Transcript MaxSinus lecture 1

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 pseduostratified 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.
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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).
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Pathology:
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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:
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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:
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Headache.
Nasal obstruction
Nasal discharge.
Fatigue.
Hyposmia/ cacosmia.
Transllumination findings.
Proof puncture.
Treatment:
√ Antibiotics.
√ Systemic decongestants.
√ Sinus wash-out.
Mycotic infection:
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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.
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Cysts and odontogenic tumors:
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Odontogenic
cysts:
√ radicular cysts.
√ residual cysts.
√ dentigerous cysts.
√ premordial cysts.
Non-odontogenic
cysts.
 Mucocele and
retention cysts.
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Odontogenic
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:
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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
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Microbiology and histological examination:
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Culture and sensitivity and biopsy.