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Maxillary sinus.pptx gaurav


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maxillary sinus

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Maxillary sinus.pptx gaurav

  3. 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. 4. Paranasal sinus
  5. 5. Paranasal sinus
  6. 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. 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. 8. Development of sinus  At the birth- Tubular.  At the childhood-Ovoid.  In the adult- Pyramidal.
  9. 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. 10. Anatomy  Arterial supply- 1. Facial artery 2. Maxillary artery 3. Infra-orbital artery 4. Greater palatine artery.
  11. 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. 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.
  13. 13. Anatomy  Lymph drainage- 1. Submandibular lymph nodes 2. Deep cervical lymph node 3. Retro pharyngeal lymph node
  14. 14. Microscopic features  3 layers surround the space of the maxillary sinus. 1. Epithelial layer 2. Basal layer 3. Sub-epithelial layers including periostium.
  15. 15. 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.
  16. 16. Diagnostic evaluation of maxillary sinus.  Detailed medical & dental history.  Clinical examination. Inspection Palpation Percussion Transillumination  Radiographs .  Ultrasound, CT scan, MRI.  Endoscopy.
  17. 17. 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.
  18. 18. 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.
  19. 19. Radiographs Intra-oral  Periapical  Occlusal  Lateral Extra-oral  Panoramic  Waters veiw  Submentovertex  PA veiw
  20. 20. CT Scan &MRI  Provides multiple sections at different planes  High resolution  Non-invasive techniques Normal Pathology
  21. 21. Ultrasound  Introduced by LANDMAN in 1986  Non-invasive  Safe  Quick  Ultrasound waves are generated by probe.
  22. 22. Endoscope  Allows direct visualization in inaccessible areas, such as maxillary moral roots that are behind distobuccal root of maxillary 1st molar.
  23. 23. Pathology  Developmental anomalies.  Infections (sinusitis).  Dental implications of maxillary sinus.  Oro-antral fistula.  Toothache of maxillary sinus origin.  Associated cysts.  Associated tumours.
  24. 24. 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
  25. 25. 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.
  26. 26. Etiology  Bacterial  Rhinovirus, influenza virus.  Allergy  Odontogenic infections  Nasotracheal intubation  Barotraumas.
  27. 27. 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.
  28. 28. Clinical features (chronic)  Repeated attacks.  Pain and tenderness.  Foul unilateral discharge.  Cacosmia i.e. Fetid odour with bad taste in mouth.
  29. 29. Maxillary sinusitis  TREATMENT- 1. Nasal decongestant. 2. Antibiotics 3. Mucolytic agents. 4. Analgesic
  30. 30. Maxillary sinusitis  Nasal decongestants:  Eg. Ephedrine sulphate, phenylephirine, xylometazoline.
  31. 31. 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.
  32. 32. Maxillary sinusitis  Mucolytic agents: 1. Benzoin compound 2. Camphor 3. Methanol in boiling water
  33. 33. Maxillary sinusitis  Analgesic to reduce pain
  34. 34. 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.
  35. 35. 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. 
  36. 36. 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.
  37. 37. 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.
  38. 38. 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.
  39. 39. Treatment  Flap surgeries. 1. Buccal flap. 2. Palatel flap. 3. Or combination.
  40. 40. 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
  41. 41. 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. 43. 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.
  44. 44. 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%.
  45. 45. Other types of malignant tumours of maxillary sinus:  Malignant melanoma.  Lymphoma  Salivary type neoplasm  Sarcomas  Metastatic tumours
  46. 46. 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.
  47. 47. Clinical features  Nasal obstruction.  Recurrent sinusitis.  Cranial neuropathy.  Sinus pain.  Facial parasthesia.  Proptosis.  Diplopia.
  48. 48. Associated tumours  Investigations 1. Endoscopy 2. X-rays 3. CT scan 4. MRI 5. Biopsy- 100% confirmation.
  49. 49. 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.
  50. 50. Thank-you