• 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.