Maxillary sinus

Def :
Air containing space , that occupy maxillary bone bilaterally .

 Paranasal sinus :
- Maxillary sinus - Frontal sinus
- Ethmoidal sinus - sphenoidal sinus

 Sinus lined by ; pseudo stratified squamous epithelium with goblet cell

- sinus opening :
posterior or inferior end of semilunar hiatus which lies in middle
meatus of nasal cavity between inferior and middle nasal conchae .

-sinus shape : pyramidal in shape

Base > forming lateral wall of the nose
Apex > toward zygomatic process
Roof > related to orbital floor
Floor > related to base of alveolar bone
Lateral wall > related to anterior plate of maxilla
Medial wall > related to posterior plate of maxilla
- Adult maxillary sinus average :

Anterioposterio > 34 mm width > 23 mm

Heights > 33 mm volume > 15 cc

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Function :

1- lightening of the weight of skull

2- Reasonave of voice

3- air conditioning

4- shock or truma absorpable

5- sneezing by cilia against foreign bodies

Vascular supply :

 Artery : branches of maxillary artery supply this sinus , thes include -

infraorbital art .
- lateral branches of sphenopalatine and greater
palatin arteries

- alveolar artery

 Veins : 1- facial vein anteriorly

2- maxillary vein posteriorly

 Diagnosis :

 History

 Clinical examination

 Rdiographic examination

 Histopathologicale examination

 Sinoscope
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Clinical examination :

- the affected sinus may be markedly tender to gentle tapping

or palpation of lateral wall of maxillary sinus

 Extraoral > over prominence of cheek bones .

 Intra oral > on the lateral surface of maxilla between zygomatic

buttress and canine fossa

-sever pain & angina - refracted pain to the ear

- increase in weight

-transillmination of maxillary sinus :

Done by placing a bright flashlight of fibroptic light against the mucosa on the
palatal or facial surface of sinus and observing the transmission of light through
the sinus in darkened room .

-Radiographic examination :

Can be obtained by the following :

-panorama - occlusal film

 Waters view : patient’s chain and tip of the nose are against film surface .

 Caldwell view : patient’s forehead and tip of the nose are placed in contact
with the film .

 Submentovertex view .

 Computed tomographic .
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Sinoscope : detec any changes of the linig mucosa of m.s

Histopathology : biopsy > tissue culture

Sinusitis

- Acute sinusitis :

Inflammation of sinus due to viral or bacterial infection of the sinus of less than 4
weeks duration , which resolves completely with appropriate treatment .

-Chronic sinusitis:

Persistence of symptoms beyond 12 weeks with or without acute exacerbation .

Acute Chronic
 Cheek pain referral to  pain free
frontal region  dentl pain
 Increase pain on  pressure headache
Symptoms bending  hyposomia
 Maxillary teeth feel
like pegs
 hyposomia

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  pain with palpation  rhinorrhea
Signs
and percussion  postnasal drip
 purulent nasal  day or neight cough
discharge  nasal obstruction
 nasal congestion
 cough lasting for than
10 days
 malaise & fever

Duration Small ( < 4 weeks ) Long ( > 12 weeks )

Onset Rapid Slowly

Pain Sharp , sever Dull or non

Microorganism Aerobic bacteria Aerobic & anaerobic

 antibiotic  antibiotic
 saline nasal rinses  decongestant
 topical decongestant  steam inhalation
Treatment  systemic decongestant  nasal cavity
 applying moist heat irrigation using
buffered formed
saline
 cald well-luc
operation

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Complication :

 acute exacerpation

 in children : adenoiditis & purulent otitis media

 orbital complication :
a- superiosteal abscess

b- orbital abscess

c- cavernous sinus thrombosis

 intracranial complication :

a- epidural abscess

b- subdural abscess

d- brain abscess

f- meningitis

 other complication :

-osteomylitis - mucosal formation

Diseases related to sinus :

Cysts : -dentigrous cyst -residual cyst

-o.k cyst - periapical cyst

Tumors : -ameloblastoma -myxomel -s.c.c - osteocarcinoma

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 Oro-antral fistula

Def : communication between oral cavity and maxillary sinus through

the tooth the tooth socket

Types :

A- alveolar ; at alveolar margin , related most common to 5 , 6

b- sublabial ; at the anterior wallof the antrum

causes : traumatic & neoplastic & inflammation

A-trumatic ( surgical & accidental ) :

 surgical ;

 displacement of tooth or root into maxillary sinus

during extraction

 radical antrum operation if sublabial incision fails to

heal .

 dentigrous cyst removal

 excision of tumor limited to antrum

 accidental ; penetrating wound of maxilla .

B- neoplastic : malignant tumor of the palate or antrum .

c- inflammation : e.g osteomyelitis of maxilla

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clinical pictures :

1- regurgitation of fluid into the nose .

2- patient can below air from hia noseinto his mouth .

3- discharge in the mouth from infected maxillary sinus often

purulent or foeted.

4- probe can pass through fistula into sinus .

5- prolapse of oedematous antral mucosa into the mouth .

6- maxillary sinusitis is common .

Radiographic examination :

1- tooth or root may be present inside the antrum .

2- injection of contrast material into fistula outline it’s trct .

3- maxillary sinus may be present .

Blow-out nasal test : +ve > no fistula

-ve > fistula presented

Treatment removal of root tips :

1- by suction tips .

2- piece of gauze

3- nasal below

4- k , H files

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Treatment :

A-small sized oroantral communication (less than 4mm)

( just observation )
small communication which is perceived immediately after the
extraction , treatment consist of :

 suturing the gingiva with figure eight suture after filling the
alveooluss with ccollagen .

 when soft tissue do not sufficient , small portion of alveolar bone

is removed with bone is removed with a bone rongeure so that
buccal and palatal mucosa can be approximated more easily .

 infection of m.s is thus avoided

 blood clot is held in place which will aid in the healing

process .

 administration of prophylactic antibiotic is not necesarly ,

unless the oral-antral communication is result of extraction
of tooth with periapical infection.

 nasal decongestant must also prescribed.

 The patient is informed of the satuation and given

appropriate instruction (E.g avoiding sneezing
blowing nose) and examind for 15 days.

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B-large sized oro-antral communication or one that has remained
open for 15 days (more than 4 mm) :

 Must be trated using other technique “such as closure with

procedure either immediately or at a later date”

This technique are achived using:

1) Local flaps ;

a. Buccal flaps.

b. Palatal rotational “pedicle flap”.

c. Submucosal c.t pedicle flap.

d. Island flap.

2) Regional flap ;

a. Tongue flap.

b. Buccal fat bad.

c. Myo-mucosal flap.

3) Distant flap ;

a. Temporal flap

4) Grafts .

 b
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  pa

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