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Unformatted text preview: King Saud University
King
Dental College
Oral and Maxillofacial Surgery
311 MDS Maxillary Sinus in Health and
Maxillary
Disease
Disease Anatomical facts and location:
Anatomical √ The largest para-nasal
sinuses.
sinuses.
√ Situated in the maxilla.
Situated
√ Has pyramidal shape.
Has
√ Lateral nasal bone forms
its base.
its √ Apex headed towards the
zygomatic bone.
zygomatic
√ 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.
meatus. Anatomical morphology:
Anatomical
√ Size varies from one
person to another.
person
√ Asymmetry existed in
the same individual.
the
√ Small in children and
grows up with aging.
grows
√ Average height is
about 3.5 cm, depth
3.2 cm and width 2.5
cm.
cm.
√ Capacity of about 15
cc.
cc. Anatomical morphology:
Anatomical √ Divided into several
compartments by bony septa
(underwood’s septa).
(underwood’s
√ Lined with pseduo-stratified
columnar ciliary epithelium
(schneiderian membrane).
(schneiderian Relation with other structures:
Relation
√ Alveolar bone and dentition.
Alveolar
√ Nasal cavity and
nasopharynex.
nasopharynex.
√ Orbital cavity and its
contents.
contents.
√ Hard palate and oral cavity
proper.
proper.
√ Pterygomaxillary fissure and
its contents.
its
√ Neurovascular structures
including infraorbital and
superior alveolar nerve.
superior Development:
Development: √ Develops from invagination of the mucous
membrane of middle meatus of the nasal
cavity at about the 3rd month of intrauterine
cavity
life.
life.
√ Fully development reaches with the age of
16 years.
16
√ Loss of permanent teeth and alveolar bone
may make the sinus to appear huge in size.
may Blood supply:
Blood Blood supply from facial, maxillary,
Blood
infraorbital, greater and lesser palatine
arteries and lateral and posterior nasal
branches of sphenopalatine artery.
branches Venous drainage to the anterior facial vein,
Venous
sphenopalatine vein and pterygopaltine
plexus.
plexus. Nerve supply:
Nerve
√ Infraorbital nerve.
Infraorbital
√ Posterior, middle and
anterior superior
alveolar nerves.
alveolar
√ Greater and lesser
palatine nerves.
palatine Lymphatic drain:
Lymphatic The lymphatic drain of the sinus is through
The
the nose or the submandibular lymph nodes.
the Physiology:
Physiology: Unknown but the following functions have
Unknown
been proposed:
been
√ Speech and voice resonance.
Speech
√ Reduce weight of skull.
Reduce
√ Warmth inspired air.
Warmth
√ Filtration of inspired air.
Filtration
√ Immunologic barrier ( body defense).
Immunologic Pathology:
Pathology: Congenital anomalies.
Inflammatory diseases.
Cysts and odontogenic
Cysts
infection.
infection.
Bone metaplasia and benign
Bone
tumors.
tumors.
Neoplasia.
Trauma. Congenital anomalies:
Congenital √ Cleft palate.
Cleft
√ Facial fistula and cleft.
Facial
√ Cystic formation.
Cystic
√ Atresia.
Atresia. Inflammatory diseases:
Inflammatory √ Bacterial infection.
Bacterial
√ Bacterial infection secondary to viral
infection.
infection.
√ Fungal infection.
Fungal Sinusitis
Sinusitis
Acute sinusitis: Suppurative or non suppurative inflammation
Suppurative
of the mucosal lining of the sinus. It
involves one or both sinuses.
involves Causes:
Causes: √ Secondary to hay fever and allergic rhinitis.
Secondary
√ Secondary to acute rhinitis (common cold)
and URT infection.
and
√ Bacterial infection due to: dental sepsis,
swimming and diving, trauma and foreign
body dislodgment.
body Sings and symptoms:
Sings and √
√
√
√
√
√
√
√ Headache.
Headache.
Pain and tenderness.
Pain
Nasal obstruction.
Nasal
Nasal discharge.
Nasal
Toxic manifestations.
Toxic
Heavy filling with bending.
Heavy
Nasal congestion.
Nasal
X-ray and transillumination findings.
X-ray Treatment:
Treatment √ Rest and fluid and mouth hygiene.
Rest
√ Antibiotics (C&S); pneumococci and
streptococci are the most causative
organisms.
organisms.
√ Analgesics and antihistamines.
Analgesics
√ Local treatment (decongestant and steam
inhalation).
inhalation). Sinusitis
Sinusitis
Chronic sinusitis:
Chronic It is a chronic type of infection affected the
It
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:
Causes: √ As a consequence of non resolved acute
sinusitis.
sinusitis.
√ Dental abscesses.
Dental
√ Virulent organism with low resistance.
Virulent
√ Foreign body dislodgement or trauma.
Foreign Signs and symptoms:
Signs √
√
√
√
√
√
√ Headache.
Headache.
Nasal obstruction
Nasal
Nasal discharge.
Nasal
Fatigue.
Fatigue.
Hyposmia/ cacosmia.
Hyposmia/
Transllumination findings.
Transllumination
Proof puncture.
Proof Treatment:
Treatment
√ Antibiotics.
Antibiotics.
√ Systemic decongestants.
Systemic
√ Sinus wash-out.
Sinus Mycotic infection:
Mycotic 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.
space Complications of sinusitis:
Complications Orbital abscess and orbital cellulites. Intracranial abscesses. Meningitis. Cavernous sinus thrombosis. Spread of infection to neighboring sinuses,
Spread
structures and organs.
structures Osteomyelitis. Gastrointestinal disturbances. Cysts and odontogenic tumors:
Cysts Odontogenic cysts: √ radicular cysts.
radicular
√ residual cysts.
residual
√ dentigerous cysts.
dentigerous
√ premordial cysts.
premordial Non-odontogenic
Non-odontogenic
cysts.
cysts. Mucocele and
Mucocele
retention cysts.
retention Odontogenic
Odontogenic
tumors:
tumors: √ ameloblastoma.
ameloblastoma.
√ Myxoma.
Myxoma. Bone metaplasia and benign tumors:
Bone √ Fibrous dysplasia.
Fibrous
√ Ossifying fibroma.
Ossifying
√ Transitional papilloma.
Transitional
√ Osteoma.
Osteoma.
√ Giant cell lesions.
Giant Neoplasia:
Neoplasia
√ Squamous cell carcinoma.
Squamous
√ Adenocarcinoma.
Adenocarcinoma.
√ Sarcoma (osteosarcoma).
Sarcoma
√ Ewing’s sarcoma.
Ewing’s Trauma:
Trauma
√
√
√
√
√
√ Tuberosity fracture.
Tuberosity
Dentoalveolar fracture.
Dentoalveolar
LeFort’s fractures.
LeFort’s
Zygomatic complex fracture.
Zygomatic
Pure and impure orbital floor fractures.
Pure
Establishment of oro-antral fistula.
Establishment Clinical examination:
Clinical
Inspection √ Assess asymmetry.
Assess
√ Color of overlaying skin.
Color Clinical examination:
Clinical
Palpation √ Tenderness.
√ Swelling and expansion.
Swelling
√ Depression.
Depression Clinical examination:
Clinical
Examination of nasal passage √ Nasal patency.
Nasal
√ Pus discharge.
Pus
√ Nasal polyps.
Nasal
√ Erythema, redness, change in the color of
nasal mucosa.
nasal Clinical examination:
Clinical
Transillumination Clinical examination:
Clinical
Diagnostic sinus lavage
√ sinus rinsing through
the canine fosaa.
the
√ Nasal antrostomy.
Nasal Radiographical examination:
Radiographical
Routine radiographical examination
√ Orthopantomogram
(OPG)
(OPG)
√ Occipitomental (water’s
view), with lateral tilt.
view), Radiographical examination:
Radiographical
Special investigation and radiographical examination Sinuscopy Sinogram CT scan MRI Microbiology and histological examination:
Microbiology Culture and sensitivity and biopsy. ...
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Full Document
- Winter '09
- TOMCO
- Sinusitis, Nasal bone, nasal discharge, nasal obstruction, Lateral nasal bone
-
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