MAXILLARY SINUS

Paranasal sinuses:

• Paranasal sinuses are essentially mucosa-lined

pneumatic airspaces within the bones of the face and
skull.

• A total of four paired sinuses –

Frontal
Ethmoid
Maxillary
Sphenoid sinuses.
 Definition

• Antrum of Highmore, sinus maxillaris.

• Maxillary sinus is a pneumatic space that is lodged

inside the body of the maxilla & that communicate
with the environment by way of the middle nasal
meatus and the nasal vestibule.

• The maxillary sinus is the largest paranasal sinus.

 Anatomy
• Pyramidal in shape.
• Volume of approximately
15 -30 ml.

• Apex is directed laterally,

is formed by the
zygomatic process.

• Base: Lateral nasal wall

• Medial wall : lateral wall
of nose
• Superior wall (roof):
orbital wall
• Anterior wall : facial
wall of maxilla
•Posterolateral:
infratemporal wall
•Inferior (floor): alveolar
process of the maxilla.
The floor:
• Projecting into the floor of the antrum are several
conical processes, corresponding to the roots of the
first and second molar teeth; in some cases the floor is
perforated by the roots of the teeth.

Because of the close relationship with the

dentition dental disease can cause maxillary infection,
and tooth extraction can result in oro-antral fistulae.
• Communicates with the middle meatus of the nose.
 Development & Age changes
• Maxillary sinuses start developing at approximately
3rd month of fetal life.
• The growth of these sinuses is biphasic
I. Primary pneumatization process
II. Secondary pneumatization.

During the later phase (as the permanent teeth

eruption take place), pneumatization spreads more
inferiorly.
Pneumatization can be so extensive as to expose
tooth roots with only a thin layer of soft tissue
Newborn
12 yrs
Adult
Age changes
Shape changes:
• Tubular at birth
• Ovoid at 9yrs
• Pyramidal at 18(adult size)
• From birth to age nine the floor of the sinus is
above that of the nasal cavity.
• At age nine the floor is generally at the level of the
nasal floor .
• The floor continues to sink as the maxillary sinus
pneumatizes in adulthood.
Less chances of oroantral opening in children and
young adult. (Killey & Kay 1972)
 Histology
• The sinus is lined by epithelial layer which is supported by
a thin basement membrane, lamina propria, and periosteum.
• The epithelial layer consists of pseudostratified ciliated
columnar epithelium which is in continuity with the mucosa
of the nasal cavities.
The epithelium of the sinuses is thinner than that of the
nose.
• There are four basic cell types - ciliated columnar
epithelial cells, noncilliated columnar cells, basal
cells, and goblet cells.
 Sinus Function

1.Warming/humidification of air
2.Assisting in regulation of intranasal pressure
3.Lightening the skull
4.Giving resonance to the voice
5.Absorbing shock
6.Contributing to facial growth.
Maxillary sinus Pathologies
• Developmental anomalies
• Maxillary Sinusitis
• Mucous retention cyst (antral retention
cyst)
• Foreign Objects in Sinus
• Maxillary Sinus Tumors
• Oro-Antral Fistula
• Genetic, Metabolic Diseases
Maxillary Sinusitis:
Sinusitis is a condition involving inflammation of
paranasal sinus mucosa, the term is usually restricted to
conditions that are primarily inflammatory, cause
subjective symptoms and persist longer than 7 days.

Based on duration (American association of

otolaryngology & Head & neck Surgery)
– Acute sinusitis < 4wks
– Subacute sinusitis 4 – 12wks
– Chronic sinusitis > 12wks
Sign & Symptoms of Sinusitis
• Heavy feeling in the head
• Constant pain in upper part of the cheek
• Maxillary teeth on affected side may be painful
• Unilateral foul nasal discharge
• Unilateral nasal obstruction on affected side
• Tenderness to pressure or swelling over the involved
sinus
• Sensitivity of tooth on percussion
• Fever, chills, malaise
 Maxillary Sinus Lymphatics

Retropharyngeal Jugulodiagastric
Squamous Cell Carcinoma
• Most common histologic type .
• Moderately differentiated
• Distant metastatic disease in 18%.

5-yr Disease-free Survival

Independent < 50%
of stage
Advanced 25 – 30%
stage
Jham BC et al. A case of maxillary sinus carcinoma. Oral Oncology, 2006(42): 157-159
 Weiss T. SIU School of Medicine, Division of Otolaryngology.

Initial
presentation
7 months
11 months
Adenocarcinoma
• 10 – 20%
• Locally aggressive with low incidence of
distant metastasis.
 OroAntral Fistula
• Traumatic Extraction • Massive mid facial trauma
• Hypercementosis •Surgery

Clinical features:
• Regurgitation of liquid from mouth to nose
• Inability to blow cheek and passage of air into the
mouth
• Unpleasant taste in mouth
• Foul smelling
• Sinusitis- after a considerable period of time
Testing to establish presence of Oro-Antral fistula
• Escape of air bubble, blood, pus may appear at oral orifice
• A wisp of cotton wool held just below the alveolar opening
usually deflected by air
• Inability to blow
• Radiographically
 Genetic, Metabolic Diseases

Osteopetrosis Paget's disease showing

showing excessive abnormal bone which usually
bone accumulation in does not penetrate but
the paranasal encircles the sinus. Notice the
sinuses. All the cotton-wool appearance of the
paranasal sinuses are skull.
radiopaque.
Fibrous dysplasia has encroached
upon and obliterated most of the sinus
cavity. The lesion has a "ground glass“
appearance.
To conclude…

• The maxillary sinus is the largest of the paranasal

sinuses, and is pyramidal in shape.
• It is the first sinus to develop.
• It is lined with pseudostratified ciliated columnar
epithelium.
• Commonly occurring disease of maxillary sinus is
sinusitis.
Thank you…

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