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Unformatted text preview: King Saud University
Oral and Maxillofacial Surgery
311 MDS Maxillary Sinus in Health and
Disease Anatomical facts and location:
Anatomical √ The largest para-nasal
√ Situated in the maxilla.
√ Has pyramidal shape.
√ Lateral nasal bone forms
its √ Apex headed towards the
√ Canine fossa, orbital floor
and hard palate form the
√ Communicates with nasal
cavity through maxillary
ostium, in the posterior end
of hitus simlunaris of middle
meatus. Anatomical morphology:
√ Size varies from one
person to another.
√ Asymmetry existed in
the same individual.
√ Small in children and
grows up with aging.
√ Average height is
about 3.5 cm, depth
3.2 cm and width 2.5
√ Capacity of about 15
cc. Anatomical morphology:
Anatomical √ Divided into several
compartments by bony septa
√ Lined with pseduo-stratified
columnar ciliary epithelium
(schneiderian Relation with other structures:
√ Alveolar bone and dentition.
√ Nasal cavity and
√ Orbital cavity and its
√ Hard palate and oral cavity
√ Pterygomaxillary fissure and
√ Neurovascular structures
including infraorbital and
superior alveolar nerve.
Development: √ Develops from invagination of the mucous
membrane of middle meatus of the nasal
cavity at about the 3rd month of intrauterine
√ Fully development reaches with the age of
√ 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,
infraorbital, greater and lesser palatine
arteries and lateral and posterior nasal
branches of sphenopalatine artery.
branches Venous drainage to the anterior facial vein,
sphenopalatine vein and pterygopaltine
plexus. Nerve supply:
√ Infraorbital nerve.
√ Posterior, middle and
√ Greater and lesser
palatine Lymphatic drain:
Lymphatic The lymphatic drain of the sinus is through
the nose or the submandibular lymph nodes.
Physiology: Unknown but the following functions have
√ Speech and voice resonance.
√ Reduce weight of skull.
√ Warmth inspired air.
√ Filtration of inspired air.
√ Immunologic barrier ( body defense).
Pathology: Congenital anomalies.
Cysts and odontogenic
Bone metaplasia and benign
Trauma. Congenital anomalies:
Congenital √ Cleft palate.
√ Facial fistula and cleft.
√ Cystic formation.
Atresia. Inflammatory diseases:
Inflammatory √ Bacterial infection.
√ Bacterial infection secondary to viral
√ Fungal infection.
Acute sinusitis: Suppurative or non suppurative inflammation
of the mucosal lining of the sinus. It
involves one or both sinuses.
Causes: √ Secondary to hay fever and allergic rhinitis.
√ Secondary to acute rhinitis (common cold)
and URT infection.
√ Bacterial infection due to: dental sepsis,
swimming and diving, trauma and foreign
body Sings and symptoms:
Sings and √
Pain and tenderness.
Heavy filling with bending.
X-ray and transillumination findings.
Treatment √ Rest and fluid and mouth hygiene.
√ Antibiotics (C&S); pneumococci and
streptococci are the most causative
√ Analgesics and antihistamines.
√ Local treatment (decongestant and steam
Chronic It is a chronic type of infection affected the
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
Causes: √ As a consequence of non resolved acute
√ Dental abscesses.
√ Virulent organism with low resistance.
√ Foreign body dislodgement or trauma.
Foreign Signs and symptoms:
√ Systemic decongestants.
√ Sinus wash-out.
Sinus Mycotic infection:
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,
structures and organs.
structures Osteomyelitis. Gastrointestinal disturbances. Cysts and odontogenic tumors:
Cysts Odontogenic cysts: √ radicular cysts.
√ residual cysts.
√ dentigerous cysts.
√ premordial cysts.
cysts. Mucocele and
tumors: √ ameloblastoma.
Myxoma. Bone metaplasia and benign tumors:
Bone √ Fibrous dysplasia.
√ Ossifying fibroma.
√ Transitional papilloma.
√ Giant cell lesions.
√ Squamous cell carcinoma.
√ Sarcoma (osteosarcoma).
√ Ewing’s sarcoma.
√ Tuberosity fracture.
Zygomatic complex fracture.
Pure and impure orbital floor fractures.
Establishment of oro-antral fistula.
Establishment Clinical examination:
Inspection √ Assess asymmetry.
√ Color of overlaying skin.
Color Clinical examination:
Palpation √ Tenderness.
√ Swelling and expansion.
Depression Clinical examination:
Examination of nasal passage √ Nasal patency.
√ Pus discharge.
√ Nasal polyps.
√ Erythema, redness, change in the color of
nasal Clinical examination:
Transillumination Clinical examination:
Diagnostic sinus lavage
√ sinus rinsing through
the canine fosaa.
√ Nasal antrostomy.
Nasal Radiographical examination:
Routine radiographical examination
√ Occipitomental (water’s
view), with lateral tilt.
view), Radiographical examination:
Special investigation and radiographical examination Sinuscopy Sinogram CT scan MRI Microbiology and histological examination:
Microbiology Culture and sensitivity and biopsy. ...
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This note was uploaded on 11/10/2011 for the course PDBIO 220 taught by Professor Tomco during the Winter '09 term at BYU.
- Winter '09