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.
 Don’t 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.
 Persistentfoul 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

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