Definition:-

Inflammation of
the mucosa of maxillary
sinus is called maxillary
sinusitis.
 Anatomy of Maxillary Antrum

Pyramidel in Shape with base of pyramid forming lateral

nasal wall & apex at the root of the Zygoma.

Dimension of Sinus = Height – 3.5 Cm.

Width – 2.5 Cm.
Depth – 3.2 Cm.

Roof = Floor of Orbit

Floor = Alveolar process of Maxilla
Anterior wall = Facial surface of Maxilla
Posterior Wall = Spheno Maxillary wall
Medial wall = Lateral wall of Nasal Cavity.
Antral Lining = Lined by respiratory mucosa which is
formed by ciliated columnar epithelium.
Arterial Supply = Facial Artery, Infraorbital Artery & greater
palatine Artery.
Nerve Supply = Infraorbital Nerve, Anterior, Middle &
Posterior superior alveolar nerve.
Venous Drainage = Facial Vein
Pterygoid venous plexus
Lymphatic Drainage= Submandibular Lymph Node.
Classification
Of
Maxillary
Sinusitis
 On the basis of duration of disease

ACUTE SUBACUTE
CHRONIC
Below 2 Week 2 week –3month More than three
month

Acute inflammation Interim stage Sequele of

Of sinus mucosa acute infection
that fails to
resolve within 3
month.
 Etiology-
Dental causes
1. Periapical infection from the teeth
2. Oroantral fistula
3. Periodontitis
4. Trauma to facial bones
5. Dental material in antrum eg. Gutta purcha
6. Implant
7. Infected dental cyst
Non dental causes

Mechanical obstruction of ostium

1. Common cold
2. Allergic rhinitis
3. Influenza
4. Blood borne infection
5. Mucosal cyst or tumour of sinus
6. Swimming in contaminated water
7. Other conditions – deviated nasal septum,
presence of nasal polyp &
prolonged nasotracheal
intubation.
tive organisms-

bic- Streptococcus pneumoniae

Haemophilus influenzae
Staphyllococcus aureus

robic-
Bacteriodes
Peptococcus
Peptostreptococcus
Fusobacterium spp.
Eubacterium

genic sinusitis is generally caused by anaerobic b

CLINICAL FEATURES—
ACUTE SINUSITIS-
1. Pain- Severe & localized
Reffered pain to maxillary teeth
( molar & premolar)
2. Tenderness in canine fossa
3. Redness over the cheek
4. Nasal discharge- mucopurulent
5. Dry cough
6. Nasal resonance
7. Blocking of nose
8. Generalized toxaemia develops- Fever with chills,
diziness,mailaise,nausea.
SUBACUTE- Interim stage between acute & chronic
sinusitis
1. Purulent discharge associated with nasal voice & stuffness.
2.Soreness of throat is common
3.Patient cannot sleep well due to cough that irritates him
constantiy.

CHRONIC-Often associated with anatomic dearrangements

that inhibits the outflow of mucous,including deviation of nasal
septum & presence of concha bullosa.
Symptoms— Sense of tiredness
Low grade fever
Stuffy sensation
Nasal obstruction
Nasal discharge
Headache
DIFFERENTIAL DIAGNOSIS-
 Canine space infection due to infection from a
maxillary teeth.
 Insect bite
 Furuncle
 Neuralgic pain
COMPLICATION—

1. Spread to other sinus

2. Osteomyelitis of maxilla
3. Orbital cellulitis or abscess
4. Middle ear infection.
EXAMINATION & INVESTIGATION OF
MAXILLARY SINUS-

Clinical Examination-
 Middle third face inspection-
Asymmetry,deformity,swelling,erythema
& haematoma
 Ephiphora,Epistaxis,Nasal obstruction,Other
discharge or odour from nostril
 Palpation- Facial wall of sinus above premolar.
 Palatal ulceration
 Eyes-Proptosis,Diplopia.
 Rhinoscopy
 Nasoendroscopy
 Transillumination
 Bacteriology & cytology
 Fiberoptic antroscopy
RADIOLOGY OF MAXILLARY SINUSITIS

Four pattern are seen-

 Localized thickening at the base of sinus.

 Roughly generalized thickening of mucoperiosteum
around the entire wall of sinus.
 Complete filling of sinus.
 Complete filling of sinus except in the region of the
osteum on the medial wall.
 Thickening of sinus mucosa & accumulation of
secreation reduces air content- Radiopaque.
Water’s view-
Radiopacification of sinus seen.
Mucosal thickening may be uniform or polypoid-
Allergy-Lobulated mucosa
Infection-Smooth(Straighter & parallel to sinus wall)

Air fluid level is present ,fluid appears radiopaque &

occupies inferior aspect of sinus.
Border between radiopaque fluid & radiolucent antrum
is horizontal & straight with a meniscus.

It is confirmed by air fluid interface by tilting the head of

patient & making another radiograph which changes
the orientation of fluid level.

Air fluid level demonstrated by putting x ray beam

horizontal & at the level of air fluid interface.

Resolution of acute sinusitis will be apparent as small

clear areas appear in the interior of the sinus as the
thickened mucosa gradually shrinks.
Chronic sinusitis may result in persistent
opacification of the sinus& sclerosis or
thickening of surronding bone.

If infected teeth - Resorption of antral

floor & remodelling - Antral halo
appearance.
MANAGEMENT---

Removal of cause of dental infection.

Antibiotic- Doxycycline hydrochloride

Penicillin
Amoxycillin
Clotrimazole

Analgesics & antiinflammatory drugs– Ibuprofen

Paracetamol
Nasal decongestant - Ephedrine( 0.5%)

Xylometazoline(0.1%)

Steam inhalation- Steam are medicated with

menthol or tincture benzoline.It act by
hydrating the mucous blanket,making it less
viscous & encouraging normal ciliary
clearance of sinus
Hot fermentation --- Local heat application
is soothing to inflammed sinus.
Antral lavage
Intranasal antrostomy
Caldwell luc operation
Transnasal endoscopic surgery.
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