Maxillary sinus occupy greater portion of maxilla.. they are helpful in making skill light, provides resonance to voice

1. MAXILLARY SINUS:

2. Contents
1. Introduction
2. Embryology of maxillary sinus
3. Anatomy of maxillary sinus
4. Microscopic anatomy
5. Drainage of sinus
6. Functions of sinus
7. Classification of diseases of maxillary sinus
8. Maxillary sinusitis
9. Oroantral fistula
10. Benign and malignant tumors of maxillary sinus
11. Approaches to maxillary sinus
12. Conclusion
13. References

3. Introduction:

4. Maxillary sinus
 Pneumatic space lodged in the body of
maxilla that communicates with the
external environment by way of middle
meatus and nasal vestibule - by Orban’s
 Also known as antrum of Highmore (1651)

5. Embryology

6. • Development of sinus begins as
evagination of mucus membrane in
lateral wall of middle meatus when
nasal epithelium invades maxillary
mesenchyme ( Kitamura, 1989)
• Growth of sinus takes place by
pneumatization
 Primary (10th weeks)
 Secondary (5th month)

7. • Post natally grows @ 2 mm vertically and 3 mm AP
• 3 growth spurts
a) 0-2.5 years
b) 7.5-10 years
c) 12-14 years

8. Growth:

10. Anatomy:

12.  Base-Lateral wall of nose
 Apex – projects laterally into zygomatic process
of maxilla
 Roof – orbital floor
 Floor – alveolar process of maxilla which
supports premolars and molars
 Posterior wall – infra-temporal and pterygo-
palatine fossa
 Anterior wall – facial surface of maxilla

13. Medial wall
IMP STRUCTURES:  Sinus ostrium
 Hiatus semilunaris
 Ethmoidal bulla
 Uncinate process
 Infundibulum

14. Natural ostium
• Located in posterior ½ of
infundibulum or behind
lower1/3 of uncinate
process.
• Tunnel shaped, length: 1-
22mm;3-6mm diameter
• Unfavorable position for
gravity dependent drainage
• Post edge-continuous with
lamina papyracea(imp for
surgical dissection)

15. Superior wall
• Forms roof of sinus and floor of orbit
• Imp structures
• Infra orbital canal
• Infra orbital foramen
• ASA nerve
• Applied aspect

16. Posterolateral wall
 Made of zygomatic and greater wing of sphenoid bone(maxillary
tuberosity)
 Imp structures
 PSA nerve
 Maxillary artery
 Maxillary nerve
 Pterygopalatine ganglion
 Nerve of pterygoid canal

17. Anterior wall
• Extends from pyriform
aperture anteriorly to ZM
suture
& IO rim superiorly to alveolar
process inferiorly.
• Imp structures
 Infraorbital foramen
 ASA, MSA nerves
 Levator labii, obicularis
oculi muscles

18. Floor of sinus
• Formed by junction of anterior sinus wall
and lateral nasal wall
• 1-1.2 cm below nasal floor

19. Vascularization & innervation
Arterial Supply
a) Nasal MucosalVasculature
SP, Ethmoid
b) OsseousVasculature
IO, PSA,ASA,GP, Facial
Venous Drainage
a) Medial wall - SP
b) Other walls – Pterygomaxillary
Plexus
Lymphatic Drainage Collecting vessels in middle meatus
Nerve Innervation ION, GP, PSA, MSA, ASA

20. Microscopic anatomy
• 3 layers
 Epithelium
 Basal lamina
 Sub epithelium
Pseudo stratified columnar
ciliated epithelium
• Cells
 Columnar ciliated
 Goblet
 Basal
 Non – ciliated

21. Drainage of sinus
Mucociliary flow from anterior sinuses converge at OMC, carried to posterior
nasopharynx & inferiorly to eustachian tube orifice
Mucus coursing along lateral wall, carried medially along roof to reach ostium
Drainage into ethmoidal infundibulum
Upward course along walls of entire cavity and then towards natural ostium in
superomedial wall
Flow of mucus superiorly against gravity
By Donald et al & Antunes et al

22. Drainage of sinus

23. Functions of sinus
1. Decrease skull weight
2. Impart resonance to voice
3. Mucus production and storage
4. Humidify and warm inhaled air
5. Define facial contour
6. Immunodefensive action
7. Conserve heat from nasal fossae
8. Moisturize air
9. Filters debris
10. Dampen pressure differential during inspiration
11. Limit extent of facial injury from trauma
12. Serves as accessory olfactory organ

24. Classification of diseases
 Maxillary sinusitis :Inflammatory
 odontogenic
 Oro antral fistula :acute and chronic
 Traumatic: hematoma in sinus
 Iatrogenic: tooth or root displaced into sinus
 Cysts of the maxillary sinus
 Intrinsic origin-
 Mucocele
 Serous cyst
 Choleosteatoma
 Extrinsic origin
 OKC
 Radicular cyst

25.  Tumors:
 1.Benign tumors
 Intrinsic origin-
 Papilloma
 Juvenile angio fibroma
 Extrinsic origin
 Ameloblastoma
 Odontoma
 CEOT
 2.Malignant tumors: carcinoma of maxillary sinus
 Tumor like lesions
 Fibrous dysplasia
 Ossyifying fibroma
 Antral rhinoliths

26. Maxillary sinusitis

27. Maxillary sinusitis

28. Maxillary sinusitis
1. Infectious causes
a) Bacterial
b)Viral
c) Fungal
d) Parasitic
2. Non infectious causes
a)Allergic
b) Non allergic
c) Pharmocologic
d) Irritants
3. Disruption of
mucociliary drainage
a) Surgery
b) Infection
c)Trauma
Extrinsic
causes 1. Genetic
a) Structural
b) Immunodeficiency
c) Mucociliary abnormality
(cystic fibrosis, dismotility)
2. Acquired
a) Aspirin hypersensitivity
b)Autonomic
dysregulation
c) Hormonal
d) Structural (Tumors,
cysts)
e)Idiopathic/ autoimmune
f) Immunodeficiency
Intrinsic
causes

29. Acute maxillary sinusitis :haemophilus influenzae, streptococcus pneumoniae, or
maraxella catarrhalis.
chronic sinusitis : anaerobic and polymicrobial and more likely to involve
staphylococcus aureus.
odontogenic etiology related with first molar infection with mucostasis of other cause.
ETIOLOGY OF MAXILLARY
SINUSITIS:

30. DIAGNOSIS:
SYMPTOMS:: maxillary pain, pressure, pain similar to toothache,
CLINICAL FINDINGS: fever, throat-clearing cough, purulent
rhinorrhea, hyposmia, headache, malaise, maxillary anterior wall
tenderness to percussion, purulence noted, in cases associated with
cellulitis ,facial swelling and erythema seen ,
RADIOGRAPH: —water’s view, fluid opacification of maxillary sinus
CT SCAN

31. SIGNS AND SYMPTOMS OF ACUTE MAXILLARY
SINUSITIS
SIGNS:
 Pain on pressure over the anterior maxillary sinus wall.
 Purulent discharge over the inferior nasal turbinate.
 Fever
 Malaise
SYMPTOMS
 Cheek pain with referral to frontal region.
 Increased pain on bending.
 Maxillary posterior teeth free like “pegs”
 Hyposmia

32. MELENS CRITERIA FOR CHRONIC SINUSITIS :
 Facial pain, nasal congestion or abnormal
secretions remain or reappear during a period of
at least 3 months.
 Sinus radiography or sinus endoscopy reveals
persistent localized or generalized mucosal
swelling with or without secretions.
 Chronic maxillary sinusitis of rhinogenous origin
that does not heal after conservative treatment.
 Chronic maxillary sinusitis of dental origin.

33. Maxillary sinusitis
 Diagnosis
1. History
2. Physical examination
 Inspection
 Palpation
 Percussion
 Diagnostic techniques
a. Rhinoscopy
b. Endoscopy
c. Culture and sensitivity

34. Maxillary sinusitis
3. Radiological examination
a) Lateral view
b) CT scan
c) MRI
4. Tests for mucociliary functions
a) Naso mucociliary clearance
b) Ciliary beat frequency
c) Rhino manometry
5. Test for olfaction

35. Maxillary sinusitis
Management
Medical
1. Antibiotics
2. Steroids
3. Decongestants
4. Analgesics
5. Antihistamines
6. Nasal spray & saline irrigation
7. Hydration
8. Mucolytics
Surgical
1. sinus aspiration and lavage
2. Maxillary needle sinusotomy
3. Caldwell luc
4. FESS

36. Antibiotics
Antibiotic Micro factors
FIRST LINETHERAPY
Amoxicillin 45 mg/kg/day or 90 mg/kg/day divided
Amoxicillin/potassium calvulanate
22.5-45 mg/kg/day divided (dose based on
amoxicillin component)
Azithromycin
10 mg/kg/day on day 1, then 5 mg/kg/day on days 2-
5
Cefdinir 14 mg/kg/day
Cefpodoxime 10 mg/kg/QID
Cefprozil 15 mg/kg/QID
Cefuroxime 15 mg/kg/QID
Ciprofloxacin
Clarithromycin 7.5 mg/kg/day
Cindamycin 8-20 mg/kg/day dividedQID
Doxycycline
Garifloxacin
Levofloxacin
Sulfamethoxazole/trimethoprim 6-12 mg/kg/day divided (based on trimethoprim)

37. 1.Steroids:
• 1st line of therapy: topical intranasal (beta methasone, dexa methasone,
triamcinolone)
• Systemic steroids:
• Prednisolone:0.5-1mg/kg x3-4 days
2.Decongestants:
Systemic (phenyl propanolamine, pseud oephidrine):
• Contraindications: hypertension, hyperthyroidism, asthma
Topical: pheny lepinephrine HCl, oxy metazoline HCl
• Adv. Effects- rhinitis medicamentosa
3.Analgesics:
• Opioid: acetaminophen, codeine
• NSAIDS:
4.Antihistamines:
• Mequitazine, terfenad
• Contraindicated in bacterial sinusitis
• Adv effect: sedation

38. Nasal lavage & sprays
• Removes debris & dead tissue
• Washes inflammatory secretions
• Eliminates nutrient source
• Methods:
• Lavage pot
• Syringe
• Irrigating bulb

39. Surgical management
Indications
• Bilateral chronic
sinusitis with polyps
• Fungal sinusitis
• Presence of
complications
• Tumor of PNS
• CSF rhinorrhea
Contraindications
• Presence of
extensive polyps
• Pt with complaint of
headache and mid
facial pain
• Medically
compromised
• Hypo plastic sinuses

40. Sinus aspiration & lavage
 Direct removal of bacteria laden secretions
 Indication: no response to medical therapy

41. Maxillary needle sinusotomy
• Complications:
• Bleeding
• Infection
• Dental injury
• Sensory nerve disturbance
• Instrument breakage
Infiltration of LA
Preparation of site
Transcutaneous
puncture ant & post to
canine eminence

42. Caldwell luc sinusotomy
 By George Caldwell (1893) & Henry Luc (1897)
 Indications
 Fungal sinusitis
 Multiple antral lesions
 Antrochoanal polyp
 Excision of tumor
 Closure of OAF
 Removal of antral foreign body
 surgical approach for transantral spheno ethmoidectomy,
orbital decompression

43. Caldwell luc sinusotomy
Complications
•Bleeding
•Dental sensitivity
•Infraorbital neuralgia
•Osseous defect in
anterolateral wall
•Entrapment of inferior
rectus muscle

44. FESS
 Coined by Kennedy
 Principle: stop the cycle that
begins with ostium blockage
that leads to chronic sinusitis
via stagnated secretions,
tissue inflammation and
bacterial infections.

45. FESS

46. FESS

47. FESS
Minor hemorrhage
Hyposmia
Adhesions
Periorbital emphysema
Intracranial hemorrhage
Brain injury
CSF leak
Diplopia
Blindness
Anosmia
Epistaxis
NL duct injury
Meningitis
Complications

48. Complications of untreated maxillary
sinusitis:
 Complications:
 Facial cellulitis
 Orbital extension
 Intracranial
extension

49. DISPLACED ROOT OR TOOTH INTO THE
SINUS
 Most common complication following tooth extraction.
 Roots are those of the 1st molar (80%) with slightly less
than 20 % are 2nd molar and the remainder involving the
3rd molar and 2nd premolar and rarely the canines

50. Procedure to retrieve broken root tip from
antrum:
 Place the pt in upright position
Determine the location of tooth /root tip
Determine antral perforation/IOPA has
to be taken
If it in the sinus
Place small suction tip in to sinus
through the socket gently/saline
irrigation can be done
Pack 0.5inch long
iodoform gauge in to the
sinus &pull it out in one
stretch
Cald well luc sinusotomy

51. SINUS EXPOSURE FOLLOWING TUBEROSITY
FRACTURE
 Prevented by preliminary expansion of the socket
 In multiple extractions 3 rd molar should be extracted 1 st
 Discontinue the extraction
 Fixation is done by an arch bar, acrylic splint or an
orthdontic appliance

52. ORO ANTRAL FISTULA

53. OROANTRAL FISTULA
 Etiology
• Iatrogenic (50%)
• Presence of periapical lesions
• Injudicious use of instruments
• During attempted extraction
• Trauma(7.5%)
• Chronic infections(11%)
• Malignant diseases(18.5%)
• Infected maxillary dentures(3.7%)
• h/o sinus surgery(7.5%)
Predisposing factors

54. Acute Chronic
1. Escape of air and fluids through nose &
mouth
1.Pain, tenderness over cheeks which is
dull and boring type
2. Epistaxis 2. Purulent discharge
3. Excruciating pain 3. Post nasal drip
4. Altered voice due to enhanced column
of air
4. Presence of polyps
5. h/o surgery in vicinity of sinus, escape
of fluids in to the nose
5. Generalized constitutional symptoms
Signs & symptoms of
oroantral fistula

55. Diagnosis
H/o previous extraction
Mouth mirror test
Nose blow test
Cotton wisp test
Inspection
Radiological
 IOPA
 OPG

56. MANAGEMENT
• 3mm-5mm heals spontaneously
• Acute OAF: closure by simple reduction of buccal and
palatal socket walls, followed by acrylic splint.
1) Antibiotics : Penicillin & derivatives
2) Nasal decongestants:
 Ephedrine drops
 Inhalations(steam , benzoin ,menthol)
3) Analgesics:
 Aspirin 500mg
 Paracetamol 500mg
 Ibuprofen 400 mg
4) Antral lavage

57. Surgical management:
Closure of Oroantral Communications:A Review of the Literature, Susan H. Visscher et al, J Oral Maxillofac
Surg68:1384-1391, 2010
•Temporalis
flap
•Forehead
flap
Overview of the treatment modalities of Oro-Antral Communications

58. Surgical closure
• Factors determining flap selection
• Size of communication
• Timeline of diagnosing
• Presence of infection

59. Buccal flap:
The defects can be closed by
a. Advancement flaps
b. Sliding flaps

60. Buccal advancement flap
Adv:
 Broad base
 No denuded area
Disad:
Depth of buccal vestibule
obliterated

61. Buccal sliding flap
 Moczair described it
 Minimal change in
buccal vestibule
 Facilitates distal shift
of flap
 Disad:
 Raw surface anteriorly
 Gingival recession

62. Modified BuccalAdvancement Flap
Laskin and Robinson
described it first
A clinical study on oro antral fistula;
J cranio maxillofacial
surg.1998;26;267-71

63. Palatal Flaps:
These includes
a. Straight advancement
b. Rotational advancement
c. Island palatal flap
d. Hinged palatal flap

64. StraightAdvancement Flap:

65. RotationalAdvancement Flap:
Ø Kruger suggested V-
shaped excision of tissue on
the lesser curvature to
minimize folding the flap.

66. Sub mucosal Connective Tissue Flap:
Ito and Hara described elevation
of full-thickness palatal flap
followed by creation of a
submucosal connective tissue
flap to close the fistula and
return of the remainder of the
flap to lower the original donor
site.

67. Island Palatal Flap:
Hendersen has described the use of a
palatal pedicle island flap.
Because of the mobility of this flap
and its excellent blood supply it
can be used to close larger defect.
James suggested that sectioning the
island should be done best so
that the tissue can still be used as
a rotational advancement flap or
rotational to tits original site will
cause injury to its vessels.

68. Hinged Flap:
The mucoperiosteum on the
palatal aspect of the
oroantral fistula can be used
as a hinged flap to close
small opening.

69. Combined Local Flaps:
They are
Simple
Transverse
Bipedicled
Buccopalatal flap
These are practiced where there
is sufficient large edentulous
surface.
Combination of inversion and
rotational advancement
flaps.
Double hinged flaps.
Double island flaps.
Superimposed reverse palatal
buccal flaps.

70. Distant Flaps
1. Flap from extremities
2. Flap from forehead
3. Tongue flap
4. Temporalis flap
5. Buccal fat pad flap

71. BUCCAL FAT PAD
Use of pedicled buccal fat pad in closure of oro antral communication;
analysis of 75 cases
Dolanmaz et.al.,
Quintessence international 2004: 35(3) ; 241-426

72. TONGUE FLAP
Introduced by lexer,1909
Technique
Advantages
Disadvantages
Use of the tongue flap for intra oral
reconstruction; report of 16 case
Kim, Yeo and Kim
J Oral Maxillofac Surg 1998; 56: 716-719

73. TEMPORALIS FLAP:
 Advantages:
Proximity to the oral cavity.
Safety of it vascular pedicle.
Its pliability
Minimal functional and esthetic sequelae
Less dysfunction during healing.
 Procedure:

74. GRAFTS

75. Grafts
GRAFTS
AUTOGENOUS
Iliac crest
Chin
Retromolar area
Zygoma
Brusati has used
bone from lateral
wall
ALLOGENOUS
Collagen sheet
Fibrin glue
Gold foil
Tantalum
PMMA
Hydroxyapatite
XENOGRAFTS
Porcine dermis
Bio guide & Bio oss

76. Other techniques
• Third molar transplantation(kitagawa et al)
• Interseptal alveolotomy(hori et al)
• GTR(Waldrop & Semba)
• Prolamine gel(Gotzfried & Kaduk)
• Laser light(Janas)
• Splints for immunocompromised pts(llogan and coates)
• Allotransplants of fasvia lata and dura
matter(guven;1995)
• Buccinator myo mucosal island flap(J.OralMaxillofacial
Surg;2002;60;816-821)

77. THE EFFECTS OF TRAUMAON
THE MAXILLARY SINUS
The effects of traumatic sinus
disruption vary from:
-Chronic sinusitis
-Polyps
-Mucocele formation
-Acute sinusitis with extension to
more vital organs

78.  Any midfacial trauma --clouding of the sinus
 ZMC fracture involves inferior orbital fissure --orbital
floor is often comminuted creating multiple fracture lines
in roof of the maxillary sinus
 Fractures of the internal orbit --teardrop radioopacity
 Lefort fractures --involve maxillary sinus

79. Response of maxillary sinus to trauma
a)Mucosal regeneration
b)Bony regeneration

80. Management:
 Generally does not require direct treatment
 The sinus regenerates after the hemorrhagic fluids have
been removed by mucociliary action
 Gross debris must be removed before closing the soft
tissues overlying it

81. Reconstruction of sinus walls:
 Common area is roof of sinus (floor of the orbit)
 Indications: enoptholmos, exopthalmos, diplopia, isolated
sinus wall defects
Autogenous
 Eg: calvarial, iliac crest
Nonautogenous
 Eg: lyophilized dura, siloxane, teflon and other
bioresorbable materials,grafts

82. INFECTIOUS DISEASES OF THE
MAXILLARY SINUS
 Aspergillosis :
Caused by the fungus aspergillus
Immune compromise is common
Severe neutropenia
H/O recent treatment with cytotoxic drugs &
corticosteroids

83.  Aspergillosis :
Thick ,dark greasy material is found in the sinus
 Three types are seen:
Non invasive
Invasive
Fulminant
Treatment includes aggressive debridement &
systemic antifungal therapy

84.  Mucormycosis :
Caused by fungi of the class phycomycetes
Infection is usually fatal
Impaired chemotaxis & phagocytic activity
Virulent strain can cause thrombosis ,ischaemia &
necrosis

85.  Clinical signs of advanced disease are:
 Proptosis
 Opthalmoplegia
 Anesthesia of trigeminal nerve distribution
 Cavernous sinus thrombosis
 Facial palsy
Management includes
 Correction of the underlying metabolic/hematologic
abnormality
 Aggressive debridement & Systemic antifungal
therapy

86. Maxillary antrolithiasis:
 Asymptomatic or pain,
nasal obstruction,
epistaxis, sinusitis.
 Investigation:
 Radiographs – opaque
mass
 Treatment – surgical
removal

87. BENIGN MUCOSAL CYST
• Most common cyst
• Due to obstruction of the glandular ducts.
Clinical features:
1. Discomfort in the cheek or maxilla.
2. Buccal expansion of the antrum.
3. Nasal obstruction.
4. Post nasal discharge.
5. External deformity of the face.

88. Radiographic features: appear as rounded lightly
opaque shadow in the floor of the sinus.
Aspiration: through inferior turbinate will reveal straw or
amber-coloured fluid “cholesterol crystals”.
Treatment:
Asymptomatic: monitor
1. Cannulation through inferior turbinate puncture.
2. Marsupialization
3. Enculeation through cald well. Luc operation with
nasal antrostomy.

89. Odontogenic keratocyst:
 Maxillary OKC’S occur primarily in the 3 rd molar
region with canine being the 2 nd most common site
 Peak incidence is in 2 nd & 3 rd decades

90. TUMOURS OF THE MAXILLARY SINUS
 Ameloblastoma
 Antrum & nasal floor are common sites
Most cases arise extrinsic to the sinus
Present as an enlarging mass
 Management : en bloc excision with good
surgical margins

91. CALCIFYING EPITHELIAL
ODONTOGENIC TUMOUR
 Arises from the epithelial remnants of the enamel
organ
 Comprises 1% of all odontogenic tumours
 Slow growing painless swelling
 Age :40 years approximately

92. CEOT
 MANAGEMENT:
 Enucleation ,resection –for smaller lesions
 Large posteriorly located lesions- resection similar to
ameloblastoma

93. MALIGNANT TUMOURS OF THE
MAXILLARY SINUS
Harrison’s classification of maxillary sinus
malignancies:
 T1- Limited to the antral mucosa
 T2- bony erosion
 T3- involvement of facial skin, orbit, ethmoid
labrynth, or extension into pterygopalatine fossa
 T4- extension into the nasopharynx, sphenoid
sinus, cribriform plate, or pterygopalatine fossa

94. TNM STAGING:
 Tx – primary tumor cannot be assessed
 T0 – no evidence of primary tumor
 Tis – carcinoma in situ
 T1 – tumor limited to antral mucosa with no erosion or
bone destruction
 T2 – tumor causing bone erosion except for posterior
antral wall
 T3 – tumor invading bone of posterior wall, skin of cheek,
subcutaneous tissues, floor or medial wall of orbit,infra
temporal fossa ,pterygoid plates ,ethmoid sinuses
 T4 – tumor invading orbital contents including orbital
apex ,cribriform plate,base of skull ,naso
pharynx,sphenoid,frontal sinuses

95. • Signs /symptoms :
 Group 1:oral signs/symptoms:
Tooth ache, loose teeth
 Group 2:nasal signs/symptoms:
Congestion, rhinorrhea, & epistaxis
 Group 3:facial signs/symptoms
Cheek mass, facial asymmetry
 Group4:ocular signs/symptoms:
Found in 23% of patients & an ocular problem is the
presenting complaint in 5% of the patients
 Group5:neurologic signs/symptoms:
Involvement of adjacent branches of cranial nerves

96.  Diagnosis
 Insidious in onset
 Can extend superomedially,
medially,superiorly, inferiorly & anteriorly

97. Ohngren’s line from the medial
canthus of the eye to the angle
of the mandible. The
infrastructure of the maxillary
sine lies anterior to this line
and tumors of this area have a
better prognosis.
STAGING

98.  Biopsy techniques :
Endoscopic biopsy by enlarging the ostium
Classical nasal antrostomy beneath inferior
turbinate
Caldwell-luc approach

99.  MANAGEMENT
 Surgery
 Hemimaxillectomy & modifications like medial
maxillectomy
 Partial maxillectomy
 Sub total maxillectomy
 Total maxillectomy
 Maxillectomy with orbital exenteration
 Craniofacial resection
 Neck dissection

100. Approaches:
 Trans nasal
 Transoral and transpalatal
 Mid face deglowing
 Weber fergussion approach
 Lefort 1 osteotomy approach
 Combined cranio facial approach

101. Lateral rhinotomy
Classical WF
WF with lynch
WF with
lat sub ciliary
WF with
supra ciliary

102. Subtotal Maxillectomy
Larger lesions of the gums, palate or the antrum which
extend to the superior aspects or beyond the
confines of the antrum
Proposed Bonycuts

103. Total Maxillectomy
Primary tumours filling the entire antrum
In some cases infra orbital rim is preserved

104. RECONSTRUCTION:
 Autogenous grafts
 Non-autogenous grafts
 Resorbable
Gelatin,polyglactin,polydioxonone films
 Non-resorbable
Sheets of silicone,teflon,porous polypropylene,metallic
mesh

105. RECONSTRUCTION:
 Prosthesis
 Local flaps:palatal flaps
 Radial fore arm flap
 Temporalis &tempero parietal galeal flap
 Iliac crest free microvascular flap

106. RADIATION THERAPY
CHEMOTHERAPY & COMBINATION THERAPY
CIS-PLATINUM(100mg/m2/d/1d)
5-FLUOROUROCIL(1000mg/m2/d1-5x3cycles)
RAD PLAT PROTOCOL
CHEMOTHERAPY—CIS-PLATINUM(150mg/m2/wk/4wk) with EXTERNAL
BEAM RADIATION THERAPY(68-72 GY)

107. 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.

108. THANK YOU