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The paranasal sinuses are air filled cavities present with some bone around the
nasal cavities. The sinuses are frontal,maxillary,sphenoid and ethmoidal.
Because of the close proximity of maxillary teeth with the maxillary sinuses,
these are the most important paranasal sinuses in dental point of view. They are
the largest air filled sinuses surrounding the nose.
It is the first among the paranasal sinuses to develop.
It starts as a groove on the medial surface of the maxilla during the 4th
At birth,it is a small cavity which is usually fluid-filled. Growth is usually
biphasic with growth occurring during the age of 0-3 years and again between
7-12 years. It attains its maximum size at adulthood at around 18years of age.
During the later phase pneumatisation proceeds more inferiorly as the
permanent teeth develop completely
Anatomy of maxillary sinus
Maxillary sinus is also called “antrum of highmore” This structure is closely
related to oral cavity and lesions/infections of the maxillary antrum may present
in the oral cavity and vice versa.
Facial artery,infraorbital artery. Greater palatine artery.
Infraorbital nerve;anterior,middle and posterior superior alveolar nerve
Facial vein which then drains into pterygoid venous plexus.
Submandibular lymph nodes and then to deep cervical lymph nodes.
Fracture of maxilla, tuberosity, nasal bone,
zygoma and orbital floor
– Blow out fracture
– Isolated injury
– Complex fracture
Hematoma due to traumatic injury
Foreign bodies displace into the sinus- fractured
Oral antral fistula
Acute and chronic sinusitis
Inflammation of the mucosa of the paranasal sinuses is referred to as
sinusitis.when maxillary sinus is involved, it is called as maxillary
sinusitis.when all the sinuses are involved it is called as pansinusitis.
Periapical infection from the teeth: it may follow dental infection
particularly from upper molars and premolars teeth
Oroantral fistula: the accidental opening in the floor of the maxillary
sinus during dental extraction is called as oroantral opening.
Periodontitis: it may spread from a deep pocket of marginal
Traumatic: injury of facial bones especially nasal bones and malar
Dental material in the antrum: perforation of endodontic filling
substance. If root canal is overfilled then there are more changes of gutta
purcha points to be inserted into the maxillary sinus.
Implant: implants are used in upper edentulous jaw to aid the retention
of dentures or bridges or replace missing teeth.implants are also used
when there is insufficiency of bone to support the denture.in these cases
as bone is thin,implant can penetrate the nose or sinus.
Infected dental cyst: cyst which have become infected and involve the
maxillary sinus can also cause sinusitis
Mechanical obstruction of ostium
Direct bacterial contamination: infected material may also be
introduced directlyby jumping or hydrosliding feet first into
contaminated water without holding the nose or during diving,when
pressure changes in the nose force nasal secretion into sinus.
Immune deficiency: sinusitis can occur in immune deficiency, state like
leukemia,lymphoma and AIDS
Influenza: it can also occur in influenza when bacteria invade as
Blood brone infection: it can also occur in some cases of blood brone
Disease of maxillary sinus: benign mucosal cyst or tumors of maxillary
sinus can also lead to maxillary sinusitis.
this is a complication of common cold and is accompanied by clear nasal
discharge or pharyngeal drainage,which may eventually become green or
After a few days the stuffiness increases and the patient complaints of pain
and tenderness to pressure or swelling over the involved sinus
There will be signs of sepsis;fever,chills,malaise and an elevated
Pain may be referred to the premolars and molar teeth on the affected side
and these teeth may also be sensitive to percussion
This is a sequel of the former two,which has failed to resolve by 3
There are no external signs, except in case of an acute exaceberation
when increased pain and discomfort is apparent.
This type is usually associated with anatomical derangements that inhibit
the outflow of mucous,like;deviation of the nasal septam and presence of
It is also associated with allergic rhinitis,asthma,cystic fibrosis and dental
Radiodensity: radiographically,the thickening of the mucous membrane
and the accumulation of secreations that accompany sinusitis reduce the
air content and it will appear as radiopaque.
Allergic sinusitis: in the case of allergy,mucosa will be more lobulated in
contrast to that in infection where it is straighter and parallel to the sinus
Chronic sinusitis: chronic sinusitis may result in persistent opacification
of the sinus and sclerosis or thickening of surrounding bone.
Antral halo appearance: sometimes if infected teeth are involved then
inflammatory changes may lead to resorption of the antral floor and
remodelling to produce the appearance described as an antral halo.
Resolution of sinusitis: resolution of acute sinusitis will appear as small
clear areas appear in the interior of the sinus as the thickened mucosa
Transillumination test: affected sinus will be found opaque.
Radiograph: water‟s view and OPG can be taken
Waters view showing maxillary sinus
Laboratory diagnosis: there is elevated leukocyte count.lining of
maxillary sinus may show a typical acute inflammatory infiltrate with
edema of the connective tissue and often hemorrhege. In chronic
cases,cellular proliferation is present.
Anti-histamines for allergy
Pseudoephedrine 30-60 mg
Phenylephrine 2-4 times/day
Amoxicillin 500 mg tid for 10-14 days
Topical nasal spray (unlimited daily use)
Nasal steroid spray
Antibiotics with exacerbations
Maxillary: usually uncomplicated
Ethmoid: cavernous sinus thrombosis-serious
Frontal: osteomyelitis of frontal bone; cavernous sinus thrombosis;
epidural, subdural, or intracerebral abscess; orbital extension
Sphenoid: Rare; extension to internal carotid artery, cavernous sinuses,
pituitary, optic nerves.
Mucositis (Thickened mucous membrane)
The normal mucosal lining of the para nasal sinus is composed of respiratory
epithelium and is approximately 1mm thick, and is not visualized on the
radiograph. When the mucosa becomes inflamed from either an infectious or
allergic process, it may increase in thickness 10mto 15 times and is then seen on
the radiograph. This thickening is called mucositis. Any thickening greater than
3mm is most likely to pathological.
It is usually asymptomatic and is discovered on a routine radiograph.
It is seen as a non-corticated band noticeably more radiopaque than the
air filled sinus, paralleling the bony wall of sinus.
Mucosal thickening seen distinctly on denta scan images.
Perforation of the floor of the maxillary sinus
Removal of the cause.
The thickened mucosa of chronically inflamed sinus frequently form
irregular folds called as „polyps’.polypoid atrophy of mucosa may
develop into an isolated area or number of ares throughout the sinus.
Antrochoanal polyps, are solitary polyps arising from the maxillary
antrum. They were first described by Killian in 1906. Although their
etiology remains unknown, allergy has been implicated.
Age: it usually occurs in young persons.
Site: maxillary sinus is more involved as compared to other sinus.in
maxillary sinus they may arise from any part of the sinus wall and
occasionally pass through the ostium to appear in the nose as
Picture showing antral polyp
Symptoms: patients present with nasal obstruction,pain is very mild on
pressure as mass present inside the nose.
Saints triad: it is associated with “saints triad”, ie.nasal and antral
polyposis, aspirin sensitivity and asthma.
Exacerbation of asthma: polyps may exaceberate the asthma by
causing obstruction of the nose. It is the most commonly pedunculated,
or sessile mass which grows slowly.after the polyps grows to occupy
most of the antrum it frequently hernites into the nasal cavity. this may
be brought about by repeated sneezing or nose blowing in about 4-6%
Appearance: it appear as homogenous soft mass with smooth,outwardly
convex borders.single or multiple lesions may be present.if polyp occurs
in the roof of the maxillary sinus in a patient with a history of trauma,the
plain film examination may simulate a blow out fracture.
Destruction of walls of sinus: polyps may cause destruction or
displacement of bone. They can displace or destroy medial or lateral wall.
CT features: have mucoid attenuation with mucosal enhancement seen at
polyps surface. It appears as smooth homogenous mass.
MRI features: mucosa adjacent to polyps will enhance as compared to
CT scan showing maxillary sinus
Oral and topical nasal steroid
Endoscopic sinus surgery
Osteomyelitis (osteo- derived from the Greek word osteon, meaning bone,
myelo- meaning marrow, and -itis meaning inflammation) simply means an
infection of the bone or bone marrow. It can be usefully subclassified on the
basis of the causative organism (pyogenic bacteria or mycobacteria), the route,
duration and anatomic location of the infection.
It is a rare type of osteomyelitis seen in infants in few weeks after birth.it
usually involves maxilla.
Site: it is more common in maxilla due to hematogenous route.
Symptoms: fever, anorexia, dehydration in some cases, convulsants, and
vomiting may occur.
Signs: redness and edema of eyelids, alveolar bone and palate of the
Radiodensity: about 10 days after acute infection, the density of
trabeculae will be decreased, with blurred and fuzzy.
Trabecular pattern: the earliest radiographic change is that trabeculae in
involved area are thin,of poor density and slightly unsharp or blurred.the
trabeculae soon loose their continuity as well as the little density
present.individual trabeculae become fuzzy and indistinct.
Multiple radiolucency: subsequently, multiple radiolucencies appear
which become apparent on radiograph.
Lamina dura: there is loss of continuity of lamina dura,which is seen in
more than one tooth.
Clinical diagnosis: fever, pain with maxillary involvement in the infant will
give clue to the diagnosis
Bacterial sampling and culture
Vigorous (empirical) antibiotic treatment
Give specific antibiotics based on culture and sensitivities
Remove source of infection, if possible
Bone and joint tuberculosis is always hematogenous in origin.
Primary focus is related to lung when disease is acquired by inhalation of
human strain or to gastrointestinal tract if it is acquired by ingestion of bovine
tubercle. The disease starts within the synovial membrane or in intra articular
bone.the disease may develop in synovial joint especially the knee and hip joint.
Tuberculosis osteomyelitis of maxilla or mandible or TMJ are rare entities
Cyst involving maxillary sinus
Mucous retention cyst (mucocele)
A mucocele is an expanding,destructive lesion that results from a blocked sinus
ostium. The blockage may result from intra-antral or intra nasal
inflammation,polyp or neoplasm.the entire sinus thus becomes the pathologic
cavity. As mucous secritions accumulate and the sinus cavity fills, the increase
in intra-antral pressure results in thinning,displacement,and in some cases
destruction of sinus walls. When the cavity is filled with pus,it is termed an
empyema,pyocele or mucopyocele.
90% of mucoceles occur in the ethmoidal and the frontal sinus and are
rare in the maxillary sphenoidal sinus
In the maxillary sinus it may exert pressurenon the superior alveolar
nerves causing radiating pain, with a swelling and fullness of the
cheek.the swelling may first observed over the anterioinferior aspect of
the antrum where the wall may be thinned or destroyed.
If the lesion expands inferiorly,it may cause loosening of the posterior
If the medial wall of the sinus is expanded the lateral wall of the nasal
cavity will deform and the nasal airway may be observed.
If it expands into the orbit,it cause diplopia or proptosis.
The normal shape of the maxillary sinus is changed into a more circular
shape as the mucocele enlarges.
The scalloped border of the frontal sinus is usually smoothed by
expansion, and the intersinus septum may be displaced.
In the ethmoidal air cells, displacement of the lamina papyracea may
occur, displacing the contents of the orbit.
In the sphenoid sinus the expansion may be in the superioe direction,
suggesting a pituitary neoplasm.
The sinus cavities appear uniformly radiopaque.
Any suggestion of a lesion associated with occluded ostium should be a
mucocele. A large odontogenic cyst displacing the maxillary antral floor
may mimic a mucocele.
There are usually no complications.
Surgical ciliated cyst
It is a delayed complication arising years after surgery involving maxilla.
It is usually occurs in the 4th
decades of life
Mostly seen in males
The patient may complain of pain,discomfort or swelling of face or intra
oral swelling of the palate or alveolus, with pus discharge
it is seen as a well defined radiolucency closely related to maxillary sinus.
There is sclerosis of the surrounding bone.
As the cyst enlarges it produces pressure effects, with thinning of the
sinus walls which may eventually perforate
There may be resorption of mallxillary alveolar process.
There is no communication between the cyst and maxillary sinus which
may be demonstated by injecting the sinus with radiopaque material.
Pseudocysts are like cysts, but lack epithelial or endothelial cells.
Initial management consists of general supportive care. Symptoms and
complications caused by pseudocysts require surgery. Computed tomography
(CT) scans are used for initial imaging of cysts, and endoscopic ultrasounds are
used in differentiating between cysts and pseudocysts. Endoscopic drainage is a
popular and effective method of treating pseudocysts.
This has not to be confused with the so-called 'pseudocystic appearance',
mainly radiographically, of other lesions, such as Stafne static bone cyst and
aneurysmal bone cyst of the jaws.
Pseudocysts are often asymptomatic. Symptoms are more common in larger
pseudocysts, though the size and time present usually are poor indicators of
it is mainly seen in 2nd
decades of life.
Males are most commonly effected than female.
Mostly involved sites are the antral floor and lateral wall of maxillary
There may be localized dull pain in the antral region or fullness and
numbness of cheek.
There may be pain in the teeth and over the face over or near the sinus.
Sometimes antral swelling may also occur.
it is homogenous mass that is more radiopaque than the surrounding sinus
It appears as a soft tissue mass rather than a calcified area so that medial
and lateral landmarks can generally be visualized through the lesion.
It is found projecting from the floor of the sinus, although some may form
on the lateral walls.
The cyst appers as spherical ,ovoid,or dome shaped
It has a uniform and a smooth outline.
They may have narrow or broad base
They vary in size from minute to very large.
There is no resorption of adjacent bone.
Mucous type will associated with thickened mucosa while serous type is
Dome shaped radiolucency seen in left maxillary sinus
Suggestive of antral pseudocyst
A radicular cyst is a cyst that most likely results when rests of epithelial cells
(Malassez) in the periodontal ligament are stimulated to proliferate and undergo
cystic degeneration by inflammatory products from a non-vital tooth.
Most common type of cyst of the jaws.
Rarely seen before the age of 10.
Most frequent between 20 and 60 years.
More common in males than females 3 to 2.
Maxilla affected more than 3 times the mandible.
Cause slowly progressive painless swelling.
No symptoms until they become large enough or infected.
If infection enters, the swelling becomes painful and may rapidly expand,
partly due to inflammatory edema.
The swelling is rounded and at the first hard
Later, when the bone has been reduced to egg-shell thickness, a crackling
sensation (crepitant) may be felt on pressure
Finally, part of the wall is resorbed entirely away, leaving soft fluctuant
(rubbery and fluctuant) swelling, bluish in color, beneath the mucous
The dead tooth from which the cyst has originated is present, and its
relationship to the cyst will be apparent in a radiograph
The main factors in the pathogenesis of cyst formation are:
Proliferation of epithelial lining and fibrous capsule
Hydrostatic pressure of cyst fluid
Resorption of Surrounding bone
Infection from the pulp chamber induces inflammation and proliferation
of the epithelial rest of Malassez.
If infection can be eliminated from the root canal, small radicular cysts
(up to 1 or 2 cm diameter) may regress without surgery.
Radicular cyst expand in balloon-like fashion, wherever the local
anatomy permits, indicates that internal pressure is a factor in their
The hydrostatic pressure within cysts is about 70 cm of water and
therefore higher than the capillary blood pressure.
Cystic fluid is largely inflammatory exudate and contains high
concentration of proteins, some of high molecular weight which can
exert osmotic pressure.
Pathogenesis of radicular cyst
Consistent with the inflammation usually present in cyst walls, cyst fluid
may contain cholesterol, breakdown products of blood cells, exfoliated
epithelial cells, and fibrin.
Collagenases are present in the walls of keratocysts, but their
contribution to cyst growth is also unclear.
All stages can be seen from a periapical granuloma containing a few
strands of proliferation epithelium derived from the epithelial rest of
Malassez, to an enlarging cyst with a hyperplastic epithelial lining and
dense inflammatory infiltrate.
Epithelial proliferation results from irritant products leaking from an
infected root canal to cause periapical inflammation.
The epithelial lining consists of stratified squamous epithelium of
It lack a well-defined basal cell layer and is sometimes incomplete.
Hyaline bodies may be seen in the epithelium and mucous cells are often
present as a result of metaplasia.
Long-standing cysts typically have a thin flattened epithelial lining, a
thick fibrous wall and minimal inflammatory infiltrate
In most cases the epicenter of a radicular cyst is located approximately at
the apex of a nonvital tooth
Occasionally it appears on the mesial or distal surface of a tooth root, at
the opening of an accessory canal or infrequently in a deep periodontal
RADICALAR CYST INVOLVING THE MAXILLA
Most radicular cysts (60%) are found in the Maxilla, especially around
incisors and canines.
Because of the distal inclination of the root, cysts that arise from the
maxillary lateral incisor may invaginate the antrum.
Radicular cysts may also form in relation to a nonvital deciduous molar
and be positioned buccal to the developing bicuspid.
CT scan showing maxillary sinus
Is based on the combination of:
Pulp vitality testing of associated teeth
Radiographs (intra/extra oral)
Aspiration and analysis of cyst fluids
Treatment of a tooth with a radicular cyst may include:
Apical surgery (Enucleation/Marsupilisation)
Adenoameloblastoma is a lesion that is often found in the upper
jaw. Some consider it a non-cancerous tumor, others a hamartoma (tumor-like
growth) or cyst. Often, an early sign of the lesion is painless swelling. These
tumors are rarely found outside of the jaw.
It is mostly seen in the maxilla
Some of the symptoms of Adenoameloblastoma incude:
It is fairly uncommon, but It is seen more in young people. Two thirds of the
cases are found in females
Presentation and diagnosis
Two thirds of cases are located in the anterior maxilla, and one third are
present in the anterior mandible.
Two thirds of the cases are associated with an impacted tooth (usually
being the canine).
On radiographs, the adenomatoid odontogenic tumor presents as a
radiolucency (dark area) around an unerupted tooth extending past the
It should be differentially diagnosed from a dentigerous cyst and the main
difference is that the radiolucency in case of AOT extends apically
beyond the cementoenamel junction.
Radiographs will exhibit faint flecks of radiopacities surrounded by a
It is sometimes misdiagnosed as a cyst.
Clinical features generally focus on complaints regarding a missing tooth. The
lesion usually present as asymptomatic swelling which is slowly growing and
often associated with an unerupted tooth. However, the rare peripheral variant
occurs primarily in the gingival tissue of tooth-bearing areas. Unerupted
permanent canine are the theeth most often involved in adenoameloblastoma.
The radiographic findings of AOT frequently resemble other odontogenic
lesions such as dentigerous cysts, calcifying odontogenic cysts, calcifying
odontogenic tumors, globule-maxillary cysts, ameloblastomas, odontogenic
keratocysts and periapical disease . Whereas the follicular variant shows a well-
circumscribed unilocular radiolucency associated with the crown and often part
of the root of an unerupted tooth, the radiolucency of the extrafollicular type is
located between, above or superimposed upon the roots of erupted permanent
teeth. Displacement of neighbouring teeth due to tumor expansion is much more
common than root resorptions. The peripheral lesions may show some erosions
of the adjacent cortical bone. Comparing diagnostic arruracy between intraoral
periapical and panoramic radiographs Dare et al. found that intraoral periapical
radiographs allow perception of the radiopacities in AOT as discrete foci having
a flocculent pattern within radiolucency even with minimal calcifies deposits
while panoramic often do not. Those calcified deposits are seen in
approximately 78% of AOT . In addition, in one recently reported case MRI
was useful to distinguish AOT from other lesions, even if it is difficult on
periapical ordinal radiographies
IOPA showing canine in maxillary sinus
Conservative surgical enucleation is the treatment modality of choice. For
periodontal intrabony defects caused by AOT guided tissue regeneration with
membrane technique is suggested after complete removal of the tumor.
Recurrence of AOT is exceptionally rare. Only three cases in Japanese patients
are reported in which the recurrence of this tumor occurred. Therefore, the
prognosis is excellent.
An exostosis (plural: exostoses) is the formation of new bone on
the surface of a bone. Exostoses can cause chronic pain ranging from mild to
debilitatingly severe, depending on the shape, size, and location of the lesion.
If an exostosis is thought to be present your podiatrist will most likely have an
x-ray taken of your foot to evaluate it. The underlying cause of forming the
exostosis needs to be addressed. An exostosis can be treated conservatively or
surgically depending on location and symptoms. If a surgery is performed
where the exostosis is removed this is termed an exostectomy.
The clinical features of osteochondromata are:
swelling - usually, at the metaphysis of a long bone
lesions may be single or multiple
the lump is bony hard, although sometimes covered by a bursa which
may be tender
Radiologically, the osteochondroma is well-defined. Often the lesion may look
smaller than it feels because the cartilage cap is invisible.
There are two main varieties that are seen:
There may be partial calcification of the osteochondroma.
On cut surface the torus and exostosis show dense bone with a lamellar or
laminated pattern. They are usually comprised of dense, mature, lamellar bone
with scattered osteocytes and small marrow spaces filled with fatty marrow or a
loose fibrovascular stroma. Some lesions have a thin rim of cortical bone
overlying inactive cancellous bone with considerable fatty or hematopoietic
marrow present. Minimal osteoblastic activity is usually seen, but occasional
lesions will show abundant periosteal activity. Large areas of bone may show
enlarged lacunae with missing or pyknotic osteocytes, indicative of ischemic
damage to the bone.
Treatment & Prognosis:
A hyperplasia of bone within the jaws. Also referred to as a dense
The lesions were all at least 1.5 cm. in diameter.
Pain, drainage, or localized expansion of the jaw was present
Womens are mostely effected
The humerus is most commonly affected. Males are more commonly affected
than females. The dog normally limps on the affected limb and only rarely holds
the limb to prevent any weight from being placed on it.
Enostoses are likely congenital or developmental, and are thought to represent
either hamartomatous lesions or failure of osteoclastic activity during bone
Location: Anywhere throughout the maxilla and mandible.
Edge: Well-defined to Well-localized, continuous with the surrounding
Shape: Does not always have a given shape, but may appear round, ovoid
or irregular in shape.
Internal: Radiopaque, radiopacity of cancellous bone.
Number: May be single or multiple. If there are multiple sites throughout
the maxilla and/or mandible, an underlying systemic condition such as
Gardner‟s Syndrome should be considered.
Diagnosis is made by pain on palpation of the long bones of the limbs. X-rays
may show an increased density in the medullary cavity of the affected bones,
often near the nutrient foramen (where the blood vessels enter the bone). This
evidence may not be present for up to ten days after lameness begins.
In the vast majority of cases, bone islands have a pathognomonic appearance.
Larger lesions may sometimes pose a diagnostic dillema, particularly in the
setting of known malignancy.
Differential considerations include:
low grade osteosarcoma
Squamous cell carcinoma
This originates from metaplastic epithelium of the sinus
The males are commonly effected.
The most common symptom is facial pain or swelling, nasal obstruction
and lesion in the oral cavity.
Lymphnodes are involved in most of the case.
Erosion of the medial wall causes nasal obstruction, nasal discharge,
bleeding and pain.
Expansion of the alveolar process in the maxillary sinus
Sinus root and floor of the orbit causes symptoms related to eye diplopia
and proptosis, pain and hyperesthesia or anesthesia and pain over the
cheek and upper teeth.
The medial wall of the sinus is best seen on the waters projections
Waters view showing maxillary sinus
As the lesion enlarges it may destroy the sinus walls and in general cause
irregular radiolucent areas in the surrounding bone
Adjacent alveolar process may show bone destruction around the teeth or
irregular widening of periodontal ligame t space.
The medial wall of the sinus maynbe thinned or destroyed and it may also
extend into the nasal cavity.
Destruction of the floor and anterior and posterior walls may be
Large retention cyst
Debridement of sinus
– Amphotericin b
Syndromes associated with maxillary sinus
Crouzon syndrome is a genetic disorder known as a branchial arch syndrome.
Specifically, this syndrome affects the first branchial (or pharyngeal) arch,
which is the precursor of the maxilla and mandible. Since the branchial arches
are important developmental features in a growing embryo, disturbances in their
development create lasting and widespread effects.
Associations with mutations in the genes of FGFR2 and FGFR3 have been
Crouzon syndrome is autosomal dominant; children of a patient have a 50%
chance of being affected
As a result of the changes to the developing embryo, the symptoms are very
pronounced features, especially in the face. Low-set ears are a typical
characteristic, as in all of the disorders which are called branchial arch
syndromes. The reason for this abnormality is that ears on a fetus are much
lower than those on an adult. During normal development, the ears "travel"
upward on the head; however, in Crouzon patients, this pattern of development
is disrupted. Ear canal malformations are extremely common, generally
resulting in some hearing loss. In particularly severe cases, Ménière's disease
Diagnosis of Crouzon syndrome usually can occur at birth by assessing the
signs and symptoms of the baby. Further analysis, including radiographs,
magnetic resonance imaging (MRI) scans, genetic testing, X-rays and CT scans
can be used to confirm the diagnosis of Crouzon syndrome.
For dentists, this disorder is important to understand since many of the physical
abnormalities are present in the head, and particularly the oral cavity. Common
features are a narrow/high-arched palate, posterior bilateral crossbite,
hypodontia (missing some teeth), and crowding of teeth. Due to maxillary
hypoplasia, Crouzon patients generally have a considerable permanent
underbite and subsequently cannot chew using their incisors. For this reason,
Crouzon patients sometimes eat in an unusual way--eating fried chicken with a
fork, for example, or breaking off pieces of a sandwich rather than taking a bite
Binder syndrome (maxilla nasal dysplasia)
Binder's Syndrome/Binder Syndrome (Maxillo-Nasal Dysplasia) is a
developmental disorder primarily affecting the anterior part of the maxilla and
nasal complex (nose and jaw). It is a rare disorder and the causes are unclear.
Hereditary and vitamin D deficiency during embryonic growth have been
researched as possible causes.
abnormal position of nasal bones,
atrophy of nasal mucosa, reduced
absent anterior nasal spine,
absence of frontal sinus (not obligatory).
Naso-maxillo-vertebral syndrome (Binder syndrome).
The prognosis is good if there is no other problem associated.
osteotomy when the children were older
An antrolith is a calcified mass within the maxillary sinus. The origin of the
nidus of calcification may be extrinsic (foreign body in sinus) or intrinsic
(stagnant mucus, fungal ball).
Most antroliths are small and asympotomatic. Larger ones may present as
sinusitis with symptoms like pain and discharge.
Location: Maxillary sinuses.
Edge: Well-defined, smooth or irregular outline.
Shape: Round, ovoid.
Internal: Radiopaque, may have a „laminated‟ appearance with
radiopaque and radiolucent bands evident due to continued laying down
of calcium salts. (This looks similar to layers of an onion.)
Number: May be single of multiple.
IOPA SHOWING AN IMAPACTED TEETH
IN THE MAXILLARY REGION
They appearas solitary or multiple, faintly to extremely radio-opaque masses
embedded within the mucoperiosteum. The sinus wall is intact.
endoscopic sinus surgery
Traumatic injuries of maxillary sinuses
Tooth roots may be fractured as a result of various forms, including iatrogenic
reasons. fractured roots may be forced into the sinus during extraction or
subsequent attemps to retrieve them.
Excess root canal filling material may be forced through the apex of an upper
posterior tooth during endodontic therapy. Foreign materials may be pushed
into the antrum via an existing oro antral fistula. Metallic objects such as
pellets, bullets and fragments of shells or bombs may be found if patients has
been exposed to the same.
no visible signs and symptoms if the roots is displaced recently.
Ask the patient to hold the nose while attempting to breathe out through,
similar to a valsalva maneuver, it will cause bubbles to appear within the
blood contained within the fresh extraction.
If the patient has the root or tooth in the sinus for a number of days, he
may present with sinusitis
The associated roots are usually of molars and premolars as the sinus is in
close proximity to these teeth.
The dislodged fragments are usually found near the floor of the sinus
because of the gravity. Sometimes the displaced structure may be
mucosal, between the osseous wall of the sinus and the periosteum. The
floor of the sinus and periosteum.
The foor of the sinus may break due to the displacement of the tooth
fragment into the sinus.
THERE IS A ROOT FRAGMENT LOCATED OBLIQUELY AND APICAL TO THE APEX LINE
CT finding which showed that the tooth was located close to mesial wall of the sinus and roots
Exostoses of the sinus wall or the floor and the septa within the sinus,
may mimic dental root fragments or even whole teeth.
This occurs due to a blow to the face that damages the lining of the paranasal
sinuses without fracturing the facial bone. There may be green stick fracture of
the sinus with a resultant tearing injury to the mucosal lining.
There is a bloody nasal discharge, extreme tenderness of the involved
sinus on pressure.
There is rapid resolution of the soft tissue changes.
Haziness of the sinus due to edema.
An opaque sinus or fluid level resulting from hemorrhage from the
This results from sudden increase in the intraorbital pressure, due to may be a
direct blow to the eye.
The pressure of the blow forces the inferior orbital content through the
It results in diplopia when the victim look upward and enophthalmus
following reduction of edema and fat atropy.
Opacification of the sinus with or without a fluid level.
There will be shadow of soft tissue mass in the upper portion of the sinus
and shadows of the depressed bone fragments into the sinus.
A tear drop shaped radiopacity is produced in the upper part of the sinus,
due to the herniation of the orbital content downward into the sinus
following the collapse of the antral roof.
The depression fracture of the orbit may be accompanied by the fracture
of the antrum wall of the maxillary sinus.
CORONAL SECTION TOMOGRAPH OF PATIENT WITH BLOW OUT FRACTURE OF RIGHT ORBITAL
This involves a single wall which may appear as a bright line on the radiograph.
The most common sites are the anterolateral wall of the antrum and the floor of
the antrum, during extraction of the upper posterior teeth whose roots are in
close proximity to the antrall floor.
Zygomatic complex fracture
This fractures occurs at the line of weakness and passes through the orbital
floor, usually medial to the zygomaticomaxillary suture.
The fractured zygoma is forced into sinus.
There may be tearing of the lining membrane with subsequent bleeding
the antrum appers cloudy or will show a fluid level.
Standard occipitomental showing fracture of the right zygomatic complex with a break of antral roof
This is a pathological pathway connecting the oral cavity and the maxillary
sinus. It may be caused due to extraction of teeth having chronic periapical
infection, extraction of solitary tooth. Extraction of teeth having apices very
close to the antral floor, blind instrumentation, surgical removal of large lesions
in the upper jaws, malignant tumors,osteomyelitis, syphilis, malignant
granulomatous lesion, facial trauma and inadequate blood clot formation.
immediate history of recent traumatic extraction or disappearance of the
roots during extraction.
Passage of fluid into the nose from the oral cavity
Inability to blow the cheek or smoke.
Unilateral epitaxis, due to blood in the antrum escaping through the nasal
Alteration in vocal resonance.
There will be a break in the continuity of the floor of the maxillary sinus,
which may be seen as a disalignment of a small portion of cortical layer
Radiographic features of acute or chronic sinusitis are present.
Periapical showing a discontinuity of the antral foor
There may be evidence of the displaced root or tooth,and a second view
of the sinus with the head in a different position may be required to
asceration the the exact location of the displace object,
It consist of repair and surgical closure under antibiotic therapy.
Dental and maxillofacial radiology: freny r kajodkar ,2nd
2009 ; page 751 to 773
Text book of oral medicine: anil govidharao editors, ghom,2nd
jaypee 2010 , page 677 to696
Text book of oral and maxillo facial surgery: chitra chakravarthy
edition, paras publishers 2011 ,page 246 to 263
Oral & Maxillofacial Pathology: Neville, B, et al. editors,3rd
Saunders 2002 ,page 219 to 226
Text book of medicine; pramod john r editor,2nd
284 to 288