maxillarysinus and antrum of highmore.pptx

Sinus and it's features

1. MAXILLARY SINUS

2. (Carl E. Misch - Contemporary Implant Dentistry - 3rd Edition) Para nasal Sinuses (PNS) are air containing bony spaces around the nasal cavity. They develop from cranial and facial bones. These spaces communicates with the nasal airway and forms the various boundaries of nasal cavity and named for the bones in which they locates. They are usually lines by respiratory mucous membrane . INTRODUCTION

3. (Carl E. Misch - Contemporary Implant Dentistry - 3rd Edition) There are 4 pairs of paranasal sinuses(bilaterally) Maxillary air sinus Frontal air sinus Ethmoidal air sinus Sphenoidal air sinus

4. DEFINITION “Maxillary sinus is the pneumatic space that is lodged inside the body of maxilla and that communicates with the environment by way of the middle meatus and nasal vestibule.’’ ( Ref: Orban’s Oral Histology – 10th Ed.)

5.  Largest of the paranasal air sinuses and pyramidal in shape First illustrated and described by Leonardo da Vinci in 1489 Later documented by the English anatomist Nathaniel Highmore in 1651 ,so known as Antrum of Highmore Two in number, one on either side of the maxilla May be identical or asymmetrical in size and shape ( Textbook of Oral and Maxillofacial Surgery- Neelima Anil Malik 3 rd edition) MAXILLARY SINUS

6. Boundaries : Base - lateral wall of the nose. Apex - projects laterally into zygomatic process of maxilla Roof - floor of orbit Floor - The alveolar process of maxilla and lateral hard palate

7.  Anterior wall- extends from inferior orbital rim to maxillary alveolar processes  Posterior wall- seperates maxillary sinus and pterygopalatine fossa

8. Greater Palantine Arteries Infraorbital Artery Anterior Superior, Middle and Posterior Superior alveolar arteries Posterior lateral nasal artery ARTERIAL SUPPLY

9.  Facial Vein  Pterygoid Plexus of Veins VENOUS SUPPLY

10. Anterior Superior Alveolar Nerve Middle Superior Alveolar Nerve Posterior Superior Alveolar Nerve Greater palatine nerve Infraorbital Nerve NERVE SUPPLY

11. Submandibular lymph nodes Deep cervical lymph node Retro pharyngeal lymph nodes LYMPHATIC DRAINAGE

12. Impart resonance to the voice. Increase the surface area and lighten the skull. Moisten and warm the inspired air. Filter the debris from the inspired air. Sinuses are located in front of the forebrain, olfactory region, etc. They create “air padding” to provide thermal insulation to the important tissues . FUNCTIONS

13. Begins to form during the 10th week of development The mucosa located at the deeper anterior end of the ethmoid infundibulum presents invaginations toward the surrounding mesenchyme. These invaginations fuse during the 11th week of development, giving rise to a single cavity representing the primordium of the maxillary sinus Joe Iwanaga, Clinical anatomy of the maxillary sinus: application to sinus floor augmentation, Anat Cell Biol , 2019;52:17-24. DEVELOPMENT

14.  The primordial shape of the sinus is characterized as an oval cavity with smooth walls.  Rapid growth of the MS has been observed during two periods of development: from the 17th to the 20 th week and from the 25th to the 28th week. Joe Iwanaga , Clinical anatomy of the maxillary sinus: application to sinus floor augmentation , Anat Cell Biol , 2019;52:17-24.

15.  Ossification of the sinus begins during the 16th week of development, beginning in the lateral wall of the sinus and spreading to the anterior wall by the 20th week , and to the posterior wall by the 21st we ek .  The medial wall shows signs of ossification by the 37th week of development. Joe Iwanaga, Clinical anatomy of the maxillary sinus: application to sinus floor augmentation, Anat Cell Biol , 2019;52:17-24.

16. 0-3 yrs years At birth Filled with deciduous tooth germs Size:7mm x 4mm x 4mm. Vol 6-8ml (Sperber,1989) 20 th month- posterior deve l opment (Ennis1937) 3 rd year : ½ Adult size (Ennis 1937) 3-4 yrs years Increase in width with facial growth Position: 2 nd deciduous molars and crypts of 1 st permanent molars. More prone to infections (Sperber 1989) 7-9 yrs years Size:27mm x 18mmx17mm Growth corresponds to permanent teeth eruption Canine present as ridge in anterior surface of sinus (Ennis 1937) AGE CHANGES OF MAXILLARY SINUS

17. 9-12 yrs years Antral floor same level with nasal floor Portion of alveolar process vacates and becomes p n eum a tised It forms p y ramid a l shape 12-15 yrs years Floor of sinus 5- 12.5 mm below nasal floor Size:32mm x 33mm x 25mm (Turner 1902) Vol 15-20 ml (Nivert 1930) old age Resorption of ridge with continued sinus pneum a ti z a t ion which leaves a thin layer of cortical bone separating the sinus mucosa from oral mucosa Extension of sinus till crest

18. Average dimensions (Turner 1902). Height = 3.2 cm Width = 2.5 cm Length = 3.5 cm( anteroposterior ) Its volume is 15 to 30 ml.

19. The sinuses are lined by respiratory epithelium ; namely, the mucus secreting; pseudostratified , ciliated, columnar epithelium. It is also known as schneiderian membrane . Maxillary sinus is lined by three layers : Epithelial layer Basal lamina Sub epithelial layer with periostium . H istology

20. Five primary cell types exist in this tissue : columnar epithelial cells nonciliated columnar cells basal cells goblet cells seromucinous cells The mucociliary mechanism is useful means for removal of particulate matter, bacteria, etc. The cilia move the mucus and other debris towards the ostium , and subsequently discharged in the middle meatus

21. The ciliated cells contain approximately 50 to 200 cilia per cell. In a healthy patient, they help to clear mucus from the sinus and into the nose. The nonciliated cells comprise the apical aspect of the membrane, contain microvilli , and serve to increase surface area. These cells have been theorized to facilitate humidification and warming of inspired air.

22.  The basal cell’s function serves most likely as a stem cell that can differentiate as needed.  The goblet cells produce glycoproteins that are responsible for the viscosity and elasticity of the mucus . The maxillary sinus membrane also exhibits few elastic fibers attached to the bone, which simplifies elevation of this tissue from the bone. The thickness of the sinus mucosa varies, but is generally 0.3 to 0.8mm.

23. REFERENCES Orban’s Oral Histology and Embryology – 10th Ed.ition Thomas Starch-Jensen , Maxillary Sinus Floor Augmentation: a Review of Selected Treatment Modalities ,J Oral Maxillofac Res, 2017 ; 8,1-3. Carl E Misch -Contemporary Implant Dentisry -3 rd Edition Joe Iwanaga, Clinical anatomy of the maxillary sinus: application to sinus floor Augumentation , Anat Cell Biol , 2019;52:17-24.

24. Muna Soltan Antral Membarane Ballon Elevation, Journal of Oral Implantology 2005;31(2). Metodi Abadzhiev , Alternative Sinus Lift Techniques Littératures review ,Journal of IMAB-Annual Proceeding (Scientific Papers) 2009. Textbook of oral and maxillofacialsurgery , Neelima malik

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