Maxillary Sinus

Introduction
u The paranasal sinuses are hollow, air-filled
cavities lined by mucous membrane
u There are four pairs of paranasal sinuses—
frontal, ethmoidal, max- illary and
sphenoidal air sinuses. The maxillary sinus is
the largest of the paranasal sinuses
u Also called the Antrum of Highmore after
Nathaniel Highmore
 Development
u The maxillary sinus develops first among the para- nasal sinuses.
u The development begins at about 2 months in utero (IU).
u The growth of the maxillary sinus is biphasic, i.e. it develops in two
phases— from 0 to 3 years and between 7 and 12 years.
u At birth, the sinus measures 6–8 cm3 in volume in the
anteroposterior direction and is tubular in shape.
u The sinus extends laterally by the age of 4 years. It grows further
inferiorly to reach the plane of the hard palate by the age of 9 years
and becomes ovoid
Development
Relations
u Anterior: The facial surface of
the maxilla
u Inferior: The alveolar and
zygomatic processes of the maxilla
u Superior: The orbital surface of
the maxilla
u Posterior: The infratemporal
surface of the maxilla
Relations
 Maxillary Ostium
u The ostia for drainage are located high on the
medial wall and open into the semilunar hiatus
(hiatus = sulcus) present in the middle nasal
meatus of the lateral wall of the nose.
u The size of the ostium is usually 2.5 mm. The ostia
are located at a high level; because of this, drainage
of the contents is difficult when the head is erect
 Nasolacrimal Duct
u The nasolacrimal duct drains the
lacrimal sac. The duct runs from the
lacrimal fossa in the orbit, down the
posterior aspect of the maxilla and
empties into the anterior aspect of the
inferior meatus. The duct lies very
close to the maxillary ostium.
 Nasal fontanelles
u Nasal fontanelles are the areas of the lateral nasal
wall that are devoid of bone, usually covered by
mucosa. In some individuals, the anterior or
posterior fontanelles may be patent/open
resulting in an accessory ostium.
u They are non-functional ostia that serve to drain
the sinus only if the natural ostium is blocked and
intrasinus pressure/gravity moves material out of
the ostium.
u Accessory ostia are usually found in the posterior
fontanelle
Vascular Supply
u The branches given out at the third part of the maxillary
artery—infraorbital, sphenopalatine, greater palatine and
posterior alveolar arteries—supply the maxillary sinus.
Venous drainage is by the facial vein and pterygoid plexus
of veins which communicate with the cavernous sinus
through emissary veins.
u Lymph drains into the submandibular nodes.
Vascular Supply
 Nerve Supply
u Parasympathetic supply: The
greater petrosal nerve (a branch
of the facial nerve) is responsible
for the mucous secretion.
u Sensory innervations: The
branches of the maxillary nerve—
the greater palatine nerve and the
infraorbital nerve—supply the
maxillary sinus.
Histology
u The histologic features of the maxillary sinus are
characterised by the presence of a mucous membrane
called the Schneiderian membrane, which is a bilaminar
membrane with ciliated columnar epithelial cells on the
internal (or cavernous) side and periosteum on the
osseous side.
u The mucosa is firmly bound to the periosteum.
Sinus Epithelium
u Cells with cilia
u Cells without cilia
u Goblet cells
u Basal cells
u Transient immune cells, that is the lymphocytes
and mast cells
Ciliated and Non-ciliated Cells

u The cells which reach the free surface are ciliated cells.
The ciliated and non-ciliated cells help in creating most
of the physical barrier, because they form a tightly
connected sheet that lines the nasal cavity.
u This tight junction formed between these cells effectively
keeps foreign materials, pollutants and microorganisms,
from entering the tissues.
Cilia
u The most important feature of the respiratory epithelium is the
cilia. Cilia are motile structures projecting in parallel rows from
certain epithelial surfaces. They are about 7–10 µm long. Cilia
beat with a wave-like synchronous rhythm.
u They propel surface films of mucus in a consistent direction over
the epithelial surface towards the pharynx from where it is
expelled. This mucociliary clearance removes the microorganisms
and irritants that are present in the inspired air
 Goblet Cells
u The goblet cells produce mucus. They have a basal portion which has highly developed
rough endoplasmic reticulum and nucleus.
u The Golgi complex is present above these. The secretory glycoproteins are synthesised in
the rough endoplasmic reticulum and pass through the Golgi bodies to undergo further
glycosylation or modification.
u Microvilli are present on the apical surface of the goblet cells. The secretory granules which
are formed are released from the apical surface by exocytosis (secretion). The secreted
mucus produces a mucus blanket.
u The mucus contains special antibodies and enzymes like the bactericidal lysozyme which
prevents viruses and bacteria from sticking to the epithelial lining and helps the white blood
cells to recognise them as invaders and kill them.
u This sticky mucus blanket serves as an efficient trapper of dust particles and also moistens
the inspired air
Immune Function
u The mucus contains special antibodies and enzymes like the
bactericidal lysozyme which prevents viruses and bacteria from
sticking to the epithelial lining and helps the white blood cells to
recognise them as invaders and kill them.

Basal Cells
u The basal cells are progenitor cells/stem cells that divide and
grow to replace the other cell types when they grow old or are
lost due to a toxic irritant.
Sub-Epithelium
u Immune cells such as lymphocytes and mast cells are present in the sub-epithelium which
play an important role in defence.
u Apart from epithelial goblet cell mucous secretion, there are serous and mucous glands
present in the subepithelial connective tissue which adds up to the sinus secretion.
u These glands are situated just beneath the epithelial layer and the secretions reach the sinus
lumen through the excretory ducts.
u The glandular secretions are predominantly serous with smaller amount of lipids, proteins,
mucous secretion, glycoproteins and mucopolysaccharides. Numerous blood capillaries and
non-myelinated nerve fibres are also seen.
Functions Of The Maxillary Sinus

u Warming of inspired air

u Humidification of dry air
u The structure and components of the sinus helps in
creating appropriate resonance in the voice and thus plays
a major role in speech
u Pneumatisation of the sinus aids in lightening the weight
of the skull
Clinical Consideration:
u Topographical relationship between maxillary sinus and oro-dental complex:
u Because of its close proximity to the dentition, dental diseases can cause
maxillary infection.
u Extraction of a maxillary posterior tooth can sometimes result in an oro-antral
communication if the roots are in close proximity to the floor of the sinus.
u The maxillary sinus is more prone to infections than the other paranasal sinuses
because of its location. Maxillary sinusitis is common because of its anatomical
location. The drainage orifice lies near the roof of the sinus and hence the
maxillary sinus does not drain well, and infection develops more easily.
u Infections and neoplasms of the maxillary sinus can cause pain in the posterior
maxillary teeth.
u Infections in the maxillary sinus can spread to the cavernous sinus and can be
life-threatening.
Clinical Consideration:
u The tight junction formed between these cells effectively
keeps foreign materials, pollutants and microorganisms,
from entering the tissues.
u The mucociliary clearance removes the microorganisms
and irritants that are present in the inspired air and thus
aids in preventing respiratory infections
u This sticky mucus blanket serves as an efficient trapper of
dust particles and also moistens the inspired air