complete histology funtions and anamolies of the antrum of highmore otherwise called as the maxillary sinus...

1. MAXILLARY
SINUS
PRESENTATION BY :
Huma Javeriya

3. Maxillary Sinus
 The maxillary sinus is
the pneumatic space
that is lodged inside
the body of the
maxilla.
 It communicates with
the environment by the
way of the Middle
nasal meatus and the
Nasal vestibule.
 It is one of the
paranasal sinuses.
ANTRUM OF HIGHMORE

4. Paranasal sinuses
– Air containing bony spaces
present around the nasal
cavity.
– Usually lined by respiratory
mucus membrane .
– Four paired
FRONTAL SINUS
SPHENOIDAL SINUS
ETHMOIDAL SINUS
MAXILLARY SINUS

5. DEVELOPMENTAL ASPECTS
First sinus to develop
Initial development of sinus follows number of
morphogenic events in differentiation of nasal
cavity

6. Horizontal shift of palatal shelves and
subsequent fusion with one another.
Nasal septum separates Oral cavity from nasal
chambers
Expansion of lateral nasal wall and 3 walls
begin to fold
3 Nasal conchae & 3 meatus
Superior & inferior
- Shallow depression for half
of IU Life
Middle
- Expansion in lateral wall and
in inferior direction

9. Developmental anomalies
1. Agenesis : complete absence of
maxillary sinus
2. Aplasia : incomplete formation.

10. Developmental anomalies
3. Hypoplasia :
failure to develop to
normal size
4. Supernumary maxillary
sinus : more than the
usual number.

11. Microscopic anatomy
• 3 layers
– Epithelium
– Basal lamina
– Sub epithelium

12. Epithelium
• Pseudostratified ciliated columnar epithelium
• Cells
– Columnar ciliated
– Goblet
– Basal
– Non – ciliated

13. Ciliated epithelium

14. Ciliated epithelium
• 100 motile and no. of immotile microvilli
present along apical surface
• Function: mucus clearance along with entrapped
debris from nose and PNS
• Ciliary motility dependent on ATP driven
molecular motors cause outer doublets of
axoneme to slide over each other
• All cilia beat together to form metachronous
wave
• Each cilia has power stroke followed by recovery
stroke

15. Microvilli
• Hair like projection of
actin filament
• Length 1-2 mm
• Function:
– Increase surface area of
cell
– Prevent drying of
surface

16. Goblet cells
• Goblet cells are modified simple columnar
epithelial cells, having a height of four times
that of their width.
• Function is to secrete gel-forming mucins, the
major components of mucus

17. The cytoplasm of goblet cells
tends to be displaced toward the
basal end of the cell body by the
large mucin granules, which
accumulate near the apical surface
of the cell along the Golgi
apparatus, which lies between the
granules and the nucleus.
Goblet cells are found scattered
among the epithelial lining
of organs

18. Physiologic nature of mucus layer
• Sino nasal epithelium covered by mucus blanket
• Traps particles>0.5-1 um
• Composition
– Water (95%)
– Others (5 %)
• Peptides
• Salts
• Debris
• Ph = 5.5-6.5

19. Physiologic nature of mucus layer
2 layers
Inner sol
- Continuous
- Low viscosity
- Surrounds shafts of cilia
Outer gel
-Discontinuous
- High viscosity
-Along ciliary tips

20. Basal lamina & subepithelium
• Contains serous glands and blood vessels
• Subepithelium – 10 serous
• Mucosa removal – 73% decrease in serous
glands and 30% in goblet cells

21. 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

22. Importance for
Dentists• There is a close proximity
between the roots of
maxillary 2nd premolars and
the 1st molars and the sinus
floor.
• Infections in the periapical
area of this teeth erodes the
already thin bone in this
region.
• It spreads to the sinus
causing sinusitis.
• And in this process causes a
communication between
the oral and the nasal cavity
which is known as oroantral
fistula

23. Maxillary sinusitis
• Group of diseases mainly
inflammation & infection
which affect the nasal
mucosa and Para Nasal
Sinus.

24. Maxillary sinusitis

25. MAXILLARY SINUSITIS
• Antral lavage

26. Oroantral fistula
Acute Chronic
1. Escape of air and fluids through nose &
mouth
1.Pain, tenderness over cheeks
2. Epistaxis 2. Purulent discharge
3. Excruciating pain 3. Post nasal drip
4. Altered voice 4. Presence of polyps
 Common in males.
 Immediate sign:
 Displaced root /tooth

27. Oroantral fistula
• Management
• 3mm-5mm heals spontaneously
• Acute OAF: closure by simple reduction of buccal and
palatal socket walls, followed by acrylic splint.

28. • Thank u