Anatomy of maxilla and various fractures associated to maxilla

3. MAXILLA : THE UPPER JAW
PRESENTED BY :
ANIKET CHOUDHARY
( PG 1ST YEAR)
DEPARTMENT OF OMFS

4. MAXILLA : THE UPPER JAW
PRESENTED BY :
ANIKET CHOUDHARY
( PG 1ST YEAR)
DEPARTMENT OF OMFS

5. CONTENT
• INTRODUCTION
• OSTEOLOGY OF MAXILLA
• DEVELOPMENT OF MAXILLA
• AGE CHANGES OF MAXILLA
• MUSCLE ATTATCHMENT
• BLOOD SUPPLY
• NERVE SUPPLY
• MAXILLARY SINUS
• APPLIED ANATOMY OF MAXILLA
• SURGICAL ANATOMY OF
MAXILLA

6. INTRODUCTION :
 2nd Largest bone of the face
 2 Maxillae forms whole of upper jaw
 Each maxilla contributes in formation of –
 Face
 Nose
 Mouth
 Orbit
 Infratemporal fossa
 Pterygopalatine fossa

7. FEATURESOFMAXILLA:
 Each maxilla has a body and 4 Processes –
1. Frontal
2. Zygomatic
3. Alveolar
4. Palatine

8. BODYOFMAXILLA:
• Shape– pyramidal
• It has-
Base - Directed at medially at nasal surface
Apex - Directed at laterally at zygomatic process
4 Surfaces - Anterior / Facial
Posterior / Infra Temporal
Superior / Orbital
Medial / Nasal

10. ANTERIOR/FACIALSURFACE:
• Directed – laterally
• Incisive fossa – Depressor septi
• Canine fossa – Levator anguli oris
• Alveloar margin - orbicularis oris attachment below the incisive
fossa
• Transverse part of nasalis/compressor nares – along with nasal
notch
• Alar part of nasalis/dilator nares - superolateral to incisive fossa
• Infraorbital foramen – below the infra orbital margin,allows
passage of infraorbital vessels and nerve
• Levator lebii superioris – above the infra orbital foraman close to
infraorbital margin
• Medially – nasal notch, Anterior nasal spine

11. POSTERIOR/INFRATEMPORALSURFACE:
• Directed – backward & laterally
• Forms- anterior wall of infratemporal
fossa & pterygopalatine fossa
• 2 - 3 number of canals behind 3rd molar
– provide passage of posterior superior
alveolar nerve and vessels
• Buccinator – attach just above the area
of 1st and 2nd molar teeth and extend
posteriorly
• Posteroinferiorly – maxillary tuberosity
& superficial head of medial pterygoid
muscle

12. SUPERIOR/ORBITALSURFACE
• Smooth , triangular, slightly concave
• Forms – Greater part of floor of orbit.
• Posterior medial border –relation with the orbital plate of
palatine bone and superior orbital fissure.
• Medial portion – anterior part of border forms lacrimal notch
which is converted in to nasolacrimal canal. Behind the notch
, the border articulate with orbital plate of ethmoid and thin
layer of sphenoid bone.
• Just lateral to lacrimal notch provide origin to inferior oblique
muscle.

13. MEDIAL/NASALSURFACE:
• Forms a part of lateral wall of nose.
• Large irregular opening of maxillary sinus called maxillary hiatus.
• Above the hiatus, articulation of labyrinth of ethmoid and lacrimal
bones.
• Below the hiatus ,smooth concave surface forms inferior meatus of
nose.
• Behind the hiatus, articulation of perpendicular plate of palatine
bone, enclosing the greater palatine canal which runs downwards and
forwards , and transmits greater palatine vessels and ant, middle , post
palatine nerve.
• In front of hiatus, an oblique ridge called conchal crest, it is articulate
with inferior nasal concha and descending process of lacrimal bone
articulate, it is form nasolacrimal canal ,which transmits nasolacrimal
duct to the inferior meatus of nose.
• Above the conchal crest, shallow depression forms a part of atrium
of middle meatus of nose.

14. FRONTALPROCESS
• Projects upwards and backwards.
• Above , articulate with nasal margin of frontal bone.
• Below , articulate with nasal bone.
• Behind, articulate with lacrimal bone.
• 2 surfaces-
Lateral surface-
• Divided by lacrimal crest, smooth anterior part and
grooved posterior part.
• Lacrimal crest gives attachment to lacrimal facia and
medial palpebral ligament.
• Anterior part provides attachment of orbicularis oculi
(above and below to ligament) and levator labii superioris
alaeque nasi (in front of orbicularis occuli).
• Posterior grooved area forms anterior half of lacrimal
groove, which lodege lacrimal sac.

15. ZYGOMATICPROCESS
• Pyramidal lateral projection.
• Situated at the junction of ant, post and
superior surfaces.
• In front and behind, it is continuous with
corresponding surface of the body.
• Superiorly, it is rough for articulation
with zygomatic bone.

16. ALVEOLARPROCESS
• Forms half of the alveolar arch and bears
socket for the roots of upper teeth.
• Eight sockets - canine socket is deepest,
molar socket is widest and divided into
three minor socket by septa.
• Incisor and 2nd premolar sockets are single
and 1st premolar socket is sometimes divided
in to two.
• Buccinator arises from the posterior part of
its outer surface up to the first molar tooth.

17. PALATINEPROCESS
• Horizontal plate projecting medially forms a large part of the roof
of mouth and floor of nasal cavity.
• Inferior surface is concave,2 palatine process form anterior ¾ of
hard palate and it presents vascular foramina and pits for palatine
glands.
• Posterolaterally , 2-3 grooves for greater palatine vessels and
anterior palatine nerves.
• Posterior border articulate with horizontal plate of palatine bone.
• Lateral border continuous with the alveolar process.
• Anterior ridge is high called incisor crest, which terminate
anteriorly as anterior nasal spine.
• Incisive foramen located in midline of the palate posterior to
central incisors, which transmits the greater palatine artery and vein
from oral to nasal cavity and nasopalatine nerve from nasal to oral
cavity.

18. DEVELOPMENT OF
MAXILLA
1. MAXILLA
PROPER
2. PREMAXILLA
3. ACCESORY
CARTILAGES

19. MAXILLAPROPER
• Develops in the mesenchyme of the
maxillary process of the 1st
branchial arch.
• Intramembranous ossification
• The ossified tissue appears as a thin
strip of bone.

20. • Ossification spreads as follow:
 Backward : below the orbit toward the developing
zygomatic bone.
 Forward : toward the future incisor region.
 Upward : to form the frontal process of the maxilla.
 Bony trough is formed infra orbital groove
 The inner and outer edges of the groove grow up,
meet and fuse forming a canal that encloses the nerve
& open anteriorly at the infra orbital foramen.
 Downward : to form the outer alveolar plate
for the maxillary tooth germs
 Toward the midline : ossification spreads with the
development of the palatal process in the substance of the
united palatal folds to form the hard palate.

21. DEVELOPMENTOFMAXILLARYSINUS
• At 4 months of IU as a small depression
of the mucosa of the lateral wall of the
nasal cavity
• In its gradual extension the sinus comes
into relation with the maxilla above the
level of the palatal process &hallow out
the interior of the bone, so separating its
upper or orbital surface from its lower or
dental region.

22. PREMAXILLA
Two centers of ossification for the premaxilla:
a) The palato-ficial center:
• Appear at the end of 6 WIU . It starts close to the external
surface of the nasal capsule, in front of the anterior superior
dental nerve and above the germ of the lateral deciduous
incisor.
 From this center bone formation spreads:
• To form the inner wall of their alveolar & palatal part of
the premaxilla.
b) The prevomerine center:
• It begins at about 8-9WIU along the outer alveolar wall it is
situated beneath the anterior part of the vomer bone and it
forms that part of the bone lies mesial to the nasal paraseptal
cartilage.

23. ACCESORYCARTILAGE
Accessory cartilaginous center appears in the region of the future
zygomatic or malar process and this undergoes rapid ossification &adds
considerable thickness to the bulk of the part.
Small area of secondary cartilaginous center appears along the growing
margin of the alveolar plate.
In the middle line of the developing hard palate between the two palatine
processes.

24. AGE CHANGES
AT BIRTH
The transverse and anteroposterior diameters are each more than
the vertical diameter
Frontal process is well marked
Body consist of a little more than the alveolar process
the tooth sockets close to the floor of orbit
Maxillary sinus is a mere furrow on the lateral wall of the nose
INADULT
Vertical diameter is greatest due to development of the
alveolar process and increase in the size of the sinus.
IN OLD
The bone reverts to infantile condition its height is reduced
as a result of absorption of the alveolar process.

25. Maxillarysinus
• It is the largest bilateral air containing cavity ,occupying the
body of maxilla, open into the nasal cavity by a single or
multiple opening.
• It is described as 4 sided pyramid wall :
 Anterior wall: to facial surface of maxilla (region to canine,
premolars)
 Posterior wall : to infra temporal surface of maxilla.
 Inferior floor : to alveolar process, 1mm below the level of
the floor of the nose
 Superior roof : floor of orbit.

26. Relationwithmaxillaryteeth
• The apices of the roots ( specially of palatal roots)
of 1st ,2nd molars are usually near to the floor of
sinus followed by 2nd and 1st premolar , canine and
3rd molar respectively.
• Formed convexity toward floor of the sinus.
• Fractured root tip push in to the floor of the sinus
due to close relation between root tip and sinus ,
this lead to infection of sinus and oroantral
communication.

27. Pneumatization of maxillary sinus
• It is process of growth by bone resorption on internal wall of
sinus & bone deposition on outer surface of maxilla.
• Maxillary sinus extended to many processes :
oOutward to zygomatic process.
oInward, upward to frontal process.
oDownward to alveolar process.
• When it extend downward into alveolar process; the apices of
the roots may appears protruded into sinus.

28. MUSCLE ATTACHMENT
 GROUP OF THE MUSCLE WHICH ORIGINATE/
INSERT ON THE MAXILLARY BONE
Levator labii superioris-
• Origin - Arises From The Maxilla Just Superior To
The Infra Orbital Foramen.
• Insertion – Blend with the orbicularis oris and insert
in to skin of the upper lip.
• Action - raises upper lip; helps to form nasolabial
furrow (smile line).

29. LEVATOR LABII SUPERIORIS
ALAEQUE NASI
It is medial to levator labii superioris, arises
from the maxilla next to the nose, and insert into
both the alar cartilage of nose and skin of the
upper lip.
LEVATOR ANGULI ORIS
It is more deeply placed and covered by the
other two levators and the zygomaticus muscle,
arises from the maxilla, just inferior to the infra
orbital foramen, and insert into the skin at the
corner of the mouth.

30. ORBICULARISORIS
• It is the complex muscle that completely
encircle the mouth.
• ORIGIN- some fibers originate near
midline from the maxilla superiorly and
the mandible inferiorly, other fibers are
derived from both buccinator, in the cheek.
• INSERTATION- forms ellipse around
mouth; insert into the skin and mucous
membrane of lips.
• ACTION- contraction of the muscle
narrows the mouth and close the lips.

31. ORBICULARIS OCULI
Large Muscle That Encircle The Orbital Orifice and
extend into each eyelids.
3 parts of the muscle:
1. Orbital part
2. Palpebral part
3. Lacrimal part
• ORBITAL PART
o ORIGIN – frontal process of maxilla; medial
palpebral ligament.
o INSERTION- fibers forms uninterrupted ellipse
around orbit.
o ACTION- closes the eye more forcefully and
produce wrinkling on the forehead.

32. BUCCINATOR
• It occupying the interval between the maxilla
and the mandible at the side of the face.
• Forms the muscular component of the cheek.
o ORIGIN- posterior part of maxilla and
mandible; pterygomandibular raphe
which separates it from the superior
pharyngeal constrictor muscle.
o INSERTION- blend with orbicularis oris.
o ACTION- the buccinators compress the
cheeks, so that , during the process of
mastication , the food is kept under the
immediate pressure of the teeth.
• It aids whistling and smiling and in neonates
it is used to suckle.

33. NASALIS
• Consists of two parts:
TRANSVERSE PART -
ORIGIN- maxilla just lateral to nose.
INSERTION –across dorsum of the nose
with muscle fibers from the other side.
ACTION- compresses nasal aperture.
ALAR PART -
ORIGIN- maxilla over lateral incisor.
INSERTION- alar cartilage of nose.
ACTION- draws cartilage downward and
laterally opening nostril.

34. 31- ORBICULARIS
OCCULI
34-NASALIS
35-LEVATOR LABI
SUPERIORIS
ALAEQUE NASI
36-LEVATOR LABI
SUPERIORIS
37-ORBICULARIS
ORIS

35. BLOOD SUPPLY
• At about the level of hyoid bone each common
carotid artery divides into an external carotid
artery and an internal carotid artery.
• Internal carotid artery supplies the tissues of
the cranium and the eyes.
• External carotid artery, with its many branches,
supplies the exterior of the head ,the face and
much of the neck.

36. • At about the level of the lower part of the ear,
the external carotid divides into its two main
terminal branches, the maxillary artery and
the superficial temporal artery.
• Maxillary Artery Through Various Branches
Supply The Bones Of The Jaws, The Teeth
And Their Supporting Tissues.

37. Important branches of maxillary artery are:
Branches of the maxillary artery Supplies blood to
Inferior alveolar artery -Supplies mandible and mandibular teeth.
-enters to mandible through mandibular
foramen.
Posterior superior artery -supplies the maxilla and the roots of the last
maxillary molar tooth.
-bone and teeth including the first bicuspid.
Greater palatine and lesser palatine artery -supplies the soft tissue of the hard palate ,
gingival tissue on the palatine and maxillary
teeth.
-emerges into the roof of the mouth through the
greater palatine foramen.
Infra orbital artery -supplies incisors and cuspids of the maxilla.

38. VENOUS DRAINAGE
• The maxilla is mainly drained by the
maxillary vein.
• The two maxillary veins are the outlet of the
large and dense pterygoid venous plexus
which surrounds the maxillary artery in the
infratemporal fossa.
• The pterygoid plexus of veins, into which
the veins of the deep structures of the face
open, is situated between temporal and
lateral pterygoid.

39. • The pterygoid plexus drains into the
maxillary vein.
• Maxillary vein drains into the
retromandibular vein which in turn drains
into internal jugular vein.
• Internal jugular vein finally drains into
the subclavian vein.

40. NERVE SUPPLY
• Nasopalatine nerve -
oIt enters the nasal cavity through the
sphenopalatine foramen, passes across the
roof of the nasal cavity below the orifice of
the sphenoidal sinus to reach the septum.
oIt runs obliquely downward and forward
between the periosteum and mucous
membrane of the lower part of the septum.
oIt descends to the roof of the mouth through
the incisive canal and it supplies palatal
structure around maxillary teeth.

41. • Greater palatine nerve -
oIt descends through the greater
palatine canal, emerges upon the
hard palate through the greater
palatine foramen.

42. • Posterior superior alveolar nerve -
oThe posterior superior alveolar nerves enter the
bone surface through two or three fine openings, the
posterior superior alveolar foramina.
oThey lead into narrow canals which run downward
and forward in the thin wall of the maxillary sinus
and supply the posterior teeth in the maxilla.
oInferior orbital fissure carries infraorbital nerve. it
supplies the soft tissue after exiting the infraorbital
canal anteriorly.
o The infraorbital fissure and canal it gives out a
branches called the middle and anterior superior
alveolar nerve which supply the teeth of the maxilla
anastomosing with the posterior superior alveolar
nerve.

44. SUPPORTIVE PILLARS :
• Canine pillar: It starts in the region of the alveolar
process of the canine, forms the lateral boundary of the
anterior nasal aperture and continues as the frontal process
of the maxilla to the frontal bone.
• Zygomatic pillar: It starts in the region of the first molar,
bends upward and outward as the zygomaticoalveolar
crest and the zygomatic process of the maxilla to continue
toward the frontal process of the zygoma to end at the
zygomatic process of the frontal bone.
• Pterygoid pillar: It is the pterygoid process of the
sphenoid bone to which the pyramidal process of the
palatine bone is anchored. These vertical pillars are braced
against each other by the superior and inferior orbital rims
and the zygomatic arch.

45. VERTICALAND HORIZONTAL BUTTRESSES
According to Bennignhoff –
 Vertical trajectories
 Frontonasal buttress
 Malarzgomatic buttress
 Pterygoid buttress
 Horizontal trajectories
 Hard palate
 Orbital margin
 Zygomatic arches
 Palatal bone
 Lesser wing of sphenoid

46. Pathologic condition of maxillary sinus
 Maxillary sinusitis
 Odontogenic cystic lesion of maxillary sinus
 Tumors of maxillary sinus

47. Maxillary sinusitis of dental origin
• Dental abscess (periodontal and
periapical infection)
• Infected dental cyst
• Oro-antral communication

48. OROANTRAL COMMUNICATION ANDOROANTRALFISTULA
• Maxillary sinus perforation occurs
occasionally during the extraction of
a maxillary tooth, and it may be a
cause of maxillary sinusitis or oro-
antral fistula.
• Less chances in patient below the age
of 15 year due to incomplete
development of sinus.
• Root which is most close to the sinus
is “palatal root of maxillary 2nd
molar”.

49. Symptoms Of Fresh Oroantral Communication
• Escape Of Fluids
• Epistaxis
• Escape Of Air
• Excruciating Pain

50. Symptoms Of EstablishedOroantral Fistula.
• Pain.
• Persistent purulent unilateral nasal
discharge.
• Popping out of antral polyp.

51. Cystic lesion of maxillary sinus
• Radicular cyst - appear at apical portion of root.
• Dentigerous cyst - usually appear on the impacted 3rd molar.
• Mucous retention cyst - very common, expansile, destructive.

52. TUMORS OF MAXILLARY SINUS
Benign tumor-
 Ameloblastoma – most common tumor affecting to maxillary sinus.

53. Malignant tumor
 Squamous cell carcinoma -
- most common malignant tumor.
- invasive and destructive lesion.

54. MAXILLARY FRACTURE
• The middle third of the facial skeleton
consists of a series of bone struts
(buttresses) passing upwards from the upper
teeth to the bones of the skull .
• Midface acts as a cushion for the trauma
directed toward the cranium from the
anterior or anterolateral direction analogous
to a “matchbox” sitting below and in front
of a hard shell containing the brain.
• Violent forces to this region are dissipated
or absorbed by fractures of the maxilla and
other facial bones, and thus offer protection
to the brain and spinal cord .

55. THANK YOU