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MAXILLARY SINUS
1
Introduction
Development, anatomy and physiology
Blood , Nerve supply& Lymphatic drainage
Functions of the paranasal sinuses
Histology & Diagnostic evaluation of sinus disease
Differences between odontalgia and sinus pain
Developmental anomalies & pathologic conditions of maxillary sinus
Clinical significance
Case report
Conclusion
References 2
Paranasal air sinus
Paranasal air sinuses are the air filled
mucosa lined cavities which develops in the
cranial and facial bones.
These are the spaces which communicates
with the nasal airway.
These forms the various boundaries of the
nasal cavity.
3
Introduction
4
•Paranasal sinuses are present in a variety of
animals (including most mammals, birds, and
crocodile).
• The sinuses are named for the bones in
which they are located.
5
I
n
t
r
o
d
u
c
t
i
o
n
6
Maxillary air sinus
Frontal air sinus
Ethmoidal air sinus
Sphenoidal air sinus
Definition of maxillary sinus
“Maxillary sinus is the pneumatic space that
is lodged inside the body of maxilla and
that communicates with the environment
by way of the middle meatus and nasal
vestibule.”
Anatomy of the maxillary sinus was 1st
described by Highmore in 1651.
7
Development
Maxillary sinus is first of the PNS to
develop.
It starts as a shallow groove on the medial
surface of maxilla during the 4th month of
intrauterine life.
8
(Koch 1930).
Expansion occurs more rapidly until all the
permanent teeth have erupted.
It reaches to maximum size around
18years of age.
9
(Bailey 1998, Sadler 1995)
AGE CHANGES
Maxillary sinus
Age changes
12
Anatomy
Largest of
PNS,communicate with other
sinuses through lateral nasal
wall.
Horizontal Pyramidal shaped
Base
Apex
4 walls
◦ Wall thickness varies with
superior
inferior
lateral
anterior
Medial wall
Formed by lateral nasal wall
◦ Below-inf . nasal conchae
◦ Behind-palatine bone
◦ Above-uncinate process
of ethmoid,lacrimal bone
Contains double layer of
mucous membrane(pars
membranacea)
Medial wall
Imp structures
Sinus ostium
Hiatus semilunaris
Ethmoidal bulla
Uncinate process
Infundibulum
Osteum:
Opening of the maxillary sinus is called
osteum.
It opens in middle meatus at the lower part
of the hiatus semilunaris.
Lies above the level of nasal floor.
16
The ostium lies approximately 2/3rds up the
medial wall of the sinus, making drainage of
the sinus inherently difficult.
17
In 15% to 40% of cases, a very small,
accessory ostium is also found.
Blockage of the ostium can easily occur when
there is inflammation of the mucosal lining of
the ostium.
18
Superior wall
Forms roof of sinus and floor of orbit
Imp structures
Infraorbital canal
Infraorbital foramen
Infraorbital nerve and vessels.
Posterolateral wall
Made of zygomatic and greater wing of sphenoid bone.
Thick laterally,thin medially
Imp structures
PSA nerve
Maxillary artery
Pterygopalatine ganglion
Nerve of pterygoid canal
Anterior wall
Extends from pyriform aperture anteriorly to ZM
suture
& Inferior orbital rim superiorly to alveolar
process inferiorly.
Convexity towards sinus
Thinnest in canine fossa
Imp structures
Infraorbital foramen
ASA, MSA nerves
Floor of sinus
Formed by junction of anterior
sinus wall and lateral nasal wall
1-1.2 cm below nasal floor
Close relationship between
sinus and teeth facilitate spread
of pathology.
VASCULAR SUPPLY:-
Arterial blood supply:-
Greater palatine arteries
Infraorbital artery
Facial artery
23
Venous drinage:-
• Pterygoid venous plexus
• Sphenopalatine vein and
• Facial vein
24
(Watzek et al. 1997)
yNerve supply
Maxillary division of the trigeminal nerve,
i.e. the posterior, middle and anterior
superior alveolar nerves, the infraorbital
nerve and the anterior palatine nerve.
25
Last 1959
26
Lymphatic Drain
The lymphatic drains in to submandibular lymph
nodes.
The lymphatic drainage reaches the specialised cells
in the maxillary sinus via infra orbital foramen or
through the anterosuperior wall and then to the
submandibular lymph nodes.
Lymphatic drainage
27Submandibular lymph nodes
Functions of the maxillary sinus
Humidification and warming of inspired air,
Assisting in regulating intranasal pressure,
Lightening the skull to maintain proper head balance,
Imparting resonance to the voice,
Absorption of shocks to the head,
Filtration of the inspired air.
(Bailey 1998).
28
HISTOLOGY
Maxillary sinus is lined by three
layers: epithelial layer, basal
lamina and sub epithelial layer
with periostium.
Epithelium is pseudo stratified,
columnar and ciliated.
As cilia beats, the mucous on
epithelial surface moves from
sinus interior towards nasal
cavity.
30
CLINICAL EXAMINATION
INSPECTION :
Middle third of the face should be inspected for the presence of
asymmetry, deformity, swelling, erythema , ecchymosis or hematom
EXTRAORAL PALPATION :
Include palpation of the facial wall of the sinus above the premolar
where the bone is thinnest.
31
INTRAORAL EXAMINATION
Examination should be performed for tenderness, or
paresthesia of upper molar and premolar region.
TRANSILLUMINATION TEST:
It is performed in a darkened room by inserting an electrically
safe light into the mouth ( with the lip closed). Good transilluminatio
indicates presence of air in the sinus while the failure of
transillumination indicates presence of pus, fluid , solid lesion or
mucosal thickening.
Radiographic examination
Radiography is the most important supplementary
investigation to clinical examination of the sinuses
Intra-Oral : Extra-Oral:
Periapical OPG View
Occlusal Waters view
(Occipitomental view)
Lateral Occlusal Submentovertex
view
PA view
32
Others:
• MRI & CT scan
Periapical radiograph
Borders of the maxillary sinus appear as a thin, delicate
radiopaque line .
(White & Pharoah 2000)
In the absence of disease it appears continuous, but on close
examination it has small interruptions in its smoothness or
density.
33
The roots of maxillary molars usually
lie in close apposition to the maxillary
sinus and may project into the floor of
the sinus, causing small elevations or
prominences.
(White & Pharoah
2000) 34
Maxillary sinus septum
35
Occlusal view Lateral occlusal view
2. Panoramic radiography
Provides an extensive overview of the
sinus floor and its relationship with the
tooth roots.
36
37
OPG
38
Water’s projection
PA view Lateral Submentovertex
5. Computerized tomography (CT) & Magnetic
resonance imaging (MRI)
 These modalities provide multiple sections through
the sinuses at different planes and therefore
contribute to the final diagnosis and the
determination of extent of the disease.
40
CT scan MRI
6. Ultrasound
 Ultrasound is becoming the diagnostic tool of choice for
more and more physicians in detecting sinusitis.
 It offers a fast ,reliable and radiation free method for
diagnosing sinusitis and has been used successfully in
Finland for around 15 years. (Landman
1986)
42
43
Ultrasound beam sent out by the sinus ultra is reflected fro
the posterior wall of the sinus when the sinus contains flu
and from the anterior wall when sinus contains air.
7. Diagnostic endoscopy
 It is an optimal method especially for the assessment
of foreign bodies (such as root filling materials and root
tips) that have penetrated into the maxillary sinus.
(Kennedy et al. 1985)
44
Transoral access via the canine fossa.
Transalveolar access via an already existing
connection between the oral cavity and the
antrum.
 Access the inferior meatus of the nose.
45
46
47
DEVELOPMENTAL ANOMALIES AND
PATHOLOGIC CONDITIONS OF
MAXILLARY SINUS
Developmental anomalies
1.Aplasia
2. Agenesis
3. Hypoplasia
Aplasia
Pathologic conditions of maxillary
sinus
Maxillary Sinusitis
Odontogenic cystic lesions of maxillary
sinus
Tumors of maxillary sinus.
49
Maxillary Sinusitis
Acute Maxillary Sinusitis
 Sudden onset
 Duration of 4wks or less
Subacute Maxillary Sinusitis
 Duration of 4 – 12 wks
Chronic Maxillary Sinusitis
 Duration of atleast 12 wks
50
Maxillary sinusitis
1. Infectious causes
a) Bacterial
b) Viral
c) Fungal
2. Non infectious
causes
a) Allergic
b) Non allergic
c) Pharmocologic
d) Irritants
3. Disruption of
mucociliary drainage
a) Surgery
c) Trauma
Etiology
Maxillary sinusitis
Signs and symptoms associated with maxillary sinusitis
Major signs and symptoms Minor signs and symptoms
Facial pain/pressure Headache
Facial congestion/fullness Fever
Nasal obstruction/blockage Halitosis
Nasal discharge/purgulence/discolored postnasal
discharge
Fatigue
Hyposmia/anosmia Dental pain
Purulence in nasal cavity on examination Cough
Ear pain
Maxillary sinusitis of Dental Origin
1.Dental abscess(periodontal and periapical
abscess)
2.Infected dental cyst
3.Dental material
4.Oro-antral communication
53
54
Spread of infection from periapical
region .
55
Overextention of dental
material like sealers,
cements ,Gp or silver
cones
A root tip of the maxillary
first molar accidentally
pushed into the sinus at the
time of tooth extraction.
56
Oro-antral communication
(It is a pathologic tract that connects the oral cavity to the
maxillary sinus. )
Patient complained of regurgitation of food through the
nose while eating.
• Maxillary sinus perforation occurs occasionally during
the extraction of a maxillary tooth, and it may be a cause
of maxillary sinusitis or oro- antral fistula.
57
ODONTOGENIC CYSTIC LESIONS
AFFECTING THE MAXILLARY SINUS
58
59
:
-Radicular cyst
-Dentigerous cyst
-Mucous retention cyst
Odontogenic Cystic Lesions of the maxilla
60
Maxillary sinusitis caused by an apical
inflammatory lesion ( radicular cyst)
at the root apices of the 2nd molar
- NOTICE the cloudiness ( Radio-
opacity) of the sinus
Radicular cyst
61
Dentigerous cyst
Also known as follicular cyst,2nd
most common cyst , it usually
appear on the impacted maxillary
3rd molar
62
Mucous retention cysts
Mucous retention cysts in the sinuses are very common,
they are expansile and potentially destructive lesions
TUMORS OF MAXILLARY SINUS
63
64
Benign tumor of MS:
Ameloblastoma:
Ameloblastoma is the most common benign
tumor affecting maxillary sinus.
65
Malignant tumors of MS
They are Invasive and destructive lesions
For Examples :
Squamouse cell carcinoma
Clinical Considerations:
The chances of creating an oro-antral fistula in patient less than
15 yrs are comparatively lesser than in adults due to incomplete
development of sinus.
The distance between apical end of maxillary posterior teeth and
floor of sinus is approximately 1-1.2 cm. In some cases the gap
may be still lesser.
66
• Maxillary sinus perforation occurs occasionally during the
extraction of a maxillary tooth, and it may be a cause of maxillary
sinusitis or oro- antral fistula.
Oro-antral communication and oro-antral fistula
Root which is most close to the sinus is
“palatal root of maxillary 2nd molar
Followed by :
1st molar
3rd molar
2nd premolar
1st premolar
canine
67
68
 Lin et al. in 1991 reported that the maxillary
sinus is more developed in female and
therefore greater possibility of the occurrence of
oro-antal communication and oro-antral fistula in
female .
69
70
Symptoms of fresh oroantral communication:
Escape of fluids
Epistaxis
Escape of air
Enhanced column of air.
Excruciating pain
71
Symptoms of established oroantral fistula:
Pain.
Persistent purulent unilateral nasal discharge.
Post nasal drip.
Popping out of antral polyp.
Buccal flap advancement
operation
Von Rehermann - 1936.
Operative technique
73
www.indiandentalacademy.com
74
PALATAL FLAPS
Rotational-advancement.(Ashley 1939)
www.indiandentalacademy.com
75
SUBMUCOUS CONNECTIVE TISSUE
FLAP( Ito et al 1980)
76
BUCCAL FAT PAD(Hanazawa et al
1995)
Maxillary sinus
pneumatization :
The expansion of the sinus is
larger following extraction of
several adjacent posterior teeth,
if dental implant placement is
planned in these cases,
immediate implantation and/or
immediate bone grafting should
be considered to assist in
preserving the 3-dimensional
bony architecture of the sinus
floor at the extraction site.
77
78
Implants in the maxilla
Lack of sufficient bone height along maxillary
sinus, produces significant difficulty for
placement of implants in edentulous maxillary
jaw, in that case, we go for sinus lift, which is a
surgical procedure which aims to increase the
amount of bone in the posterior maxilla.
79
SINUS LIFT
There are two
main approaches
to lift the maxillary
sinus
Direct( Caldwell
luc)
Indirect
`
I
D
R
E
C
T
Jensen and
Terheyden
in 2009,
81
Direct sinus lift - advantage
1.It is clear
2. Easy access
3.More efficient work is done.
82
Disadvantage
1. More painful.
2. More post operative discomfort
3. More time consuming
4. Needs highly efficient practitioner
5. More susceptible to infection
83
INDIRECT TECHNIQUE
Invented by SUMMER IN 1994
ADVANTAGE
84
1. Minimally invasive surgical procedure
2. Requires less time and expertise than direct technique.
DISADVANTAG
E
1.Blind procedure
2.More chances of errors to occur.
85
 Maxillary Sinusitis : Because of the thickned and inflammed sinus
lining compresses the nerve supply of the maxillary posterior teeth
causing tenderness of the maxillary teeth.
The infraorbital and superior alveolar vessels are freqently ruptured in
maxillary fracture causing hemotoma formation in the antrum.
Foreign body: Foreign body like GP, silver point, calcium hydroxide,
sodium hypochloride, sealers, root piece ,may sometimes be
accidentally forced into the maxillary antrum causing maxillary
sinusitis.
Differences between symptom of
odontalgia and sinus pain
History of cold, allergy, congestion or nasal
drainage.
Dull aching pain that is difficult to localized
Feel pressure in the cheek and below the
eyes
Position change like bending forward
produces pain
Dental local anesthetic blockade will not relief
sinus pain
Normal pulp vitality test.
86
87
88
89
Conclusion
Due to close proximity of maxillary sinus to orbit, alveolar
ridge, maxillary teeth, diseases involving these structures
may produce confusing symptoms. Hence a precise
information about the surgical anatomy is essential to
surgeons.
•Knowledge of the anatomical relationship between the
maxillary sinus floor and the maxillary posterior teeth is
important for the preoperative treatment planning of
maxillary posterior teeth. Clinicians must be particularly
cautious when performing dental procedures involving
the maxillary posterior teeth.
References
• Textbook of oral and maxillofacialsurgery, Neelima malik
Maxillary sinus and its implication Killey and Kay
Textbook of Maxillary sinus Mc’gowan
Orban’s, Oral histology and embryology, 11th edition.
Cate A.R. Ten, Oral Histology: development, structure, and function. 6th
edition.
ITI Treatment Guide , sinus floor elevation procedures, H. Katsuyama & S.S.
Jensen
Textbook of general anatomy, B.D. Chaurasia
IEJ vol 35 2002
J Endod. 2001 July;(27)
91
92

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Maxillary sinus

  • 2. Introduction Development, anatomy and physiology Blood , Nerve supply& Lymphatic drainage Functions of the paranasal sinuses Histology & Diagnostic evaluation of sinus disease Differences between odontalgia and sinus pain Developmental anomalies & pathologic conditions of maxillary sinus Clinical significance Case report Conclusion References 2
  • 3. Paranasal air sinus Paranasal air sinuses are the air filled mucosa lined cavities which develops in the cranial and facial bones. These are the spaces which communicates with the nasal airway. These forms the various boundaries of the nasal cavity. 3 Introduction
  • 4. 4 •Paranasal sinuses are present in a variety of animals (including most mammals, birds, and crocodile). • The sinuses are named for the bones in which they are located.
  • 5. 5
  • 6. I n t r o d u c t i o n 6 Maxillary air sinus Frontal air sinus Ethmoidal air sinus Sphenoidal air sinus
  • 7. Definition of maxillary sinus “Maxillary sinus is the pneumatic space that is lodged inside the body of maxilla and that communicates with the environment by way of the middle meatus and nasal vestibule.” Anatomy of the maxillary sinus was 1st described by Highmore in 1651. 7
  • 8. Development Maxillary sinus is first of the PNS to develop. It starts as a shallow groove on the medial surface of maxilla during the 4th month of intrauterine life. 8 (Koch 1930).
  • 9. Expansion occurs more rapidly until all the permanent teeth have erupted. It reaches to maximum size around 18years of age. 9 (Bailey 1998, Sadler 1995)
  • 13. Anatomy Largest of PNS,communicate with other sinuses through lateral nasal wall. Horizontal Pyramidal shaped Base Apex 4 walls ◦ Wall thickness varies with superior inferior lateral anterior
  • 14. Medial wall Formed by lateral nasal wall ◦ Below-inf . nasal conchae ◦ Behind-palatine bone ◦ Above-uncinate process of ethmoid,lacrimal bone Contains double layer of mucous membrane(pars membranacea)
  • 15. Medial wall Imp structures Sinus ostium Hiatus semilunaris Ethmoidal bulla Uncinate process Infundibulum
  • 16. Osteum: Opening of the maxillary sinus is called osteum. It opens in middle meatus at the lower part of the hiatus semilunaris. Lies above the level of nasal floor. 16
  • 17. The ostium lies approximately 2/3rds up the medial wall of the sinus, making drainage of the sinus inherently difficult. 17
  • 18. In 15% to 40% of cases, a very small, accessory ostium is also found. Blockage of the ostium can easily occur when there is inflammation of the mucosal lining of the ostium. 18
  • 19. Superior wall Forms roof of sinus and floor of orbit Imp structures Infraorbital canal Infraorbital foramen Infraorbital nerve and vessels.
  • 20. Posterolateral wall Made of zygomatic and greater wing of sphenoid bone. Thick laterally,thin medially Imp structures PSA nerve Maxillary artery Pterygopalatine ganglion Nerve of pterygoid canal
  • 21. Anterior wall Extends from pyriform aperture anteriorly to ZM suture & Inferior orbital rim superiorly to alveolar process inferiorly. Convexity towards sinus Thinnest in canine fossa Imp structures Infraorbital foramen ASA, MSA nerves
  • 22. Floor of sinus Formed by junction of anterior sinus wall and lateral nasal wall 1-1.2 cm below nasal floor Close relationship between sinus and teeth facilitate spread of pathology.
  • 23. VASCULAR SUPPLY:- Arterial blood supply:- Greater palatine arteries Infraorbital artery Facial artery 23
  • 24. Venous drinage:- • Pterygoid venous plexus • Sphenopalatine vein and • Facial vein 24 (Watzek et al. 1997)
  • 25. yNerve supply Maxillary division of the trigeminal nerve, i.e. the posterior, middle and anterior superior alveolar nerves, the infraorbital nerve and the anterior palatine nerve. 25 Last 1959
  • 26. 26 Lymphatic Drain The lymphatic drains in to submandibular lymph nodes. The lymphatic drainage reaches the specialised cells in the maxillary sinus via infra orbital foramen or through the anterosuperior wall and then to the submandibular lymph nodes.
  • 28. Functions of the maxillary sinus Humidification and warming of inspired air, Assisting in regulating intranasal pressure, Lightening the skull to maintain proper head balance, Imparting resonance to the voice, Absorption of shocks to the head, Filtration of the inspired air. (Bailey 1998). 28
  • 29. HISTOLOGY Maxillary sinus is lined by three layers: epithelial layer, basal lamina and sub epithelial layer with periostium. Epithelium is pseudo stratified, columnar and ciliated. As cilia beats, the mucous on epithelial surface moves from sinus interior towards nasal cavity.
  • 30. 30 CLINICAL EXAMINATION INSPECTION : Middle third of the face should be inspected for the presence of asymmetry, deformity, swelling, erythema , ecchymosis or hematom EXTRAORAL PALPATION : Include palpation of the facial wall of the sinus above the premolar where the bone is thinnest.
  • 31. 31 INTRAORAL EXAMINATION Examination should be performed for tenderness, or paresthesia of upper molar and premolar region. TRANSILLUMINATION TEST: It is performed in a darkened room by inserting an electrically safe light into the mouth ( with the lip closed). Good transilluminatio indicates presence of air in the sinus while the failure of transillumination indicates presence of pus, fluid , solid lesion or mucosal thickening.
  • 32. Radiographic examination Radiography is the most important supplementary investigation to clinical examination of the sinuses Intra-Oral : Extra-Oral: Periapical OPG View Occlusal Waters view (Occipitomental view) Lateral Occlusal Submentovertex view PA view 32 Others: • MRI & CT scan
  • 33. Periapical radiograph Borders of the maxillary sinus appear as a thin, delicate radiopaque line . (White & Pharoah 2000) In the absence of disease it appears continuous, but on close examination it has small interruptions in its smoothness or density. 33
  • 34. The roots of maxillary molars usually lie in close apposition to the maxillary sinus and may project into the floor of the sinus, causing small elevations or prominences. (White & Pharoah 2000) 34 Maxillary sinus septum
  • 35. 35 Occlusal view Lateral occlusal view
  • 36. 2. Panoramic radiography Provides an extensive overview of the sinus floor and its relationship with the tooth roots. 36
  • 39. PA view Lateral Submentovertex
  • 40. 5. Computerized tomography (CT) & Magnetic resonance imaging (MRI)  These modalities provide multiple sections through the sinuses at different planes and therefore contribute to the final diagnosis and the determination of extent of the disease. 40
  • 42. 6. Ultrasound  Ultrasound is becoming the diagnostic tool of choice for more and more physicians in detecting sinusitis.  It offers a fast ,reliable and radiation free method for diagnosing sinusitis and has been used successfully in Finland for around 15 years. (Landman 1986) 42
  • 43. 43 Ultrasound beam sent out by the sinus ultra is reflected fro the posterior wall of the sinus when the sinus contains flu and from the anterior wall when sinus contains air.
  • 44. 7. Diagnostic endoscopy  It is an optimal method especially for the assessment of foreign bodies (such as root filling materials and root tips) that have penetrated into the maxillary sinus. (Kennedy et al. 1985) 44
  • 45. Transoral access via the canine fossa. Transalveolar access via an already existing connection between the oral cavity and the antrum.  Access the inferior meatus of the nose. 45
  • 46. 46
  • 47. 47 DEVELOPMENTAL ANOMALIES AND PATHOLOGIC CONDITIONS OF MAXILLARY SINUS
  • 49. Pathologic conditions of maxillary sinus Maxillary Sinusitis Odontogenic cystic lesions of maxillary sinus Tumors of maxillary sinus. 49
  • 50. Maxillary Sinusitis Acute Maxillary Sinusitis  Sudden onset  Duration of 4wks or less Subacute Maxillary Sinusitis  Duration of 4 – 12 wks Chronic Maxillary Sinusitis  Duration of atleast 12 wks 50
  • 51. Maxillary sinusitis 1. Infectious causes a) Bacterial b) Viral c) Fungal 2. Non infectious causes a) Allergic b) Non allergic c) Pharmocologic d) Irritants 3. Disruption of mucociliary drainage a) Surgery c) Trauma Etiology
  • 52. Maxillary sinusitis Signs and symptoms associated with maxillary sinusitis Major signs and symptoms Minor signs and symptoms Facial pain/pressure Headache Facial congestion/fullness Fever Nasal obstruction/blockage Halitosis Nasal discharge/purgulence/discolored postnasal discharge Fatigue Hyposmia/anosmia Dental pain Purulence in nasal cavity on examination Cough Ear pain
  • 53. Maxillary sinusitis of Dental Origin 1.Dental abscess(periodontal and periapical abscess) 2.Infected dental cyst 3.Dental material 4.Oro-antral communication 53
  • 54. 54 Spread of infection from periapical region .
  • 55. 55 Overextention of dental material like sealers, cements ,Gp or silver cones A root tip of the maxillary first molar accidentally pushed into the sinus at the time of tooth extraction.
  • 56. 56 Oro-antral communication (It is a pathologic tract that connects the oral cavity to the maxillary sinus. ) Patient complained of regurgitation of food through the nose while eating. • Maxillary sinus perforation occurs occasionally during the extraction of a maxillary tooth, and it may be a cause of maxillary sinusitis or oro- antral fistula.
  • 57. 57
  • 58. ODONTOGENIC CYSTIC LESIONS AFFECTING THE MAXILLARY SINUS 58
  • 59. 59 : -Radicular cyst -Dentigerous cyst -Mucous retention cyst Odontogenic Cystic Lesions of the maxilla
  • 60. 60 Maxillary sinusitis caused by an apical inflammatory lesion ( radicular cyst) at the root apices of the 2nd molar - NOTICE the cloudiness ( Radio- opacity) of the sinus Radicular cyst
  • 61. 61 Dentigerous cyst Also known as follicular cyst,2nd most common cyst , it usually appear on the impacted maxillary 3rd molar
  • 62. 62 Mucous retention cysts Mucous retention cysts in the sinuses are very common, they are expansile and potentially destructive lesions
  • 64. 64 Benign tumor of MS: Ameloblastoma: Ameloblastoma is the most common benign tumor affecting maxillary sinus.
  • 65. 65 Malignant tumors of MS They are Invasive and destructive lesions For Examples : Squamouse cell carcinoma
  • 66. Clinical Considerations: The chances of creating an oro-antral fistula in patient less than 15 yrs are comparatively lesser than in adults due to incomplete development of sinus. The distance between apical end of maxillary posterior teeth and floor of sinus is approximately 1-1.2 cm. In some cases the gap may be still lesser. 66 • Maxillary sinus perforation occurs occasionally during the extraction of a maxillary tooth, and it may be a cause of maxillary sinusitis or oro- antral fistula. Oro-antral communication and oro-antral fistula
  • 67. Root which is most close to the sinus is “palatal root of maxillary 2nd molar Followed by : 1st molar 3rd molar 2nd premolar 1st premolar canine 67
  • 68. 68  Lin et al. in 1991 reported that the maxillary sinus is more developed in female and therefore greater possibility of the occurrence of oro-antal communication and oro-antral fistula in female .
  • 69. 69
  • 70. 70 Symptoms of fresh oroantral communication: Escape of fluids Epistaxis Escape of air Enhanced column of air. Excruciating pain
  • 71. 71 Symptoms of established oroantral fistula: Pain. Persistent purulent unilateral nasal discharge. Post nasal drip. Popping out of antral polyp.
  • 72. Buccal flap advancement operation Von Rehermann - 1936. Operative technique
  • 77. Maxillary sinus pneumatization : The expansion of the sinus is larger following extraction of several adjacent posterior teeth, if dental implant placement is planned in these cases, immediate implantation and/or immediate bone grafting should be considered to assist in preserving the 3-dimensional bony architecture of the sinus floor at the extraction site. 77
  • 78. 78 Implants in the maxilla Lack of sufficient bone height along maxillary sinus, produces significant difficulty for placement of implants in edentulous maxillary jaw, in that case, we go for sinus lift, which is a surgical procedure which aims to increase the amount of bone in the posterior maxilla.
  • 79. 79 SINUS LIFT There are two main approaches to lift the maxillary sinus Direct( Caldwell luc) Indirect
  • 81. 81 Direct sinus lift - advantage 1.It is clear 2. Easy access 3.More efficient work is done.
  • 82. 82 Disadvantage 1. More painful. 2. More post operative discomfort 3. More time consuming 4. Needs highly efficient practitioner 5. More susceptible to infection
  • 84. ADVANTAGE 84 1. Minimally invasive surgical procedure 2. Requires less time and expertise than direct technique. DISADVANTAG E 1.Blind procedure 2.More chances of errors to occur.
  • 85. 85  Maxillary Sinusitis : Because of the thickned and inflammed sinus lining compresses the nerve supply of the maxillary posterior teeth causing tenderness of the maxillary teeth. The infraorbital and superior alveolar vessels are freqently ruptured in maxillary fracture causing hemotoma formation in the antrum. Foreign body: Foreign body like GP, silver point, calcium hydroxide, sodium hypochloride, sealers, root piece ,may sometimes be accidentally forced into the maxillary antrum causing maxillary sinusitis.
  • 86. Differences between symptom of odontalgia and sinus pain History of cold, allergy, congestion or nasal drainage. Dull aching pain that is difficult to localized Feel pressure in the cheek and below the eyes Position change like bending forward produces pain Dental local anesthetic blockade will not relief sinus pain Normal pulp vitality test. 86
  • 87. 87
  • 88. 88
  • 89. 89
  • 90. Conclusion Due to close proximity of maxillary sinus to orbit, alveolar ridge, maxillary teeth, diseases involving these structures may produce confusing symptoms. Hence a precise information about the surgical anatomy is essential to surgeons. •Knowledge of the anatomical relationship between the maxillary sinus floor and the maxillary posterior teeth is important for the preoperative treatment planning of maxillary posterior teeth. Clinicians must be particularly cautious when performing dental procedures involving the maxillary posterior teeth.
  • 91. References • Textbook of oral and maxillofacialsurgery, Neelima malik Maxillary sinus and its implication Killey and Kay Textbook of Maxillary sinus Mc’gowan Orban’s, Oral histology and embryology, 11th edition. Cate A.R. Ten, Oral Histology: development, structure, and function. 6th edition. ITI Treatment Guide , sinus floor elevation procedures, H. Katsuyama & S.S. Jensen Textbook of general anatomy, B.D. Chaurasia IEJ vol 35 2002 J Endod. 2001 July;(27) 91
  • 92. 92