explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.

2. APPLIED
ANATOMY OF
MAXILLARY
SINUS AND
ITS
DEVELOPMENT

3. CONTENTS
 Introduction
 Development
 Features
 Applied aspects
 Conventional endodontic treatments
 Endodontic surgery
 Conclusion
 References

4. INTRODUCTION
 Non odontogenic cause
 Deserves important consideration
 Result of misdiagnosis
 Rhino sinusitis from odontalgia
 Understanding the effects of periapical
infections

5. Para nasal sinuses

6. Lining mucosa

7. Functions:
 Air filtration
 Humidify
 Voice resonance
 Defining tonal quality
 Voice amplification
 Reducing the weight of skull

8. Maxillary sinus
 Largest
 Most prone to infection
 Antrum
 Body of maxilla

9. DEVELOPMENT
 From the mucous membrane of lateral
wall of nose
 Growth continues
 Identified at 4-5 months

10. FEATURES
 Opening

11. Boundaries

12. Measurement
s :

13. Arterial supply:

14. Venous drainage:

15. Nerve supply:

16. APPLIED ASPECTS:
 Endo-antral-syndrome
 Rhino sinusitis
 Referral of maxillary sinus pain to the teeth
 Distinguishing differences between
symptoms of odontalgia and sinus pain
 Periapical mucositis
 Maxillary sinusitis of dental origin

17. ENDO ANTRAL
SYNDROME
 Spread of pulpal diseases beyond confines
of dental supporting tissues into the sinus
 Findings:
 Pulpal disease in a tooth
 Periapical radiolucency
 Loss of laminadura
 A faintly radiopaque mass bulging into
sinus space
 Varying degree of radiopacity of the
surrounding sinus space

18.  Treatment:
• Non surgical root canal treatment
• Surgical approach

19. ETIOLOGY
RHINO SINUSITIS

20. EPIDIMIOLOGY:
 16% - total population
 5% - all visits to primary care physicians
 Study : 247- men
93% - maxillary tooth ache

21. Rhino sinusitis
 Classification:
a) Acute
b) Sub acute
c) Recurrent acute or chronic

22. Acute :
 Sudden onset
 40-50% patients recover spontaneously
 Respond well to antibiotic and / or
adjunctive treatments
 Predominant bacterial flora
-Streptococcus pneumoniae
-Haemophilus influenza
-Moraxella catarrhalis
 Treatment: Amoxicillin
Trimethoprim- sulfamethaxazole

23. CHRONIC RHINO
SINUSITIS:
 Less severe symptoms
 More difficult to resolve
 Extremely difficult to recognize
 Mixed infection
 Treatment :
 narrow spectrum regimens
 Broad spectrum regimens
 Amoxicillin-clavulanate
 Clindamycin
 Combination of metronidazole & pencillin
 Other ajunctives: steroid nasal sprays
decongestants
saline irrigation

24.  Endoscopic sinus surgery

25. Referral of maxillary
sinus pain to the teeth:
 Close anatomic relationship
 Thickness of bony partition
-0.83 mm
 Percussion of proximate teeth
 Stimulation of maxillary sinus ostium
 Sensory innervation of the maxillary sinus

26. Distinguishing differences
between symptoms of
odontalgia and sinus pain:
 Proper diagnosis
 Important questions to ask a patient

27. MAXILLARY RHINO
SINUSITIS
 Dull aching pain, difficult to localize or
pinpoint
 Feel presuure in the cheeks and below
the eyes
 Positional changes

28. Pain usually
increases when

29. Pulpal pain
 More easily localized
 Unchanged with positions
 Rarely intermittent in intensity

30. Percussion test:
Maxillary rhino sinusitis Pulpal pain
All teeth that are
proximate to the floor of
the sinus are positive
Only offending teeth are
percussion sensitive

31. PULP VITALITY TEST
 Eelectric pulp test (EPT) or ice
 Tooth in question
 Regardless of percussion sensitivity or
patients complaint of spontaneous
dental pain, endodontic therapy is not
indicated

32. Diagnosis
 Periapical radiographs
 A variation in bone density
 Presence of maxillary sinus and its bony septa
as well as zygomatic and palatal processes
 Multiple radiographic angles
 Thorough clinical examination

33. Periapical mucositis:

34.  - Periapical mucositis is the
inflammation or swelling of the sinus
membrane secondary to periapical
inflammation

35. Radiographic representation

36. - mucositis
 Usually asymptomatic
 Not to confuse with mucocele or mucous
retention cyst
 Occasionally apical periodontitis will not
penetrate the antral floor

37. Thin layer of new bone
on the periphery of disease
process
Periapical
osteoperiosteitis
Or “halo”
Resolve following
endodontic treatment

38. Maxillary sinusitis of dental
origin:
 First referred by BAUER in 1943.
 According to ABRAHAMS ET AL.
60% cases
 According to MATILLA
80% cases

39. MSDO
 Usually affects floor of the maxillary
sinus
 If ostial obstruction occurs
-bacterial colonization
- sinus infection

40.  Reported frequency of MSDO
4.6 and 47 %
 Due to difference in criteria and
definitions as well as the inherent
difficulty in establishing an exact casual
relationship

41.  Dental infections accounts approximately:
10-15%:acute sinusitis
40.6 % : chronic sinusitis
 Chronic sinusitis- predominant anaerobic
bacteria are:
prevotella sp.,
porphyromonas sp.,
fusobacterium nucleatum
peptostreptococcus sp.,

42.  If sinus infection is secondary to dental
infection, sinus healing cannot occur unless
the offending tooth is treated or removed.
 Importance is heightened with reports in the
literature of dental infections spreading rapidly
through the maxillary sinus causing
 orbital cellulitis
 blindness
 Meningitis
 Subdural empyema
 Brain abscess
 Cavernous sinus thrombosis

43. RADIOGRAPHS
 IOPA

44.  PANOROMIC RADIOGRAPH

45.  CT

46. DENTAL ORIGIN
SINUS INFECTION
ENDODONTIC TREATMENT
EXTRACTION
CONCOMITENT MANAGEMENT

47. RESOLUTION
 Follow-up radiograph
 CT scan
 Positive patient report

48. CONVENTIONAL ENDODONTIC
TREATMENT
 Maxillary sinus poses a special
challenge
 All endodontic materials an instruments
should be restricted to the confines of
root canal system
 Procedural errors

49. Inflammatory response

50. Periapical extrusion of
debris
 Periapical inflammation
 Post operative pain
 Delayed healing

51. Overzealous reaming or
filing
 Severe damage
 Severe Inflammatory response
 Non specific mediators of inflammation
 Continued release of antigens
 Resulting in immunologic reactions

52. Severe irritation
 Defense mechanism cannot overcome
 Granuloma
 cyst

53. Sodium hypochlorite
 Commonly employed root canal irrigant
 Severe inflammatory reactions
 Extremely toxic
 Soft tissue complications

54. Immediate complications
 Severe pain
 Oedema
 Profuse hemorrhage
 Several days of increasing oedema and
ecchymosis
tissue necrosis, paraesthesia
secondary infection

55. Calcium hydroxide
 Intra canal medicament
 Irritating to tissues
 Immediate degenerative effect
 Sinusitis

56. Sealer or gutta percha or silver
cones
 Mechanical irritation results from
overfilling the root canal
 Inflammatory reaction
 Persists until the foriegnbody is
removed

57. Dodd et al. (1984)
 Maxillary first molar overfilled with silver
cones
 Chronic sinusitis
 Initially undiagnosed
 Endodontic retreatment

58. ENDODONTIC SURGERY
 Broken instruments and / or filling
materials in the maxillary sinus can only
be removed by means of a caldwell-luc
procedure

59. CALDWELL-LUC
PROCEDURE

60. CONCLUSION
 The close anatomical relationship of maxillary sinus and
roots of maxillary molars and premolars can lead to
severe endodontic complications
 In case of sinusitis of dental origin, conventional
endodontic treatment of retreatment is the treatment of
choice with surgical intervention only in refractory cases
 Root ends & materials that may enter sinus during
endodontic therapy may nee caldwell luc approach
 Antibiotics, decongestants & analgesics are indicated for
the treatment of sinusitis or when sinus is penetrated
during surgical endodontic procedures

61. REFERENCES
 HUMAN ANATOMY HEAD AN NECK, B D
CHAURASIA’S, FIFTH EDITION.
 INGLE’S ENDODONTICS SIXTH EDITION
 ENDODONTIC IMPLICATIONS OF THE
MAXILLARY SINUS- A REVIEW
 INTERNATIONAL ENDODONTIC
JOURNAL, 35, 127-141,2002

62. T
H
A
N
K
Y
O
U