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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY

MRDC

MAXILLARY SINUS

LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 1


DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

LECTURE TOPIC: MAXILLARY SINUS

• LEARNING OBJECTIVES

• SECTION I
• TO Understand Anatomy of Maxillary sinus
• Development of maxillary sinus
• Developmental Anomalies of Maxillary Sinus
• Blood Supply of Maxillary Sinus

• SECTION II
• Functions of Maxillary Sinus
• Histology of maxillary sinus

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
AT THE CONCLUSION STUDENT IS EXPECTED TO UNDERSTAND AND ANSWER

• Types of Sinuses
• Development of Maxillary Sinus
• Biological Functions of Maxillary Sinus

• Histological Component:
1. Goblet Cells
2. Secretory Components

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

Anatomy of Maxillary Sinus


Sinus is a Latin word meaning a fold or pocket.
SINUS- It is an air filled cavity in a dense portion of skull.
Types of sinuses-
1. Paranasal air sinus
a) Maxillary sinus
b)Ethmoidal sinus
c)Sphenoidal sinus
d)Frontal sinus
2. Dural venous sinus
3. Coronary sinus

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

MAXILLARY SINUS
SYNONYMS- Antrum of Highmore, Maxillary
Antrum
Largest air sinus
large pyramidal cavity within the body of the
maxilla.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

Development of maxillary sinus


Established in the embryo of 32 mm CRL.
Horizontal shift of palatal shelves

Fusion of shelves with one another and with nasal


septum

Seperation of sec. oral cavity and from two sec. nasal


chambers

Influences further expansion of lateral nasal wall in


that the wall begins to fold

3 nasal conchae, 3 subjacent meatuses arise

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

• Inferior and superior meatus remains as shallow


depressions on lateral nasal wall.

• Middle meatus expand immediately into the


lateral nasal wall.

• Cartilagenous skeleton of lateral nasal capsule is


already established, expansion of middle meatus
proceeds primarily in inferior direction, occupying
progressively more of future maxillary body.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
DEVELOPMENTAL ANOMALIES
• Agenesis(complete absence)
• Aplasia
• Hypoplasia(under development)

• Occurs alone or in association with cleft


palate, high palate, septal deformity, absence
of concha, malformation of external ear.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

• Supernumerary maxillary sinus- occurrence of


2 completely seperated sinuses on the same
side.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

ROOF- floor of the orbit.


FLOOR- alveolar process of maxilla.
BASE- lateral nasal wall.
APEX- zygomatic process of maxilla.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

• The floor varies in it's level.


• Birth to age 9 -floor is above that of the nasal
cavity.
• At age 9- floor is generally at the level of the nasal
floor. The floor continues to sink as the maxillary
sinus pneumatizes.
• The close relationship with the dentition dental
disease can cause maxillary infection, and tooth
extraction can result in oral-antral fistulae.
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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

Average size of maxillary sinus


HEIGHT- 3.5 cm
WIDTH- 2.5 cm
ANTEROPOSTERIOR DEPTH- 3.5 cm
VOLUME( approx.) 15ml

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

On dental radiographs the floor of the sinus is often


observed approximating the root apices of the teeth and is
seen to extend from the canine or premolar region
posteriorly to the molar or tuberosity region

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

 Conical elevations corresponding to roots of 1st


or 2nd molar tooth projects into the floor of the
sinus. Sometimes the premolar, 3rd molar and
canines are also found protruding into the sinus.
 A layer of bone always seperates the roots of the
teeth and the floor of sinus
 The infra orbital nerve is found at the roof of the
sinus & the supra alveolar nerve in the floor of
the sinus.
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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

• Maxillary sinus may be incompletely divided


by septa, complete septa being present very
rarely.
• Sinus is joined to nasal cavity via small
orifices- Ostia

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

Blood supply of maxillary sinus

Arterial blood supply : Facial, infra orbital, PSA.

Venous drainage- facial and pterygoid plexus of vein

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

Nerve supply : Infra orbital, anterior, middle and


post superior alveolar nerves.
Lymphatic drainage : Submandibular nodes.
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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
Biological function of Paranasal sinus
• Decreasing the relative weight of the front of
the skull, and especially the bones of the face.
• Increasing resonance of the voice.
• Providing a buffer against blows to the face.
• Insulating sensitive structures like dental roots
and eyes from rapid temperature fluctuations
in the nasal cavity.
• Humidifying and heating of inhaled air
because of slow air turnover in this region.
• Increases surface area for tooth eruption.
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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

HISTOLOGY
 Three microscopically
distinct layers surround
the space of maxillary
sinus.
I. Epithelial layer
II. Basal lamina
III. Subepithelial layer ( Maxillary
including Periosteum) sinus

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

EPITHELIUM
 Pseudostratified, columnar &ciliated( derived
from olfactory epithelium of middle meatus)
 Most numerous cells in maxillary sinus are the
–COLUMNAR CILIATED CELLS.
 Basal cells, columnar non ciliated cells, mucus
secreting -goblet cells.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
Histology………..

• A ciliated cell encloses the nucleus & an electrolucent


cytoplasm with numerous mitochondria & enzyme containing
organelles.

• The basal bodies, which serve as the attachment of the ciliary


microtubules to the cell, are characteristic of the apical
segment of the cell.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
HISTOLOGY OF MAXILLARY SINUS
GOBLET CELL

CILLIA
PSEUDOSTRATIFIED
CILITED COLUMNAR
EPITHELIUM
BASAL
LAMINA

CONNECTIVE
TISSUE

MINOR
SALIVARY
GLAND
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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
HISTOLOGY

PSEUDOSTRATIFIED
COLUMNAR –CILIATED
EPITHELIUM

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
GOBLET CELL-Unicellular Secretory organ
Is broader above & has a narrow stem attached to a
base.
Expanded upper part which is distended with mucin
granules.( Goblet cells are mucus secreting cells)

LRM 33 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC 24


DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

• Inconsonance with their secretory function these cells have a


well developed golgi complex & abundant RER.
• The nucleus is flattened & is basally placed with a distended
supranuclear cytoplasm that is tightly packed with basophilic
tiny vacuole representing packages of mucus.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
GOBLET CELL

Cliiia are absent but faint streaks of mucus


topping the broad luminal end of goblet cell,
resembling cilia can be seen easily.

The luminal surface of the cell bears some


irregular microvilli.

In H/E stained preparations, the mucin content


remains unstained, it stains brightly with the PAS
technique.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
SECRETORY CONTENT
In addition to the epithelial secretion , the surface of the sinus
is provided with a mixed secretory product
1. SEROUS secretion-> primarily of water , with small amounts
of neutral non-specific lipids, proteins & carbohydrates
2. MUCOUS secretion-> consisting of compound glycoproteins
or mucoploysaccharide or both.
 These are located in the subepithelial layer of the sinus &
reach the sinus lumen by way of excretory ducts after the
ducts have pierced the basal lamina.

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

MUCUS CELLS Serous cell-toludine blue


staining

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

HISTOLOGY
Cilia is composed of 9+1 pairs of microtubules
& provides mobile apparatus to the sinus
epithelium
By ciliary beating , the mucous blanket lining
the epithelial surface moves from the interior
of the sinus towards the nasal cavity.
Goblet cells (secretory cells) contains RER&
SER along with golgi apparatus all of which are
involved in the synthesis of secretory
substances
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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

MCQ’s
1. Maxillary sinus communicates with environment by :
a) Superior nasal meatus
b) Middle nasal meatus
c) Middle nasal meatus and nasal vestibule
d) Inferior nasal meatus

2. Maxillary sinus epithelium is :


a) Stratifid columnar
b) Pseudo stratified columnar and ciliated
c) Squamous and non ciliated
d) Glandular

3. Secretory cells present in present in the subepithelial glands of maxillary sinus :


a) Mucous cells
b) Serous cells
c) Both of the above
d) None of the above
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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

4. All functions of maxillary sinus except :


• Protect internal structure against exposure to cold
• Contibute to resonance to voice
• Production of bactericidal lysozymes
• Helps in mastication

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
5. The paranasal sinuses drains into the middle meatus of the nose EXCEPT:
a) Sphenoid sinus
b) Middle ethmoid sinus
c) Maxillary sinus
d) Posterior sinus

6. Olfactory cleft lies between the:


a) Middle turbinate & cribriform plate
b) Superior turbinate & cribriform plate
c) Superior turbinate & inferior turbinate
d) Inferior turbinate & cribriform plate

7. True about the nerve supply of the nose:


a) Sympathetic supply from superior cervical ganglion
b) Parasympathetic supply via nervus intermedius
c) Nerve supply is extremely rich
d) All of the above

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
8. Type of sphenoid sinus in normal population is usually:
a) Sellar
b) Postseller
c) Preseller
d) Maximal Pneumatisation

9. Pain in vertexis seen in:


a) Ethmoid sinusitis
b) Sphenoid sinusitis
c) Frontal sinusitis
d) Maxillary sinusitis

10. Maxillary sinusitis Incidence of mucocele is lowest in


a) Frontal sinus
b) Sphenoid sinus
c) Maxillary sinus
d) Ethmoid sinus

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

Short question’s
Q1. Acute maxillary sinusitis
Q2. Functions of maxillary sinus
Q3. Lining epithelium and function of different
cells
Q4. Anatomical landmarks of maxillary sinus
Q5. Clinical consideration and treatment of
sinusitis

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

Long questions
Q.1 Describe maxillary sinus and functions of
maxillary sinus
Q.2 Explain development , location and
epithelium lining maxillary sinus

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC

• Thank You

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