Maxillary sinus in Disease and Trauma

Question 1

Maxillary Sinus - Anatomical facts and location
(4)

Answer 1

The largest para-nasal sinuses.
Located in the maxilla.
Is pyramidal in shape.
The Lateral nasal bone forms its base.

Question 2

Maxillary Sinus - Physiological Functions
* Not clearly known but the following functions
have been proposed:
(5)

Answer 2

Speech and voice resonance.
Reduces weight of skull.
Warms the inspired air.
Filtration of inspired air.
Immunologic barrier ( body defense).

Question 3

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 —-

Answer 3

Asymmetry
increases
3.5, 3.2, 2.5
bony septa (Underwood’s septa)

Question 4

Ostium
Opens at

Answer 4

postero-inferior end of semi lunar hiatus lying in the middle meatus

Question 5

The — membrane is the membranous lining of the maxillary sinus cavity.

Answer 5

Schneiderian

Question 6

Microscopically there is a bilaminar membrane with

Answer 6

mucous secreting pseudostratified
ciliated columnar epithelial cells on the internal side and periosteum on the osseous side.

Question 7

Lining contains osteoclasts which contribute to —.

Answer 7

pneumatisation

Question 8

Maxillary Sinus Disorders
(7)

Answer 8

• Congenital anomalies.
• Inflammatory diseases.
• Odontogenic infection.
• Cysts .
• Neoplasia.
• Bone metaplasia and benign tumors
• Trauma

Question 9

Inflammatory diseases of (4)

Answer 9

Maxillary Sinus
Bacterial infection.
Bacterial infection secondary to viral infection.
Fungal infection.
About 10% of inflammatory episodes are extensions of dental infections.

Question 10

Classification of Maxillary Sinusitis
(3)

Answer 10

Acute sinusitis (<2 weeks),
Subacute sinusitis (2 weeks to 3 months),
Chronic sinusitis (>3 months)

Question 11

Acute Maxillary Sinusitis

Answer 11

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.

Question 12

Acute Maxllary Sinusitis - Causes
(2)

Answer 12

Secondary to hay fever and allergic rhinitis.
Secondary to acute rhinitis (common cold) and Upper Respiratory Tract infection.

Question 13

Bacterial infection due to:
(2)

Answer 13

Dental infections Foreign body dislodgment into the maxillary sinus

Question 14

Acute Maxillary Sinusitis - Treatment
(5)

Answer 14

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

Question 14

Acute Maxillary Sinusitis - Clinical Exam
(3)

Answer 14

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)

Question 14

Acute Maxillary Sinusitis - Signs and Symptoms
(7)

Answer 14

Headache.
Pain and tenderness.
Nasal obstruction.
Nasal discharge.
Toxic manifestations.
Heavy filling with bending.
Nasal congestion.

Question 14

Chronic sinusitis

Answer 14

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).

Question 14

Local treatment
(2)

Answer 14

Nasal Decongestant
e.g. Afrin Sinus decongestant, 2 to 3 Nasal puffs 2 times daily for 3 to 4 days
Steam inhalation

Question 14

Mucosal Polyps in the Sinus

Answer 14

• A polypoidal type of inflammation can lead to formation of multiple or single mucosal
  polyps inside the sinus

Question 15

Chronic Maxillary Sinusitis - Causes
(4)

Answer 15

As a consequence of non resolved acute maxillary
sinusitis.
Dental abscesses.
Virulent organism with low resistance.
Foreign body dislodgement or trauma.

Question 16

Chronic Maxillary Sinusitis - Signs and symptoms
(5)

Answer 16

Headache.
Nasal obstruction
Nasal discharge.
Fatigue.
Hyposmia/ Anosmia.

Question 17

Chronic Maxillary Sinusitis - Treatment
(5)

Answer 17

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

Question 18

Local treatment
(2)

Answer 18

Nasal Decongestant
e.g. Afrin Sinus decongestant, 2 to 3 Nasal puffs 2 times daily for 3 to 4 days
Steam inhalation

Question 19

Complications of Maxillary Sinusitis
(5)

Answer 19

• Orbital abscess and orbital cellulitis.
• Intracranial abscesses / Meningitis.
• Cavernous sinus thrombosis.
• Spread of infection to neighboring sinuses, structures
  and organs.
• Osteomyelitis.

Question 20

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.

Answer 20

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.

Question 21

Odontogenic cysts
(4)

Answer 21

Radicular cysts.
Residual cysts.
Dentigerous cysts.
Primordial cysts

Question 22

Non-odontogenic cysts
(2)

Answer 22

Mucous Retention cyst.
Mucocele

Question 23

Odontogenic Tumors of the Maxillary Sinus
(2)

Answer 23

• Ameloblastoma.
• Myxoma.

Question 24

Maxillary Sinus Neoplasia
(4)

Answer 24

Squamous cell carcinoma.
Adenocarcinoma
Sarcoma (osteosarcoma)
Ewing’s sarcoma.

Question 25

Bone metaplasia and benign tumors of the maxillary sinus
(5)

Answer 25

Fibrous dysplasia.
Ossifying fibroma.
Transitional papilloma.
Osteoma.
Giant cell lesions.

Question 26

Trauma to the Maxillary sinus
(4)

Answer 26

Le Fort I fracture.
Zygomatic complex fracture.
Orbital floor fractures.
Oro-antral communications, Tuberosity Fracture
(during tooth extraction process).

Question 27

Trauma to the Maxillary Sinus - Le Fort I Fracture
Horizontal fracture through the maxilla above the level of the nasal floor and alveolar process
(4)

Answer 27

Piriform rims
Anterior maxilla
Zygomatic buttresses
Pterygoid plates