- 1.PRESENTED BY DR. SHEETAL KAPSE
2. INCLUSIONS - INTRODUCTION FEATURES OF MAXILLA DEVELOPMENT
SURGICAL ANATOMY CONCLUSION RESOURCES 3. INTRODUCTION 2nd largest
bone of face 2 maxillae forms whole of upper jaw Each maxilla
contributes in formation of 1. Face2. Nose3. Mouth4. Orbit5.
Infratemporal fossa6. Pterygopalatine fossa 4. FEATURES OF MAXILLA
Each maxilla has 1. A body2. 4 processes
frontalzygomaticalveolarpalatine 5. BODY OF MAXILLA Shape pyramidal
It has 1. Base directed medially at nasal surface2. Apex - directed
laterally at zygomatic process3. 4 surfaces anterior /
facialposterior / infratemporalmedial / nasalsuperior /
orbitalEncloses a cavity maxillary sinus 6. ANTERIOR / FACIAL
SURFACE Directs laterally Incisive fossa -depressor septi Incisivus
alveolar margin Nasalis superiolateral, along nasal notch 7. Canine
fossa levator anguli oris Infraorbital foramen levator labii
superioris Medially the nasal notch- anterior nasal spine 8.
POSTERIOR / INFRATEMPORAL SURFACE Concave Directed backward &
laterally Forms anterior wall of infratemporalfossa Separated from
anterior surface 2-3 alveolar canals for posterior superioralveolar
nerve Posteroinferiorly maxillary tuberosity &superficial head
of medial pterygoidmuscle Above maxillary tuberosity -anterior
wallof infratemporal fossa, grooved bymaxillary nerve 9. SUPERIOR /
ORBITAL SURFACE Smooth, triangular & slightly concave Forms
Greater Part Of Floor Of Orbit Anterior border forms part of
inferior orbital margincontinues with lacrymal crest of frontal
process 10. Posterior border smooth & rounded Forms most
anterior margin ofinferior orbital fissure In middle infraorbital
grooveMedial border Anteriorly lacrymal notch, converted into
nasolacrymal canal Behind the notch, articulation with
-LacrymalLabrynth of ethmoidOrbital process of palatine bone 11.
The superior surface presents Infraorbital groove & canal
Canalis sinosus Inferior oblique muscles 12. THE MEDIAL /NASAL
SURFACE Part of lateral wall of nose Posterosuperiorly maxillary
hiatus Above the hiatus air sinuses Below the hiatus anterior part
of inferior meatus Behind the hiatus articulates withperpendicular
plate ofpalatine bone&encloses greater& lesser palatine
canals 13. THE MEDIAL /NASAL SURFACE Infront of the hiatus
nasolacrymal groove articulates withdescending process of lacrymal
bone & lacrymal process ofinferior nasal concha to forms
nasolacrymal canal 14. THE MEDIAL /NASAL SURFACE More anteriorly
conchal creast for articulation with inferiornasal concha. Above
the conchal crest atrium of middle meatus. 15. PROCESSESOFMAXILLA1.
FRONTAL2. ZYGOMATIC3. ALVEOLAR4. PALATINE 16. FRONTAL PROCESS
Projects upward & backwards to articulateabove nasal margin of
frontal boneinfront nasal bonebehind lacrymal bone Lateral surface
divided by anterior lacrymal crest intoanterior smooth &
posterior grooved anterior lacrymal crestgives attachment
tolacrymal fascia &medial palpebral ligament 17. FRONTAL
PROCESS Medial surface forms lateral wall of nosefrom above
downwards 1. Uppermost roughened area for articulation with
ethmoid2. Ethmoidal crest a horizontal ridge, articulates with
middle nasalconcha3. Below the ethmoidal crest atrium of middle
meatusconchal crestinferior meatus 18. Pyramidal lateral projection
Anterior, posterior & superior surfaces converge here
Superiorly rough, to articulate with zygomatic boneZYGOMATIC
PROCESS 19. Forms half of alveolar arch Bears socket for maxillary
teeth In adults = 8 sockets Buccinator arises from posterior part
of its outer surface upto1st molar tooth. Maxillay torus
(occasionally)ALVEOLAR PROCESS 20. Thick horizontal plate
Projecting medially Forms largest part of roof & floor Inferior
surface concave & forms anterior 3/4th of bony
hardpalate.PALATINE PROCESS 21. Various foramina & pits
Posterolaterally greater & lesserpalatine foremen Superior
surface concavefrom side to side & formsfloor of nasal cavity.
22. Medial border Thicker anteriorly Groove betweennasal crest of 2
maxilla receives lower border vomerAnterior part of ridge incisal
crest & anterior nasal spine, Incisive canalPosterior border
articulates with horizontal plate of palatine boneLateral border is
continuous with alvolar process 23. ARTICULATIONS OF MAXILLA
Superiorly 3 bones1. Frontal2. Nasal3. Lacrymal Laterally 1 bone1.
Zygomatic bone 24. ARTICULATIONS OF MAXILLAMedially 5 bones1.
Ethmoid2. Inferior nasal concha3. Vomer4. Palatine5. Opposite
maxilla 25. AGE CHANGES IN MAXILLA AT BIRTH 1. Transverse &
anterioposterior diameter > vertical diameter2. Well marked
frontal process3. Body consists of little more than alveolar
process4. Tooth sockets close to orbit5. Maxillary sinus is a mere
furrow on the lateral wall of nose IN ADULTS Vertical Diameter Is
More due to 1. Developed alveolar process2. Increased size of
maxillary sinus IN OLD 1. Infantile condition2. Resorption of
alveolar bone 26. DEVELOPMENT OF MAXILLA MAXILLA develops from
ossification in mesenchyme of maxillary processof 1st arch. No arch
cartilage / primary cartilage Center of ossification close to the
cartilage of nasal capsule Center of ossification in angle between
division of infraorbital nerve From this center the bone formation
spreads Bony trough for infraorbital canal is formed .Posteriorly
below the orbit toward the developing maxillaAnteriorly toward the
future incisor regionSuperiorly to form frontal processMedially to
form palate 27. From this trough a downward extension of bone forms
the lateral alveolarplate. Medial alveolar plate from junction of
palatal process & main body offorming maxilla. These plates
forms a trough of bone around the maxillary tooth germ. There is
contribution of secondary cartilage. Zygomatic / malar cartilage
adds in development of maxilla. 28. According to B.D. Chaurassias
human anatomy 4th edition vol. 3 TheHead & Neck MAXILLA
ossifies from 3 centers in the membrane 1. 1 center for maxilla
proper 6th week of IUL, above the canine fossa2. 2 centers for
premaxillaOf 2 premaxillary centers-o Main center above the
incisive fossa - 7th week of IULo Second center ventral margin of
nasal septum - 10th week of IULsoon fuses with palatal process of
maxilla.Premaxilla begin to fuse with alveolar process almost
immediately after theossification begins. 29.
SURGICALANATOMYOFMAXILLA 30. Normal AnatomyFace (midface) is the
region from supraorbital rimsto maxillary alveolar process 31.
Major structuresare labeled in thepicture.Nasofrontal
sutureZygomaticofrontalsutureZygomaticotemporalsutureSOF = Superior
orbital fissureIOF = Inferior orbital fissureOrbital rim3D
CTAnterior View 32. Nasofrontal sutureZygomaticofrontal
sutureZygomaticotemporal suture3D CTLeft Lateral View 33. Axial
viewKey structuresA = Frontal sinus, anterior wallB = Frontal
sinus, posterior wall*Note: The right frontal sinus is
notpneumatized in this case.Posterior wall of frontal sinus
fracture may coexistwith brain injury 34. Do not confuse the suture
between nasal bone andfrontal process of maxilla for a fracture
Look for a piece of fracture in the optic foramen, it isthe true
emergency of facial fractureKey structuresD = Orbit, medial wallE =
Orbit, lateral wallF = Suture betweensphenoid andzygomatic bones=
Nasomaxillarysuture1 = Globe2 = Ethmoid sinus3 = Sphenoid sinus4 =
Nasal bone5 = Maxilla, frontalprocess6 = Orbit, lateral rim7 =
Sphenoid bone8 = Optic foramenAxial view 35. Clear maxillary
sinuses can almostrules out certain fractures such asZMC, LeFort,
blowout fracturesKey structuresF = Groove forinfraorbital nerveG =
Maxillary sinus,posterolateral wall5 = Maxilla, frontal process9 =
Maxillary sinus10 = Zygomatic arch11 = Pterygoid bone12 =
Nasolacrimal duct13 = Mandible, condyleAxial view 36. Key
structuresH = Maxillary sinus,anterior wallI = Maxillary
sinus,medial wallJ = Medial pterygoidplateK = Lateral
pterygoidplate9 = Maxillary sinus14 = Mandible, ramusFracture of
the pterygoid plates may representLeFort fractureAxial view 37.
Lucency in midline of the maxilla is anormal finding seen
occasionallyKey structuresJ = Medial pterygoid plateK = Lateral
pterygoid plateL = Maxilla, spine14 = Mandible, ramus15 = Maxilla
bone/ hard palateAxial view 38. Coronalsection Remind yourself that
CT can miss subtletooth fracture, although with the coronaland
sagittal reformation. Obtainorthopanthogram or dedicated tooth
filmwhen in doubtKey structuresL = Maxilla, spine* = Nasomaxillary
suture4 = Nasal bone5 = Maxilla, frontal process 39. Key
structuresD = Orbit, medial wallM = Nasal septum5 = Maxilla,
frontal process15 = Maxilla bone/ hard palate16 = Frontal sinus17 =
Mandible, bodyCoronal section 40. Key structuresM = Nasal septumN =
Ethmoid bone,perpendicular plateO = Orbit, roofP = Orbit, floorQ =
Maxillary sinus,posterolateral wall**= Zygomaticofrontalsuture1 =
Globe2 = Ethmoid sinus6 = Orbit, lateral rimCoronal section 41. Key
structuresJ = Medial pterygoidplateK = Lateral pterygoidplateN =
Ethmoid,perpendicular plate3 = Sphenoid sinus10 = Zygomatic arch14
= Mandible, ramus18 = Mandible, angleCoronal section 42. Key
structuresP = Orbit, floor7 = Pterygoid bone9 = Maxillary sinus15 =
Maxilla bone /hardPalate Orbital blowout fractureis best seen in
sagittaland coronal images Facial CT is notcompleted without
imagereconstructionSagittal section 43. Key structures3 = Sphenoid
sinus4 = Nasal bone15 = Maxilla bone/ hard palateMid saggital
section 44. WATERS VIEWThe most comprehensive singleprojection
display Excellent view ofMaxillaMaxillary sinusesZygomaZygomatic
archesRims of orbits,esp. floorNasal bones 45. WATERS
VIEWRule:smooth, nondisrupted,same contour on both sidesKey
structures1 = Frontal sinus2 = Maxillary sinus3 = Frontal process
ofZygoma4 = Body of Zygoma (malareminence)5 = Temporal process
ofZygomaDotted line = zygomaticofrontalsutureDolans lines of
referenceLine A, B, C 46. Line ABegins at inner surface
ofZygomaticofrontal suture, followsorbital surface ofzygoma,
maxilla, frontalprocess of maxilla and archof nasal boneIf drawn to
both sides, theline is similar to lazy W orhalf frame of
readingglassesLine BBegins at lateral andinferior margin of
maxillaand extends along lateralwall of maxillary sinus andinferior
surface of zygomaticArch Ends at glenoid fossa 47. Line CBeginsat
lateral andinferior margins of maxilla,extends along lateral wall
ofmaxillary sinus and inferiorsurface of zygomatic archEnds at
glenoid fossaFriendly LineMedial half of Line C is theanterolateral
wall of themaxillary sinus.If it is disrupted, thepossibilities of
fracture include1) Isolated maxillaryantrum2)
Zygomaticomaxillarycomplex (ZMC)3) LeFort 48. Mc Grigors /Campbells
line 49. Caldwells ViewExcellent view ofEntire rim of orbit,
esp.superomedial rimEthmoid sinusFloor of orbit may be wellseen in
petrous bones areprojected below the inferiororbital rim (not in
thisexample) 50. Key structures1 = Ethmoid sinuses2 = OrbitLine A,
B, C, D = superior,lateral, inferior and medialwalls of the
orbit,respectivelyLine E = midline nasalseptum and
vomerRule:Ethmoidsinuses densityshould be equal, darkerthan
orbitSmoothnondisruptedorbital walls2 51. Lateral
cephalogramExcellent view of1. Frontal sinus: anterior wall2.
Maxillary sinus: anterior and posteriorwall3. Sphenoid sinus4.
Pterygoid plate, hard palate5. Floor of anterior cranial fossa, 52.
Key structures1 = Frontal sinus2 = Maxillary sinus3 = Sphenoid
sinus4 = Hard palate5 = Anterior wall of temporal fossaBetween
green arrows =Pterygoid plateLine A = Anterior wall offrontal
sinusLine B = Anterior cranialfossaLine C = Anterior wall
ofmaxillary sinusLine D = Posterior wall ofmaxillary sinus 53.
TOWNS VIEWKey structures1 = Zygomatic archLine A = Posterolateral
wall of maxillarysinusRule:Smooth, nondisrupted lineExcellent view
of Maxillary sinus:posterolateral wall Zygomatic arch 54. Hot Sites
55. Maxillary Fractures Types of maxillary fractures - Maxillary
sagittal fracture (maxillary sinus fracture) Palate fracture
Alveolar process fracture LeFort fractures LeFort I fracture LeFort
II fracture LeFort III fracture Combination (bilateral, hemi-) 56.
Maxillary sagittal fracture Maxillary sinus fracture Fracture of a
maxilla in sagittal plane, involving anterior-lateral wallof a
maxillary sinus (LeFort fractures represent bilateral
maxillaryfractures) Due to direct blow to either right or left
midface Plain film shows opacified maxillary sinus, however it is
usuallyinadequate for diagnosis 57. 68-year-old man was
founddown.There is a sagittal planefracture of the left
maxillarysinus (red arrow) withhemosinus (H) 58. Isolated alveolar
processfracture Fracture of any portion of the alveolar process
Clinically evident by malalignment and displacement of
teethcontained within fractured segment Even on CT, fracture may be
subtle and easily overlooked Further imaging may be needed when the
diagnosis is madeX-ray of the teeth or a panoramic view (look for
dental injuries)Chest radiograph (look for aspirated teeth) 59.
Middle age women fell onto her mouth.Red arrows show the comminuted
fractures of the maxillary alveolar processon the right side. These
fractures are considered open as they are connectedto the oral
cavity. 60. LeFort Fractures Among the most severe fractures seen
in face and associated withhigh-energy trauma Named after Ren
LeFort, a French physician, who studied facialfractures in
cadavers. Result was published in 1901 Key facts - In each type,
there is a partial or complete separation of maxilla from
theremainder of the facial skeleton All LeFort fractures must
extend through posterior face, transects thepterygoid processes Any
combination of LeFort I, II, and III patterns can occur 61. LeFort
I fracture Definition: transmaxillary fracture Transverse
(horizontal) fracture of inferior maxillae, involving
maxillarysinuses (all except superior walls), lateral margin of
nasal fossa, nasalseptum and pterygoid plates Clinical: free
floating and movable hard palate with maxillary teeth Imaging
findings Opacified bilateral maxillary sinuses Transverse fracture
through the inferior maxillae above hard palate Best shown and
confirmed by coronal and sagittal reformatted CT images 62.
48-year-old man was kicked by a horse.LeFort I fracture line along
bilateral maxillary sinuses (red arrows). Pterygoid platefractures
are not shownH = Hemosinus, Blue arrow = Mandibular fracture 63.
LeFort II fracture Pyramid-shaped maxillary fracture, involving
maxillarysinuses (anterior-lateral walls), inferior orbital rim,
orbitalfloor and nasofrontal sutureClinical: free floating, movable
midface includingmaxillary teeth, hard palate and nose Imaging
findings: Opacified bilateral maxillary sinuses and orbital
emphysema Fractures of anterior/lateral walls of maxillary sinuses,
inferior orbitalrims/floors and disruption of nasofrontal suture
Best seen and confirmed by coronal reformatted CT images 64. Middle
age man in motor vehicle accident.Fracture lines are demonstrated
in red arrows.Fracture of pterygoid plates are present in alltype
of LeFort fractures.H = Hemosinus 65. LeFort III fracture
Craniofacial disjunction This fracture separates calvaria (skull)
from the facialbones. Most severe of all LeFort fractures
Definition: separation of facial bones from the skull Zygomas
separated from sphenoid at zygomatico-sphenoid sutures Nasal bones
and medial orbital walls separated from frontal bone at nasofrontal
sutures Best seen in coronal imagesClinical: movement of face
relative to the skull Imaging findings: Plain film will
underestimate degree of injuryto severe soft tissue
swellingobscuring the bony details. CT is recommended due 66.
32-year-old man, unrestraineddriver in a motor vehicleaccident.Blue
arrows define LeFort II fracture.Red arrows define the LeFort III
fracture. 67. malar fractures-Trauma to infraorbital margin may
cause sensoryloss of infraorbital skin.Sometimes injury to
nasolacrymal duct epiphora. 68. Imaging Approach - Plain Film
Friendly line (anterolateralantral wall of maxillary sinus) Both
intact NO ZMC or LeFort fractures Blowout fracture Isolated
fractures of lateral orbitalwall, zygomatic arch One disrupted ZMC
fractures Maxillary sagittal fracture (isolated sinusfracture) Both
disrupted LeFort fractures 69. Clear sinus sign (= all sinuses and
mastoid are clear of fluid), there arethree possible facial
fractures: Nasal bone fractures Isolated zygomatic arch fractures
Mandible fractures Bloody sinuses Pterygoid plate fracture present
- probable LeFort fracture Maxillary wall fractures Orbital floors,
NOE region fractures ZMC fractures With fracture of lateral margin
of nasal fossa= LeFort I With fracture of inferior orbital rim =
LeFort II With fracture of zygomatic arch = LeFort III 70.
TRAJECTORIES OF MAXILLAAccording to Bennignhoff Vertical
trajectories1. Frontonassal buttress2. Malarzgomatic buttress3.
Pterygoid buttress horizontal trajectories1. Hard palate2. Orbital
margin3. Zygomatic arches4. Palatal bone5. Lesser wing of sphenoid
71. Maxilla is spongy bone & houses paranasal sinuses- absorbs
the energy of blunt trauma Articulation with frontal process &
zygoma stability. Porous ample blood supply prevents spread
ofinfection. Boney defect > 5 mm = grafting. 72. SINUS LIFT
PROCEDURE 73. ECTOPIC INFRAORBITAL NERVEIN A MAXILLARY SINUS
SEPTUM:ANOTHER POTENTIALLYDANGEROUS VARIANT FORSINUS SURGERYP.
Mailleux1, O. Desgain2, M.I. Ingabire1Evidence in Health and Social
Care(Online
journal)www.rbrs.org/dbfiles/journalarticle_0814.pdfWorld
Neurosurg. 2011 Sep-Oct;7 2010, 93:308-309 ; discussion 266-7 74.
POSITION OF INFRAORBITALFORAMENSrka Bejdov a,*, Vclav Krajcek b,
MiroslavPeterka a,c, Pavel Trefn a,d, Jana Velemnska Variability in
palatal shape and size inpatients with bilateral complete cleft lip
andpalate assessed using dense surface modelconstruction and 3D
geometricMorphometrics, Journal of Cranio-Maxillo-Facial Surgery 40
(2012) 201e208100Skulls196 sides 75. Majority Oval in male skull
(54.7%) & on left side (52.8%) Round on right side (34) &
oval in left side (23) Directed inferomedially 65.8 % in males-
67.8 % in females Present in vertical line with 1st premolar =
70/196 sidesno gender predilection Mean distance between
infraorbital margine & infraorbital foramen =7.39 1.63 mm 4/
100 skulls accessory foramina1 accessory foramina 2 male & 1
female2 accessory foramina 1 male skullmostly on left side &
oval in shape. 76. Variability in palatal shape and size inpatients
with bilateral complete cleft lipand palateSrka Bejdov a,*, Vclav
Krajcek , Miroslav Peterka , Pavel Trefn ,JanaVelemnsk ;
Variability in palatal shape and size in patients with
bilateralcomplete cleft lip and palate assessed using dense surface
modelconstruction and 3D geometric morphometrics; Journal of
Cranio-Maxillo-Facial Surgery 40 (2012) 201e208. 77. Flatter &
narrower in bilateral cleft lip & palate cases. Most notable
size difference is in area in between maxilla & maxilla,
evenpremaxilla can remain separate from rest of the palate. Mean
Palatal configuration of premaxilla & adjacent palatal area in
lateralprojection is concave in normal individualsclefted in
bilateral cleft lip & palate cases Palate of clefted patient is
more conical anteriorly than posteriorly. 78. Anatomical variation
and morphology in theposition of the palatine foramina in
adultMaria Piagkou , Theodore Xanthos , Sophia Anagnostopoulou,
Theano Demesticha , Evangelos Kotsiomitis, GiannoulisPiagkos,
Vassilis Protogerou , Dimitrios Lappas , PanayiotisSkandalakis ,
Elizabeth O. Johnson ; Anatomical variation andmorphology in the
position of the palatine foramina in adulthuman skulls from Greece;
Journal of Cranio-Maxillo-FacialSurgery 40 (2012) e206ee210 79. The
study was conducted on 71, Greek dry, adult humanskulls of the
twentieth century available in the AnatomicalMuseum of the
Department of Anatomy, Faculty ofMedicine, Athenian University. The
investigated normal skulls with fully erupted 3rdmaxillary molars
were evaluated to describe the intraorallandmarks of the GPF and
related structures. 80. High tuberosity block for maxillary
anesthesia. Control hemorrhage in cases of repair of nasal
septum(septorhinoplasty). Greater palatine artery can damage in
fracture of 1. Medial wall of maxillary sinus2. Lateral wall of
maxillary sinus3. Pterygomaxillary dysjunction4. Downfracturing of
maxilla Greater palatine foramen is also important in closure
oforoantral communication with palatal flap. 81. Mean distance of
greater & lesser palatine foramina frommidsagittal
suturegreater palatine foramina = 1.53 cmlesser palatine foramina =
1.46 0.22 cm (rt),1.47 0.17 cm (lt) 82. Mean distance of greater
palatine foramina from posterior border ofmaxillaRt side = 0.46
0.10 cm Lt side = 0.47 0.11 cm 83. Mean distance of greater &
lesser palatine foramina from alveolarridgeRt side = 0.31 0.17 cm
Lt side = 0.29 0.16 cmAvarage = 0.3 cmRt side = 0.41 0.19 cmLt side
= 0.38 0.02 cm 84. Average anteroposterior diameter = Average
transverse diameter = 76.2% cases = between proximal distal surface
of maxillary 3rd molars 71.9 % cases = at the junction of palatine
bone & inner lamella of pterygoidplateRt side = 0.53 0.09 cm Lt
side = 0.54 0.09 cmLt side = 0.27 0.05 cmRt side = 0.26 0.06 cm 85.
53.45 % cases = 131% cases = 2 (bilaterally)2.1 % cases = 5 (rare)
86. CONGENITAL DEFECTSMacrostomia Microstomia 87. Oblique cleft
lipBilateral cleft lipcleft lip & cleftpalate 88.
SYNDROMEASSOCIATED 89. ROMBERG / PARRY ROMBERG SYNDROME progressive
hemifacial atrophy 90. CROUZON SYNDROME/ CRANIFACIALDYSOSTEOSIS
midface hypoplasia,underdeveloped maxilla 91. APERT
SYNDROME/ACROCEPHALOSYNDUCTYLY middle third of face is markedly
retruded 92. Marfan syndrome 93. DYCROCYSTORHINOSTOMY 94. Some
important structures related toposterior wall of maxilla 95.
MAXILLOFACIALTRAUMA 96. MECHANISM OF INJURY Middle third of face is
a complex of bones & cartilages organized in a systemof
buttresses. In adults it is extensively pneumatized. The maxilla a
box like bone has been harder to assess as an entity;NAHUM (1975)
tested the thin anterior wall of maxilla & found that
thisshattered at quite low force loadings in the range 150-300 lbs
(0.67-1.34kN).208- 475 lb for zygoma> 75 lb for nasal bone 97.
STANLEY & NOWARK (1985) did cephalometric study about
thecadaver facial impacts where they stresses on importance of
angle of impactin relation to the horizontal buttress of the facial
skeleton.Impact on the nasion at 30-60oabove the horizontal = Le
Fort IIIfracture (craniofacial disjunction) 98. 2. Horizontal
impacts along the Frankfort plane = Le Fort II fracturepyramidal
fracture 99. 3. Direct horizontal or angular blow at the level of
upper teeth but below theanterior nasal spine = Le Fort I or
horizontal maxillary fracture. 100. Riu et al 1960 Blanton &
Biggs 1969 proposed that when force is transmitted frombelow the
honeycomb (Blanton &Biggs) pyramidal (Riu et al)configuration
of paranasal sinuses ,with maxillary sinus forming thebase &
sphenoid sinus forming theapex, forms an architecturalstructure
that is particularly wellsuited to a protective energyabsorbing
role. 101. GEOMATRIC CONCEPTOFTHE CRANIOFACIAL SKELETON These
models represents simplified interpretations of thecomplex anatomy
of the bony structural pillars thattransmits the forces of
mastication, devised to furtherunderstanding of fracture patterns .
102. Rowe & Killey (1955) emphasized the mechanical strength of
3 pairedgirders in transmission of force evenly to the skull base
1. Alveoli & transpalatal arch2. Palatine-pterygoid buttress
posteriorly3. Zygomaic complex laterallyAdditionl support in the
central buttress ofvomer & ethmoid vertical plateThe arched
palate & infraorbital rim join theanterior & lateral
girders. 103. In a functional analysis of the facial skeleton
Sicher & Du Brul 1975considered that the facial structures are
anchored to the skull base by 3 pairsof curved vertical pillars 1.
Canine pillar2. Zygomatic pillar3. Pterygoid pillarThese authors
gave greater importance to thehorizontal pillars connecting the
curved verticalpillars, specially the supraorbital bar. 104. Sturla
et al 1980performed cadaverimpaction studies &proposed a
latticeshaped structure offacial skeleton.They emphasized on
theimportance of vertical pillars &transverse plateforms the
hardpalate below & frontal sphenoidbone above. 105. Manson et
al 1983 and Gruss & Mackinnon 1986advised that anterior
vertical buttress are reconstituted topreserve the facial height,
in case of trauma. 106. Gentry et al 1983 studied the thin axial
section CT scan of cadaver &identified 3 horizontal sturts1.
Superior2. Middle / orbital3. Inferior / palatal 107. 3 sagittal
sturts 1. Median / septal2. Parasagittal3. Lateral 108. 2 paired
posterior coronal sturts 1. Posterior maxillary2. pterygoid 109.
IMPORTANCE OF OHNGRENS PLANE 110. MAXILLARYOSTEOTOMYHistory - 1859
Langenbeck1921 Cohn Stock 111. Osteotomy Segmental maxillary
osteotomies1. Single tooth osteotomy2. Corticitomies3. Anterior
segmental osteotomy4. Posterior segmental osteotomy5. Horse shoe
osteotomy 112. Total maxillary osteotomies1. Le Fort I osteotomy2.
Le Fort II osteotomy3. Le Fort III osteotomy 113. Le Fort I
osteotomy 114. Vascular structures 115. Seibert (1997) palatal
contribution to blood supply ofmobilized Le Fort I segment , which
is mainly by 1. Ascending palatinebranch of facial artery2.
Ascending pharyngealbranch of externalcarotid artery. 116. Le Fort
II osteotomy 117. Le Fort III osteotomy 118. Segmental maxillary
osteotomy 119. Anterior segmentalosteotomy 120. Posterior
segmentalosteotomy 121. SAME (surgically assisted
maxillaryexpansion) 122. External SinusSurgeryAndrew H. Murr,
MDJOURNAL OFAMERICAN RHINOLOGY SOCIETYRevised
6/2011care.american-rhinologic.org/external_sinus_surgery 123.
Caldwell-Luc ApproachGeorge Caldwell (1893); New York & Henri
Luc (1897); Paris 124. PNEUMATIZATION OF MAXILLARY SINUS Increase
pneumatization thinning of walls Mattila & Westerholm
1968-continuation ofwidening of sinus after dentalextraction. Young
v/s adult maxillary sinus Killey & Kay 1972 9/362
oroantralcommunication in 0-15 years of agegroup. 125.
RESOURCESTEXT BOOK 1. B.D. Chaurassias human anatomy 4th edition
vol. 3 The Head & Neck.2. Grays Anatomy 39th edition.3. Ten
Cates Oral Histology, 6th edition.4. The Head & Neck by- Hennry
Hollinshed5. Killeys fracture of middle third of facial skeleton6.
Orthognathic Surgery By George Dimitroulis, M. Franklin Dolwick,
Joseph E. VanSickels.7. Craniomaxillofacial trauma by D.J. David,
D.A. Simpson.8. Oral & maxillofacial surgery fonseca vol. 2 by
Betts & Turvey.9. The Maxillary Sinus & Its Dental
Implications by Killey & Kay. 126. RESOURCESOTHER SOURCES -1.
Reoperative midface trauma.Yang RS, Salama AR, Caccamese JF. Oral
Maxillofac Surg Clin North Am. 2011Feb;23(1):31-45, v. Epub 2010
Dec 3.2. Gruss JS, Phillips JH. Complex facial trauma: the evolving
role of rigid fixation and immediate bone graftreconstruction. Clin
Plast Surg. 1989 Jan;16(1):93-1043. Evidence in Health and Social
Care,4. World Neurosurg. 2011 Sep-Oct;7 2010, 93: 308-309 ;
discussion 266-75. P. Mailleux, O. Desgain, M.I. Ingabire;Ectopic
infraorbital nerve in a maxillary sinus septum:anotherpotentially
dangerous variant for sinus surgery6. Maria Piagkou , Theodore
Xanthos , Sophia Anagnostopoulou , Theano Demesticha ,
EvangelosKotsiomitis, Giannoulis Piagkos, Vassilis Protogerou ,
Dimitrios Lappas , Panayiotis Skandalakis , ElizabethO. Johnson ;
Anatomical variation and morphology in the position of the palatine
foramina in adult humanskulls from Greece; Journal of
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