Maxillary Sinus for 1st BDS students

1. MAXILLARY SINUS
DR.SMITHA RA0

2. CONTENTS
 Introduction
 Paranasal sinuses
 Maxillary sinus
-Definition
-Development
-Anatomy
-Histology
-Functional importance
 Clinical considerations
-Developmental anomalies
-Infections
-Pathologic conditions
 Conclusion

3. Introduction

4. PARANASAL SINUSES
MAXILLARY
SINUS
FRONTAL
SINUS
ETHMOID
SINUS
SPHENOID
SINUS

5. PARANASAL SINUSES

6. PARANASAL SINUSES
 Arranged in pairs
 Except ethmoidal sinuses-3 groups of air-filled
spaces
 All of them open into the nasal cavity through its
lateral wall
 Lined by mucous membrane consisting of
ciliated columnar epithelium

7. PARANASAL SINUSES
 Pneumatic diverticula from the nasal cavity
 Process begins prenatally
 Continues through the course of an organism's lifetime
 At birth→ rudimentary/ absent. Enlarge rapidly →6-7
years. (during time of eruption of permanent tooth and
then after puberty)
 Birth to adult life, the growth→ resorption of the
surrounding cancellous bone

8. MAXILLARY SINUS
 Also k/a ANTRUM OF HIGHMORE.
 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

9. MAXILLARY SINUSES

10. Development

11. MAXILLARY SINUS
 Horizontal shift of palatal shelves
 Fusion of the 2 shelves with one
another
 Fusion with the nasal septum
 Nasal septum separate the secondary
oral cavity from 2 secondary nasal
chambers
 Folding of lateral nasal wall→ 3 nasal
conchae & 3 nasal meatus

12. MAXILLARY SINUS

13. MAXILLARY SINUS
 Established in the embryo of about 32
mm CRL
 Expands vertically into the primordium of
the maxillary body
 Diameter -1mm in 50mm CRL fetus
3.5mm in 160mm CRL fetus
7.5 mm in 250 mm CRL fetus

14. Anatomy

15. Measurements:
 Vertical (height): 3.5 cm
 Transverse (width): 2.5 cm
 Antero-posterior (depth): 3.25 cm
MAXILLARY SINUS

17. MAXILLARY SINUS
 Roof → floor of the orbit
 Floor→ alveolar process of the maxilla, very
small
 Base→ nasal surface of body of maxilla
 Apex→ extends into the zygomatic process of
the maxilla
 Anterior wall→ infraorbital plexus of nerves
canalis sinuosus.
 Posterior wall →anterior boundary of
infratemporal fossa

18. MAXILLARY SINUS
 Opens into
middle meatus of
the nose in the
lower part of the
hiatus
semilunaris
 Second opening
is often present
at the posterior
part of the hiatus

19. MAXILLARY SINUS

20. MAXILLARY SINUS
 Openings are nearer the roof than
the floor of the sinus

21. MAXILLARY SINUS
 Septa in the
maxillary sinus give
a compartmentalized
appearance to the
sinus

22. MAXILLARY SINUS
Pneumatization of the sinus:
 is the enlargement of a sinus by resorption of alveolar bone that
formerly served to support a missing tooth or teeth and then
occupies the edentulous space.
 A thin cortex remains over the alveolar ridge (arrow) to maintain
a normal contour. Maxillary sinus showing septa that divide it into
separate compartments

23. MAXILLARY SINUS
Arterial supply Anterior superior alveolar artery
Middle superior alveolar artery
Posterior superior alveolar artery
Venous drainage Facial vein
Pterygoid plexus of veins
Lymphatic
drainage
Submandibular lymph nodes
Nerve Supply Anterior superior alveolar nerve
Middle superior alveolar nerve
Posterior superior alveolar nerve
Branches of maxillary nerve
Branches of infra-orbital nerve

24. Histology

25. MAXILLARY SINUS

26. HISTOLOGY:
 3 microscopically distinct layers surround the
space of the maxillary sinus:
 Epithelial layer
 Basal lamina
 Sub epithelial layer- including the periosteum

27. HISTOLOGY
 . It is lined by pseudo stratified ciliated
columnar epithelium.
 .
 The epithelial layer is mainly composed of
ciliated columnar cells. Along with these,
there are non ciliated columnar cells, basal
cells and goblet cells.

28. GOBLET CELL

29. GOBLET CELL
 Goblet cells are unicellular secretary organ
which are goblet shaped with a basally
placed nucleus and apical cytoplasm filled
with secretory products, producing mucous.
In a hematoxylyn and eosin stained section
cytoplasm of goblet cells appear empty. Cilia
of the lining epithelium help to move the
secretions.

30. HISTOLOGY
 This epithelium is separated from sub
epithelial connective tissue by a basal
lamina.
 Sub epithelial connective tissue layer has
collagen fibers and fibroblasts and also minor
salivary glands which include both serous
and mucous glands. This layer is attached to
the periosteum of the bone of the maxilla.

31. MAXILLARY SINUS
Important Histologic features:
1. Pseudo stratified ciliated columnar
epithelium
2. Goblet cells
3. Both serous & mucous minor salivary
glands

32. Functions

33. MAXILLARY SINUS
 Accessory space to nasal cavity
 Humidifying & heating of inhaled air
 Protects internal structures like brain, &
eyeball against exposure to cold air
 Resonance of voice
 Lightening of skull weight
 Resistance to mechanical shock

34. Clinical
considerations

35. MAXILLARY SINUS
Developmental anomalies:
 Supernumerary maxillary sinus
 Agenesis
 Aplasia/ hypoplasia

36. MAXILLARY SINUS
 Supernumerary maxillary sinus:
occurrence of two completely separated
sinuses on the same side

37. MAXILLARY SINUS
 Agenesis: complete absence of sinus

38. MAXILLARY SINUS
 Aplasia/ hypoplasia:
altered/ under development –alone or in
association with other anomalies like-
cleft palate, high palate, septal deformity,
absence of concha, mandibulofacial
dysostosis

39. CLINICAL CONSIDERATION
Maxillary sinusitis
 Inflammation of the sinus
lining - Sinusitis
 Commonly caused
by bacterial, viral, & / or
microbial infections; as
well as, structural
issues such as blockage
of the sinus opening
(ostium).
 If the ostium becomes
swollen normal mucus
drainage may not occur.
Which may lead to
infection & inflammation
of the sinuses

40.  It causes headache with thick purulent
persistent discharge from nose
 Diagnosed by:- transillumination &
radiograph
 In chronic cases:- superior alveolar nerve
is involoved & may cause pain.
(Examination of maxillary sinus &
maxillary teeth is required—due to
pathology)

41. RELATIONSHIP OF MAXILLARY SINUS &
MAXILLARY MOLAR
 The roots of the
maxillary first and
second molars are in
intimate relation to the
floor of the maxillary
sinus .

42. MAXILLARY SINUS
Infections:
Sinusitis:
 an inflammation of the paranasal sinuses, which may or may not
be as a result of infection from bacterial, fungal, viral, allergic or
autoimmune issues
-(Wikipedia, the free encyclopedia)
Rhinosinusitis:
 Newer classifications of sinusitis refer to it as rhinosinusitis
 Taking into account the thought that inflammation of the
sinuses cannot occur without some inflammation of the nose as
well (rhinitis)
(-Ramadan H, Sanclement J, Thomas J (2005). “Chronic rhinosinusitis and
biofilms.". Otolaryngol Head Neck Surg 132 (3): 414–7)

43. MAXILLARY SINUS
Sinusitis:
Classification:
A. By location
B. By duration

44. MAXILLARY SINUS
Sinusitis:
Classification:
A. By location:
 Maxillary sinusitis - pain or pressure in the maxillary
area
 Frontal sinusitis - pain or pressure in the frontal sinus
cavity
 Ethmoid sinusitis - pain or pressure pain
between/behind eyes
 Sphenoid sinusitis - pain or pressure behind the eyes,
but often refers to the vertex of the head

45. MAXILLARY SINUS
Sinusitis:
Classification:
B. By duration:
 Acute: going on less than four weeks
 Subacute: between 4-12 weeks
 Chronic: going on for 12 weeks or more
(-Harrison's Manual of Medicine 16/e)

46. MAXILLARY SINUS
Acute Sinusitis:
 Precipitated by an earlier URT infection→ viral
 Most common: Haemophilus influenzae, Streptococcus
pneumoniae, Moraxella catarrhalis, Staphylococcus
aureus
 Others: dental problems, fungal invasion, diabetes or
other immune deficiencies
 Blocking of openings to the sinuses, allergies
Maxillary sinusitis caused by apical
infection and extensive periodontal
lesions involving the molars and
premolar

47. MAXILLARY SINUS
Symptoms :
 Pain, tenderness, and swelling
 Yellow or green pus
 Fever & chills
 Change in vision or swelling around the eye→
very serious condition

48. CONTD……
Histologic feautures:
 Acute inflammatory infiltrate with edema of
the connective tissue
 Squamous metaplasia of the specialized
ciliated columnar epithelium

49. MAXILLARY SINUS
Acute Sinusitis:
Diagnosis :
 Typical symptoms
 Radiographic studies
 Computed tomography (CT)
 Check for dental abscesses
 Endoscopic view
Left-sided maxillar sinusitis
(Absence of the air transparency
of left maxillar sinus)

50. MAXILLARY SINUS
Management:
 Antihistamine along with decongestant or pain
reliever
 Antibiotics
 Rest
 Nasal irrigation/sparys
 Hot drinks
 Most cases of acute sinusitis, antibiotics and
nasal corticosteriods work no better than a
placebo”
Pulsating nasal irrigator
(Ian G. Williamson et al. "Antibiotics and Topical Nasal Steroid for
Treatment of Acute Maxillary Sinusitis". JAMA 2007; 298: 2487–249)

51. MAXILLARY SINUS
Chronic Sinusitis:
 Multifactorial→ allergy, environmental factors such as
dust or pollution, bacterial infection, or fungus (either
allergic, infective, or reactive)
 Non allergic factors→ Vasomotor rhinitis can also cause
chronic sinus problems
 Abnormally narrow sinus passages,
 Streptococcus bacteroides,veillonella species

52. MAXILLARY SINUS
Diagnosis :
 Typical symptoms
 Radiographic studies
 Computed tomography (CT)
 Allergy test
 Nasal endoscopic view

53. MAXILLARY SINUS
Chronic Sinusitis:
Maxillary sinusitis
exhibiting a fluid level
(arrow) in the right
antrum

54. MAXILLARY SINUS
Fungal Sinus Infections:
 Fungi can cause significant nasal and sinus
inflammation
 “Triggers” & incite an inflammatory response in
susceptible individuals
 Fungus balls are an overgrowth of fungi in
otherwise healthy people
 Symptoms: sinus pain, pressure, nasal
congestion, drainage of fluids, chronic infections

55. MAXILLARY SINUS
Fungal Sinus Infections:

56. MAXILLARY SINUS
Fungal Sinus Infections:
Allergic fungal sinusitis:
 Fungi cause a reaction characterized by marked
nasal congestion and the formation of nasal and
sinus polyps
 Polyps obstruct the nose and the openings to
the sinuses and produce chronic inflammation
 Involve only one side of the nose
 Management: Surgery/corticosteroids/
antibiotics/ antifungal drugs

57. MAXILLARY SINUS
Fungal Sinus Infections:
Invasive fungal sinusitis:
 Very serious disorder
 In those immune system is impaired by
chemotherapy or by diseases such as poorly
controlled diabetes, leukemia, lymphoma, multiple
myeloma, or AIDS
 Symptoms: pain, fever, and discharge of pus from
the nose
 The fungus may spread to the eye socket, causing a
bulging of the affected eye (proptosis) and blindness
 Management: Biopsy, surgery, antifungal drugs

58. Pathologic
conditions

59. MAXILLARY SINUS
Chronic abscesses:
 loss of the outline of the lower border of the
sinus where it abutted the associated tooth

60. MAXILLARY SINUS
Tooth displacement:
Need to be differentiated from
sinus bone nodules &
antroliths
Pathologic conditions of maxillary sinus:

61. MAXILLARY SINUS
Tooth displacement:
 Tooth in the maxillary sinus

62. MAXILLARY SINUS
Antrolith:
•Antroliths are calcified
masses found in the
maxillary sinus
•They are formed by
deposition of calcific material
on a nidus such as a root
fragment, bone chip, foreign
object, or a mass of stagnant
mucus in sites of previous
inflammation

63. MAXILLARY SINUS
Foreign bodies:
 needs to be made to differentiate between clearly
demarcated real images, and blurred magnified ghost
images of foreign bodies

64. MAXILLARY SINUS
Oro-antral fistula:
 following dental extraction are only noticeable on
panoramic radiography when large and within the
panoramic image layer

65. Conclusion

66. MAXILLARY SINUS
 The growth of tumors within the maxilla is not
concentric
 Hence, the site of origin is not necessarily the
epicenter of the lesion
 The early detection of insidious maxillary sinus
disease can be very important for the patient’
prognosis, especially in the case of malignant
neoplasia

67. References

68.  B.D Churasia’s Human Anatomy, Vol 3, 3rd Edn
 Maji Jose Oral histology & Oral Pathology, 1st Edn
 Neville, Oral & Maxillofacial Pathology, 2nd Edn
 Shafer’s T.B. of Oral Pathology, 5th Edn
 Orban’s Oral histology & Embryology, 12th Edn
 Wood & Goaz, Differential Diagnosis Of Oral &
Maxillofacial Leions, 5th Edn
 Bricker, Oral diagnosis, Oral medicine &
Treatment Planning, 2nd Edn