Maxillary Sinus and Its Surgical An
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Transcript of Maxillary Sinus and Its Surgical An
8/12/2019 Maxillary Sinus and Its Surgical An
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MAXILLARY SINUS AND ITS
SURGICAL ANATOMY
Dr. Fazil ArshadDept of Oral & Maxillo Facial Surgery
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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
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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
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• Post wall —sep sinus from infratemp &pterygopalatine fossae.it is pierced by PSAnerves which supplies molar teeth
• ANTERIOR WALL —Facial surface ofmaxilla
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Avg Dimensions
• Ant.posterior – 3.5cm
• Height -- 3.2cm
• Width -- 2.5cm
• Volume --15 to 30ml
• Ostium(opening)3 to 6 mm dia
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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.
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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
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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
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9yrs 60% of adult size ovoid
12yrs Antral floor parallelsnasal floor __
18yrs adult size pyramidal
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• 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
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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
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• 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
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• 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)
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• 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
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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
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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
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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
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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
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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‖
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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
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CLOSURE OF ORO-ANTRAL COMMUNICATION:
By 3 methods
1)Palatal pedicle flap operation
2)Buccal flap operation
3)Combined technique
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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
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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
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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
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• 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.
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THANK YOU