GJHJ

1. GOOD MORNING

2. MAXILLARY SINUS
AND ITS
ENDODONTIC
CONSIDERATIONS

3. CONTENTS
 Introduction
 Maxillary Sinus
 Maxillary Sinusitis
 Difference between dental pain and sinus pain
 Endodontic considerations of maxillary sinus
 Conclusion

4. INTRODUCTION
 Paranasal sinuses (PNS) are air filled spaces located within the facial
bones that surround the nasal cavity.
 There are 4 pairs of paranasal sinuses:-
a. Frontal
b. Ethmoidal
c. Maxillary
d. Sphenoidal

5. MAXILLARY SINUS
 It is a pyramidal shaped pneumatic
cavity which is located in the
maxillary bone.
 ANTRUM OF HIGHMORE

6. DEVELOPMENT
• 17 week of i.u.l
• Growth of maxillary sinus is proportional to growth
of facial bones.
• Lateral and inferior extension of sinus takes place.
• Sinus expansion is by pneumatization of maxillary
alveolus.
• Eruption of permanent molars and premolars.
• Displacement of floor of sinus 4-5mm below the
nasal cavity.

7. Shape of Maxillary Sinus

8. ANATOMY
OF
MAXILLARY
SINUS
Pyramidal in shape.
2 in Number.
Vol: 15 -30 ml
• Anteroposterior :3.5cm
• Height :3.2cm
• Width :2.5cm
Dimensions (turner ,1902)
Largest sinus

9. Base - Lateral Nasal Wall.
Apex - Zygomatic process of maxilla.
Base
Apex
pyramidal shape

10. ROOF
 Formed by FLOOR OF THE ORBIT
 It is traversed by the Infraorbital nerve.

11. FLOOR
 Formed by Alveolar Process Of Maxilla.
 Lies about 1cm below the level of the Floor Of The Nose.
 Closely related to root apices of the maxillary premolar and molar.

12. ANTERIOR WALL
 Formed by Facial Surface Of Maxillary Bone.
 Identified by 3 landmarks –
1. Canine fossa.
2. Infra orbital foramen.
3. Infra orbital groove.

13. POSTERIOR WALL
 Formed by Spheno-maxillary wall.
 Adjacent to Infratemporal fossa.

14. MEDIAL WALL
 Lateral wall of the nasal cavity.
 Ostium is located superiorly on
the lateral wall of the nose.

15. OSTIUM (OPENING)
 Ostium of the maxillary sinus opens into the posterior lower most
part of the hiatus semilunaris of the middle meatus.
 Poorly placed from the point of view of free drainage.

16. PHYSIOLOGY OF MAXILLARY SINUS
 Lined by Pseudostratified ciliated columnar epithelium.
 Spiral movements : 1000 strokes/min -flow rate of 6mm/min.

17. ARTERIAL SUPPLY
• Posterior superior alveolar
Artery
• Infraorbital Artery
• Greater Palatine Artery

18. VENOUS DRAINAGE
 Anteriorly - Facial vein.
 Posteriorly - Pterygoid
Venous Plexus.

19. NERVE SUPPLY
 Anterior superior
alveolar nerve.
 Middle superior alveolar
nerve.
 Posterior superior
alveolar nerve.
 Infra-orbital nerve.

20. LYMPHATIC DRAINAGE
 Submandibular lymph
nodes.
 Deep cervical lymph
node.

21. FUNCTIONS
 Increases the surface area and lightens the skull.
 Moistens and warms the inspired air.
 Filters the debris from the inspired air.
 Mucus production and storage.
 Limits the extent of facial injury from trauma.
 Imparts resonance to the voice.
 Provides thermal insulation to important tissues.
 Serves as accessory olfactory organs.

22. DIAGNOSTIC EVALUATION
 Radiography is the most important supplementary investigation to clinical
examination of sinuses.
Intra oral Extra oral
 Periapical Panoramic view
 Occlusal Waters view
 Lateral occlusal Submentovertex view
Lateral skull
Others
CT scan and MRI

24.  Radiographic changes in sinusitis :
- Thickened sinus mucus membrane
- Air fluid level
- Opacifications

25. EXAMINATION OF
MAXILLARY SINUS
1. Palpation and Percussion
2. Rhinoscopy
3. Nasal endoscopy
4. Sinus endoscopy
5. Aspiration
6. Transillumination

26. DEVELOPMENTAL ANOMALIES AND
PATHOLOGICAL CONDITIONS OF
MAXILLARY SINUS

27. DEVELOPMENTAL ANOMALIES
 Aplasia.
 Agenesis.
 Hypoplasia.
 Supernumerary.

28. PATHOLOGICAL CONDITIONS OF
MAXILLARY SINUS
Maxillary sinusitis:
 It is the inflammation of the maxillary sinus mucosa.
 Types : Depending on duration.
1. Acute : 4 weeks or less.
2. Subacute : 4-12 weeks.
3. Chronic : 4 or more attacks per year.

29. PATHOPHYSIOLOGY
VIRAL / BACTERIAL / ALLERGEN
MUCOSAL SWELLING
BLOCKAGE OF DRAINAGE IN OSTEOMEATEL COMPLEX
MUCOSTASIS
BACTERIAL INVASION AND OVER GROWTH
SEVER OBSTRUCTION DUE TO FURTHER MUCOSAL
THICKENING

30. DENTAL RELATED ETIOLOGY
 Periapical infection from the teeth.
 Oroantral fistula.
 Dental material in antrum.
 Traumatic injuries.
 Implant.
 Infected dental cyst.
 Periodontitis.

31. Signs and
symptoms of
sinusitis
Heavy feeling in the head
Constant pain in the upper part
of cheek
Foul nasal discharge
Maxillary teeth in affected
patients may be painful
Sensitivity of tooth on percussion
Nasal obstruction
Fever, chills and malaise

32. MEDICAL MANAGEMENT OF
SINUSITIS
 Antibiotics.
 Decongestants.
 Analgesics.
 Antihistamines.
 Steam Inhalation
 Hot formentation

33. SURGICAL MANAGEMENT
 Sinus aspiration & lavage.
 Caldwell-Luc approach.
 FESS (Functional Endoscopic Sinus Surgery).

34. SINUS PAIN DENTAL PAIN
Dull and continuous Intermittent and spontaneous
Bilateral Unilateral
Bending over / Shaking head Stimulus ( Cold, Heat or Electric )
Several posterior teeth show tender
on percussion
Single tooth show tender on percussion
Topical Lignocaine to Sinus Ostium Thermal Pulp Sensibility Test
DIFFERENCE BETWEEN SYMPTOMS OF
DENTAL PAIN AND SINUS PAIN
Cohn SA. Clinical update--the teeth and the maxillary sinus: the mutual impact of clinical procedures, disease conditions and their treatment implications. Part 1. The differential diagnosis
of tooth sinus pain--the dentist's view. Australian endodontic journal: the journal of the Australian Society of Endodontology Inc. 1999 Apr 1;25(1):29-31.

35. DENTAL CONSIDERATIONS
OF MAXILLARY SINUS

36. DURING CONVENTIONAL
ENDODONTIC TREATMENT
Irritation and inflammation of sinus mucosa may result due to:
 Introduction of instruments and medicaments beyond apical foramen.
 Overzealous reaming or filing.
 Inadverent injection of NaOCl into periapex.
 Invasion of periapical tissues by sealer or solid materials.
 Inadverent inoculation of infected root canal contents.

37. PERIAPICAL INFECTION
FROM THE TEETH
 The spread of pulpal disease beyond the confines of the dental supporting tissues
into the maxillary sinus was termed Endo – antral syndrome (EAS) by Selden
(1974).
 The anatomic proximity of the roots of the maxillary bicuspid and molar teeth to the
floor of the sinus leads to potential infection of the sinus by direct extension of an
apical abscess.

38. DENTAL MATERIAL IN THE ANTRUM
 During obturation the sinus may be
invaded by either sealer or by solid
materials such as gutta-percha or
silver cones.
 This material produces an inflammatory
reaction in the periapical tissues.

39. FRACTURED ROOT
 A root tip of the maxillary first molar
accidentally pushed into the sinus at the
time of tooth extraction.
 Removal of root tip can be done through
the tooth socket or through the canine
fossa by Caldwell Luc approach.
Huang IY, Chen CM, Chuang FH. Caldwell-Luc procedure for retrieval of displaced root in the maxillary sinus. Oral Surgery, Oral
Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2011 Dec 1;112(6):e59-63.

40. ANTROLITH (STONE) IN THE
MAXILLARY SINUS
 Antroliths are calcified masses found in the
maxillary sinus.
 Stagnant mucus in site of previous
inflammation, root fragments or bone chips.
 Asymptomatic but if continues to grow patient
complain of blood stain nasal discharge or
facial pain.

41. CONCLUSION
 Due to close proximity of maxillary sinus to orbit, alveolar ridge, diseases
involving these structures may produce confusing symptoms. hence a
precise information about the surgical anatomy is essential to surgeons.
 The close anatomical relationship of the maxillary sinus and the roots of
maxillary molars, premolars and in some instances canines, can also lead
to several endodontic complications.
 Clinicians must be particularly cautious when performing dental
procedures involving the maxillary posterior teeth.

42. REFERENCES
 BD CHAURASIA’S HUMAN ANATOMY, HEAD AND
NEECK, VOLUME-3
 INDERBIN SINGH’S HUMAN EMBRYOLOGY
 NEELIMA ANIL MALIK’S ORAL AND MAXILLOFACIAL
SURGERY, 4TH EDITION
 INGLE’S ENDODONTICS, VOLUME-7