Maxillary Sinus

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Maxillary Sinus
Dr. Adel Abou-ElFetouh

Professor, Oral & Maxillofacial Surgery Dept.
Cairo University, Egypt
a.abouelfetouh@dentistry.cu.edu.eg
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Histology of the Maxillary Sinus
Pseudostratified columnar ciliated epithelium with Goblet

cells overlying lamina propria (connective tissue)
containing a mixture of serous and mucous glands as well
as small venules.

Slide 4
Physiology of the Maxillary

Sinus
 Primary defense mechanism to protect
against inhaled pollutants, allergens and
pathogens.

Slide 5

Sinus
Air conditioning of the inspired air:
warming and humidifying
-Large surface area / convolusions of the
turbinates
-Mucous.
-Profuse blood supply.

Slide 6

Sinus
 Minimize bone mass of the skull.
 Voice resonance.
 To act as a “crumple-zone” in maxillofacial
trauma.

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Development of the Maxillary Sinus

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Development of the Maxillary

Sinus
 Dimensions are Variable and differ
according to the ethnicity, 38-45 mm in
length, 25-35 mm in width and 36-45 mm
in height.
 The average volume is 150 cubic

millimeters.

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Imaging Anatomy of the

Maxillary Sinus
I) Mucosa
• Normal mucosa is usually no more than
2-3 mm thick.
• Thicker in males than females.
• Thickening of the mucosa lining the
inferior aspect of the maxillary sinus is
usually related to pathology of dental
origin (periapical inflammation,
periodontitis, oroantral communication.

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Maxillary Sinus
I) Mucosa

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Maxillary Sinus
I) Osseous
Pyramidal in Shape
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Maxillary Sinus
I) Osseous
Six walls
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I) Osseous

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I) Osseous

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I) Osseous
Posterior Superior Alveolar Artery

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I) Osseous
Maxillary Sinus floor anatomy

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I) Osseous
Maxillary Sinus floor anatomy

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Relationship of Maxillary teeth

Apices to the Maxillary Sinus

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Relationship of Maxillary teeth

Apices to the Maxillary Sinus

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Innervation and Blood Supply

of the Maxillary Sinus
 Innervation by branches of the Maxillary
nerve: Anterior and Posterior superior
alveolar nerves (and middle superior
alveolar nerve if present)
 Arterial blood supply by branches of the

maxillary artery: Infraorbital / posterior
superior alveolar anastomosis along the
anterolateral wall of the sinus. Additional
blood supply from greater palatine and
sphenopalatine arteries.
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Innervation and Blood Supply

of the Maxillary Sinus

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OROANTRAL
COMMUNICATIONS

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Definition
 An unnatural opening between the oral

cavity and the maxillary sinus.

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Etiology
 Complication following extraction of Maxillary

posterior teeth due to proximity of their roots
to the sinus.
 Fracture of the maxillary tuberosity during
extraction.
 Implant dislodgement.
 Dehiscence following failure of dental
implants.
 Pathological: lesions within the sinus,
maxillary tumors, cyst enucleation.
 As a complication of Caldwell-luc surgery.

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Prognosis of Oroantral
communications
 Small communications can heal and close
spontaneously: supportive measures include
the use of dressings, avoidance of negative
sinus pressure.
 If a communication fails to heal within 48

hours: oral epithelium invades and creates a
permanent fistulous tract  continuous inflow
of bacteria and allergens  inflammation of
the Schneiderian membrane  obliteration of
the osteum  chronic maxillary sinusitis

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Diagnosis of OAC and OAF
 Clinical signs and symptoms:

- Altered nasal resonance
- Nasal regurgitation of fluids
- Foul smell (halitosis)
- Chronic sinusitis symptoms: nasal congestion,
postnasal discharge, midface pressure,
headache and pain
• Adjunctive test: Valsalva maneuver (blowing

the nose with the nostrils closed and the
mouth open)  notice the flow of air or blood.

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 Imaging: Panoramic or CT scanning to identify

the exact location and size of the
communication. Also to localize any foreign
bodies (if present) and to evaluate the intra-
sinus condition.

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Management of OAC
Factors affecting choice of treatment modality
 Time of Diagnosis: the earlier the better,
ideally within 24 hours.
 Sinus infection: Antibiotics, irrigation,
nasal decongestants, surgical??
 Size of the defect.
 Amount and condition of available soft
tissue for repair.
 Future restorative plans: dental implants
bone grafting

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Management of OAC
Factors affecting choice of treatment modality
 Size of the defect:
Smaller than 2mm  usually heals
spontaneously
2-5 mm  gel foam and figure of 8 sutures

to stabilize the forming blood clot, then
follow up
>5 mm  surgical intervention

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Management of OAC
Surgical Techniques

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Management of OAC
Soft tissue flaps
 Buccal Advancement Flap (Rehrmann flap):
- Most common, oldest
- Small to moderate defects.
- 90% success rate
- Trapezoidal flap with a wide base  adequate
blood supply.
- Disadvantages: Shortening of the buccal
vestibule  prosthetic difficulty

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Management of OAC

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Management of OAC
Soft tissue flaps
 Buccal fat pad:
- Rich in blood supply (maxillary, superficial
temporal, facial)
- Abundant soft tissue to close larger defects (5
mm)

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Management of OAC
Soft tissue flaps
 Buccal fat pad:
- Complications: Cheek depression
occasionally, trismus (mouth opening
exercises)

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Management of OAC
Soft tissue flaps
 Palatal rotational flap:
- Indications: large defects (10 mm or more), previous
failed attempts
- Advantages: robust blood supply, preservation of
buccal vestibule, keratinized mucosa for
reconstruction.

Slide 39
Management of OAC
Soft tissue flaps
 Palatal rotational flap:
- Contraindications: previous palatal surgeries, trauma
to the palate
- Disadvantage: bare palatal bone (painful)

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Management of OAC
Soft tissue flaps
 Tongue flap:
- Indications: failed buccal and palatal flaps, very large
defects >15 mm, midline or paramidline OAC
- Advantages: rich blood supply, thick pliable tissues,
versatile.
- Disadvantages: very patient bothering, the need for
IMF

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Management of OAC

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Sinus Lift
 Osteotome Sinus Lift  Lateral-window Sinus Lift

(Closed Sinus Lift) (Open Sinus Lift)
(Summers Technique) (Tatum Technique)
Why Sinus Lift and not Onlay Bone Grafting/GBR ??
- Esthetics or Function ??
- Predictability ??

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Osteotome Sinus Lift

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Lateral-window Sinus Lift

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Slide 1

Dr. Adel Abou-ElFetouh

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Histology of the Maxillary Sinus

Pseudostratified columnar ciliated epithelium with Goblet

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Physiology of the Maxillary

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Physiology of the Maxillary

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Physiology of the Maxillary

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Development of the Maxillary Sinus

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Development of the Maxillary

 The average volume is 150 cubic

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Imaging Anatomy of the

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Imaging Anatomy of the

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Imaging Anatomy of the

Imaging Anatomy of the

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Posterior Superior Alveolar Artery

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Maxillary Sinus floor anatomy

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Maxillary Sinus floor anatomy

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Relationship of Maxillary teeth

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Relationship of Maxillary teeth

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Innervation and Blood Supply

 Arterial blood supply by branches of the

Innervation and Blood Supply

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 An unnatural opening between the oral

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 Complication following extraction of Maxillary

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 If a communication fails to heal within 48

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Diagnosis of OAC and OAF

 Clinical signs and symptoms:

• Adjunctive test: Valsalva maneuver (blowing

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Diagnosis of OAC and OAF

 Imaging: Panoramic or CT scanning to identify

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Diagnosis of OAC and OAF

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