2. OUTLINE
Define Maxillary Sinus
Anatomy
Nerve innervation
Blood supply
Lymphatic Drainage
Sinus Development
Anatomic morphology
Functions of Maxillary Sinus's
Define Maxillary sinusitis's
Symptoms,Aetiology and Risk Factors of MS
Maxillary Sinusitis from Dental Origin
Conclusion
3. What is Maxillary Sinus?
Maxillae refers to
-Upper jaw bone or Upper jaw
-Is a twin bones joint in the midline at the palatine or
medial suture.
-It is an irregular shape preumatized bone supporting the
superior teeth, take part in the formation of the orbit, hard
palate, nasal cavity and gives shapes to the upper face.
It contains the maxillary sinus
Sinus
-Antrum
-is a cavity or hollow space within the bone
Maxillary Sinus- is an air cavity located within the body of each
maxillae
4.
5. Anatomy
Maxillary sinus are largest sinuses amongst the other
paranasal sinuses;
Situated in the maxillae
The resemble a pyramidal shape
walls
SUPERIOR – Orbital, base of the infra orbital, and is
positioned towards the zygomatic bone
INFERIOR – Alveolar process of maxillary roots.The roots of
molars and pre molars (3,4,5,6,7,8)
POSTERIOR- Pterygopalatine fossa
LATERALLY – the nasal bone forms it base
Each sinus communicate with the nasal cavity through maxillary
ostium in the posterior end of the hitus semulunaris of the
middle meatus.
7. Nerve Innervations
The maxillary sinus is innervated by the
maxillary division of the trigeminal nerve.
The maxillary nerve branches into
following nerves
◦ Posterior Superior Alveolar Nerve
◦ Middle Superior Alveolar Nerve
◦ Infra Orbital Nerve
◦ Anterior Superior Nerve
◦ Greater and Lesser Palatine Nerves
11. Lymphatic Drain
The lymphatic drain of the sinus is
through the nose or the submandibular
lymph nodes.
The lymphatic drainages reaches the
specialised cells in the maxillary sinus via
infra orbital foramen or through the
anterosuperior wall and then to the
submandibular lymphatic gland.
13. Sinus Development
Development of the maxillary sinus occurs after 3 months of
gestation
After the development of paranasal sinuses the maxillary
sinus are separated from the maxillae by the membrane of
the nasal capsule.
Maxillary sinuses are first to be developed
Increase in the height of the maxillae is due to increase in the
size of the sinus
Maxillary sinus fully develops as the human being reaches the
age of 16.
Base is formed by the alveolar process and maxillary molars
and premolars teeth root lining in close approximation.
Sinus may increase in size during adult life by extension into
the alveolar process.
16. Anatomic Morphology
The morphology of maxillary sinus varies
from person to person
The average size of maxillary sinus in an
adult is about 3.2cm depth, 3.5cm height,
2.5cm width
In children the size increases with age as
the child grows up the size changes.
Each sinus in both maxillary has an
average capacity of 15ml of fluid.
17. Anatomical Morphology
The maxillary sinus is divided into several
compartments by bony septa
1. The schnerderian membrane
The maxillary sinus are lined with a specialised cells
(ciliated columnar epithelium) similar to those found
on the respiratory tract.The mucous film it secrets
moves spirally and upwards against the gravity
across the membrane to the opening of the sinus
located on the anterior superior wall where it drain
into the nasal cavity.
This forms the schnerderian membrane (mucosa of
the nose)
18. The maxillary sinus are lined with a specialised cells (ciliated
columnar epithelium) similar to those found on the
respiratory tract
Courtesy of Killey et al 1975
19. Function of Maxillary Sinus
The following functions have been proposed
1. Speech andVoice Resonance
2. Reduce or lighten the weight of the skull
3. Warmth inhaled oxygen
4. Filtration of the inspired air
5. Immunological Barrier (body Defence)
6. Humidity for inspires air
7. Regulation of intra nasal pressure
8. Acts as a shock absorber
9. Regulation of intra nasal pressure
10. Increase surface area for olfaction
11. Contributes to facial growth
20. Maxillary Sinusitis
Maxillary sinusitis is the inflammation of the maxillary
sinus
Clinically, two types of Maxillary Sinusitis
Acute sinusitis
◦ sings and symptoms of infection proceeds more than 3 weeks
but less that a month
◦ Suppurative or non suppurative inflammation of the mucosal
lining of the sinus. It involves one or both sinuses.
Chronic sinusitis
◦ signs and symptoms of infection proceeds for more that 60 days.
◦ It is a chronic type of infection affected the mucosal lining of one
or both sinuses, resulted in mucopus or pus collection.
◦ A polypoidal type of inflammation can lead to formation of
multiple or single mucosal polyps.
21. Symptoms
Blocked nose or Nasal obstruction.
Nasal congestion
Headache
Fever
Nasal discharge-Yellow or green coloured mucus from the nose
Swelling of the face
Aching teeth in the upper jaw
Loss of the senses of smell and taste
Persistent cough
Generally feeling unwell
X-ray and transillumination findings.
22. Etiology
The common cause of etiology are
Allergic response
Infection mechanical obstruction
Infected maxillary premolar and molar teeth
Neoplasia- squamous cell carcinoma
Trauma- egTuberosity fracture
Congenital anamolites- cleft palate
Cysts and odontogenic infection- primordial
cysts
Inflammatory disease- bacterial infection and
fungal infection
23. Risk Factors
Frequent cold
Cigarette smoking
Regular nasal decongestion sprays
Untreated hay fever or other allergies
Trauma of the nose
Nasal Polups
Dental Disease
24. Maxillary sinusitis from Dental
Origin
1. Dental abscess
2. Infected dental cyst
3. Dental material
4. Oro-natral communication
25. Oro-Antral fistula
A pathologic communication
between the oral cavity and the
maxillary sinus, most commonly
a complication of maxillary or
molar tooth extraction.
Oro-antral fistula is formed by a break
in the floor of the maxillary sinus
between the premolar and molar.
Condition in which when the OAC is
not corrected or treated quickly,it will
become lined with the epithelium (skin).
Hence,oro-antral fistula is an
epithelised tract linking the maxillary
sinus to the mouth;the tract becomes
permanent.
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.
Patient also fells air entering their
mouth during eating and smoking.
Courtesy of Killey et al 1975
26. Oro-natral communication
Communication or hollow
space that links between
the maxillary sinus and
nasal and oral cavity.
When an OAC is created,
it allows the flow of food,
smoke or fluid from the
mouth into the nose –
Also bacteria, fungi and
viruses.
This set up a maxillary
sinusitis, which depending
on how long the
communication lasts for,
may either yield an acute
chronic maxillary sinusitis.
Courtesy of Killey et al 1975
27. Dental Material
Can be cause by either of these
1. Displacement of root extraction
molars or pre-molars
2. Implant
3. Root canal over filling
28. Displacement of root extraction
molars or pre-molars
A root tip of the
maxillary first molar
accidentally pushed
into the sinus at the
time of tooth
extraction.
The root tip is
asymptomatic and has
been present for many
years.
A root tip in the sinus
does not have a lamina
dura around it.
Courtesy of Killey et al 1975
29. Antrolith (stone)
Antrolith (stone) in
the maxillary sinus.
Antroliths are calcified
masses found in the
maxillary sinus.
They are formed by
deposition of calcified
material on a nidus
such as a root
fragment, bone chip,
foreign object, or a
mass of stagnant
mucus in sites of
previous inflammation.
Courtesy of Killey et al 1975
31. Infected dental cyst
Any cyst of the maxilla may result in
sinusitis
1. Radicular cyst
2. Dentigerous cyst
3. Mucous retention cyst
32. Radicular cyst
Courtesy of Killey
et al 1975
Maxillary sinusitis
caused by an apical
inflammatory lesion
(probably,a
granuloma) at the
root apices of the
second molar.
Notice the
cloudiness
(radiopacity) of the
sinus
Courtesy of Killey et al 1975
33. Periodontal disease
Maxillary sinusitis
caused by apical
infection and
extensive
periodontal lesions
involving the molars
and premolar.
Notice the
cloudiness (radi-
opacity) of the sinus
(s).
Courtesy of Killey et al 1975
34. Peri-apical Abscess
Apical infection
associated with the
first molar.
A thickened sinus
mucosa (arrow)
surrounds the lesion
in response to the
apical infection.
Courtesy of Killey et al 1975
35. Clinical Management
Acute
Rest and fluid and mouth hygiene.
Antibiotics penicillins , ampicillin amoxicilin
Analgesics and antihistamines.
Local treatment (decongestant and steam inhalation).
Chronic
Antibiotics. penicillins , ampicillin amoxicilin
Systemic decongestant
Surgical Treatments
Flap surgery
37. Complications of Maxillary
Sinusitis
Following are some of the possible complications that may
occur
Orbital abscess and orbital cellulites
Intracranial abscesses
Meningitis
Cavernous sinus thrombosis
Spread of infection to neighboring sinuses, structures
and organs
Osteomyelitis
Gastrointestinal disturbances
Mucocele
Facial cellulitis
Oro-antral fistula
Epidural, subdural, or intra-cerebral abscess
38. CONCLUSION
MS can affect any body regardless of the
age, sex and gender.
Infection is associated with risk factors
and ignorance of basic health principles
In dealing clinical cases with MS it is handy
to know basic the anatomy; blood supply,
nerve innervations, anatomical
boundaries.
39. Reference List
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Louis, Missouri.Washington University School of Medicine, Department of Otolaryngology.
Killey, H., C. and Kay, H., C. (1975).The Maxillary Sinus and its Dental Implications. England, Great
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Lloyd, D., E. (1980). Sichers Oral Anatomy. 7th Edition.Toronto USA: C.V. Mosby Publishing
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