3. The maxillary sinus is the first of the paranasal
sinuses to develop.
Appears as a lateral evagination or pouch of
the mucous membrane of the middle meatus of
the nose at about the third month of intra-uterine
life.
The neck of the pouch remains small and
forms the future ostium.
4. At birth,
less than a cm in any direction
Expands by pneumatization into the
developing alveolar process
Later on, extends anteriorly and inferiorly from
skull base closely matching the growth rate of
the maxilla and the developing dentition
Expansion ceases after eruption of the
permanent teeth
8. Largest of the paranasal sinuses, pyramidal
shape, the base being the lateral nasal wall
and the apex extends into the zygomatic
process of the maxilla
The upper wall or the roof of the sinus is also
the floor of the orbit
The floor of the sinus forms the base of the
alveolar process
9. The posterior wall extends the length of the
maxilla and dips into the maxillary tuberosity
Anterolaterally the sinus extends into the
region of first bicuspid or cuspid teeth
Opens into the nasal cavity through the middle
meatus
The average diameter would be from 30-34mm
and volume being about 15cc
10. Blood supply –
From small artery derived from the facial,
maxillary, infra-orbital, and greater palatine
arteries.
Venous drainage –
Accompany the arteries and drain into
anterior facial vein pterygoid plexus
Lymphatic drainage –
Submandibular lymphatic glands
11. Physiology
Sinuses lined by respiratory epithelium –
mucous-secreting pseudostratified ciliated
columnar epithelium and periosteum.
Mucociliary mechanism provides the means for
the removal of particulate matter and bacteria.
Mucous and other debris discharged into the
middle meatus of the nose.
12. Functions
Impart resonance to the voice during speech.
Lighten the skull.
Warm the inspired air
Increases the surface area
21. Cysts
Round or oval radiolucency circumscribed by a
sharp radio opaque margin
22. ‘‘YY’’ sshhaappeedd lliinnee ooff EEnnnniiss
The line of junction of the lateral wall of the nose
and the nasal floor is represented by the long leg of
the letter ‘y’. A cyst in the area obliterates & modifies
the typical pattern.
28. Sinusitis (acute / chronic)
Commonly..
Causes:
Spread of infection from a dental abscess
Facial fracture involving the maxillary sinus
Tooth or root in the maxillary sinus
Oro-antral fistulae
Cysts
Polyps
Thickening of the sinus walls
Dental prosthetic material (rear)
29. Acute maxillary sinusitis
Symptoms:
Heavy felling in the face.
Throbbing pain in the upper part of the cheek or entire of
the face which increases on bending the head.
Foul unilateral discharge
Foul taste in the mouth
Pyrexia
Nocturnal coughing
30. Chronic maxillary sinusitis
Symptoms:
History of repeated attacks of acute mucopurulent rhinitis.
Pain and tenderness are common.
Diagnosis depends on long history of standing nasal or
post nasal discharge.
Inspection of oropharynx frequently confirm the existence
of a descending pharyngeal exudate.
Pain is feature of chronic sinusitis of dental origin.
Lump on the gum
35. Trouble-shooting Areas Of
Dental Interest
Displacement of root into the sinus
Fracture of the maxillary tuberosity
Oro-antral Fistula
36. Root displacement into the
antrum
Sudden disappearance of the root from the
socket during extraction
Accompanied by
a) Unilateral epistaxis
b) Escape of fluids from the mouth into the
nose
c) Passage of air into the mouth when the
patient sucks or swallows
37. Alteration in vocal resonance
Difficulty in blowing out the cheeks or
drawing on a cigarette
42. CAUSES:
Invasion of tuberosity by the antrum
Common in isolated maxillary molars
Divergent or hypercementosed roots
43. If fracture occurs…
Bony fragment and the tooth should be freed from the
soft tissues followed by
apposition of soft tissue by mattress sutures
44. OOrroo--aannttrraall ffiissttuullaa
It is a pathological or unnatural
communication between the oral cavity and
maxillary sinus
Fistula always lined by epithelium and is
long standing
45. Contd..
Acute form is oro-antral communication
If oro-antral communication does not heal
or is untreated, epithelial tract forms
46. Predisposing factors
When apices of the upper teeth and the
lining of the maxillary sinus are intimately
related
Chronic apical or advanced periodontal
disease replaces apical bone with
granulation tissue
In suspected cases traumatizing the socket
47. When the sinus is infected, the infection
destroys the clot in the socket
Excessive damage to the bone of the socket
the loss of the clot
Upper first molar- risky
48. On examination..
An obvious large opening leading into the
sinus
Symptoms as per root in antrum
Small perforation - difficult to detect
Never probe or abuse a socket
49. Pinch nose and blow gently
Whistling noise may be heard as air escapes
from the fistula
50. Large Oro-antral fistula – good drainage,
seldom sinusitis
Pin hole fistula- no drainage, chances of
sinusitis
54. Late presentation…
After a week
Formation of fistulous tract - to be excised
Maxillary sinusitis – if present to be treated
Attempt surgical closure
56. Local Flaps
Buccal approach= von Reherman’s flap
Palatal approach= Ashley’s flap
Combination of buccal and palatal flaps
57.
58. Buccal approach
Local anaesthesia
A) Excision of epithelial tract
B) Buccal flap, von Reherman’s flap- divergent
incision into the buccal sulcus-
3- 4 mm from each side of the resulting alveolar
defect
horizontal incision in taut periosteum to
mobilize the mucoperiosteal flap
59. Contd..
.. the free margin of the buccal flap rests on the
palatal mucoperiosteum on sound bone where
it is sutured covering the Oro-antral fistula
60.
61. 2nd approach
Palatal transposition flap (Ashley’s flap)
- based on greater palatine artery
- thicker flap
- longitudinal incision about 4-5 mms above
the gingival margin
62. Contd…
Followed by a parallel incision
Almost along the midline of the palate
Both incisions connected anteriorly with a U
shaped cut
The thick palatal flap is rotated to cover the
alveolar orifice with edges resting on sound
bone for healing
66. Clinical Features
Ulcer, Swelling, Mobile Teeth &
Pain (Nerve Involvement)
Management
- Maxillectomy
• Partial/Limited
• Subtotal
• Total
67. Subtotal Maxillectomy
Larger lesions of the gums, palate or the antrum which
extend to the superior aspects or beyond the confines
of the antrum
Proposed Bony cuts
68. Total Maxillectomy
Primary Tumours filling the entire antrum
In some cases infra orbital rim is preserved