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Presentation on theme: "P."— Presentation transcript:

1 P

2 The Maxillary Sinus Prof. Ragab Shaaban

3 Applied anatomy. Diseases. Oro-Antral fistula.
Outlines: Applied anatomy. Diseases. Oro-Antral fistula.

4 Contemporary Oral and Maxillofacial surgery Peterson-Hupp
Text book Contemporary Oral and Maxillofacial surgery Peterson-Hupp

5 Largest paranasal sinuses
Child Adult Pneumatization Pseudo stratified ciliated columnar epithelium

6 General Considerations
It is a pyramidal-shaped air space which occupies the body of the Maxilla. The base is formed by lateral wall of nasal cavity. Upward (roof) by the orbital floor and downward (base) by the alveolar process of the posterior maxillary teeth. It is bounded anteriorly by the outer wall of maxilla. The outlet of the sinus is present in the middle meatus and called hiatus semilunaris or ostium maxillary.




10 The function of the sinuses is to improve resonance to warm inspired air and to decrease the weight of the skull. The teeth related to the maxillary antrum are first molar, second molar, second premolar, third molar and first premolar in that order, sinus problems can be mixed up with maxillary dental problems.

11 Obstruction of natural flow of drainage from the sinuses due to:
Inadequate and higher position of the anatomic openings, Septal deviations, Hyperplasia of the lining and inadequate ciliary action.

12 Diagnosis of the maxillary sinus diseases
I ) History II ) Clinical Examination III ) Radiographic Examination IV ) Sinoscopy

13 I ) History II ) Clinical Examination Percussion Palpation

14 III ) Radiographic Examination
1- Intraoral periapical films Detect approximation of the teeth to the sinus . Detect root tips or foreign bodies in the sinus . 2- Panoramic view Give an overview of the maxillary sinuses bilaterally 3- Water’s view ( 15 degree Occipitomental view ) Produce a very clear unobstructed view of both sinuses .

15 III ) Radiographic Examination
4- Tomogram 5- Computerized Tomography Scanning ( C.T )









24 IV ) Sinoscopy It is a recent investigation method
which have an important role in the diagnosis of the malignancy and other pathological conditions of the maxillary ant rum .

25 Affection of the Maxillary Sinus
Maxillary Sinustis May be either acute, subactue or chronic depending on the virulance of the organism, the local condition and resistance of the individuals. Etiology Inflammation of the sinus and its lining is caused by bacteria from the following sources. Nasal origin: common cold and influenza.

26 Affection of the Maxillary Sinus
Dental origin: Infection from dental abscess. Infection from cystic lesion of related teeth. Dental material pushed into the sinus “gutta percha”. Tooth or root pushed in the sinus. Oro-Antral fistula. Facial fracture involving the sinus. Sever periodontal pocketing.

27 Acute Maxillary Sinusitis
Clinical features Treatment Headache and sever pain increasing by bending of the bending head downwards. Pain and tenderness in the upper teeth. Unilateral fetid nasal discharge. Nasal obstruction with unpleasent smell. General sympoms of toxamia as fever, malaise and dizzines. Ab from 5-7 days. Decongestive nasal drops to shrink the mucous lining and help drainage. Analgesics to relieve pain. If an oror-antral fistula is present, daily irrigation of the sinus by warm normal saline. Removal of the cause, e.g., closure of O.A.F.

28 Chronic Maxillary Sinusits
Clinical features Treatment Continous dull pain and Intermittant headache. Periodic or persistant unilateral nasal discharge. Fetid breath. Posterior nasal discharge. Transillumination reveals opacity of the affected side. X-ray show opacity of the sinus with marked thickening of its lining. Extraction of infected tooth. Repair of O.A communications. The thickened lining should be removed through a Coldwell-Luc operation.

29 Trauma of the sinus Prolapse of the sinus
Occur with fracture of middle third of the face, fracture tuberosity or floor of the sinus during extraction, also may occur from nasal operations Trauma of the sinus This rare condition which may follow perforation of the floor of the maxillary sinus as from dental extraction. Prolapse of the sinus

30 Hematoma of the Sinus Treatment:
This formed in case of fracture of the middle third of the face and cause continuous nasal bleeding. Treatment: Cold application to stop bleeding and decrease swelling. Drainage of the sinus through inferior turbinate puncture. Continuous bleeding needing interference by cold well-luc operation and inserting a pressure pack inside the sinus or by tying the bleeding vessel.

31 Antral Rhinoliths "Calculi or Stones" Treatment:
There are hard calcific bodies with rough irrigular surface, it is asymptomatic and discovered on routine radiography as radio-opaque mass, it may become secondarily infected causing maxillary sinusitis. Treatment: Removal through Coldwell-Luc operation


33 Cysts Affecting the Sinus
Usually all the cysts affecting the sinus are asymptomatic. They are discovered by routine radiographic examination. Cysts occurring in the sinus: Benign mucosal cyst. b. Mucocele. Cyst encroaching on the sinus: Periodontal cysts b. Dentigerous cyst. Odontogenic keratocyst.

34 Benign Mucosal Cyst Clinical features:
Most common cyst occurs in the sinus as a result of obstruction of the glandular ducts. Small cysts are formed in the lining, or these cysts may ruptured and coalesce to form one large cyst. Clinical features: Discomfort in the cheek or maxilla. Buccal expansion of the antrum. Nasal obstruction. Post nasal discharge. External deformity of the face.

35 Radiographic picture: appear as rounded lightly opaque shadow in the floor of the sinus.
Aspiration: through inferior turbinate will reveal straw or amber-coloured fluid “cholesterol crystals”.

36 Treatment: Can be left untreated if found in routine x-ray.
Cannulation through inferior turbinate puncture. Marsupialization Enculeation through cold well. Luc operation with nasal antrostomy.

37 Tumors Affecting The Sinus

38 Benign (Non Odonlogenic)
Benign Odonlogenic Ameloblestoma. Adenoameloblastoma Odontoma. Benign (Non Odonlogenic) Osteoma. Fibro-osteoma. Ossifying fibroma. Fibroma. Treatment By surgical excision.

39 Benign odontogenic tumors: 1- Ameloblastoma:
Ameloblastoma (adamantinoma) is a benign neoplasm deriving from the enamel organ. ---Its etiology has not been ultimately determined. It constitutes about 1% of all head and neck tumours, and about 11% of teeth-originating tumours . NESRIN Abdel Monem Ahmed

40 -Ameloblastoma,Diagnosis:
1 -in upper jaw, molar area is the commonest site . 2-no deformity results as the tumor grows into the sinus. 3-slowly growing, locally invasive . 4-asymptomatic condition usually. 5-egg shell crackling sensation due to thinning of bone 6-malocclusion due to tooth movement. NESRIN Abdel Monem Ahmed

41 Radiographics: 1-Multilocular radilucency: -soap bubble appearance.
-honey combed appearance. 2-unilocular radiolucency: Resembling cystic lesions with irregular scalloping margins. NESRIN Abdel Monem Ahmed

42 Ameloblastoma involving the left maxilla
Ameloblastoma involving the left maxilla. Axial CT image (soft tissue algorithm). Note the extension beyond the posterior maxilla. NESRIN Abdel Monem Ahmed

43 Treatment: Surgical excision is the treatment of choice to reduce the recurrence possibility. NESRIN Abdel Monem Ahmed

44 2-adenoameloblastoma:
It is an adenomatoid odontogenic tumor with no glandular elements. Most common site is maxillary canine region. -slowly enlarging swelling or rarely occurs peripherally as a small sessile mass in the anterior upper gigiva. X-ray: Well defined unilocular area with faint[snow flakes] radioopacities. Treatment: Enucleation is the treatment of choice with no recurrence NESRIN Abdel Monem Ahmed

45 Adenomatoid odontogenic tumor of maxilla in an edentulous patient
Adenomatoid odontogenic tumor of maxilla in an edentulous patient. Radiographically, a dentigerous cyst is suggested NESRIN Abdel Monem Ahmed

46 3-odontomes: They are mixed lesions containing fully formatted dental tissues, both epithelial and mesenchymal, and are usually found during a routine radiographic examination . Radiographic picture: In early stage, it is well defined radiolucent and radiopaque foci usually associated with an impacted tooth and radiopaue rim. Mature lesion appears radiopaque with radiolucent rim. Compound odontomes appear as a bag of teeth Complex odontomes appear as a radiopaque mass(as osteoma ) with radiating structure and a radiolucent rim. NESRIN Abdel Monem Ahmed

47 Clinical picture: Treatment:
1-odontomas occur in children and young adults[second decade]. 2-there is usually a retained deciduous tooth. 3- it is usually asymptomatic as they are a small lesion . 4- large lesions result in jaw expansion. Treatment: Enucleation or local excision with excellent prognosis. NESRIN Abdel Monem Ahmed

48 Benign non odontogenic tumors : 1-Osteoma
It is mesenchyme non odontogenic benign tumor composed of mature or cancellous bone. Osteoma of the paranasal sinuses is a benign, slow growing and well-defined bony tumor arising mostly from the frontal sinus, and less frequently from the ethmoid, the maxillary and the sphenoid sinus. NESRIN Abdel Monem Ahmed

49 Osteoma clinically: -small asymptomtic lesion.
-commener in the mandible premolar lingual area or the condyle region. -types: A] periosteal osteoma; may arise on the surface of the bone as polypoid or sessile mass. B] endosteal osteoma; Arise in the medullary bone. NESRIN Abdel Monem Ahmed

50 Radiography: well circumscribed sclerotic radiopaque mass
Differential diagnosis: -osteoblastoma -focal sclerosing osteomyelitis. Treatment: Conservative surgical excision NESRIN Abdel Monem Ahmed

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