauma.
115. Gentry et al 1983 studied the thin axial section CT scan of cadaver &
identified
3 horizontal sturts
1. Superior
2. Middle / orbital
3. Inferior / palatal
128. Seibert (1997) – palatal contribution to blood supply of
mobilized Le Fort I segment , which is mainly by –
1. Ascending palatine
branch of facial artery
2. Ascending pharyngeal
branch of external
carotid artery.
138. PNEUMATIZATION OF MAXILLARY SINUS
Increase pneumatization –
thinning of walls
Mattila & Westerholm 1968-
continuation of
widening of sinus after dental
extraction.
Young v/s adult maxillary sinus
Killey & Kay 1972 –
9/362 oroantral
communication in 0-15 years of age
group.
139. RESOURCES
TEXT BOOK –
1. B.D. Chaurassia’s human anatomy 4th edition vol. 3 The Head & Neck.
2. Gray’s Anatomy 39th edition.
3. Ten Cate’s Oral Histology, 6th edition.
4. The Head & Neck by- Hennry Hollinshed
5. Killey’s fracture of middle third of facial skeleton
6. Orthognathic Surgery By – George Dimitroulis, M. Franklin Dolwick, Joseph E. Van
Sickels.
7. Craniomaxillofacial trauma by – D.J. David, D.A. Simpson.
8. Oral & maxillofacial surgery fonseca vol. 2 by – Betts & Turvey.
9. The Maxillary Sinus & Its Dental Implications by – Killey & Kay.
140. RESOURCES
OTHER SOURCES -
1. Reoperative midface trauma.Yang RS, Salama AR, Caccamese JF. Oral Maxillofac Surg Clin North Am. 2011
Feb;23(1):31-45, v. Epub 2010 Dec 3.
2. Gruss JS, Phillips JH. Complex facial trauma: the evolving role of rigid fixation and immediate bone graft
reconstruction. Clin Plast Surg. 1989 Jan;16(1):93-104
3. Evidence in Health and Social Care,
4. World Neurosurg. 2011 Sep-Oct;7 2010, 93: 308-309 ; discussion 266-7
5. P. Mailleux, O. Desgain, M.I. Ingabire;Ectopic infraorbital nerve in a maxillary sinus septum:another
potentially dangerous variant for sinus surgery
6. Maria Piagkou , Theodore Xanthos , Sophia Anagnostopoulou , Theano Demesticha , Evangelos
Kotsiomitis, Giannoulis Piagkos, Vassilis Protogerou , Dimitrios Lappas , Panayiotis Skandalakis , Elizabeth
O. Johnson ; Anatomical variation and morphology in the position of the palatine foramina in adult human
skulls from Greece; Journal of Cranio-Maxillo-Facial Surgery 40 (2012) e206ee210
7. Sárka Bejdová a,*, Václav Krajícek , Miroslav Peterka , Pavel Trefný ,Jana Velemínská ; Variability in palatal
shape and size in patients with bilateral complete cleft lip and palate assessed using dense surface model
construction and 3D geometric morphometrics; Journal of Cranio-Maxillo-Facial Surgery 40 (2012) 201e208.
Axial CT scan slices, from top to bottom. A. Upper part of the maxillarysinus.B,C, slightly below A: the septum (straight arrow ) starts from the lateral sinuswall. Within it the infraorbital nerve (curved arrow) .D: lower portion of the sinus , withoutseptum. CT parameters in both cases were the following: 64 slices MDCT , 0625 mmthin slices, 100 kV, 50 mA resulting in patient 1 in a CTD/vol of 2,74 mGy, DLP 37,5 mGycmand 1,5 mSev
Creation of large antrostomies, however, is now a somewhat controversial topic amongst rhinologists. A competing technology to the creation of large surgical drainage openings was popularized by Ruben Setliff and is referred to as “small hole” or “small fenestra” surgery. Also, the development of balloon technologies to expand natural sinus drainage tracts has been recently refined which have a theoretical advantage of requiring less sinus surgical disruption to achieve improvement of chronic sinusitis symptoms. One of the new balloon technologies actually uses a Caldwell-Luc approach to place the balloon through a small incision in the gum under the upper lip much as described in the original operation. The advantage of the Caldwell-Luc approach in this setting is that it allows a more direct approach to the natural ostium of the maxillary sinus for balloon placement using endoscopic instrumentation and causes less disruption of the ethmoid sinus anatomy.