Maxillary sinus in Disease and Trauma Flashcards
Maxillary Sinus - Anatomical facts and location
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The largest para-nasal sinuses.
Located in the maxilla.
Is pyramidal in shape.
The Lateral nasal bone forms its base.
Maxillary Sinus - Physiological Functions
* Not clearly known but the following functions
have been proposed:
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Speech and voice resonance.
Reduces weight of skull.
Warms the inspired air.
Filtration of inspired air.
Immunologic barrier ( body defense).
Maxillary Sinus - Anatomical Morphology
- Size varies from one person to another.
- — between the sinuses exists in the same individual.
- Small in children and — in size with aging.
- Average height is about – cm, depth is – cm, width is – cm and the Capacity is 15 cc.
- Divided into several compartments by —-
Asymmetry
increases
3.5, 3.2, 2.5
bony septa (Underwood’s septa)
Ostium
Opens at
postero-inferior end of semi lunar hiatus lying in the middle meatus
The — membrane is the membranous lining of the maxillary sinus cavity.
Schneiderian
Microscopically there is a bilaminar membrane with
mucous secreting pseudostratified
ciliated columnar epithelial cells on the internal side and periosteum on the osseous side.
Lining contains osteoclasts which contribute to —.
pneumatisation
Maxillary Sinus Disorders
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- Congenital anomalies.
- Inflammatory diseases.
- Odontogenic infection.
- Cysts .
- Neoplasia.
- Bone metaplasia and benign tumors
- Trauma
Inflammatory diseases of (4)
Maxillary Sinus
Bacterial infection.
Bacterial infection secondary to viral infection.
Fungal infection.
About 10% of inflammatory episodes are extensions of dental infections.
Classification of Maxillary Sinusitis
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Acute sinusitis (<2 weeks),
Subacute sinusitis (2 weeks to 3 months),
Chronic sinusitis (>3 months)
Acute Maxillary Sinusitis
There is suppurative or non -suppurative inflammation of the mucosal lining of the
maxillary sinus.
Acute sinusitis (<2 weeks),
It involves one or both of the Maxillary sinuses.
Acute Maxllary Sinusitis - Causes
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Secondary to hay fever and allergic rhinitis.
Secondary to acute rhinitis (common cold) and Upper Respiratory Tract infection.
Bacterial infection due to:
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Dental infections Foreign body dislodgment into the maxillary sinus
Acute Maxillary Sinusitis - Treatment
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Rest and fluid and oral hygiene.
Antibiotics (Augmentin) after C&S is done; pneumococci and streptococci are the
most causative organisms.
Analgesics and NSAIDS (Acetoaminophen, Ibuprofen)
Antihistamines
Local treatment
Acute Maxillary Sinusitis - Clinical Exam
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Examine the nasal cavity: discharge–pus–blood -polyps….
Palpate the anterior wall of the maxilla (Intra and extra-oral approach)
Rule out odontogenic cause (through clinical and radiographic exam)
Acute Maxillary Sinusitis - Signs and Symptoms
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Headache.
Pain and tenderness.
Nasal obstruction.
Nasal discharge.
Toxic manifestations.
Heavy filling with bending.
Nasal congestion.
Chronic sinusitis
It is a chronic type of infection that affects the mucosal lining of one or both sinuses, resulting
inmucous or pus collection.
Chronic sinusitis (>3 months).
Local treatment
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Nasal Decongestant
e.g. Afrin Sinus decongestant, 2 to 3 Nasal puffs 2 times daily for 3 to 4 days
Steam inhalation
Mucosal Polyps in the Sinus
- A polypoidal type of inflammation can lead to formation of multiple or single mucosal
polyps inside the sinus
Chronic Maxillary Sinusitis - Causes
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As a consequence of non resolved acute maxillary
sinusitis.
Dental abscesses.
Virulent organism with low resistance.
Foreign body dislodgement or trauma.
Chronic Maxillary Sinusitis - Signs and symptoms
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Headache.
Nasal obstruction
Nasal discharge.
Fatigue.
Hyposmia/ Anosmia.
Chronic Maxillary Sinusitis - Treatment
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Rest and fluid and oral hygiene.
Antibiotics (Augmentin) after C&S is done; pneumococci and streptococci are the
most causative organisms.
Analgesics and NSAIDS (Acetoaminophen, Ibuprofen)
Antihistamines
Local treatment
Local treatment
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Nasal Decongestant
e.g. Afrin Sinus decongestant, 2 to 3 Nasal puffs 2 times daily for 3 to 4 days
Steam inhalation
Complications of Maxillary Sinusitis
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- Orbital abscess and orbital cellulitis.
- Intracranial abscesses / Meningitis.
- Cavernous sinus thrombosis.
- Spread of infection to neighboring sinuses, structures
and organs. - Osteomyelitis.
Mycotic Infections of the Maxillary Sinus
Aspergillosis
It is an opportunistic infection caused by maxillary
sinus flora fungi called as “Aspergillosis fumigatus” in
an susceptible individual (low immunity).
This leads to obliteration of the sinus space and erosion
of its bony components.
Treatment is essentially surgical removal of the
associated lesion from the maxillary sinus.
It is an opportunistic infection caused by maxillary
sinus flora fungi called as “Aspergillosis fumigatus” in
an susceptible individual (low immunity).
This leads to obliteration of the sinus space and erosion
of its bony components.
Treatment is essentially surgical removal of the
associated lesion from the maxillary sinus.
Odontogenic cysts
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Radicular cysts.
Residual cysts.
Dentigerous cysts.
Primordial cysts
Non-odontogenic cysts
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Mucous Retention cyst.
Mucocele
Odontogenic Tumors of the Maxillary Sinus
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- Ameloblastoma.
- Myxoma.
Maxillary Sinus Neoplasia
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Squamous cell carcinoma.
Adenocarcinoma
Sarcoma (osteosarcoma)
Ewing’s sarcoma.
Bone metaplasia and benign tumors of the maxillary sinus
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Fibrous dysplasia.
Ossifying fibroma.
Transitional papilloma.
Osteoma.
Giant cell lesions.
Trauma to the Maxillary sinus
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Le Fort I fracture.
Zygomatic complex fracture.
Orbital floor fractures.
Oro-antral communications, Tuberosity Fracture
(during tooth extraction process).
Trauma to the Maxillary Sinus - Le Fort I Fracture
Horizontal fracture through the maxilla above the level of the nasal floor and alveolar process
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Piriform rims
Anterior maxilla
Zygomatic buttresses
Pterygoid plates
