This document provides an overview of the maxilla bone including its development, features, blood supply, age changes, and maxillary sinus elevation procedures. Some key points: - The maxilla develops from ossification centers and contributes to the formation of the face, nose, mouth, orbit, and palate. - Features include the body, frontal process, zygomatic process, alveolar process, and palatine process. The maxillary sinus is located within the body. - The maxillary sinus expands with age, sometimes exposing tooth roots. Sinus elevation procedures use grafts to augment the bone for dental implants. - The second molar is often close to the floor of the

2.  PRESENTED BY –Dr.SONI
BISTA
(1st year PG student)
UNDER THE GUIDANCE:
Prof.DR.C.S. SAMBI(H.O.D)
DR.VIKASH KUMAR(ASST.PROF)

3. CONTENTS
 INTRODUCTION
 DEVELOPMENT
 FEATURES OF MAXILLA
 MAXILLARY SINUS
 AGE CHANGES IN MAXILLA
 VASCULATURE
 MAXILLARY SINUS ELEVATION AND AUGMENTATION
 RESOURCES

4. INTRODUCTION
 2nd largest bone of face
 Paired bone
 2 maxillae forms whole of upper jaw
 Hollowed out by the maxillary sinus
and nasal cavity.
 Each maxilla contributes in
formation of –
1. Face
2. Nose
3. Mouth
4. Orbit
5. Infratemporal fossa
6. Pterygopalatine fossa

5. DEVELOPMENT OF MAXILLA
 MAXILLA develops from ossification in mesenchyme of maxillary process
of 1st arch.
 No arch cartilage / primary cartilage
 Center of ossification:
close to the cartilage of nasal capsule in angle
between division of infraorbital nerve.
 From this center the bone formation spreads
Posteriorly – below the orbit toward the developing maxilla
Anteriorly – toward the future incisor region
Superiorly – to form frontal process
Medially – to form palate

6. According to B.D. Chaurassia’s human anatomy 4th
edition vol. 3 The Head & Neck
 MAXILLA ossifies from 3 centers in the membrane –
1. 1 center for maxilla proper – 6th week of IUL, above
the canine fossa
2. 2 centers for premaxilla
Of 2 premaxillary centers-
o Main center above the incisive fossa - 7th week of IUL
o Second center – ventral margin of nasal septum - 10th
week of IUL
soon fuses with palatal process of maxilla.
Premaxilla begin to fuse with alveolar process almost
immediately after the ossification begins.

8.  Bony trough for infraorbital canal is formed .
From this trough a downward extension of bone forms the
lateral alveolar plate.
 Medial alveolar plate – from junction of palatal process & main body of
forming maxilla…..
These plates forms a trough of bone around the maxillary tooth germ.
 There is contribution of secondary cartilage.
 Zygomatic / malar cartilage adds in development of maxilla.

9. FEATURES OF MAXILLA
 Each maxilla has –
1. A body
2. 4 processes – frontal
zygomatic
alveolar
palatine

10. BODY OF MAXILLA
Shape – pyramidal
 It has –
4 surfaces – anterior / facial
posterior / infratemporal
medial / nasal
superior / orbital
Encloses a cavity – maxillary sinus
Nasal
surface
Zygomatic
process

11. MAXILLARY SINUS
 Also called as antrum of Highmore(1651).
 Occupy the body of the maxilla
 Largest of the paranasal sinus, communicates
with other sinus through lateral nasal wall.
 Air filled cavity.
 pCO2: 110 mmHg
.
B
O
R
D
E
R
S
Floor of the orbit
Lateral wall of the
nasal
cavity
Lateral wall of the maxilla, alveolar process and the zygomatic arch
Average measurement:
Height: 3.5 cm
Width: 2.5cm
Depth: 3.5 cm

12. oPyramidal in shape; Base directed medially towards the
lateral wall of nose and
Apex directed laterally into the zygomatic process of
maxilla.
oIts roof is formed by the floor of the orbit and is
traversed by the infraorbital nerve.
oIts floor is formed by the alveolar process of maxilla
and lies about 1 cm below the level of the floor of the
nose.
oThe roots of maxillary 1st and 2nd molar are often close
to the floor of the sinus
Less frequently: roots of premolars and 3rd molars.

13. MAXILLARY NASAL SEPTA
•Subdivided (incompletely) into recesses by one or more septa.
•Frequently present(upto 39% of sinuses)_Ella B et al(2008)
•CT scans are prefered more to detect septa than panoramic radiograph
•Septa are found in anterior (24%), middle(41%), posterior(35%)
of the maxillary sinus,with the most common location
between 2nd premolar and 1st molar_Kasabah S et al (2002)
•The height of the septa vary as well, ranging from 0 to 20.6mm
•Only 0.5% of septa form complete separation of the sinus spaces
into separate chambers.
Lined with a thin mucosal membrane called the schneiderian membrane.
Entrance: through the orifice or maxillary duct(orifice:3-6mm in length and diameter.
located at the superior medial aspect the cavity)
occasional accessory opening is found inferior and posterior to the main opening.
Drains: into the middle meatus (orban’)of the main cavity through maxillary duct, which
passes secretions medially to the semilunar hiatus of lateral nasal cavity.
Normal amount of secretion are moved from the sinus by the spiral pattern of beating (respiratory)cilia
surrounding the orifice.
Inflammation/Infection: Impairs the drainage…….The floor of the maxillary sinus extends down below the
nasal cavity into alveolar process.

14. BLOOD SUPPLY
Superior alveolar branches of maxillary
artery
Greater palatine artery
Infraorbiatl artery
Facial artery
VENOUS DRAINAGE
Via the pterygoid plexus
Facial vein
NERVE SUPPLY
Superior alveolar nerve
(anterior,middle,posterior),
Branches of maxillary artery
Infraorbital nerve
LYMPHATIC DRAINAGE
Submandibular lymph nodes

16. ANTERIOR / FACIAL SURFACE
 Directs laterally
 Incisive fossa -depressor septi,
orbicularis oris
 Canine fossa –levator anguli oris
 Infraorbital foramen(above canine fossa)
infraorbital nerves and vessels
 Above sharp border between anterior
and orbital surface:
levator labii superioris
 Medially – the nasal notch
- anterior nasal spine

17. POSTERIOR / INFRATEMPORALSURFACE
 Concave
 Directed – backward & laterally
 Forms – anterior wall of
infratemporal fossa
 Separated from anterior surface
 2-3 alveolar canals for –
posterior superior alveolar nerve
 Posteroinferiorly – maxillary
tuberosity & superficial head of
medial pterygoid muscle
 Above maxillary tuberosity -
anterior wall of infratemporal
fossa, grooved by maxillary nerve

18. SUPERIOR / ORBITAL SURFACE
 Smooth, triangular & slightly concave
 Forms – Greater Part Of Floor Of Orbit
 Anterior border forms – part of inferior orbital margin
continues with lacrymal crest of
frontal process.

19. Posterior border –
 smooth & rounded
 Forms most anterior margin of
inferior orbital
fissure
 In middle – infraorbital groove
Medial border –
 Anteriorly lacrymal notch, converted into
nasolacrymal canal
 Behind the notch, articulation with -
Lacrymal
Labrynth of ethmoid
Orbital process of palatine bone

20. The superior surface presents –
 Infraorbital groove & canal
 Canalis sinosus
 Inferior oblique muscles

21. THE MEDIAL /NASAL SURFACE
 Part of lateral wall of nose
 Posterosuperiorly – maxillary hiatus
 Above the hiatus – air sinuses
 Below the hiatus – anterior part of inferior meatus
 Behind the hiatus –
articulates with
perpendicular plate of
palatine bone
&
encloses greater
& lesser palatine canals

22. THE MEDIAL /NASAL SURFACE
 Infront of the hiatus –
nasolacrymal groove articulates with
descending process of lacrymal bone &
lacrymal process of inferior nasal concha to
forms nasolacrymal canal

23. THE MEDIAL /NASAL SURFACE
 More anteriorly – conchal creast for
articulation with inferior nasal concha.
 Above the conchal crest – atrium of middle
meatus.

24. PROCESSES
OF
MAXILLA
1. FRONTAL
2. ZYGOMATIC
3. ALVEOLAR
4. PALATINE

25. FRONTAL PROCESS
 Projects upward & backwards to
articulate
above – nasal margin of frontal
bone
in front – nasal bone
behind – lacrymal bone
 Lateral surface – divided by
anterior lacrymal crest into
anterior smooth & posterior
grooved
 Medial surface – forms lateral
wall of nose

26. ZYGOMATIC PROCESS
 Pyramidal lateral projection
 Anterior, posterior & superior surfaces converge
here
 Superiorly – rough, to articulate with zygomatic bone

27. ALVEOLAR PROCESS
 Forms half of alveolar arch
 Bears socket for maxillary teeth
 In adults = 8 sockets
 Buccinator arises from posterior part of its outer
surface upto 1st molar tooth.
 Maxillary torus (occasionally)

28. PALATINE PROCESS
 Thick horizontal plate
 Projecting medially
 Forms largest part of roof & floor
 Inferior surface – concave & forms anterior 3/4th of
bony hard palate.

29.  Various foramina & pits
 Posterolaterally –
greater & lesser
palatine foremen
 Superior surface –
concave from side to
side & forms floor of
nasal cavity.

30. Medial border –
 Thicker anteriorly
 Groove between
nasal crest of 2 maxilla receives lower border vomer
 Anterior part of ridge – incisal crest & anterior nasal spine,
Incisive canal
Posterior border articulates with horizontal plate of palatine bone
Lateral border is continuous with alveolar process.

31. ARTICULATIONS OF MAXILLA
 Superiorly– 3 bones
1. Frontal
2. Nasal
3. Lacrymal
 Laterally– 1 bone
1. Zygomatic bone
Medially– 5 bones
1. Ethmoid
2. Inferior nasal concha
3. Vomer
4. Palatine
5. Opposite maxilla

32. AGE CHANGES IN MAXILLA
 AT BIRTH –
1. Transverse & anterioposterior diameter > vertical diameter
2. Well marked frontal process
3. Body consists of little more than alveolar process
4. Tooth sockets – close to orbit
5. Maxillary sinus is a mere furrow on the lateral wall of nose
 IN ADULTS –
Vertical Diameter Is More due to –
1. Developed alveolar process
2. Increased size of maxillary sinus
 IN OLD –
1. Infantile condition
2. Resorption of alveolar bone
MAXILLARY SINUS
With increasing age , it expands,
becoming more and more
pneumatized down around the
roots of the maxillary teeth,
sometimes resulting in exposure
of the roots through the bony
floor into the sinus

33.  Terminal branch of nasopalatine nerve and vessels pass through the incisive
canal,which opens in the midline anterior area of the palate.
 The greater palatine foramen opens 3 to 4 mm anterior to the posterior border
of the hard palate. Greater palatine nerve and vessels emerge through this
foramen and run anteriorly in the submucosa of the palate, between palatal and
alveolar processes. Palatal flaps and donor sites should be carefully performed
and selected to avoid invading these areas because profuse hemorrhage may
ensue, particularly if vessels are damaged at the palatine foramen. Vertical
incisions in the molar regions should be avoided.
 The submucous layer of the palate protects the vessels and nerves.
 The area distal to the last molar called maxillary tuberosity consists of the
posterior-inferior angle of the infratemporal surface of the maxilla. Medially it
articulates with the pyramidal process of the palatine bone. It is covered by
dense, fibrous connective tissue and contains the terminal branches of the
middle and posterior palatine nerves. Excision of the area for distal flap
surgery may reach medially to the tensor palati muscle.

35. MAXILLARY SINUS ELEVATION
AND BONE AUGMENTATION
 Rehabilitation of the edentulous posterior maxilla with endosseous
dental implants often represents a clinical challenge because of
insufficient bone volume resulting from pneumatization of the
maxillary sinus along with resorption or loss of alveolar crestal bone.
 In 1980, Boyne and James first described a procedure
to graft the maxillary sinus floor with autogenous
marrow and bone for placing an implant(blade type)
Access to the maxillary sinus was gained through a
“Cardwell-Luc” procedure(i.e., an opening is
created at the anterior-superior aspect)
Since then, several other techniques have been
described,including variations on the lateral
window osteotomy and a variety of techniques
to lift the sinus floor from a crestal approach.

37.  Various bone graft materials have been used to augment the
maxillary sinus.
 The 1996 Consensus Conference on maxillary sinus bone
grafting reviewed available data and concluded that
allografts,alloplasts,and xenografts, alone or in combination
with autogenous bone, can be effective as bone substitute
graft materials for sinus bone augmentation.
Conclusion:
The sinus graft procedure with implant
placement is effective treatment modality for the
rehabilitation of the posterior maxilla.

38. INDICATIONS:
An alveolar bone height
in posterior maxilla is less
than 7mm
CONTRAINDICATIONS
LOCAL FACTORS:
1. Tumors or pathologic growth in the sinus
2. Maxillary sinus infection
3. Severe chronic sinusitis
4. Surgical scar/deformity of sinus cavity
5. Dental infection involving in or proximity
to sinus
6. Severe allergic rhinitis/sinusitis
7. Chronic topical steroid use
SYSTEMIC FACTORS:
1. Radiation therapy involving sinus
2. Metabolic diseases(e.g., uncontrolled
diabetes mellitus)
3. Excessive tobacco use
4. Drug/alcohol abuse
5. Psychological/mental impairment
RISKS AND
COMLICATIONS
1. Technique sensitive, requiring
meticulous surgical skills
2. Tearing /perforation
of the
schneiderian membrane
3. intraoperative/
postoperative bleeding
4.Loss of bone graft or implant

39. RESOURCES
TEXT BOOK –
1. B.D. Chaurassia’s human anatomy 4th edition vol. 3 The Head & Neck.
2. CARRANZA’ clinical periodontology 11th edition
3. GRAY’ anatomy 379h edition
4. TEN CATE’ oral histology 6th edition
5. The maxillary sinus and its dental implications Killey and Key.

40. Which of the following tooth is very close to the
maxillary antrum:
(a)Third molar
(b)Second molar
(c)Premolar
(d)Canine