Maxillary Sinus


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about the maxillary sinus- its anatomy, development, histology.uses,clinical considerations.

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Maxillary Sinus

  1. 1.  Introduction Definition, Structure & Variations Developmental Aspect & Anomalies Microscopic Features* Functional Importance Clinical Considerations Revision & Conclusion!
  2. 2.  “The maxillary sinus is the pneumatic space that is lodged inside the body of maxilla & communicates with the environment by way of the middle nasal meatus” It is also known as the “Antrum of Highmore”
  3. 3.  Four-sided pyramid Base Apex
  4. 4. Four-Sided Pyramid
  5. 5.  Four Sides:1. Anterior2. Posterior3. Superior4. Inferior
  6. 6.  Perforation at the level of middle nasal meatus Accessory Ostia-In 23% Population Different locations of ostium
  7. 7.  Some processes of maxilla get invaded by air spaces & these expansions k/a recesses Later pneumatizes floor of sinus adjacent to roots of Molars
  8. 8.  Fully developed alveolar recess: Three depressions separated by two incomplete bony septa1. Anterior2. Middle3. Posterior
  9. 9.  Maxillary sinus is the first of the PNS to develop Initial development of the sinus follows a number of morphogenic events in the differentiation of nasal cavity in early gestation (32 mm CRL)
  10. 10.  Horizontal shift of the Palatal Shelves & subsequent fusion with one another Nasal Septum separates the 2° Oral cavity from the two nasal chambers Influences further expansion of the lateral nasal wall & 3 walls begin to fold 3 Conchae & Meatuses arise
  11. 11. 1. Superior Nasal Meatus 2. Middle Nasal Meatus 3. Inferior Nasal Meatus
  12. 12. Superior & Inferior Meatuses remainas shallow depressions along thelateral nasal wall for the first half ofIULMiddle Meatus expands immediatelyinto lateral nasal wall & expands inan inferior direction occupying moreof the future maxillary body
  13. 13.  Development of sinus starts at 12 weeks as an evagination of the mucous membrane in the lateral wall of the middle meatus
  14. 14. In its development: Tubular at birth Ovoid at childhood Pyramidal in adulthood
  15. 15. Three Growth Spurts1. Birth-2.5 years2. 7.5-10 years3. 12-14 years
  16. 16.  Agenesis(complete absence), Aplasia & Hypoplasia(altered development or under development) of the sinus occurs either alone or in association with other anomalies like: Chonal atresia Cleft palate Septal deformity Absence of concha Malformation of external nose
  17. 17.  Three layers surround the space of the Maxillary sinus:1. Epithelial Layer2. Basal Lamina3. Sub-epithelial layer including periosteum
  18. 18.  Ciliated Pseudostratified Columnar –> derived from olfactory epithelium of middle nasal meatus Most numerous cells -> Columnar ciliated cells Additional cells :1. Basal cells2. Columnar non-ciliated cells3. Goblet cells
  19. 19.  The cilia is composed of typical 9+1 pairs of microtubules & provide mobile apparatus to the sinus epithelium
  20. 20.  The ciliated cells enclose the nucleus & electron-lucent cytoplasm with numerous mitochondria & enzyme containing organelles
  21. 21.  The basal bodies serve as attachment of ciliary microtubules The cilia provide motile apparatus
  22. 22.  By ciliary beating the mucous blanket lining the epithelial surface moves from the interior of the sinus towards the nasal cavity
  23. 23.  Basal segment contains nucleus Goblet cells contain RER & SER along with Golgi apparatus, all of which are involved in synthesis of secretory substances This means that they contain all the characteristics of secretory cells
  24. 24.  They are located in the subepithelial layers of the sinus & reach the sinus lumen by the way of excretory ducts The glands contain both serous & mucous acini Myoepithelial Cells  Surrounded by acini
  25. 25.  The subepithelial layer consists of collagen bundles, fibroblasts, vessels & nerves
  26. 26.  In addition to epithelial secretion, the surface of the sinus is provided with a mixed secretory product
  27. 27.  The serous secretion consists of water, neutral lipids, proteins, carbohydrates & a mucous secretion consisting of compound glycoproteins & mucopolysaccharides
  28. 28.  These are located in the subepithelial layers of the sinus & reach the sinus lumen by way of excretory ducts
  29. 29.  Mucous blanket lining the sinus epithelium moves from the sinus to nasal cavity
  30. 30.  Three types of mucociliary flow have been described:1. Smooth-Moving at 0.85cm/min2. Jerky-Moving at 0.30cm/min3. Mucostasis-Moving at less than 0.30cm/min
  31. 31.  Warming/Humidification of air Contribution to immune response Lightening of skull Resonance to voice Assistance in regulation of intracranial pressure Enhance facio-cranial resistance to shock Most recent research on sinus function has focused on Molecular NO
  32. 32. 1. Superior dental nerve2. Infraorbital nerve3. Greater palatine nerve
  33. 33.  Internal maxillary artery via:1. Infraorbital artery2. Posterior superior dental artery3. Anterior superior dental artery
  34. 34. 1. Inferior ophthalmic vein2. Anterior facial vein
  35. 35.  Submandibular lymph nodes
  36. 36.  Developmental Anomalies: Agenesia Aplasia Hypoplasia Supernumerary sinus
  37. 37.  Pituitary gigantism-Sinuses larger than normal Some congenital infections-Sinuses smaller than normal Example: Congenital Syphilis by Spirochetes Pathologically generated-Functional & systemic association Transfer of pathologic condition is through MECHANICAL, BLOOD or LYMPHATIC SYSTEM
  38. 38.  Oroantral Fistula [Maxillary Molars]˜ Surgical Manipulation for extraction˜ Extraction of tooth showing Hypercementosis˜ Radicular cyst˜ Granuloma˜ Abscess˜ Therefore, RADIOGRAPHIC INTERVENTION is necessary
  39. 39.  Chronic infections of the mucoperiosteal layer cause Neuralgia Neuralgia of Maxillary nerve-’tic douloreux’ Non-specific bacterial sinusitis
  40. 40.  Infections caused by streptococci, staphylococci, pneumococci, virus of common cold Malignant Lesions:˜ Adenocarcinoma˜ Squamous cell carcinoma˜ Osteosarcoma˜ Fibrosarcoma˜ Lymphosarcoma