LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 1
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
LECTURE TOPIC: MAXILLARY SINUS
• LEARNING OBJECTIVES
• SECTION I • TO Understand Anatomy of Maxillary sinus • Development of maxillary sinus • Developmental Anomalies of Maxillary Sinus • Blood Supply of Maxillary Sinus
• SECTION II • Functions of Maxillary Sinus • Histology of maxillary sinus
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 2
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC AT THE CONCLUSION STUDENT IS EXPECTED TO UNDERSTAND AND ANSWER
• Types of Sinuses • Development of Maxillary Sinus • Biological Functions of Maxillary Sinus
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 3
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
Anatomy of Maxillary Sinus
Sinus is a Latin word meaning a fold or pocket. SINUS- It is an air filled cavity in a dense portion of skull. Types of sinuses- 1. Paranasal air sinus a) Maxillary sinus b)Ethmoidal sinus c)Sphenoidal sinus d)Frontal sinus 2. Dural venous sinus 3. Coronary sinus
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 4
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
MAXILLARY SINUS SYNONYMS- Antrum of Highmore, Maxillary Antrum Largest air sinus large pyramidal cavity within the body of the maxilla.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 5
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
Development of maxillary sinus
Established in the embryo of 32 mm CRL. Horizontal shift of palatal shelves
Fusion of shelves with one another and with nasal
septum
Seperation of sec. oral cavity and from two sec. nasal
chambers
Influences further expansion of lateral nasal wall in
that the wall begins to fold
3 nasal conchae, 3 subjacent meatuses arise
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 6
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
• Inferior and superior meatus remains as shallow
depressions on lateral nasal wall.
• Middle meatus expand immediately into the
lateral nasal wall.
• Cartilagenous skeleton of lateral nasal capsule is
already established, expansion of middle meatus proceeds primarily in inferior direction, occupying progressively more of future maxillary body.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 7
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC DEVELOPMENTAL ANOMALIES • Agenesis(complete absence) • Aplasia • Hypoplasia(under development)
• Occurs alone or in association with cleft
palate, high palate, septal deformity, absence of concha, malformation of external ear.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 8
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
• Supernumerary maxillary sinus- occurrence of
2 completely seperated sinuses on the same side.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 9
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
ROOF- floor of the orbit.
FLOOR- alveolar process of maxilla. BASE- lateral nasal wall. APEX- zygomatic process of maxilla.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 10
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
• The floor varies in it's level.
• Birth to age 9 -floor is above that of the nasal cavity. • At age 9- floor is generally at the level of the nasal floor. The floor continues to sink as the maxillary sinus pneumatizes. • The close relationship with the dentition dental disease can cause maxillary infection, and tooth extraction can result in oral-antral fistulae. LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 11 DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
Average size of maxillary sinus
HEIGHT- 3.5 cm WIDTH- 2.5 cm ANTEROPOSTERIOR DEPTH- 3.5 cm VOLUME( approx.) 15ml
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 12
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
On dental radiographs the floor of the sinus is often
observed approximating the root apices of the teeth and is seen to extend from the canine or premolar region posteriorly to the molar or tuberosity region
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 13
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
Conical elevations corresponding to roots of 1st
or 2nd molar tooth projects into the floor of the sinus. Sometimes the premolar, 3rd molar and canines are also found protruding into the sinus. A layer of bone always seperates the roots of the teeth and the floor of sinus The infra orbital nerve is found at the roof of the sinus & the supra alveolar nerve in the floor of the sinus. LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 14 DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
• Maxillary sinus may be incompletely divided
by septa, complete septa being present very rarely. • Sinus is joined to nasal cavity via small orifices- Ostia
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 15
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
Blood supply of maxillary sinus
Arterial blood supply : Facial, infra orbital, PSA.
Venous drainage- facial and pterygoid plexus of vein
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 16
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
Nerve supply : Infra orbital, anterior, middle and
post superior alveolar nerves. Lymphatic drainage : Submandibular nodes. LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 17 DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC Biological function of Paranasal sinus • Decreasing the relative weight of the front of the skull, and especially the bones of the face. • Increasing resonance of the voice. • Providing a buffer against blows to the face. • Insulating sensitive structures like dental roots and eyes from rapid temperature fluctuations in the nasal cavity. • Humidifying and heating of inhaled air because of slow air turnover in this region. • Increases surface area for tooth eruption. LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 18 DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
HISTOLOGY Three microscopically distinct layers surround the space of maxillary sinus. I. Epithelial layer II. Basal lamina III. Subepithelial layer ( Maxillary including Periosteum) sinus
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 19
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
EPITHELIUM Pseudostratified, columnar &ciliated( derived from olfactory epithelium of middle meatus) Most numerous cells in maxillary sinus are the –COLUMNAR CILIATED CELLS. Basal cells, columnar non ciliated cells, mucus secreting -goblet cells.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 20
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC Histology………..
• A ciliated cell encloses the nucleus & an electrolucent
cytoplasm with numerous mitochondria & enzyme containing organelles.
• The basal bodies, which serve as the attachment of the ciliary
microtubules to the cell, are characteristic of the apical segment of the cell.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 21
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC HISTOLOGY OF MAXILLARY SINUS GOBLET CELL
MINOR SALIVARY GLAND LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 22 DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC HISTOLOGY
PSEUDOSTRATIFIED COLUMNAR –CILIATED EPITHELIUM
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 23
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC GOBLET CELL-Unicellular Secretory organ Is broader above & has a narrow stem attached to a base. Expanded upper part which is distended with mucin granules.( Goblet cells are mucus secreting cells)
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 24
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
• Inconsonance with their secretory function these cells have a
well developed golgi complex & abundant RER. • The nucleus is flattened & is basally placed with a distended supranuclear cytoplasm that is tightly packed with basophilic tiny vacuole representing packages of mucus.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 25
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC GOBLET CELL
Cliiia are absent but faint streaks of mucus
topping the broad luminal end of goblet cell, resembling cilia can be seen easily.
The luminal surface of the cell bears some
irregular microvilli.
In H/E stained preparations, the mucin content
remains unstained, it stains brightly with the PAS technique.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 26
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC SECRETORY CONTENT In addition to the epithelial secretion , the surface of the sinus is provided with a mixed secretory product 1. SEROUS secretion-> primarily of water , with small amounts of neutral non-specific lipids, proteins & carbohydrates 2. MUCOUS secretion-> consisting of compound glycoproteins or mucoploysaccharide or both. These are located in the subepithelial layer of the sinus & reach the sinus lumen by way of excretory ducts after the ducts have pierced the basal lamina.
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 27
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 28
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
MUCUS CELLS Serous cell-toludine blue
staining
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 29
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
HISTOLOGY Cilia is composed of 9+1 pairs of microtubules & provides mobile apparatus to the sinus epithelium By ciliary beating , the mucous blanket lining the epithelial surface moves from the interior of the sinus towards the nasal cavity. Goblet cells (secretory cells) contains RER& SER along with golgi apparatus all of which are involved in the synthesis of secretory substances LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 30 DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
MCQ’s 1. Maxillary sinus communicates with environment by : a) Superior nasal meatus b) Middle nasal meatus c) Middle nasal meatus and nasal vestibule d) Inferior nasal meatus
2. Maxillary sinus epithelium is :
a) Stratifid columnar b) Pseudo stratified columnar and ciliated c) Squamous and non ciliated d) Glandular
3. Secretory cells present in present in the subepithelial glands of maxillary sinus :
a) Mucous cells b) Serous cells c) Both of the above d) None of the above LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 31 DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
4. All functions of maxillary sinus except :
• Protect internal structure against exposure to cold • Contibute to resonance to voice • Production of bactericidal lysozymes • Helps in mastication
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 32
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC 5. The paranasal sinuses drains into the middle meatus of the nose EXCEPT: a) Sphenoid sinus b) Middle ethmoid sinus c) Maxillary sinus d) Posterior sinus
6. Olfactory cleft lies between the:
a) Middle turbinate & cribriform plate b) Superior turbinate & cribriform plate c) Superior turbinate & inferior turbinate d) Inferior turbinate & cribriform plate
7. True about the nerve supply of the nose:
a) Sympathetic supply from superior cervical ganglion b) Parasympathetic supply via nervus intermedius c) Nerve supply is extremely rich d) All of the above
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 33
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC 8. Type of sphenoid sinus in normal population is usually: a) Sellar b) Postseller c) Preseller d) Maximal Pneumatisation
9. Pain in vertexis seen in:
a) Ethmoid sinusitis b) Sphenoid sinusitis c) Frontal sinusitis d) Maxillary sinusitis
10. Maxillary sinusitis Incidence of mucocele is lowest in
a) Frontal sinus b) Sphenoid sinus c) Maxillary sinus d) Ethmoid sinus
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 34
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
Short question’s Q1. Acute maxillary sinusitis Q2. Functions of maxillary sinus Q3. Lining epithelium and function of different cells Q4. Anatomical landmarks of maxillary sinus Q5. Clinical consideration and treatment of sinusitis
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 35
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
Long questions Q.1 Describe maxillary sinus and functions of maxillary sinus Q.2 Explain development , location and epithelium lining maxillary sinus
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 36
DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY MRDC
• Thank You
LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 37
