Maxillary Sinus and Its Surgical An

8/12/2019 Maxillary Sinus and Its Surgical An

http://slidepdf.com/reader/full/maxillary-sinus-and-its-surgical-an 1/31

MAXILLARY SINUS AND ITS

SURGICAL ANATOMY

Dr. Fazil ArshadDept of Oral & Maxillo Facial Surgery



Introduction

• Maxillary sinuses are air containing spaces

that occupy the maxillary bone bilaterally• They r the 1st of the paranasal

sinuses(eg:maxillary,ethmoidal,frontal,sph

enoid)to devp embryonically.• It was 1st described in 1651,by

NATHANIEL HIGHMORE.So it is also

known as ANTRUM OF HIGHMORE





BOUNDARIES

• Apex – projects laterally into zygo processof maxilla

• Base – lateral wall of the nose

• Roof – orbital surface of maxilla

•Floor – lateral part of hard palate

alveolar process of maxilla



• Post wall —sep sinus from infratemp &pterygopalatine fossae.it is pierced by PSAnerves which supplies molar teeth

• ANTERIOR WALL —Facial surface ofmaxilla



Avg Dimensions

• Ant.posterior – 3.5cm

• Height -- 3.2cm

• Width -- 2.5cm

• Volume --15 to 30ml

• Ostium(opening)3 to 6 mm dia



FUNCTIONS

• Imparts resonance to the voice.

• Makes facial bones lighter.• Moisten & warm the inspired air.

• Filter the debris from inspired air.

• Sinuses are located infront of

forebrain,olfactory region.They create ―AIRPADDING‖ to provide thermal insulation to theseimp tissues.



PHYSIOLOGY

• Lined by resp epithelium i.e pseudostratified,ciliated, columnar epi.it is also known asSCHNEIDERIAN MEMBRANE

• The mucociliary mech is useful means forremoval of particulate matter,bacteria,etc.

• The cilia move the mucus & other debristowards the ostium & subsequentlydischarged in the middle meatus



EMBRYOLOGY:

• In early stages,M.sinus is high in maxilla.latergradually grows downward by a process of

pneumatization• Stages of devp:

• Time growth shape

• 3/12 IU outpouching in middle _

meatus

• BIRTH Tubular2cmx1cmx1cm Tubular



9yrs 60% of adult size ovoid

12yrs Antral floor parallelsnasal floor __

18yrs adult size pyramidal



• The expansion of sinuses normally stopsafter eruption of permanentteeth.however,occasionally the sinuses

pneumatize further,after removal of 1 ormore max post teeth & extend into the

―Residual Alveolar Process‖

• In adults.the apex of root tips of postteeth may extend into sinus cavity



APPLIED SURGICAL ANATOMY

• 1)Relation of root apices with the floor ofthe sinus

• 2)Lining of maxillary sinus

• 3)foreign bodies in the sinus

• 4)Clinical Examn• 5)infections of sinus

• 6)oro-antral communication



• 1)Relation of root apices with floor of the sinus:

• Adults:Approx Distance btw root apex of max

teeth & floor is 1-1.25cm• Sometimes,the floor of the sinus is in close

proximity with roots of these teeth

• The roots of 2nd max molar were closest to thefloor with the next in order of freq were

• 1st molar

• 3rd molar

• 2nd P.M

• 1stP.M

• canine



• LINING OF MAX.SINUS:• It does not get torn,unless the force of

extraction is undue

• The confirmation of breach,can beobtained can be carried out

• a)occipitomental radiograph[radiopacity]

• b)unilateral epistaxis(bleeding from nose)



• FOREIGN BODIES IN SINUS:

• Presence of foreign bodies,such as toothor root fragment,it changes its positionwith movement of head.This change can

be confirmed by serial radiograph.• In case F.body does not move inconsective radiograph,then it is

• a)trapped in thick mucosa• b)btw antral lining & bony wall



CLINICAL EXAMINATION:

• E/O Examn:pain & tenderness,swelling over the prominenceof cheeck bones

• I/O Examn:pain & tenderness,swelling over the maxilla btwcanine fossa & zygomatic buttress



TRANSILLUMINATION

• It is one of the methods of examn & can becarried out becoz of relative THINNESS of walls ofsinus

• Here a strong light is placed in center of mouth of

pt with lips closed• RESULTS:

• a)Normal sinus-shows definite infraorbitalcrescent of light & glowing pupil

• b)Affected sinus —decreased transmission oflight,due to accumulation of fluids,debris,pus &thickening mucosa



MAXILLARY SINUSITIS:

• Def: suppurative or nonsuppurativeinflammation of antral mucosa

• Signs & symptoms

• Tenderness over cheek• Percussion of max teeth shows TENDERNESS

• Pt may give history of cold 3-4days prior

infection• Heavy feeling of head

• Constant pain in upper part of cheek which is

increased by bending down



MANAGEMENT:

• Classical antral regimen includes• Bed rest,plenty of fluids,maintenance of oral

hygiene

• ANTIBIOTICS:• Erytromycin 250-500mg six hourly for 5days

• Amoxicillin 250-500mg tid for 5days

• NSAIDS:

• Aspirin,paracetamol,ibuprofen



OROANTRAL COMMUNICATION:

• DEF:unnatural communication btw oralcavity & maxillary sinus

• ETIOLOGY:

• Extrn of teeth• Perforation of the floor with improper useof instruments

• Forcing tooth or root during attemptedremoval

• Chronic inf of sinus,such as ―osteomyelitis‖



SYMPTOMS(fresh communication)

• 1)Escape of fluids – from mouth to nose onthe side of extrn. This happens when the ptrinses or gargles the mouth following extrnof tooth

• 2)EPISTAXIS(unilateral)

• 3)ESCAPE OF AIR

• 4)ENCHANCED COLUMN OF AIR —causesalteration in voice

• 5)EXTREME PAIN







CLOSURE OF ORO-ANTRAL COMMUNICATION:

By 3 methods

1)Palatal pedicle flap operation

2)Buccal flap operation

3)Combined technique



Palatal pedicle flap

• Procedure under L.A• Flap design is planned

• Flap is incised with G.P artery

• The gingiva on buccal side is undermined• Flap is swung over the defect & tucked under

buccal flap

• Then it is sutured using nylon material

• Pt advised not to cough,sneeze, smoke & kepton soft diet





BUCCAL FLAP OPERATION

• Same as palatal flap procedure but onlydiff is here flap is taken from ―buccal side‖instead of palatal side

• COMBINED TECHNIQUE:

• It is used to cover large defects

• It is the combination of buccal & palatal

flap operations



CLADWELL-LUC OPERATION

• INDICATIONS

• 1)Removal of tooth or root fro antrum

• 2)removal of foreign bodies

• 3)Removal of lining in cases of chronic max

sinusitis• PROCEDURE

• Performed under L.A or G.A

• Gingiva is incised from canine to 2nd molar &antero lateral wall of sinus is exposed

• Window(opening) is made above roots of

premolars with surgical bur





• Window size-equal to dia of index finger

• Then removal of tooth or root fragmentsor foreign bodies is carried out throughwindow and procedure is completed.



THANK YOU

Documents

Maxillary Sinus and Its Surgical An