maxillary sinus

1. PRESENTED BY:
Dr. GAURAV S. SALUNKHE
PG-Student
ORAI & MAXILLOFACIAL PATHOLOGY

2. Content
 INTRODUCTION
 DISCOVERY
 DEFINITION
 DEVELOPMENT
 ANATOMY
 MICROSCOPIC FEATURE
 FUNCTIONS
 DIAGNOSTIC EVALUATION
 ASSOCIATED PATHOLOGY

3. Introduction
 Paranasal sinus are air containing bony spaces around
the nasal cavity.
 There are 4 pairs of paranasal sinuses(bilaterally).
I. Maxillary
II. Frontal
III. Ethmoidal
IV. Sphenoidal
V. It is is also called as Antrum of Highmore.
 LARGEST paranasal sinus.

4. Paranasal sinus

5. Paranasal sinus

6. Discovery
 The maxillary sinus was first discovered and illustrated
by Leonardo da vinci, but the earliest attribution of
significance was given by NATHANIEL HIGHMORE.
 The British surgeon and anatomist who described it in
detail in the year 1651.

7. Definition
 The maxillary sinus is the pneumatic space that is
lodged inside the body of the maxilla and that
communicates with the environment by way of the
middle nasal meatus and the nasal vestibule.

8. Development of sinus
 At the birth- Tubular.
 At the childhood-Ovoid.
 In the adult- Pyramidal.

9. Anatomy
 Pyramidal shaped cavity with in the body of maxilla.
 Boundaries:
 Apex- zygomatic process of maxilla.
 Base- nasal surface of maxilla.
 Roof-orbital surface of maxilla.
 Floor- alveolar process of maxilla.
 Anterior wall is related to infra-orbital plexus of
nerves and vessels and origin of muscles of upper lip.
 Posterior wall is pierced by post. Superior alveolar
nerve and vessels.

10. Anatomy
 Arterial supply-
1. Facial artery
2. Maxillary artery
3. Infra-orbital artery
4. Greater palatine artery.

11. Anatomy
 Venous drainage-
Anteriorly- sphenopalatine vein
Posteriory- pterygoid venous
plexus drain into facial vein
Pterygoid plexus communicates
with the cavernous sinus
by emissary veins.

12. Anatomy
 Nerve supply
1. Anterior superior alveolar nerve
2. Middle superior alveolar nerve
3. Posterior superior alveolar nerve
4. Infra-orbital nerve
5. Greater palatine.

14. Anatomy
 Lymph drainage-
1. Submandibular lymph nodes
2. Deep cervical lymph node
3. Retro pharyngeal lymph node

15. Microscopic features
 3 layers surround the space of the maxillary sinus.
1. Epithelial layer
2. Basal layer
3. Sub-epithelial layers including periostium.

16. Functions
1. Warming of inspired air.
2. Humidification of dry air.
3. Lightening of skull weight.
4. Resonance of voice.
5. Filters debris.
6. Accessory olfactory organ.
7. Protects skull from mechanical shock.
8. Production of bactericidal lysozyme.

17. Diagnostic evaluation of maxillary sinus.
 Detailed medical & dental history.
 Clinical examination.
Inspection
Palpation
Percussion
Transillumination
 Radiographs .
 Ultrasound, CT scan, MRI.
 Endoscopy.

18. Palpation
 Tapping of lateral wall of sinus over prominence of
cheek bone and palpation intra-orally on lateral
surface of maxilla between canine fossa and zygomatic
buttress.

19. Transillumination
 It is done by placing a bright flash light or fiber optic
light against the mucosa on the palatal or facial surface
of the sinus and observing the transmission of light
through the sinus in the darkroom.

20. Radiographs
Intra-oral
 Periapical
 Occlusal
 Lateral
Extra-oral
 Panoramic
 Waters veiw
 Submentovertex
 PA veiw

21. CT Scan &MRI
 Provides multiple sections at different planes
 High resolution
 Non-invasive techniques
Normal Pathology

22. Ultrasound
 Introduced by LANDMAN in 1986
 Non-invasive
 Safe
 Quick
 Ultrasound waves are generated by probe.

23. Endoscope
 Allows direct visualization in inaccessible areas, such
as maxillary moral roots that are behind distobuccal
root of maxillary 1st molar.

24. Pathology
 Developmental anomalies.
 Infections (sinusitis).
 Dental implications of maxillary sinus.
 Oro-antral fistula.
 Toothache of maxillary sinus origin.
 Associated cysts.
 Associated tumours.

25. Developmental anomalies
 Agenesis.- Complete absent
 Aplasia/ hypoplasia- seen with
 Cleft palate, choanal atresia, high palate, septal
deformity, mandibular dysostosis, malformation of
external nose.
 Supernumery- two completely separated sinus on
same side

26. Maxillary sinusitis
 When the inflammation develops in the sinus either
due to infection or allergy it is termed as sinusitis.
 Most common disease involving the maxillary sinus.
 Maxillary sinusitis can be divided into-
1. Acute - < 3 weeks .
2. Subacute- 3 weeks to 3 months.
3. Chronic/Recurrent -> 3 months.

27. Etiology
 Bacterial
 Rhinovirus, influenza virus.
 Allergy
 Odontogenic infections
 Nasotracheal intubation
 Barotraumas.

28. Clinical features (acute)
 Can occur at any age.
 Pt. complains of pain, pressure and heavyness at the
affected side.
 Headache is the most common.
 Facial erythema, swelling, fever.
 Drainage of foul smelling mucopurulant material into
the nasal cavity and nasopharynx.
 Pain is exacerbated on bending position.
 Dull pain may be present on premolar and molar
region.

29. Clinical features (chronic)
 Repeated attacks.
 Pain and tenderness.
 Foul unilateral discharge.
 Cacosmia i.e. Fetid odour with bad taste in mouth.

30. Maxillary sinusitis
 TREATMENT-
1. Nasal decongestant.
2. Antibiotics
3. Mucolytic agents.
4. Analgesic

31. Maxillary sinusitis
 Nasal decongestants:
 Eg. Ephedrine sulphate, phenylephirine,
xylometazoline.

32. Maxillary sinusitis
 Antibiotics :
1. Amoxicillin- 500 mg TDS 10-15 days
2. Augmentin – 625 mg BD 7 days
3. If patient fails to respond to the initial T/t within
72hrs, culture & sensitivity test should be carried out.

33. Maxillary sinusitis
 Mucolytic agents:
1. Benzoin compound
2. Camphor
3. Methanol
in boiling water

34. Maxillary sinusitis
 Analgesic to reduce pain

35. Dental implications of maxillary
sinus
 Spread of infection from periapical/PDL space.
 Due to over extension of dental materials .
 Result of periapical surgery.
 Iatrogenic causes.

36. Oro-Antral fistula
 Invasion of the maxillary sinus and establishment of
direct communication with the oral cavity is referred
to as an oro-antral fistula.


37. Fistula
 It is a biological tract that connect an anatomical
cavity with the external surface or other anatomical
cavity. It is always lines by stratified squamous
epithelium and the potency of the tract is preserved
until epithelial cells scraped off.

38. Factors- influencing creation of
oro-antral fistula.
 Hypercemntosis.
 Density of alveolar bone and thickness of sinus.
 Size if sinus.
 Rough extraction.
 Apical pathosis.
 Attached granulomas.
 Periodontal disease that may erode the sinus floor.
 Presence of cyst or tumor.

39. Sings & Symptoms
 Antral floor fracture.
 Fracture of alveolar process or tuberosity.
 Evidence of air stream passing from nostril.
 Change in speech tone and resonance.
 Bubbling of blod from the socket or nostril.

40. Treatment
 Flap surgeries.
1. Buccal flap.
2. Palatel flap.
3. Or combination.

41. Toothache of maxillary sinus origin
 In sinusitis, a feeling of constant dull, aching pressur
can be felt on the posterior maxillary teeth.
 Similarities between pulpal pain and sinusitis
Similarities Pulpal pain Sinusitis pain
Tenderness on
percussion.
present present
Sensitive to cold present present
Pain on mastication present present

42. Toothache of maxillary sinus origin
Dissimilarities Pulpal pain Sinusitis pain
Location Single tooth Can not locate
Radiating pain /headache May/may not be present Present
Fever May/may not be present Present
URTI/ Viral infection Absent Present
Pain of changing position Absent Present
Nasal discharge Absent Present
Foul taste, blood, pus
tinged mucous
Absent present

43. Cyst
 Odontogenic & Non-odontodenic cysts
ODONTOGENIC NON-ODONTOGENIC
PRIMORDIAL CYST MUCOUS RETENTION CYST
(antral retention cyst)
DENTIGEROUS CYST
RADICULAR CYST
KERATOCYST

44. Cyst
 Mucous retention cyst (antral retention cyst) seen as a
dome-shaped lesion on the floor of the sinus.
Associated with sinusitis. Result from obstruction of
mucous glands. It is usually asymptomatic but may
sometimes cause some pain and tenderness in the
teeth and face over the sinus. In some cases the cyst
disappears spontaneously due to rupture as a result of
abrupt pressure changes from sneezing or "blowing" of
the nose. Later on, the cyst may reappear after a few
days.

45. Associated tumours
 The location of nasal cavity and PNS makes them
extremely close to vital organs.
 Sino-nasal malignancies are rare but common in
African & Asia than America.
 Among the sino-nasal tumours, 60%-70% are
maxillary sinus tumours.
 Commonest type of malignancy involving the
maxillary sinus is squamous cell carcinoma about
80%. The second commonest tumour involving the
maxillary sinus is adenoidcystic carcinoma about
10%.

46. Other types of malignant tumours
of maxillary sinus:
 Malignant melanoma.
 Lymphoma
 Salivary type neoplasm
 Sarcomas
 Metastatic tumours

47. Etiological
 Viral infections – EB virus, and Human papilloma virus
infections
 Exposure to wood dust – Especially African Mahogany
wood dust causes adenocarcinoma of maxillary sinus.
 People working in nickel and chrome industries are more
prone to develop cancer of maxillary sinus.
 People working in leather industries are also known to
develop cancer of maxillary sinus.
 Iatrogenic causes – Post irradiation.
 Use of snuff have also been documented to be the causative
factor.

48. Clinical features
 Nasal obstruction.
 Recurrent sinusitis.
 Cranial neuropathy.
 Sinus pain.
 Facial parasthesia.
 Proptosis.
 Diplopia.

49. Associated tumours
 Investigations
1. Endoscopy
2. X-rays
3. CT scan
4. MRI
5. Biopsy- 100% confirmation.

50. Associated tumours
 Treatment depends upon extent and histological type.
1. Surgery- maxillectomy
2. Radiotherapy- total 6500 rads in 5 weeks.
3. chemotherapy- cisplatin & 5 flurouracil.
4. Combined manegment.

51. Thank-you