1. MAXILARY
SINUS
Presenter Kaspar Solo Puli
BOH/BDS 3
2013

2. OUTLINE
 Define Maxillary Sinus
 Anatomy
 Nerve innervation
 Blood supply
 Lymphatic Drainage
 Sinus Development
 Anatomic morphology
 Functions of Maxillary Sinus's
 Define Maxillary sinusitis's
 Symptoms,Aetiology and Risk Factors of MS
 Maxillary Sinusitis from Dental Origin
 Conclusion

3. What is Maxillary Sinus?
Maxillae refers to
-Upper jaw bone or Upper jaw
-Is a twin bones joint in the midline at the palatine or
medial suture.
-It is an irregular shape preumatized bone supporting the
superior teeth, take part in the formation of the orbit, hard
palate, nasal cavity and gives shapes to the upper face.
It contains the maxillary sinus
Sinus
-Antrum
-is a cavity or hollow space within the bone
Maxillary Sinus- is an air cavity located within the body of each
maxillae

5. Anatomy
 Maxillary sinus are largest sinuses amongst the other
paranasal sinuses;
 Situated in the maxillae
 The resemble a pyramidal shape
walls
SUPERIOR – Orbital, base of the infra orbital, and is
positioned towards the zygomatic bone
INFERIOR – Alveolar process of maxillary roots.The roots of
molars and pre molars (3,4,5,6,7,8)
POSTERIOR- Pterygopalatine fossa
LATERALLY – the nasal bone forms it base
Each sinus communicate with the nasal cavity through maxillary
ostium in the posterior end of the hitus semulunaris of the
middle meatus.

6. Courtesy Of Susan Standring 2008

7. Nerve Innervations
 The maxillary sinus is innervated by the
maxillary division of the trigeminal nerve.
The maxillary nerve branches into
following nerves
◦ Posterior Superior Alveolar Nerve
◦ Middle Superior Alveolar Nerve
◦ Infra Orbital Nerve
◦ Anterior Superior Nerve
◦ Greater and Lesser Palatine Nerves

8. Innervation

9. Blood supply
 The Maxillary sinus is
supplied by blood from
following arteries
◦ External Carotid Artery
◦ Sphnopalatine Artery
◦ Internal Carotid Artery
◦ Maxillary Artery
◦ Ophthalime Artery
◦ Anterior Ethomoid Artery
◦ Posterior Ethmoid Artery
◦ Superior Orbital Artery
◦ Supra Orbital Artery
◦ Supratrochlear Artery
◦ Facial Artery

10. Courtesy of Susan Standring 2008

11. Lymphatic Drain
 The lymphatic drain of the sinus is
through the nose or the submandibular
lymph nodes.
 The lymphatic drainages reaches the
specialised cells in the maxillary sinus via
infra orbital foramen or through the
anterosuperior wall and then to the
submandibular lymphatic gland.

12.  Sinus Drain schema
Courtesy of Richard Et al 2003

13. Sinus Development
 Development of the maxillary sinus occurs after 3 months of
gestation
 After the development of paranasal sinuses the maxillary
sinus are separated from the maxillae by the membrane of
the nasal capsule.
 Maxillary sinuses are first to be developed
 Increase in the height of the maxillae is due to increase in the
size of the sinus
 Maxillary sinus fully develops as the human being reaches the
age of 16.
 Base is formed by the alveolar process and maxillary molars
and premolars teeth root lining in close approximation.
 Sinus may increase in size during adult life by extension into
the alveolar process.

14. Development of the
maxillary sinus
(numbers are age in
years)
Courtesy of Lioyd 1980

15. 
Courtesy of Lioyd 1980

16. Anatomic Morphology
 The morphology of maxillary sinus varies
from person to person
 The average size of maxillary sinus in an
adult is about 3.2cm depth, 3.5cm height,
2.5cm width
 In children the size increases with age as
the child grows up the size changes.
 Each sinus in both maxillary has an
average capacity of 15ml of fluid.

17. Anatomical Morphology
 The maxillary sinus is divided into several
compartments by bony septa
1. The schnerderian membrane
The maxillary sinus are lined with a specialised cells
(ciliated columnar epithelium) similar to those found
on the respiratory tract.The mucous film it secrets
moves spirally and upwards against the gravity
across the membrane to the opening of the sinus
located on the anterior superior wall where it drain
into the nasal cavity.
This forms the schnerderian membrane (mucosa of
the nose)

18. The maxillary sinus are lined with a specialised cells (ciliated
columnar epithelium) similar to those found on the
respiratory tract
Courtesy of Killey et al 1975

19. Function of Maxillary Sinus
The following functions have been proposed
1. Speech andVoice Resonance
2. Reduce or lighten the weight of the skull
3. Warmth inhaled oxygen
4. Filtration of the inspired air
5. Immunological Barrier (body Defence)
6. Humidity for inspires air
7. Regulation of intra nasal pressure
8. Acts as a shock absorber
9. Regulation of intra nasal pressure
10. Increase surface area for olfaction
11. Contributes to facial growth

20. Maxillary Sinusitis
 Maxillary sinusitis is the inflammation of the maxillary
sinus
 Clinically, two types of Maxillary Sinusitis
Acute sinusitis
◦ sings and symptoms of infection proceeds more than 3 weeks
but less that a month
◦ Suppurative or non suppurative inflammation of the mucosal
lining of the sinus. It involves one or both sinuses.
Chronic sinusitis
◦ signs and symptoms of infection proceeds for more that 60 days.
◦ 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.

21. Symptoms
 Blocked nose or Nasal obstruction.
 Nasal congestion
 Headache
 Fever
 Nasal discharge-Yellow or green coloured mucus from the nose
 Swelling of the face
 Aching teeth in the upper jaw
 Loss of the senses of smell and taste
 Persistent cough
 Generally feeling unwell
 X-ray and transillumination findings.

22. Etiology
 The common cause of etiology are
Allergic response
Infection mechanical obstruction
Infected maxillary premolar and molar teeth
Neoplasia- squamous cell carcinoma
Trauma- egTuberosity fracture
Congenital anamolites- cleft palate
Cysts and odontogenic infection- primordial
cysts
Inflammatory disease- bacterial infection and
fungal infection

23. Risk Factors
 Frequent cold
 Cigarette smoking
 Regular nasal decongestion sprays
 Untreated hay fever or other allergies
 Trauma of the nose
 Nasal Polups
 Dental Disease

24. Maxillary sinusitis from Dental
Origin
1. Dental abscess
2. Infected dental cyst
3. Dental material
4. Oro-natral communication

25. Oro-Antral fistula
 A pathologic communication
between the oral cavity and the
maxillary sinus, most commonly
a complication of maxillary or
molar tooth extraction.
 Oro-antral fistula is formed by a break
in the floor of the maxillary sinus
between the premolar and molar.
 Condition in which when the OAC is
not corrected or treated quickly,it will
become lined with the epithelium (skin).
 Hence,oro-antral fistula is an
epithelised tract linking the maxillary
sinus to the mouth;the tract becomes
permanent.
 It is a pathologic tract that connects the
oral cavity to the maxillary sinus.
 Patient complained of regurgitation of
food through the nose while eating.
 Patient also fells air entering their
mouth during eating and smoking.
Courtesy of Killey et al 1975

26. Oro-natral communication
  Communication or hollow
space that links between
the maxillary sinus and
nasal and oral cavity.
 When an OAC is created,
it allows the flow of food,
smoke or fluid from the
mouth into the nose –
 Also bacteria, fungi and
viruses.
 This set up a maxillary
sinusitis, which depending
on how long the
communication lasts for,
may either yield an acute
chronic maxillary sinusitis.
Courtesy of Killey et al 1975

27. Dental Material
 Can be cause by either of these
1. Displacement of root extraction
molars or pre-molars
2. Implant
3. Root canal over filling

28. Displacement of root extraction
molars or pre-molars
  A root tip of the
maxillary first molar
accidentally pushed
into the sinus at the
time of tooth
extraction.
 The root tip is
asymptomatic and has
been present for many
years.
 A root tip in the sinus
does not have a lamina
dura around it.
Courtesy of Killey et al 1975

29. Antrolith (stone)
  Antrolith (stone) in
the maxillary sinus.
Antroliths are calcified
masses found in the
maxillary sinus.
 They are formed by
deposition of calcified
material on a nidus
such as a root
fragment, bone chip,
foreign object, or a
mass of stagnant
mucus in sites of
previous inflammation.
Courtesy of Killey et al 1975

30. Antrolith in the maxillary sinus
Courtesy of Killey et al 1975

31. Infected dental cyst
Any cyst of the maxilla may result in
sinusitis
1. Radicular cyst
2. Dentigerous cyst
3. Mucous retention cyst

32. Radicular cyst
 Courtesy of Killey
et al 1975
 Maxillary sinusitis
caused by an apical
inflammatory lesion
(probably,a
granuloma) at the
root apices of the
second molar.
 Notice the
cloudiness
(radiopacity) of the
sinus
Courtesy of Killey et al 1975

33. Periodontal disease
  Maxillary sinusitis
caused by apical
infection and
extensive
periodontal lesions
involving the molars
and premolar.
 Notice the
cloudiness (radi-
opacity) of the sinus
(s).
Courtesy of Killey et al 1975

34. Peri-apical Abscess
  Apical infection
associated with the
first molar.
 A thickened sinus
mucosa (arrow)
surrounds the lesion
in response to the
apical infection.
Courtesy of Killey et al 1975

35. Clinical Management
 Acute
 Rest and fluid and mouth hygiene.
 Antibiotics penicillins , ampicillin amoxicilin
 Analgesics and antihistamines.
 Local treatment (decongestant and steam inhalation).
 Chronic
 Antibiotics. penicillins , ampicillin amoxicilin
 Systemic decongestant
 Surgical Treatments
 Flap surgery

36. Courtesy of Francis 2002
 Palatal flap  Buccal flap

37. Complications of Maxillary
Sinusitis
Following are some of the possible complications that may
occur
 Orbital abscess and orbital cellulites
 Intracranial abscesses
 Meningitis
 Cavernous sinus thrombosis
 Spread of infection to neighboring sinuses, structures
and organs
 Osteomyelitis
 Gastrointestinal disturbances
 Mucocele
 Facial cellulitis
 Oro-antral fistula
 Epidural, subdural, or intra-cerebral abscess

38. CONCLUSION
 MS can affect any body regardless of the
age, sex and gender.
 Infection is associated with risk factors
and ignorance of basic health principles
 In dealing clinical cases with MS it is handy
to know basic the anatomy; blood supply,
nerve innervations, anatomical
boundaries.

39. Reference List
 Crispian, S. Oslei, P.,A. Jose, B., Pedro, D., D. Adalberto, M.,T. (2010). Oral Medicine and
Pathology at Glance. 1st Edition, Singapore. John Wiley and Son Publications.
 Francis, B., Q. and Glen,T., P. (2002). Paranasal Sinuses:Anatomy and Function. Lecture notes. St.
Louis, Missouri.Washington University School of Medicine, Department of Otolaryngology.
 Killey, H., C. and Kay, H., C. (1975).The Maxillary Sinus and its Dental Implications. England, Great
Britain. John Wright & Sons Publishing Company.
 Lloyd, D., E. (1980). Sichers Oral Anatomy. 7th Edition.Toronto USA: C.V. Mosby Publishing
Company.
 Ricken, C., S. (2007).Woelfel’s Dental Anatomy its Relevance to Dentistry. 7th Edition. New York,
NK: Lippincott Williams and Wilkins Publications.
 Richard,W., B. Donald, E., I. and Elaine, S. (2003).Anatomy of Orofacial Structures. 7th Edition.
Michigan, USA: Mosby Elsevier Publication Company.
 Susan Standring. (2008) Gray’s Anatomy the Anatomical Basis for Clinical Practices. 39th Edition.
London, UK: Elvester Churchill Living Stone Publishing Company.