SURGICAL ANATOMY OF

MAXILLARY SINUS

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.1 INTRODUCTION
• Pneumatic space lodged in the body of maxilla.
• Described by Nathenial Highmore (1651)
• Also known as antrum of Highmore
• 2 in number
• Largest paranasal sinus
• Vol:15-30 ml
• Dimensions (Turner, 1902)
• Anteroposterior: 3.5cm
• Height: 3.2cm
• Width: 2.5cm
Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.2 ANATOMY
• Base - lateral wall of nose.
• Apex - zygomatic process of maxilla.
• Roof - floor of orbit traversed by the infraorbital
canal.
• Floor – Base of the maxillary alveolar process.
• Anterior wall-facial surface of maxilla
• Posterior wall-separates sinus from
infratemporal and pterygopalatine fossa

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.3 ARTERIAL & NERVE SUPPLY, VENOUS & LYMPHATIC DRAINAGE

• Arterial supply
• Facial artery
• Infraorbital artery
• Greater palatine artery
• Venous drainage
• Facial Vein
• Pterygoid plexus of vein
• Lymphatic Drainage
• Submandibular Nodes
• Nerve Supply
• Anterior superior alveolar nerve
• Middle superior alveolar nerve
• Posterior superior alveolar nerve
Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.4 SURGICAL IMPORTANCE OF NERVE SUPPLY

ASA- Given off from infraorbital and

To avoid any chance of damage of about 15mm form infraorbital
nerve during surgical procedure foramen, courses down on anterior
Wall

Surgical Importance
of Nerve supply

MSA-seen in 50 % cases arise from PSA- Superior branch runs at level of

lateral aspect of infraorbital nerve malar tuberosity, Inferior branch
runs parallel to transverse facial part
of anterior nerve
Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.5 PHYSIOLOGY & FUNCTIONS OF SINUS
• Physiology
• Lined by respiratory epithelium
• Mucous secreting Pseudostratified ciliated columnar epithelium
• Schneiderian membrane
• It has mucociliary mechanism
• Cilia moves the mucous and debris towards osteum and discharged in middle meatus

• Functions
• Impart resonance to voice
• Increase surface area and lighten skull
• Moisten and warm inspired air
• Filters debris from inspired air
• Gives air padding to provide thermal insulation to adjacent important tissues

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.6 CLINICAL EXAMINATION
Tapping of lateral walls of Sinus externally over
the prominence of cheek bone

Palpation Intraorally on lateral surface of maxillary

both canine fossa & zygomatic buttress

Affected Sinuses – Tender to gentle tapping /

Palpation

Transillumination

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.7 RADIOLOGY OF MAXILLARY SINUS
• EXTRAORAL VIEWS
• OCCIPITOMENTAL/WATERS
• LATERAL SKULL
• SUBMENTOVERTEX
• ORTHOPANTOMOGRAPHY
• CT SCAN

• INTRAORAL VIEWS
• OCCLUSAL
• LATERAL OCCLUSAL
• PERIAPICAL

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.7 RADIOLOGY OF MAXILLARY SINUS…CONT

Occipitomental or waters view Orthopantomograph

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.7 RADIOLOGY OF MAXILLARY SINUS…CONT

Lateral Skull CT- SINUS –AXIALVIEW CT- SINUS - CORONAL VIEW

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.7 RADIOLOGY OF MAXILLARY SINUS…CONT

Occlusal view Periapical view

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.8 Endoscopy

Direct optical evaluation of the antral floor region..

Path of access used:

• Trans oral via canine fossa

• Trans alveolar via connection between oral cavity & antrum
• Trans nasal approach

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.9 APPLIED SURGICAL ANATOMY
Relation of root apices with the floor of the sinus

Lining of maxillary sinus

Foreign bodies in the sinus

Infections of sinus

Oro-antral communication

Tumors associated with maxillary sinus

• Implant placement

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.10 TREATMENT MODALITIES FOR CLOSURE OF OAF

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
1.9 SURGICAL PROCEDURES INVOLVING MAXILLARY SINUS

• Caldwell-Luc Operation

• Intra nasal antrostomy

• Functional Endoscopic Sinus Surgery

• Sinus Lift Procedure

• Mid Face fractures

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
REFRENCES

• B D Chourasia , Text book of Anatomy

• Contemporary oral and maxillofacial surgery, Peterson

• Fonseca text book of oral and maxillofacial surgery

• Treatment of Oro antral Fistula using Bone press fit technique. American association of oral

and maxillofacial surgeon 2012

• Sinus Lift Procedure, An overview of current technique Avichai Stern, James Green. Dent

clinics of N America 2012, 219-233

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University
 THE END
THANK YOU

Guided By: Dr. Nitin Bhagat, Prepared By: Dr. Monalisa, MDS- 1st Year, Department of Oral & Maxillofacial Surgery, School Of Dental Sciences, Sharda University