Maxilary sinus


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Maxilary sinus

  1. 1. MAXILARY SINUS Presenter Kaspar Solo Puli BOH/BDS 3 2013
  2. 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. 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. 4. 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.
  5. 5. Courtesy Of Susan Standring 2008
  6. 6. 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
  7. 7. Innervation
  8. 8. Blood supply  The Maxillary sinus is supplied by blood from following arteries ◦ External Carotid Artery ◦ Sphnopalatine Artery ◦ Internal Carotid Artery ◦ Maxillary Artery ◦ Ophthalime Artery ◦ Anterior Ethomoid Artery ◦ Posterior Ethmoid Artery ◦ Superior Orbital Artery ◦ Supra Orbital Artery ◦ Supratrochlear Artery ◦ Facial Artery
  9. 9. Courtesy of Susan Standring 2008
  10. 10. 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.
  11. 11.  Sinus Drain schema Courtesy of Richard Et al 2003
  12. 12. 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.
  13. 13. Development of the maxillary sinus (numbers are age in years) Courtesy of Lioyd 1980
  14. 14.  Courtesy of Lioyd 1980
  15. 15. 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.
  16. 16. 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)
  17. 17. 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
  18. 18. 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
  19. 19. 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.
  20. 20. 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.
  21. 21. 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
  22. 22. Risk Factors  Frequent cold  Cigarette smoking  Regular nasal decongestion sprays  Untreated hay fever or other allergies  Trauma of the nose  Nasal Polups  Dental Disease
  23. 23. Maxillary sinusitis from Dental Origin 1. Dental abscess 2. Infected dental cyst 3. Dental material 4. Oro-natral communication
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. Antrolith in the maxillary sinus Courtesy of Killey et al 1975
  30. 30. Infected dental cyst Any cyst of the maxilla may result in sinusitis 1. Radicular cyst 2. Dentigerous cyst 3. Mucous retention cyst
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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
  35. 35. Courtesy of Francis 2002  Palatal flap  Buccal flap
  36. 36. 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
  37. 37. 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.
  38. 38. Reference List  Crispian, S. Oslei, P.,A. Jose, B., Pedro, D., D. Adalberto, M.,T. (2010). Oral Medicine and Pathology at Glance. 1st Edition, Singapore. John Wiley and Son Publications.  Francis, B., Q. and Glen,T., P. (2002). Paranasal Sinuses:Anatomy and Function. Lecture notes. St. 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 Britain. John Wright & Sons Publishing Company.  Lloyd, D., E. (1980). Sichers Oral Anatomy. 7th Edition.Toronto USA: C.V. Mosby Publishing Company.  Ricken, C., S. (2007).Woelfel’s Dental Anatomy its Relevance to Dentistry. 7th Edition. New York, NK: Lippincott Williams and Wilkins Publications.  Richard,W., B. Donald, E., I. and Elaine, S. (2003).Anatomy of Orofacial Structures. 7th Edition. Michigan, USA: Mosby Elsevier Publication Company.  Susan Standring. (2008) Gray’s Anatomy the Anatomical Basis for Clinical Practices. 39th Edition. London, UK: Elvester Churchill Living Stone Publishing Company.