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King Saud University Dental College Oral and Maxillofacial Surgery

King Saud University Dental College Oral and Maxillofacial Surgery. 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.

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King Saud University Dental College Oral and Maxillofacial Surgery

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  1. King Saud UniversityDental CollegeOral and Maxillofacial Surgery Maxillary Sinus in Health and Disease

  2. Anatomical facts and location: √ The largest para-nasal sinuses. √ Situated in the maxilla. √ Has pyramidal shape. √ Lateral nasal bone forms its base.

  3. √ 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.

  4. 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.

  5. Anatomical morphology: √ Divided into several compartments by bony septa (underwood’s septa). √ Lined with pseduo-stratified columnar ciliary epithelium (schneiderian membrane).

  6. 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.

  7. 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.

  8. 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.

  9. Nerve supply: √ Infraorbital nerve. √ Posterior, middle and anterior superior alveolar nerves. √ Greater and lesser palatine nerves.

  10. Lymphatic drain: • The lymphatic drain of the sinus is through the nose or the submandibular lymph nodes.

  11. 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).

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

  13. Congenital anomalies: √ Cleft palate. √ Facial fistula and cleft. √ Cystic formation. √ Atresia.

  14. Inflammatory diseases: √ Bacterial infection. √ Bacterial infection secondary to viral infection. √ Fungal infection.

  15. SinusitisAcute sinusitis: Suppurative or non suppurative inflammation of the mucosal lining of the sinus. It involves one or both sinuses.

  16. 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.

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

  18. 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).

  19. SinusitisChronic 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.

  20. Causes: √ As a consequence of non resolved acute sinusitis. √ Dental abscesses. √ Virulent organism with low resistance. √ Foreign body dislodgement or trauma.

  21. Signs and symptoms: √ Headache. √ Nasal obstruction √ Nasal discharge. √ Fatigue. √ Hyposmia/ cacosmia. √ Transllumination findings. √ Proof puncture.

  22. Treatment: √ Antibiotics. √ Systemic decongestants. √ Sinus wash-out.

  23. 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.

  24. 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.

  25. Odontogenic cysts: √ radicular cysts. √ residual cysts. √ dentigerous cysts. √ premordial cysts. Non-odontogenic cysts. Mucocele and retention cysts. Odontogenic tumors: √ ameloblastoma. √ Myxoma. Cysts and odontogenic tumors:

  26. Bone metaplasia and benign tumors: √Fibrous dysplasia. √ Ossifying fibroma. √ Transitional papilloma. √ Osteoma. √ Giant cell lesions.

  27. Neoplasia: √ Squamous cell carcinoma. √ Adenocarcinoma. √ Sarcoma (osteosarcoma). √ Ewing’s sarcoma.

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

  29. Clinical examination:Inspection √ Assess asymmetry. √ Color of overlaying skin.

  30. Clinical examination:Palpation √ Tenderness. √ Swelling and expansion. √ Depression.

  31. Clinical examination: Examination of nasal passage √ Nasal patency. √ Pus discharge. √ Nasal polyps. √ Erythema, redness, change in the color of nasal mucosa.

  32. Clinical examination: Transillumination

  33. Clinical examination:Diagnostic sinus lavage √ sinus rinsing through the canine fosaa. √ Nasal antrostomy.

  34. Radiographical examination:Routine radiographical examination √ Orthopantomogram (OPG) √ Occipitomental (water’s view), with lateral tilt.

  35. Radiographical examination:Special investigation and radiographical examination • Sinuscopy • Sinogram • CT scan • MRI

  36. Microbiology and histological examination: • Culture and sensitivity and biopsy.

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