• It is a pyramidal-shaped air space which
occupies the body of the Maxilla. The base
is formed by lateral wall of nasal cavity.
Upward (roof) by the orbital floor and
downward (base) by the alveolar process of
the posterior maxillary teeth. It is bounded
anteriorly by the outer wall of maxilla.
• The outlet of the sinus is present in the
middle meatus and called hiatus
semilunaris or ostium maxillar.
• The function of the sinuses is to improve
resonance to warm inspired air and to
decrease the weight of the skull.
• The teeth related to the maxillary antrum are
first molar, second molar, second premolar,
third molar and first premolar in that order,
sinus problems can be mixed up with
maxillary dental problems.
Obstruction of natural flow of Obstruction of natural flow of
drainage from the sinuses due to:drainage from the sinuses due to:
1. Inadequate and higher position of
the anatomic openings,
2. Septal deviations,
3. Hyperplasia of the lining and
inadequate ciliary action.
• May be either acute, subactue or chronic depending on the virulance of the organism, the local condition and resistance of the individuals.
EtiologyEtiology• Inflammation of the sinus and its lining is
caused by bacteria from the following sources.
A. Nasal origin: common cold and influenza.
B.B. Dental origin:Dental origin:a. Infection from dental abscess.
b. Infection from cystic lesion of related teeth.
c. Dental material pushed into the sinus “gutta percha”.
d. Tooth or root pushed in the sinus.
e. Oro-antrol fistula.
f. Facial fracture involving the sinus.
g. Sever periodontal pocketing.
1. Headache and sever pain increasing by bending of the bending head downwards.
2. Pain and tenderness in the upper teeth.
3. Unilateral fetid nasal discharge.
4. Nasal obstruction with unpleasent smell.
5. General sympoms of toxamia as fever, malaise and dizzines.
Clinical features Clinical features
1. Ab from 5-7 days.2. Decongestive nasal drops
to shrink the mucous lining and help drainage.
3. Analgesics to relieve pain.
4. If an oror-antral fistula is present, daily irrigation of the sinus by warm normal saline.
5. Removal of the cause, e.g., closure of O.A.F.
Treatment Treatment
1. Continous dull pain and Intermittant headache.
2. Periodic or persistant unilateral nasal discharge.
3. Fetid breath.4. Posterior nasal discharge.5. Transillumination reveals
opacity of the affected side.
6. X-ray show opacity of the sinus with marked thickening of its lining.
Clinical features Clinical features
1. Extraction of infected
tooth.
2. Repair of O.A
communications.
3. The thickened lining
should be removed
through a could well luc
operation.
Treatment Treatment
Occur with fracture of middle third of the face, fracture tuberosity or floor of the sinus during extraction, also may occur from nasal operations
Occur with fracture of middle third of the face, fracture tuberosity or floor of the sinus during extraction, also may occur from nasal operations
Trauma of the sinus
Trauma of the sinus
This rare condition which
may follow perforation of the
floor of the maxillary sinus as
from dental extraction.
This rare condition which
may follow perforation of the
floor of the maxillary sinus as
from dental extraction.
Prolapse of the sinus
Prolapse of the sinus
• This formed in case of fracture of the middle third of the face and cause continuous nasal bleeding.
Treatment:Treatment:1. Cold application to stop bleeding and
decrease swelling.2. Drainage of the sinus through inferior
turbinate puncture.3. Continuous bleeding needing interference
by cold well-luc operation and inserting a pressure pack inside the sinus or by tying the bleeding vessel.
• There are hard calcific bodies with rough irrigular surface, it is asymptomatic and discovered on routine radiography as radio-opaque mass, it may become secondarily infected causing maxillary sinusitis.
Treatment:Treatment:• Removal through cald well-Luc operation
• Usually all the cysts affecting the sinus are
asymptomatic. They are discovered by
routine radiographic examination.
1. Cysts occurring in the sinus:
a. Benign mucosal cyst. b.
Mucocele.
2. Cyst encroaching on the sinus:
a. Periodontal cysts b. Dentigerous
cyst.
c. Odontogenic keratocyst.
• Most common cyst occurs in the sinus as a result of obstruction of the glandular ducts. Small cysts are formed in the lining, or these cysts may ruptured and coalesce to form one large cyst.
Clinical features:Clinical features:1. Discomfort in the cheek or maxilla.2. Buccal expansion of the antrum.3. Nasal obstruction.4. Post nasal discharge.5. External deformity of the face.
• Radiographic picture: Radiographic picture: appear as
rounded lightly opaque shadow in the
floor of the sinus.
• Aspiration: Aspiration: through inferior turbinate
will reveal straw or amber-coloured
fluid “cholesterol crystals”.
Treatment:Treatment:
1. Can be left untreated if found in
routine x-ray.
2. Cannulation through inferior
turbinate puncture.
3. Marsupialization
4. Enculeation through cold well. Luc
operation with nasal antrostomy.
a. Ameloblestoma.b. Adenoameloblastomac. Odontoma.
a. Osteoma.b. Fibro-osteoma.c. Ossifying fibroma.d. Fibroma.
By surgical excision.
1. Epidermoid carcinoma.2. Adenocarcinoma.3. Malignant lymphoma.4. Metastatic deposits from breast or lung
carcinoma.5. Malignant granuloma.
1. Radical resection by maxillectomy.2. Irradiation.3. Cytotoxic drugs and corticosteroid may be
helpful in malignant granuloma.
I. History diffuse toothache with history of common cold.
II. Clinical examination:
Percussion Palpation Transillumination
III. Radiographic examination:
a. Intra-oral periapical and occlusal: may be
helpful to detect root tips or foreign bodies
in sinus.
b. Panoramic view.
c. Water view: 15°° occipito-mental produce a
very clear view of both sinuses and permits
comparison of both sinuses.°
d. Tomogram: it is of high benefit to reveal
early errosion of the wall by neoplastic
lesions.
e. Computerized tomography (C.T. scanning).
IV. Sinoscopy: it is a recent investigation
method which will have an important
role in the diagnosis of malignancy and
other pathological condition in the
sinus.
• It is the communication between maxillary sinus cavity and oral cavity through a perforation in the sinus wall.
Etiology:Etiology:1. Accidental antral opening after extraction.2. Massive trauma to middle third, e.g.,
gunshot injuries.3. After surgical excision of large cyst.
4. May occur as a result of malignant
tumor.
5. Osteomyelitis of the maxilla.
6. Gumma of the palate.
7. After implants.
8. Unhealed cold well-luc operation.
Clinical features:Clinical features:
1. Abnormal deep socket after
extraction.
2. Regurgitation of liquids, from the
mouth into the nose.
3. Unilateral epistaxis.
4. Alternations in vocal resonance.
5. Inability to blow-out the cheek.
6. Difficulty in smoking.
7. Foul or salty unpleasant taste (chronic).
8. In chronic fistula a painless lump present at
the site of extraction.
9. The nose blowing test: when the patient
blows we found bubbling of blood in the
socket.
10. In chronic fistula there are signs of sinusitis.
11. X-ray (periapical or water’s view) reveals
presence of a fistulous tract.
• Immediate oro-antral communications.
• Chronic oro-Antral fistula.
1. Stop bleeding.2. Examine the socket
carefully and (remove the root).
3. Undremining the wound margins and decrease the height of buccal and palatal alveolar plates.
4. Approximate the Bu & palatal mucoperiosteum with proper suturing.
Post-operative care:
o Avoid any positive or
negative pressure.
o Ab sedatives.
o Nasal decongestant
drops.
o Soft dite.
1. A small fistula may heal spontaneously.
2. The fisula persists in case of:
a. The orifice is more than 4mm width.
b. Infection.
c. Laceration of soft tissue.
d. Presence of root.
1. The buccal flap operation.
2. The palatal flap operation.
3. Combination of buccal and palatal flap.
4. Tongue flap.
5. Tunneled palatal pedicle flap.
1. Incomplete elimination of infected tissues.2. Presence of a tooth or a root fragment inside
the sinus.3. Placement of the soft tissue flap under tension.4. Inadequate length of the flap.5. Improper approximation of the flap.6. Haematoma formation and its infection.7. Inadequate drainage through a small nasal
antrostomy.8. Mechanical interference with sutures by the
patients.9. Inadequate post-operative care or instructions.
1. Define the exact location of the tooth or root
using x-ray films and careful clinical
examination.
2. Use of L.A or G.A.
3. Remove through cold well-Luc operation.
4. Close the O.A communication.
1. Removal of tooth and root fragments from the sinus.
2. Trauma to the maxilla “orbital floor” fractures.
3. Management of hematoma of the sinus.
4. Chronic maxillary sinusitis.
5. Cysts in the maxillary sinus.
6. Neoplasms in the maxillary sinus.
7. Resection of maxillary nerve.
• Anesthesia of lip, cheek and gum.
• O.A. fistula.
• Heavy Bleeding.
• Devitalization of teeth.
• Osteomyelitis.
1. Keep biting on the pack for 2 hr.
2. Apply cold fomentation for 24 hr.
3. Avoid any mouth wash for 24hr.
4. Avoid any hot drinks or food for 24hr.
5. Ab, analgesics, decongestive nasal
draps.
6. Avoid any negative or positive pressure
as smoking, blowing, sucking and
caughing.