Odontogenic Diseases of the Maxillary Sinus

1. ODONTOGENIC DISEASES
OFTHE MAXILLARY SINUS
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. Outline
• Anatomy of the Maxillary Sinus
• Physiology of the Maxillary Sinus
• Clinical Examination of the Maxillary Sinus
• Radiographic Examination of the Maxillary Sinus
• Non-Odontogenic Infections of the Maxillary Sinus
• Odontogenic Infections of the Maxillary Sinus
• Treatment of Maxillary Sinus Infections
• Management of Complications involving the Maxillary Sinus in oral Surgery
• References

3. Anatomy ofThe Maxillary Sinus
• Air-containing spaces. Antrum of Highmore.
• Four-Sided Pyramid:
• Base: Lateral NasalWall
• Apex: Extends Laterally toThe Zygomatic Process
• Roof: Floor of the orbit
• Anterior and Laterally: First Bicuspid or molar.
• Posterior Wall: Length of the maxilla
• 34 mm (AP) * 33 mm (H) * 23 mm (W).Volume = 15 to 20 mL
• Schneiderian Membrane

5. Physiology of Maxillary Sinus
• Reduction of skull weight
• Air Conditioning
• Resonance of voice
• Heat Insulation
• Humidification of inspired air
• ShockAbsorption (Eye)

6. Clinical Examination
• Careful HistoryTaking
• Inspection
• Palpation
• Percussion
• Charting
• Transillumination

7. Radiographic Examination
• Periapical Radiographs
• Occlusal Radiographs
• Panoramic Radiographs – Screening view
• Water’s view - 37 degrees OcciptoMental
• Lateral Skull Radiographs
• CT scan

11. Non-Odontogenic Infections of the Maxillary Sinus
• Sinusitis
• Acute: Rapid Development of a sense of pressure, pain, fullness, may be
accompanied by facial swelling and erythema, malaise, fever, and drainage of foul-
smelling mucopurulent material into the nasal cavity
• Chronic: low grade and recurrent bacterial or fungal infections, obstructive nasal
disease, or allergy
• Characterized by episodes of sinus disease that respond initially to treatment, only
to return, or that remain symptomatic in spite of treatment.
• Aerobic vs. Anaerobic

12. Odontogenic Infections of the Maxillary Sinus
• 10-12% of all cases
• Acute and chronic periapical diseases and periodontal diseases.
• Trauma to the dentition
• Surgery in the posterior maxilla; removal of teeth, alveolectomy, tuberosity
reduction, sinus lift grafting and implant placement.
• Other procedures that create communication between the oral cavity and the
maxillary sinus.
• Aerobic vs. Anaerobic

14. Complications of Sinusitis

15. Treatment of Maxillary Sinus Infections
• Non-SurgicalTreatment:
• Humidification of inspired air.
• Decongestants (Ex. Pseudoephidrine)
• Anti-Histamines
• Antibiotics
• Nasal WarmWashes
• Analgesics

16. • Surgical
• Caldwell-Luc
Treatment of Maxillary Sinus Infections

17. Treatment of Sinus Infection
• Surgical:
• FESS: Functional Endoscopic Sinus Surgery

18. Management of Oro-Antral Communication
• ImmediateTreatment:
• Identification
• X-Ray
• BlowTest! NEVER
• Management

19. How to identify an Oro-Antral
Communication while extraction of
teeth?

20. Management of Oro-Antral Communication
• If the opening to the sinus is small and the sinus is disease free. Sutures are placed to
reposition soft tissue, and a gauze pack is placed over the surgical site for 1 to 2 hours.
• If larger than 2 mm opening:
• Buccal Advancement Flap
• Palatal Rotational Flap
• Metal Foil [Not Recommended]
• Buccal Fat Pad Flap
• Interpositional Flaps

21. BuccalAdvancement Flap

22. Palatal Rotational Flap

24. Sinus Instructions
• USUAL Extraction instructions +
• Opening the mouth while sneezing
• Not sucking on a straw or cigarettes
• Avoiding nose blowing and any other situation that may produce pressure
changes between the nasal passages and oral cavity.
• The patient is placed on an antibiotic, Anti-Histamine and Decongestants for 2
weeks
• Rhinitis Medacementosa

25. References
• Contemporary - Chapter 20: Odontogenic Infections of the Maxillary Sinus
• Peterson’s – Chapter 16: Sinus Infections

26. THANKYOU