MAXILLARY SINUS

DEPARTMENT OF ORAL
&MAXILLOFACIAL SURGERY
PRESENTED
BY
SALUJA S- IV BDS
INTRODUCTION
First described by Nathaniel Highmore in 1651.
Also called Antrum of Highmore
Largest of paranasal sinuses
ANATOMY
Dimension 3.5(A-P) x 3.2(H) x 2.5(W)
Volume - 15-30ml
Pyramidal in shape.
BLOOD SUPPLY-
ARTERIES-Facial,Maxillary,Infra orbital,Greater palatine
arteries
VEINS- Ant-facial vein ,Pterygoid plexus of veins.
LYMPHATIC DRAINAGE
Submandibular,Deep cervical nodes
NERVE SUPPLY
Superior dental nerves& Greater palatine nerves.
EMBRIOLOGY
Grows by a process of pneumatisation
Tubular at birth
.
Ovoid at 9 yrs
Pyramidal when reaches adult size.
PHYSIOLOGY
Lined by respiratory epithelium.
Also called schneiderian membrane.
FUNCTIONS
Lightens the skull
Moisten & warm the inspired air.
Filter debris from inspired air.
Acts as a shock absorber.
Impart resonance to voice.
OROANTRAL FISTULA
Unilateral pathological communication between
oral cavity & maxillary sinus.
ETIOLOGY
Extraction of teeth.
Periapical lesions.
Injudicious use of instruments.
Forcing a tooth or root into the sinus during attempted
removal.
Extensive trauma
Surgery
Osteomyelitis
Teratomatous destruction of maxilla.
Infected maxillary implant dentures.
Malignant diseases.
ACUTE OROANTRAL FISTULA
SYMPTOMS
Escape of air & fluid through the nose.
Epistaxis
Enhanced column of air.
Excruciating pain.
SEQUELAE
Most of the fistula heal spontaneously.
But they are likely to persist if,
o Traumatic extraction
o Disturbance to normal healing
o Already infected sinus
o Diameter of gap > 5mm
DIAGNOSIS
Physical examination.
Nose blowing test.
MANAGEMENT
AIM:To preserve the blood clot intact.
Remove foreign bodies if present.eg:tooth,root,etc
Provide adequate support to the tooth socket.
Reduce the height of the alveolar bone.
A buccal advancement flap or a palatal mucoperiosteal
pedicled flapor a combination procedure.
Additional support with an acryllic splint.
Dont rinse the mouth vigorously, or blow.
Suitable antibiotics & analgesics
Nasal decongestants.
CHRONIC OROANTRAL FISTULA
Have epithelialised fistulous tract.
Cause maxillary sinusitis.
CHRONIC ORO ANTRAL FISTULA
Signs & symptoms of acute maxillary
sinusitis.
Tenderness
Mild edema
Ear ache
Nasal congestion
Pus /mucopurulent discharge
Signs & symptoms of chronic sinusitis.
Impared sense of smell.
Foul smelling mucopurulent discharge.
Mild tenderness.
Herniation of polyp into middle meatus.
Prolapse of polyp through fistula.
CLINICAL FEATURES OF CHRONIC
ORO ANTRAL FISTULA.
Persistent foul nasal discharge.
Post nasal drip .
Possible systemic sequelae.
Pain
polyp
INVESTIGATION
Patient made to rinse the mouth-it finds way into
the sinus & come out through the nose.
Intra oral periapical radiograph.
Maxillary sinus radiograph.
MANAGEMENT
MAIN OBJECTIVES
Elimination of antral pathology.
Elimination of epithelial lining.
Establishment of stable closure of fistula
Establishment of satisfactory drainage
SURGERY FOR MAXILLARY
SINUSITIS
CALDWELL-LUC OPERATION
First described by George Caldwell & Henri Luc.
CALDWELL LUC OPERATION
SURGICAL CLOSURE OF ORO
ANTRAL FISTULA.
Buccal advancement flap
Palatal pedicled flap
Combination procedure.
Modified closure with a double flap repair.
Pedicled buccal pad of fat.
BUCCAL ADVANCEMENT FLAP
BIPEDICLED FLAP
THANK YOU
.