maxsinus lecture 1

8/14/2019 MaxSinus Lecture 1

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King Saud UniversityKing Saud University

Dental CollegeDental CollegeOral and Maxillofacial SurgeryOral and Maxillofacial Surgery311 MDS311 MDS

Maxillary Sinus in Health andMaxillary Sinus in Health and

DiseaseDisease


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Anatomical facts and location:Anatomical facts and location:

The largest para-nasalThe largest para-nasalsinuses.sinuses.

Situated in the maxilla.Situated in the maxilla. Has pyramidal shape.Has pyramidal shape.

Lateral nasal bone formsLateral nasal bone forms

its base.its base.


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Apex headed towards theApex headed towards thezygomatic bone.zygomatic bone. Canine fossa, orbital floorCanine fossa, orbital floor

and hard palate form theand hard palate form thepyramidal walls.pyramidal walls. Communicates with nasalCommunicates with nasalcavity through maxillarycavity through maxillary

ostium, in the posterior endostium, in the posterior endof hitus simlunaris of middleof hitus simlunaris of middlemeatus.meatus.


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Anatomical morphology:Anatomical morphology:

Size varies from oneSize varies from oneperson to another.person to another.

Asymmetry existed inAsymmetry existed in

the same individual.the same individual.

Small in children andSmall in children andgrows up with aging.grows up with aging.

Average height is aboutAverage height is about3.5 cm, depth 3.2 cm3.5 cm, depth 3.2 cmand width 2.5 cm.and width 2.5 cm.

Capacity of about 15 cc.Capacity of about 15 cc.


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Anatomical morphology:Anatomical morphology:

Divided into severalDivided into severalcompartments by bony septacompartments by bony septa

(underwoods septa).(underwoods septa). Lined with pseduo-Lined with pseduo-stratified columnar ciliarystratified columnar ciliary

epithelium (schneiderianepithelium (schneiderianmembrane).membrane).


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Relation with other structures:Relation with other structures:

Alveolar bone and dentition.Alveolar bone and dentition. Nasal cavity andNasal cavity and

nasopharynex.nasopharynex.

Orbital cavity and itsOrbital cavity and itscontents.contents. Hard palate and oral cavityHard palate and oral cavity

proper.proper.

Pterygomaxillary fissure andPterygomaxillary fissure andits contents.its contents.

Neurovascular structuresNeurovascular structuresincluding infraorbital andincluding infraorbital andsuperior alveolar nerve.superior alveolar nerve.


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Development:Development:

Develops from invagination of the mucousDevelops from invagination of the mucousmembrane of middle meatus of the nasalmembrane of middle meatus of the nasalcavity at about the 3cavity at about the 3rdrd month of intrauterinemonth of intrauterinelife.life.

Fully development reaches with the age ofFully development reaches with the age of16 years.16 years.

Loss of permanent teeth and alveolar boneLoss of permanent teeth and alveolar bonemay make the sinus to appear huge in size.may make the sinus to appear huge in size.


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Blood supply:Blood supply:

Blood supply from facial, maxillary,Blood supply from facial, maxillary,infraorbital, greater and lesser palatineinfraorbital, greater and lesser palatinearteries and lateral and posterior nasalarteries and lateral and posterior nasalbranches of sphenopalatine artery.branches of sphenopalatine artery.

Venous drainage to the anterior facial vein,Venous drainage to the anterior facial vein,sphenopalatine vein and pterygopaltinesphenopalatine vein and pterygopaltineplexus.plexus.


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Nerve supply:Nerve supply:

Infraorbital nerve.Infraorbital nerve.

Posterior, middle andPosterior, middle andanterior superioranterior superioralveolar nerves.alveolar nerves.

Greater and lesserGreater and lesserpalatine nerves.palatine nerves.


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Lymphatic drain:Lymphatic drain:

The lymphatic drain of the sinus is throughThe lymphatic drain of the sinus is throughthe nose or the submandibular lymph nodes.the nose or the submandibular lymph nodes.


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Physiology:Physiology:

Unknown but the following functions haveUnknown but the following functions havebeen proposed:been proposed:

Speech and voice resonance.Speech and voice resonance. Reduce weight of skull.Reduce weight of skull.

Warmth inspired air.Warmth inspired air.

Filtration of inspired air.Filtration of inspired air. Immunologic barrier ( body defense).Immunologic barrier ( body defense).


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Pathology:Pathology:

Congenital anomalies.Congenital anomalies. Inflammatory diseases.Inflammatory diseases. Cysts and odontogenicCysts and odontogenic

infection.infection. Bone metaplasia and benignBone metaplasia and benign

tumors.tumors.

Neoplasia.Neoplasia. Trauma.Trauma.


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Congenital anomalies:Congenital anomalies:

Cleft palate.Cleft palate.

Facial fistula and cleft.Facial fistula and cleft.

Cystic formation.Cystic formation.

Atresia.Atresia.


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Inflammatory diseases:Inflammatory diseases:

Bacterial infection.Bacterial infection.

Bacterial infection secondary to viralBacterial infection secondary to viralinfection.infection.

Fungal infection.Fungal infection.


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SinusitisSinusitisAcute sinusitis:Acute sinusitis:

Suppurative or non suppurative inflammationSuppurative or non suppurative inflammationof the mucosal lining of the sinus. Itof the mucosal lining of the sinus. It

involves one or both sinuses.involves one or both sinuses.


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Causes:Causes:

Secondary to hay fever and allergic rhinitis.Secondary to hay fever and allergic rhinitis.

Secondary to acute rhinitis (common cold)Secondary to acute rhinitis (common cold)and URT infection.and URT infection.

Bacterial infection due to: dental sepsis,Bacterial infection due to: dental sepsis,swimming and diving, trauma and foreignswimming and diving, trauma and foreignbody dislodgment.body dislodgment.


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SingsSingsand symptoms:and symptoms:

Headache.Headache. Pain and tenderness.Pain and tenderness. Nasal obstruction.Nasal obstruction. Nasal discharge.Nasal discharge. Toxic manifestations.Toxic manifestations.

Heavy filling with bending.Heavy filling with bending.

Nasal congestion.Nasal congestion. X-ray and transillumination findings.X-ray and transillumination findings.


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TreatmentTreatment::

Rest and fluid and mouth hygiene.Rest and fluid and mouth hygiene.

Antibiotics (C&S); pneumococci andAntibiotics (C&S); pneumococci and

streptococci are the most causativestreptococci are the most causativeorganisms.organisms.

Analgesics and antihistamines.Analgesics and antihistamines.

Local treatment (decongestant and steamLocal treatment (decongestant and steaminhalation).inhalation).


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SinusitisSinusitisChronic sinusitis:Chronic sinusitis:

It is a chronic type of infection affected theIt is a chronic type of infection affected themucosal lining of one or both sinuses,mucosal lining of one or both sinuses,

resulted in mucopus or pus collection. Aresulted in mucopus or pus collection. Apolypoidal type of inflammation can lead topolypoidal type of inflammation can lead to

formation of multiple or single mucosalformation of multiple or single mucosalpolyps.polyps.


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Causes:Causes:

As a consequence of non resolved acuteAs a consequence of non resolved acutesinusitis.sinusitis.

Dental abscesses.Dental abscesses.

Virulent organism with low resistance.Virulent organism with low resistance.

Foreign body dislodgement or trauma.Foreign body dislodgement or trauma.


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Signs and symptoms:Signs and symptoms:

Headache.Headache.

Nasal obstructionNasal obstruction

Nasal discharge.Nasal discharge. Fatigue.Fatigue.

Hyposmia/ cacosmia.Hyposmia/ cacosmia.

Transllumination findings.Transllumination findings. Proof puncture.Proof puncture.


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TreatmentTreatment::

Antibiotics.Antibiotics.

Systemic decongestants.Systemic decongestants.

Sinus wash-out.Sinus wash-out.


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Mycotic infection:Mycotic infection:

Aspergillosis:Aspergillosis:

Opportunistic infection caused by maxillaryOpportunistic infection caused by maxillary

sinus flora fungi environment in susceptiblesinus flora fungi environment in susceptibleindividual, leads to obliteration of the sinusindividual, leads to obliteration of the sinusspace and erosion of its bony components.space and erosion of its bony components.


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Complications of sinusitis:Complications of sinusitis:

Orbital abscess and orbital cellulites.Orbital abscess and orbital cellulites. Intracranial abscesses.Intracranial abscesses. Meningitis.Meningitis. Cavernous sinus thrombosis.Cavernous sinus thrombosis. Spread of infection to neighboring sinuses,Spread of infection to neighboring sinuses,

structures and organs.structures and organs. Osteomyelitis.Osteomyelitis. Gastrointestinal disturbances.Gastrointestinal disturbances.


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Cysts and odontogenic tumors:Cysts and odontogenic tumors:

OdontogenicOdontogeniccysts:cysts:

radicular cysts.radicular cysts.

residual cysts.residual cysts. dentigerous cysts.dentigerous cysts. premordial cysts.premordial cysts.

Non-odontogenicNon-odontogenic

cysts.cysts. Mucocele andMucocele and

retention cysts.retention cysts.

OdontogenicOdontogenictumors:tumors:

ameloblastoma.ameloblastoma. Myxoma.Myxoma.


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Bone metaplasia and benign tumors:Bone metaplasia and benign tumors:

Fibrous dysplasia.Fibrous dysplasia.

Ossifying fibroma.Ossifying fibroma.

Transitional papilloma.Transitional papilloma.

Osteoma.Osteoma.

Giant cell lesions.Giant cell lesions.


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NeoplasiaNeoplasia::

Squamous cell carcinoma.Squamous cell carcinoma.

Adenocarcinoma.Adenocarcinoma.

Sarcoma (osteosarcoma).Sarcoma (osteosarcoma).

Ewings sarcoma.Ewings sarcoma.


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TraumaTrauma::

Tuberosity fracture.Tuberosity fracture.

Dentoalveolar fracture.Dentoalveolar fracture.

LeForts fractures.LeForts fractures. Zygomatic complex fracture.Zygomatic complex fracture.

Pure and impure orbital floor fractures.Pure and impure orbital floor fractures.

Establishment of oro-antral fistula.Establishment of oro-antral fistula.


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Clinical examination:Clinical examination:InspectionInspection

Assess asymmetry.Assess asymmetry.

Color of overlaying skin.Color of overlaying skin.


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Clinical examination:Clinical examination:PalpationPalpation

Tenderness.Tenderness.

Swelling and expansion.Swelling and expansion.

DepressionDepression..


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Clinical examination:Clinical examination:Examination of nasal passageExamination of nasal passage

Nasal patency.Nasal patency.

Pus discharge.Pus discharge.

Nasal polyps.Nasal polyps.

Erythema, redness, change in the color ofErythema, redness, change in the color ofnasal mucosa.nasal mucosa.


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Clinical examination:Clinical examination:TransilluminationTransillumination


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Radiographical examination:Radiographical examination:Routine radiographical examinationRoutine radiographical examination

OrthopantomogramOrthopantomogram(OPG)(OPG)

Occipitomental (watersOccipitomental (watersview), with lateral tilt.view), with lateral tilt.


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Radiographical examination:Radiographical examination:Special investigation and radiographical examinationSpecial investigation and radiographical examination

SinuscopySinuscopy SinogramSinogram

CT scanCT scan MRIMRI


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Microbiology and histological examination:Microbiology and histological examination:

Culture and sensitivity and biopsy.Culture and sensitivity and biopsy.

maxsinus lecture 1

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