King Saud University

Dental College
Oral and Maxillofacial Surgery
311 MDS

Maxillary Sinus in Health and

Disease
Anatomical facts and location:

√ The largest para-nasal

sinuses.
√ Situated in the maxilla.
√ Has pyramidal shape.
√ Lateral nasal bone forms
its base.
√ Apex headed towards the
zygomatic bone.
√ Canine fossa, orbital floor
and hard palate form the
pyramidal walls.
√ Communicates with nasal
cavity through maxillary
ostium, in the posterior end
of hitus simlunaris of middle
meatus.
Anatomical morphology:

√ Size varies from one

person to another.
√ Asymmetry existed in
the same individual.
√ Small in children and
grows up with aging.
√ Average height is about
3.5 cm, depth 3.2 cm
and width 2.5 cm.
√ Capacity of about 15 cc.
Anatomical morphology:

√ Divided into several

compartments by bony septa
(underwood’s septa).
√ Lined with pseduo-
stratified columnar ciliary
epithelium (schneiderian
membrane).
Relation with other structures:

√ Alveolar bone and dentition.

√ Nasal cavity and
nasopharynex.
√ Orbital cavity and its
contents.
√ Hard palate and oral cavity
proper.
√ Pterygomaxillary fissure and
its contents.
√ Neurovascular structures
including infraorbital and
superior alveolar nerve.
Development:

√ Develops from invagination of the mucous

membrane of middle meatus of the nasal
cavity at about the 3rd month of intrauterine
life.
√ Fully development reaches with the age of
16 years.
√ Loss of permanent teeth and alveolar bone
may make the sinus to appear huge in size.
Blood supply:
 Blood supply from facial, maxillary,
infraorbital, greater and lesser palatine
arteries and lateral and posterior nasal
branches of sphenopalatine artery.
 Venous drainage to the anterior facial vein,
sphenopalatine vein and pterygopaltine
plexus.
Nerve supply:

√ Infraorbital nerve.

√ Posterior, middle and

anterior superior
alveolar nerves.

√ Greater and lesser

palatine nerves.
Lymphatic drain:

 The lymphatic drain of the sinus is through

the nose or the submandibular lymph nodes.
Physiology:

 Unknown but the following functions have

been proposed:
√ Speech and voice resonance.
√ Reduce weight of skull.
√ Warmth inspired air.
√ Filtration of inspired air.
√ Immunologic barrier ( body defense).
Pathology:

 Congenital anomalies.
 Inflammatory diseases.
 Cysts and odontogenic
infection.
 Bone metaplasia and benign
tumors.
 Neoplasia.
 Trauma.
Congenital anomalies:

√ Cleft palate.

√ Facial fistula and cleft.

√ Cystic formation.

√ Atresia.
Inflammatory diseases:

√ Bacterial infection.

√ Bacterial infection secondary to viral

infection.

√ Fungal infection.
Sinusitis
Acute sinusitis:

Suppurative or non suppurative inflammation

of the mucosal lining of the sinus. It
involves one or both sinuses.
Causes:

√ Secondary to hay fever and allergic rhinitis.

√ Secondary to acute rhinitis (common cold)

and URT infection.

√ Bacterial infection due to: dental sepsis,

swimming and diving, trauma and foreign
body dislodgment.
Sings and symptoms:

√ Headache.
√ Pain and tenderness.
√ Nasal obstruction.
√ Nasal discharge.
√ Toxic manifestations.
√ Heavy filling with bending.
√ Nasal congestion.
√ X-ray and transillumination findings.
Treatment:

√ Rest and fluid and mouth hygiene.

√ Antibiotics (C&S); pneumococci and
streptococci are the most causative
organisms.
√ Analgesics and antihistamines.
√ Local treatment (decongestant and steam
inhalation).
Sinusitis
Chronic sinusitis:

It is a chronic type of infection affected the

mucosal lining of one or both sinuses,
resulted in mucopus or pus collection. A
polypoidal type of inflammation can lead to
formation of multiple or single mucosal
polyps.
Causes:

√ As a consequence of non resolved acute

sinusitis.

√ Dental abscesses.

√ Virulent organism with low resistance.

√ Foreign body dislodgement or trauma.

Signs and symptoms:

√ Headache.
√ Nasal obstruction
√ Nasal discharge.
√ Fatigue.
√ Hyposmia/ cacosmia.
√ Transllumination findings.
√ Proof puncture.
Treatment:

√ Antibiotics.

√ Systemic decongestants.

√ Sinus wash-out.
Mycotic infection:

 Aspergillosis:
Opportunistic infection caused by maxillary
sinus flora fungi environment in susceptible
individual, leads to obliteration of the sinus
space and erosion of its bony components.
Complications of sinusitis:

 Orbital abscess and orbital cellulites.

 Intracranial abscesses.
 Meningitis.
 Cavernous sinus thrombosis.
 Spread of infection to neighboring sinuses,
structures and organs.
 Osteomyelitis.
 Gastrointestinal disturbances.
Cysts and odontogenic tumors:
 Odontogenic  Non-odontogenic
cysts: cysts.
 Mucocele and

√ radicular cysts. retention cysts.

√ residual cysts.
√ dentigerous cysts.  Odontogenic
√ premordial cysts. tumors:

√ ameloblastoma.
√ Myxoma.
Bone metaplasia and benign tumors:

√ Fibrous dysplasia.

√ Ossifying fibroma.

√ Transitional papilloma.

√ Osteoma.

√ Giant cell lesions.

Neoplasia:

√ Squamous cell carcinoma.

√ Adenocarcinoma.

√ Sarcoma (osteosarcoma).

√ Ewing’s sarcoma.
Trauma:

√ Tuberosity fracture.
√ Dentoalveolar fracture.
√ LeFort’s fractures.
√ Zygomatic complex fracture.
√ Pure and impure orbital floor fractures.
√ Establishment of oro-antral fistula.
Clinical examination:
Inspection

√ Assess asymmetry.

√ Color of overlaying skin.

Clinical examination:
Palpation

√ Tenderness.

√ Swelling and expansion.

√ Depression.
Clinical examination:
Examination of nasal passage

√ Nasal patency.

√ Pus discharge.

√ Nasal polyps.

√ Erythema, redness, change in the color of

nasal mucosa.
Clinical examination:
Transillumination
Clinical examination:
Diagnostic sinus lavage

√ sinus rinsing through

the canine fosaa.

√ Nasal antrostomy.
Radiographical examination:
Routine radiographical examination

√ Orthopantomogram
(OPG)

√ Occipitomental (water’s
view), with lateral tilt.
Radiographical examination:
Special investigation and radiographical examination

 Sinuscopy
 Sinogram
 CT scan
 MRI
Microbiology and histological examination:

 Culture and sensitivity and biopsy.