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 pseduo-
stratified 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.
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).
Pathology:
 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:
√ 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:
√ Headache.
√ Nasal obstruction
√ Nasal discharge.
√ Fatigue.
√ Hyposmia/ cacosmia.
√ Transllumination findings.
√ Proof puncture.
Treatment:
√ Antibiotics.
√ Systemic decongestants.
√ Sinus wash-out.
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.
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.
Cysts and odontogenic tumors:
 Odontogenic  Non-odontogenic
cysts: cysts.
 Mucocele and
√ radicular cysts. retention cysts.
√ residual cysts.
√ dentigerous cysts.  Odontogenic
√ premordial cysts. 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:
√ 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.

Palpation
√ Tenderness.
√ Swelling and expansion.
√ Depression.
Examination of nasal passage
√ Nasal patency.
√ Pus discharge.
√ Nasal polyps.
√ Erythema, redness, change in the color of

nasal mucosa.
Transillumination
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
Microbiology and histological examination:
 Culture and sensitivity and biopsy.

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King Saud University

Maxillary Sinus in Health and

√ The largest para-nasal

√ Size varies from one

√ Divided into several

√ Alveolar bone and dentition.

√ Develops from invagination of the mucous

√ Posterior, middle and

√ Greater and lesser

 The lymphatic drain of the sinus is through

 Unknown but the following functions have

√ Facial fistula and cleft.

√ Bacterial infection secondary to viral

Suppurative or non suppurative inflammation

√ Secondary to hay fever and allergic rhinitis.

√ Secondary to acute rhinitis (common cold)

√ Bacterial infection due to: dental sepsis,

√ Rest and fluid and mouth hygiene.

It is a chronic type of infection affected the

√ As a consequence of non resolved acute

√ Virulent organism with low resistance.

√ Foreign body dislodgement or trauma.

 Orbital abscess and orbital cellulites.

√ Giant cell lesions.

√ Squamous cell carcinoma.

√ Color of overlaying skin.

√ Swelling and expansion.

√ Erythema, redness, change in the color of

√ sinus rinsing through

 Culture and sensitivity and biopsy.

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