MAXILLARY SINUS AND ITS SURGICAL ANATOMY (2) (1) [Autosaved].ppt

sinus

1. MAXILLARY SINUS AND ITS
SURGICAL
ANATOMY

2. Introduction
•Maxillary sinuses are air containing spaces that occupy the maxillary
bone bilaterally
•They r the 1
st
of the paranasal sinuses ( eg: maxillary, ethmoidal, frontal,
sphenoid) to developed embryonically.
•It was 1
st
described in 1651,by NATHANIEL HIGHMORE. So it is also
known as ANTRUM OF HIGHMORE

4. BOUNDARIES
•Apex– projects laterally into zygomatic process of maxilla
•Base– lateral wall of the nose
•Roof– orbital surface of maxilla
•Floor– lateral part of hard palate
alveolar process of maxilla

5. •Post wall—sep sinus from infratemporal & pterygopalatine fossae.It is
pierced by PSA nerves which supplies molar teeth

•ANTERIOR WALL—Facial surface of maxilla

6. Average Dimensions
•Antero-posterior – 3.5cm
•Height -- 3.2cm
•Width -- 2.5cm
•Volume --15 to 30ml
•Ostium(opening)3 to 6 mm diameter

7. 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 the forebrain, olfactory
region. They create “AIR PADDING” to provide thermal
insulation to these imp tissues.
•Enhancement of faciocranial resistance to mechanical shock.
•Production of bactericidal lysozyme to the nasal cavity.

8. PHYSIOLOGY
•Lined by respiratory epithelium i.e pseudostratified, ciliated, columnar
epithelium. It is also known as SCHNEIDERIAN MEMBRANE
•The mucociliary mechanism is useful means for removal of particulate matter,
bacteria,etc.
•The cilia move the mucus & other debris towards the ostium & subsequently
discharged in the middle meatus.

9. EMBRYOLOGY:
•In early stages ,Maxillary sinus is high in maxilla, later
gradually grows downward by a process of
pneumatization
•Stages of deveplopment:
•Time growth shape
•3/12 IU outpouching in middle _
meatus
•BIRTH Tubular2cmx1cmx1cm Tubular

10. 9yrs 60% of adult size ovoid
12yrs Antral floor parallels
nasal floor __
18yrs adult size pyramidal

11. •The expansion of sinuses normally stops after eruption of permanent
teeth. However, occasionally the sinuses pneumatize further ,after
removal of 1 or more max post teeth & extend into the “Residual Alveolar
Process”
•In adults,the apex of root tips of post teeth may extend into sinus cavity

12. APPLIED SURGICAL ANATOMY
•1)Relation of root apices with the floor of the sinus
•2)Lining of maxillary sinus
•3)Foreign bodies in the sinus
•4)Clinical Examination
•5)Infections of sinus
•6)Oro-antral communication

13. •1)Relation of root apices with floor of the sinus:
•Adults: Approximately Distance between 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 2
nd
max molar were closest to the floor with the
next in order of freq were
•1
st
molar
•3
rd
molar
•2
nd
P.M
•1stP.M
•canine

14. •LINING OF MAX.SINUS:
•It does not get torn, unless the force of extraction is undue
•The confirmation of breach, can be obtained can be carried out
•a)occipitomental radiograph [radiopacity]
•b)unilateral epistaxis (bleeding from nose)

15. •FOREIGN BODIES IN SINUS:
•Presence of foreign bodies, such as tooth or root fragment, it changes
its position with movement of head. This change can be confirmed by
serial radiograph.
•In case foreign body does not move in conservative radiograph, then it is
•a) Trapped in thick mucosa
•b) Between antral lining & bony wall

16. CLINICAL EXAMINATION:
•E/O Examination:
pain & tenderness, swelling over the prominence of
cheeck bones
•I/O Examination:
pain & tenderness, swelling over the maxilla btw canine
fossa & zygomatic buttress

17. TRANSILLUMINATION
•It is one of the methods of examination & can be carried
out because of relative THINNESS of walls of sinus
•Here a strong light is placed in center of mouth of pt with
lips closed
•RESULTS:
•a) Normal sinus-shows definite infraorbital crescent of light
& glowing pupil
•b) Affected sinus—decreased transmission of light, due to
accumulation of fluids, debris, us & thickening mucosa

18. MAXILLARY SINUSITIS:
•Def: suppurative or nonsuppurative inflammation 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

19. 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

20. OROANTRAL COMMUNICATION:
•DEF:unnatural communication btw oral cavity & maxillary sinus
•ETIOLOGY:
•Extraction of teeth
•Perforation of the floor with improper use of instruments
•Forcing tooth or root during attempted removal
•Chronic infection of sinus, such as “osteomyelitis”

21. SYMPTOMS (fresh communication)
•1)Escape of fluids– from mouth to nose on the side of extraction. This
happens when the pt rinses or gargles the mouth following extraction of
tooth
•2)EPISTAXIS(unilateral)
•3)ESCAPE OF AIR
•4)ENCHANCED COLUMN OF AIR—causes alteration in voice
•5)EXTREME PAIN

24. CLOSURE OF ORO-ANTRAL COMMUNICATION:
By 3 methods
1)Palatal pedicle flap operation
2)Buccal flap operation
3)Combined technique

25. 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 & kept on soft diet

27. BUCCAL FLAP OPERATION
•Same as palatal flap procedure but only diff 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

28. CLADWELL-LUC OPERATION
•INDICATIONS
•1)Removal of tooth or root from 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 2
nd
molar & antero lateral wall of sinus is
exposed
•Window (opening) is made above roots of premolars with surgical bur

30. •Window size-equal to diameter of index finger
•Then removal of tooth or root fragments or foreign bodies is carried out
through window and procedure is completed.

31. THANK YOU