2.

4 Maxillary Sinus
2.4.1 Definition of Maxillary Sinus
The maxillary sinus is one of the four paranasal sinuses, which are sinuses located near
the nose. The maxillary sinus is the largest of the paranasal sinuses. The two maxillary sinuses
are located below the cheeks, above the teeth and on the sides of the nose. The maxillary sinuses
are shaped like a pyramid and each contain three cavities, which point sideways, inwards, and
downwards. The sinuses are small air-filled holes found in the bones of the face. They reduce
skull weight, produce mucus, and affect the tone quality of a person's voice.
The maxillary sinus drains into the nose through a hole called the ostia. When the ostia
becomes clogged, sinusitis can occur. The ostia of the maxillary sinus often clog because the
ostia are located near the top of the maxillary sinus, thus making proper drainage difficult.
Maxillary sinusitis or an infection of the maxillary sinus can have the following symptoms :
fever, pain or pressure in face near the cheekbones, toothache, and runny nose. Sinusitis is the
most common of maxillary sinus illnesses and is usually treated with prescription antibiotics.
Maxilarry sinusitis is a pathologic condition that must be recognized and treated before
any anticipated sinus elevation procedure prior to bone grafting. (Krouse, JH , 1999)
2.4.2 Anatomy of Maxilarry Sinus
The maxilary sinus is the largest of the four bilateral air filled cavities in the skull. It is
located in body of the maxilla an d is a pyramidal-shaped structure having as its base the medial
wall (the lateral nassal wall ). The pyramid has three main processes or projection : (1)the
alveolar procss inferiorly (bounded by the alveolar bone, (2) the zygomatic recess (bounded by
zygomatic bone) and (3) the infraorbital process pointing superiorly ( bounded by the bony floor
of the orbital ,and below it, the canine fossa . The alveolar and palatine process form the floor
of the maxillary sinus, which after age 16 ususally lies 1-1,2 cm below the floor of the nasal
cavity. (Chanavaz, M.,1990 ; Garg, AK., 1999 ; Becker et all, 2011)

Figure 1. Sinus anatomy. The maxillary sinus is the largest air filled cavity in the skull. (Chanavaz, M.,1990
; Garg, AK., 1999 ; Becker et all, 2011)

Usually the maxillary sinus is separated from the roots of the molar dentition by a layer
of cancellous bone, although occasionally significant bone volume is absent, allowing the apices
of the molar teeth to be very near or project into the floor of the sinus cavity. This can provide a
direct pathway for odontogenic infection to spread into the maxillary sinus. In such cases, tooth
extraction may cause oroantral fistula formation with or without infection.
The zygomatic process or projection is largerly unremarkable. Occasionally maxillary
sinus may be divided into two or even three separate compartments by bony septa. (Kim et all ,
2006). These can usually be seen clearly on radiographic examiation, as well as by other
diagnostic media. The four sinus cavities are all lined with pseudostratified, ciliate, columnar

epithelium overlaying a layer of periosteum in contact with the bony sinus walls. The bilaminar
structure is knows as the Schneiderian membrane and its innner specialized epithelial lining is
contiguous with the lining of the nasal cavitiy through an opening known as the natural ostium.
The sinus linings, although similar in structure, are somewhat thinnner than the lining of the
nasal cavity. (Bailey BJ Johnson JT, 2006 ; Anon et all, 1996)
The natural ostium is located in a anteromedial position in the superior aspect of the
medial sinus wall (lateral nasal wall), and its location makes sinus drainage by gravity
impossible. It opens into the semilunar hiatus of the nasal cavity and is usually located in the
posterior half of the ethmoid infundibulum behind the lower one-third of the uncinate process.
The ostium size can vary from 1 to 17 mm and avergaes 24mm. Because the superior location
makes the natural drainage impossible, drainage is dependent upon the wave like motion or
beating of the hair like cilia. The ostium is much smaller than the actual bony opening and
mucossa fills most of the space and defines the ostium. (Chung SK et all, 1999). On the nasal
aspect of the lateral nassal wall, the ostium is hidden behind the uncinate process in 88%
cases.Often there are acsessory ostia present, usually located distal to the natural ostium in the
area of posterior fontanelle. (Yaanagisawa E, 1994)

Figure 2. The maxillary ostium enters the infundibulum ehich is the space between the uncinate process and the
ethmoid bulla

The medial sinus wall (lateral nassal wall) is a most significant structure, because the
lateral wall presents a series of furrows and projection that can either facilitate maxillary sinus
drainage through the ostium or under certain circumstances, alter or impede sinus drainage.
Small swellings of the pathways or the projection resulting from inflammation can be caused by
infection, allergic rhintis or trauma leading impaired sinuss drainage. When normal sinus
drainage becomes altered or obstructed, this can lead the chronic sinusitis. The medial sinus wall
remain relatively smooth during development, while the nasal side (lateral nassal wall) develops
a series of projections and outhgrowths into the nasal cavitiy. The lateral nassal wall develops as
the medial wall of the maxillary sinus and includes portions of the ethmoid, the maxillary, the
palatine, the lacrymal, the medial pterygoid plate of the sphenoid, the nasal, and the inferior
turbinate bones. The lateral nasal wall give rise to the following structures that become part of
the ostiometal complex (OMC), a name given to the structure forming the projections of the
lateral wall and their respective furrows, meatuses, hiatuses, which become the drainage
pathways from the sinuses. (Fireman SM, 1976)

Figure 3. sinus infection.

2.4.3 Etilogic of Maxilarry Sinusitis

The etiologic elements underlying a chronic ( or acute ) sinusitis can be : (1) disruption in
the mucociliary flow patterns, causing stagnation and failure of normal drainage through the
ostium, (2) viral or bacterial infection of the upper respiratory tract, or (3) inflammatory swelling

and blockage of the ostiomeatal pathways due to allergic reaction and/or infection. As with the
most disease processes, etiologies are usually multifactorial. In cases of chronic or acute
sinusitis, referral to an appropriate ENT physician is essential. (Krouse, JH , 1999)

References
Chanavaz M. Maxillary sinus : anatomy, physiology, surgery and bone grafting related to
implantology eleven years of surgical experience (1979-1990). J oral implantol 16 (1990): 199209
Garg AK. Augmentation grafting of the maxilary sinus for placement of dental implants :
anatmy, physiology, and procedures. Implant Dent 8 (1990) : 36-46
Becker SS, Roberts DM, Beddow PA, Russel PT, Duncavage JA. Comparison of
maxillary sinus specimens removed during Caldwell-Luc procedures and traditional maxillary
sinus antrostomies. Ear Nose Throat J 90 (2011): 262-266
Kim MJ, Jung UW, Kim CS et all. Maxillary sinus septa : prevalence, height, location,
and morphology. A reformated computed tomography scan analysis. J Periodontal 77 (2006) :
903-908