Localizare

Este situat în corpul maxilar și, inconstant, în procesele acestuia.

Este mic la naștere și se dezvoltă complet în adolescență în jurul vârstei de 18 ani.

Formă

Sinusul maxilar este supus unei mari variații în privința formei, dimensiunii și modului de dezvoltare de
aceea orice descriere a structurii sinusale maxilare nu poate fi aplicată satisfăcător tuturor sinusurilor
umane. Cele două sinusuri maxilare pot fi identice sau asimetrice în privința formei și dimensiunii.

De obicei este descrisă ca o piramidă cu patru laturi, cu baza dispusă vertical și orientată medial spre
cavitatea nazală și cu apexul orientat lateral spre corpul osului zigomatic. Baza sinusului se mai numește
și peretele medial al sinusului și se indentifică cu peretele lateral al cavității nazale. Apexul se găsește în
procesul zigomatic dar poate pătrunde uneori chiar în osul zigomatic atunci când sinusul este foarte
mare.

Cele patru laturi corespund celor patru pereți ai sinusului: peretele superior sau plafonul se identifică cu
podeaua orbitei prin care este despărțită de orbita propriu-zisă, peretele anterior sau peretele facial,
dispus spre suprafața facială a corpului, peretele inferior sau podeaua sinusală dispusă spre procesele
alveolare și zigomatice și peretele posterior spre suprafața infratemporală.

Cei patru pereți se găsesc la distanță unul de altul medial și converg lateral intr-un unghi obtuz.
Diferențierea celor patru pereți se discerne cu dificultate, tranziția de la un perete la altul nu este bine
definită, astfel comparația spațiului sinusal cu un corp geometric bine definit având doar valoare
pedagogică.

Peretele intersinuzal care înspre medial formeză peretele lateral al cavității nazale și înspre lateral
formeză baza sinusului (cel mai subțire perete al sinusului), prezintă o perforație, ostiumul, la nivelul
meatului nazal mijlociu. La unii indivizi, în afară de ostiumul principal, două sau mai multe ostiumuri
accesorii (adiționale față de cel principal) conectează sinusul cu meatul nazal mijlociu. În 5.5% din cazuri
ostiumul este localizat în treimea anterioară a hiatusului semilunar, în 11% în treimea mijlocie și în
71.7% în treimea posterioară. În 11.3 % ostiumul este localizat în afara și posterior de hiatul semilunar.
Ostiumuri accesorii se găsesc în 23% din aceste situații în meatul nazal mijlociul și se găsesc foarte rar în
meatul nazal inferior.

Drenajul fiziologic prin meatul mijlociu.

În partea anterosuperioară a bazei sinusului se află ostiumul care asigură comunicarea cu partea
inferioară a hiatului semilunar. Un ostium secundar este frecvent observat în posterior hiatusului.

Hiatul semiluar este mărginit inferior de o margine ascuțită concavă numită procesul uncinat a osului
etmoid ce duce către un canal curbat numit infundibulum, limitat superior de bulla etmoidală și inferior
și lateral de suprafața laterală a procesului uncinat.
Celulele etmoidale anterioare se deschid în partea frontală a infudibulumului iar aceasta, în mai mult de
50% dintre subiecți, este direct continuată cu ductul frontonazal sau pasajul ce duce la sinusul frontal.

Dar atunci când partea anterioră a procesului uncinat fuzionează cu porțiunea frontală a bullei, această
continuitate este inreruptă și ductul frotonazal se deschide în partea anterioră a meatusului mijlociu.
Sub bulla etmoidală și parțial ascunsă de partea inferioară a procesului uncinat, se află ostiumul maxilar.
Într-o secțiune frontală, ostiumul se vede plast lângă plafonul sinusului. Un ostium accesor se găsește
frecvent inferior de partea posterioră a cornetului nazal mijlociu.

Peretele sinonazal prezintî o apertură mare, iregulară, ce comunică cu cavitatea nazală. În craniul
articulat această apertură este mult redusă în dimensiune de următoarele oase: superior: procesul
uncinat al etmoidului, inferior: cornetul nazal inferior, posterior porțiunea verticală a osului etmoid,
superior și anterior o porțiune mică a osului lacrimal.

Sinusul comunică cu meatul nazal mijlociu prin două aperturi. Unul din cele două deschideri se află în
partea superioară a cavității, cealaltă este acoperită de membrana mucoasă.

Peretele anterior extinde sinusul anterior și lateral în regiunea primului premolar sau a caninului,

Plafonul sinusului este format de o placuță subțire de os ce separă sinusul ce cavitatea orbitară și este
traversat de canalul infraorbitar ce conține vase și nervi.

Peretele posterior spre suprafața infratemporală, extinde lungimea maxilei și coboară în tuberozitatea
maxilară. Separă sinusul de spațiul infratemporal și fosa pterigopalatină. La nivelul peretelui posterior se
găsesc canale alveolare ce transmit vasele și nervii alveolari superiori posteriori la molari. Canalele
alveolare pot forma uneori creste adiționale de-a lungul lor.

Podeaua sinusului este formată din partea laterală a palatului dur și de procesul alveolar al maxilei ce
conține molarii și premolarii astfel antrul prezentă raporturi anatomice de vecinătate cu dinţii laterali ai
arcadei superioare. Aceste raporturi variază cu mărimea sinusului maxilar, lungimea rădăcinilor şi
înălţimea proceselor alveolare.

La adulți, distanța dintre sinus și apexul rădăcinilor dentare ale dinților posteriori maxilari este de 0.2-16
mm. Uneori sinusurile se extind până la nivelul apexurilor dentare fiind despărțite doar de mucoasa
sinuzală, alteori apexurile se pot afla chiar în sinus, iar sinusul poate expansiona în spațiile
interradiculare ale molarilor și premolarilor maxilari. Expansiunea sinusului încetează în mod normal
după erupția dinților, dar uneori, pot pneumatiza în continuare în urma pierderii unuia sau mai mulți
dinți maxilari posteriori, ocupând astfel creasta alveolară reziduală. Pacienții adulți edentați maxilar
posterior prezintă sinusuri mai mari.

Studiile lui Von Bornsdorff (1925) au arătat că dinții cu raport sinusal mai frecvent au fost molarii
maxilari secunzi. Paatero (1939) a confirmat concluziile lui Von Bornsdorff; următorii dinți în ordinea
frecvenței fiind primii molari, molarii de minte, premolarii secunzi, primii premolari și caninii.

Pierderea de os periapical din urma afecțiunilor dentare poate scade și mai mult grosmea osului ce
separă sinusul de dinți.

Cavitatea sinusală conține aer, iar ocazional sinusul poate fi împărțit în două sau chiar trei de septuri
osoase.

Foarte des sinusul expansionează față de anatomia normală formând recese. Recesurile se extind cel
mai frecvent în procesul alveolar (50% din cazuri) și mai puțin frecvent în procesele frontale (40% din
cazuri), zigomatice (41.5% din cazuri) și palatine (1.75% din cazuri) ale maxilei. Recesurile zigomatice
aduc plexurile neurovasculare alveolare superioare în spațiul sinusal. Recesul frontal invadează canalul
infraorbital. Recesul alveolopalatin pneumatizează în jurul rădăcinilor molarilor primi și mai puțin
rădăcinile premilarilor secunzi, primi, molarilor secunzi (în această ordine a frecvenței). Un reces
alveoloar complet format este caracterizată de trei depresiuni separate de septuri osoase incomplete:
depresiunea sau fosa anterioară ce corespunde cu locul original al mugurilor premolarilor, depresiunea
mijlocie corespunde situației originale a mugurilor molarilor si depresiunea posterioară corespunde
mugurilor molarilor trei.

.................

având forma unei piramide triunghiulare. Baza piramidei este reprezentată de peretele lateral al fosei
nazale şi este situată medial, iar vârful este situat lateral, către osul zigomatic (Fig. 8. 1).

The maxillary sinus is described as a four-sided pyramid, with the base lying vertically on the medial
surface and forming the lateral nasal wall. The apex extends laterally into the zygomatic process of the
maxilla. The upper wall, or roof, of the sinus is also the floor of the orbit. The posterior wall extends the
length of the maxilla and dips into the maxillary tuberosity. Anteriorly and laterally, the sinus extends to
the region of the first bicuspid or cuspid teeth. The floor of the sinus forms the base of the alveolar
process (Figures 20-1 and 20-2).

They may be identical or asymmetrical in size and shape.

It can be described as pyramidal in shape, consisting of a base, an apex and four sides. The base is
formed by the lateral wall of the nose. The apex projects laterally into zygomatic process of maxilla; and
it may extend into zygomatic bone when the sinus is very large.
The four walls of pyramid are formed by: (1) The roof of antrum or the floor of orbit, (2) The anterior,
and (3) Infratemporal surfaces of body of maxilla, and (4) The alveolar process of maxilla which is the
floor of sinus.

pyramidal in shape and located within the body of the maxillary bone.

• Its apex, directed laterally, is formed by the zygomatic process.

• Its base directed medially is formed by the lateral wall of the nose.

• The alveolar process of the maxilla forms the floor.

• Many projections are seen on the floor of the antrum corresponding to the roots of the first and
second molar teeth.

Its nasal wall or base presents a large, irregular aperture, communicating with the nasal cavity. In the
articulated skull, this aperture is much reduced in size by the following bones: uncinate process of the
ethmoid above, ethmoidal process of the inferior nasal concha below, vertical part of the palatine
process behind and a small part of the lacrimal bone above and in front.

• The sinus communicates with the middle meatus of the nose, generally by two small apertures
between the above mentioned bones. In the fresh state, usually only one small opening exists, near the
upper part of the cavity; the other is closed by mucous membrane.

• On the posterior wall are the alveolar canals, transmitting the posterior superior alveolar vessels and
nerves to the molar teeth.

• The infraorbital canal usually projects into the cavity as a well marked ridge extending from the roof to
the anterior wall; additional ridges are sometimes seen in the posterior wall of the cavity and are caused
by the alveolar canals. The size of the cavity varies in different skulls and even on the two sides of the
same skull.

and it is pyramidal in shape. The maxillary sinus is very small at birth, but enlarges and becomes fully
formed in adolescence (around 18 years of age).

It is pyramidal in shape, with its base directed medially towards the lateral wall of the nose, and its apex
directed laterally to the zygomatic process of the maxilla. The boundaries of the maxillary sinus are:

• Medial wall or base = by lateral wall of the nasal cavity.

• Apex = Extends into or beyond the zygomatic process of maxilla

• Anterior wall = by anterior or facial wall of maxilla

• Posterior wall = by infra temporal surface of maxilla

• Roof wall = by orbital surface of maxilla

• Floor = by alveolar process of maxilla.

The maxillary sinus is subject to a great extent of variation in shape, size, and mode of developmental
pattern. It is inconceivable therefore to propose any structural description that would satisfy the
majority of human maxillary sinuses. Usually, however, the sinus is described as a four-sided pyramid,
the base of which is facing medially toward the nasal cavity and the apex of which is pointed laterally
toward the body of the zygomatic bone (Fig. 16.2). The four sides are related to the surface of the
maxilla in the following manner: (1) anterior, to the facial surface of the body; (2) inferior, to the
alveolar and zygomatic processes; (3) superior, to the orbital surface; and (4) posterior, to the
infratemporal surface. The four sides of the sinus, which are usually distant from one another medially,
converge laterally and meet at an obtuse angle. The identity of each of the four sides is somewhat
difficult to discern, and the transition of the surface from one side to the other is usually poorly defined.
Thus it is apparent that the comparison of the sinus space to a geometrically well-defined body is of
pedagogic value only.

SUMMARY

It is generally described as a four-sided pyramid with its base towards nasal cavity medially and apex
pointing towards zygomatic bone laterally. Its four sides are related to the maxilla in the following
manner; anterior to the facial surface, posterior to the infratemporal surface, superior to the orbital
surface, and inferior to the alveolar process. The bony wall in the base of the sinus is the thinnest. The
sinus opening called the ostium, is located near the base and it opens into the middle meatus of the
nose. The sinus often expands beyond its normal anatomy and they are known as recesses. These
extend most often to the alveolar processes and to a lesser extent to frontal, zygomatic, or palatine
processes of the maxilla.

Normal anatomy

The maxillary antrum or sinus is an approximately pyramidal cavity. It contains air, is lined by
mucoperiosteum with a pseudostratified ciliated columnar epithelium and occupies most of the body of
the maxillary bone.

The internal surface can be smooth or ridged with prominent bony septa. The lateral wall contains
canals or grooves for the nerves and blood vessels supplying the upper posterior teeth.

The main anatomical parts of the antra (see Fig. 27.1) can be divided into:

• A central air-filled cavity

• A roof or upper border, bounded by the orbit

• A medial wall, bounded by the nasal cavity

• A posterior wall, related to the pterygopalatine fossa

• A lateral wall, related to the zygoma and cheek

• An anterior wall, related to the cheek

• A floor, related to the apices of the upper posterior teeth.

It is located in the body of the maxilla and is a pyramidal-shaped structure having as its base the medial
wall (the lateral nasal wall). This important complex structure will be discussed later in greater detail.
The pyramid has three main processes or projections: (1) the alveolar process inferiorly (bounded by the
alveolar ridge), (2) the zygomatic recess (bounded by the zygomatic bone), and (3) the infraorbital
process pointing superiorly (bounded by the bony floor of the orbit, and below it, the canine fossa). The
alveolar and palatine processes form the floor of the maxillary sinus, which after the age of 16 usually
lies 1–1.2 cm below the floor of the nasal cavity (Figure 1.1).1–3

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.

The zygomatic process or projection is largely unremarkable. Occasionally the maxillary sinus may be
divided into two or even three separate compartments by bony septa.4

In the course of development the maxillary sinus often pneumatizes the maxilla beyond the boundaries
of the maxillary body. Some of the processes of the maxilla consequently become invaded by the air
space. These expansions, referred to as the recesses, are found in the alveolar process (50% of all
instances), zygomatic process (41.5% of all instances), frontal process (40.5% of all instances), and
palatine process (1.75% of all instances) of the maxilla. The occurrence of the zygomatic recess usually
brings the superior alveolar neurovascular bundles into proximity with the space of the sinus. The
frontal recess invades and sometimes surrounds the content of the infraorbital canal, whereas the
alveolopalatine recesses reduce the amount of the bone between the dental apices and the sinus space.

The latter development most often pneumatizes the floor of the sinus adjacent to the roots of the first
molar (Fig. 16.4) and less often to the roots of the second premolar, first premolar, and second molar, in
that order of frequency. The fully developed alveolar recess is characterized by three depressions
separated by two incomplete bony septa. The anterior depression, or fossa, corresponds to the original
site of premolar buds, the middle to the molar buds, and the posterior to the third molar bud.

........................................................................................................................................................................

situată în corpul osului maxilar şi, inconstant, în procesele acestuia.

La adult, sinusul ocupă aproape în totalitate osul maxilar, fiind situat sub cavitatea orbitară şi având
forma unei piramide triunghiulare. Baza piramidei este reprezentată de peretele lateral al fosei nazale şi
este situată medial, iar vârful este situat lateral, către osul zigomatic (Fig. 8. 1).

Considerat o anexă a foselor nazale, sinusul maxilar comunică cu cavitatea nazală la nivelul peretelui
intersinonazal (baza piramidei), printr-un orificiu ovalar care se deschide în meatul mijlociu, prin acest
orificiu sino-nazal realizându-se drenajul fiziologic al sinusului maxilar (Fig. 8. 2).
Prin podeaua sinusului, care corespunde procesului alveolar maxilar, antrul are raporturi anatomice de
vecinătate cu dinţii laterali ai arcadei superioare. Variabilitatea acestor raporturi depinde de mărimea
sinusului maxilar, de lungimea rădăcinilor dentare şi de înălţimea proceselor alveolare.

[…] la adulţi, dimensiunea subantrală se micşorează [...]

Podeaua sinusului maxilar are variaţii anatomice dimensionale semnificative, putând fi între 0, 2 şi 16
mm. în aceste condiţii, un sinus maxilar voluminos se poate extinde până la nivelul apexurilor dentare,
sau chiar le poate coafa, pătrunzând în spaţiile interradiculare ale molarilor şi premolarilor superiori.

........................1

In adults, the apices of teeth may extend into the sinus cavity […]

Expansion of the sinus normally ceases after the eruption of permanent teeth, but on occasion, the sinus
will pneumatize further, after the removal of one or more posterior maxillary teeth, to occupy the
residual alveolar process. In many of the cases, the sinus often extends virtually to the crest of the
edentulous ridge. The maxillary sinus is significantly larger in adult patients who are edentulous in the
posterior maxilla compared with patients with complete posterior dentition.4

The maxillary sinus is described as a four-sided pyramid, with the base lying vertically on the medial
surface and forming the lateral nasal wall. The apex extends laterally into the zygomatic process of the
maxilla. The upper wall, or roof, of the sinus is also the floor of the orbit. The posterior wall extends the
length of the maxilla and dips into the maxillary tuberosity. Anteriorly and laterally, the sinus extends to
the region of the first bicuspid or cuspid teeth. The floor of the sinus forms the base of the alveolar
process (Figures 20-1 and 20-2).

The maxillary sinus opens into the posterior, or inferior, end of the semi-lunar hiatus, which lies in the
middle meatus of the nasal cavity, between the inferior and middle nasal conchae.

............................2

It is important to the dental surgeon because of its close relationship to the posterior maxillary teeth
(generally from first premolar to third molar). The proximity varies between individuals (Fig. 15.1) but
tends to increase with age as the antrum enlarges.

The antrum can encroach into alveolar bone after tooth extraction, and periapical bone loss resulting
from dental disease may further decrease the amount of bone separating it from the teeth.

...............................4

They communicate with the other paranasal sinuses through the lateral wall of the nose. They may be
identical or asymmetrical in size and shape.

It can be described as pyramidal in shape, consisting of a base, an apex and four sides. The base is
formed by the lateral wall of the nose. The apex projects laterally into zygomatic process of maxilla; and
it may extend into zygomatic bone when the sinus is very large.

The four walls of pyramid are formed by: (1) The roof of antrum or the floor of orbit, (2) The anterior,
and (3) Infratemporal surfaces of body of maxilla, and (4) The alveolar process of maxilla which is the
floor of sinus.
The roof is formed by thin orbital plate; separating it from orbital contents. The infraorbital canal,
containing the vessels and nerves, runs down along the roof. The floor is formed by the lateral hard
palate; alveolar process of maxilla carrying the roots of premolars and molars. The posterior wall
separates the sinus from infratemporal and pterygopalatine fossae. It is pierced by posterior-superior
alveolar nerves which travel to molar teeth. The anterior wall is the facial surface of maxilla.

......................................6

Applied Surgical Anatomy

Relation of the Root Apices with the Floor of the Sinus

In adults, there is a distance of approximately, 1–1.25 cm between the floor of the sinus and the root
apices of maxillary posterior teeth. Sometimes, the floor of the sinus is in close proximity with the roots
of these teeth. The teeth, in close proximity with the sinus vary from studyto- study. Von Bornsdorff
(1925) found in his series, that the roots of second molar were closest to the floor. Paatero (1939) also
confirmed this finding; with the next in order of frequency were; the first molar, third molar, second
premolar, first premolar, and canine (Figs 41.3A to C).

Anatomy

• Maxillary sinus is the largest of the paranasal sinuses, pyramidal in shape and located within the body
of the maxillary bone.

• Its apex, directed laterally, is formed by the zygomatic process.

• Its base directed medially is formed by the lateral wall of the nose.

• The alveolar process of the maxilla forms the floor.

• Many projections are seen on the floor of the antrum corresponding to the roots of the first and
second molar teeth. Its nasal wall or base presents a large, irregular aperture, communicating with the
nasal cavity. In the articulated skull, this aperture is much reduced in size by the following bones:
uncinate process of the ethmoid above, ethmoidal process of the inferior nasal concha below, vertical
part of the palatine process behind and a small part of the lacrimal bone above and in front.

• The sinus communicates with the middle meatus of the nose, generally by two small apertures
between the above mentioned bones. In the fresh state, usually only one small opening exists, near the
upper part of the cavity; the other is closed by mucous membrane.

• On the posterior wall are the alveolar canals, transmitting the posterior superior alveolar vessels and
nerves to the molar teeth.

• The infraorbital canal usually projects into the cavity as a well marked ridge extending from the roof to
the anterior wall; additional ridges are sometimes seen in the posterior wall of the cavity and are caused
by the alveolar canals. The size of the cavity varies in different skulls and even on the two sides of the
same skull.

Drainage of the Sinus (Figs. 32.3, 32.4)

In the anterosuperior part of its base is an opening through which it communicates with the lower part
of the hiatus semilunaris; a second orifice is frequently seen in or immediately behind the hiatus.

Hiatus semilunaris is bounded inferiorly by sharp concave margin of uncinate process of the ethmoid
bone and leads into a curved channel, the infundibulum, bounded above by bulla ethmoidalis and below
by lateral surface of uncinate process of the ethmoid.

Anterior ethmoidal cells open into the front part of the infundibulum and this, in slightly more than 50%
of subjects, is directly continuous with the frontonasal duct or passage leading from the frontal air sinus.
But when anterior end of the uncinate process fuses with front part of the bulla, this continuity is
interrupted and frontonasal duct then opens directly into anterior end of the middle meatus. Below the
bulla ethmoidalis and partly hidden by the inferior end of the uncinate process, is the ostium maxillare
or opening from the maxillary sinus. In a frontal section, this opening is seen to be placed near the roof
of the sinus. An accessory opening from the sinus is frequently present below the posterior end of the
middle nasal concha.

Applied anatomy

Dental infection and root anatomy:

The most common teeth whose roots are in close approximation to the maxillary sinus are second
maxillary molar followed by first and third molars, second premolar, first premolar, and canine.

Maxillary sinus in adult:

In adults, the distance between apical ends of maxillary posterior tooth with the floor of the sinus is
approximately 1–1.2 cm but in some individuals this gap may be still lesser. In some cases, floor of the
sinus lies in between the roots of the adjacent teeth or adjacent roots of the same tooth, which causes
elevation of floor of the sinus.

.............................7

Amongst the paranasal subgroups, it is the maxillary sinus that is perhaps the most significant for
dentists and oral surgeons. The maxillary sinus is the largest of the paranasal sinuses, and it is pyramidal
in shape. The maxillary sinus is very small at birth, but enlarges and becomes fully formed in
adolescence (around 18 years of age).5 The maxillary sinus opens into the middle meatus of the nose
through the hiatus semilunaris. The mucus produced by the glands of the mucous membranes is
transferred to the nose by cilliary action of the columnar cells. Drainage of the mucus is also achieved by
the siphon action created during nose blowing. The cilia and mucus play a significant role in draining
foreign substances including bacteria from the sinus to the nasal cavity. The apices of the second
maxillary premolar and the first and second molar teeth are located in close relation to the floor of the
sinus and may be separated only by mucous membrane and thus permit dissemination of agents from
dental infection.

...............................9

Anatomy of Maxillary Sinus

Maxillary sinus is the largest of all the paranasal sinuses present within the body of maxilla. It is
pyramidal in shape, with its base directed medially towards the lateral wall of the nose, and its apex
directed laterally to the zygomatic process of the maxilla. The boundaries of the maxillary sinus are:

• Medial wall or base = by lateral wall of the nasal cavity.

• Apex = Extends into or beyond the zygomatic process of maxilla

• Anterior wall = by anterior or facial wall of maxilla

• Posterior wall = by infra temporal surface of maxilla

• Roof wall = by orbital surface of maxilla

• Floor = by alveolar process of maxilla.

...................................10

STRUCTURE AND VARIATIONS

The maxillary sinus is subject to a great extent of variation in shape, size, and mode of developmental
pattern. It is inconceivable therefore to propose any structural description that would satisfy the
majority of human maxillary sinuses. Usually, however, the sinus is described as a four-sided pyramid,
the base of which is facing medially toward the nasal cavity and the apex of which is pointed laterally
toward the body of the zygomatic bone (Fig. 16.2). The four sides are related to the surface of the
maxilla in the following manner: (1) anterior, to the facial surface of the body; (2) inferior, to the
alveolar and zygomatic processes; (3) superior, to the orbital surface; and (4) posterior, to the
infratemporal surface. The four sides of the sinus, which are usually distant from one another medially,
converge laterally and meet at an obtuse angle. The identity of each of the four sides is somewhat
difficult to discern, and the transition of the surface from one side to the other is usually poorly defined.
Thus it is apparent that the comparison of the sinus space to a geometrically well-defined body is of
pedagogic value only.

The base of the sinus, which is the thinnest of all the walls, presents a perforation, the ostium, at the
level of the middle nasal meatus (Fig. 16.3). In some individuals, in addition to the main ostium, two or
many more accessory ostia connect the sinus with the middle nasal meatus. In 5.5% of instances the
main ostium is located within the anterior third of the hiatus semilunaris, in 11% within the middle third,
and 71.7% within the posterior third; in 11.3% the ostium is found outside and in a posterior position to
the hiatus semilunaris. The accessory ostia are found in 23% of these instances in the middle nasal
meatus and occur rarely in the inferior nasal meatus.

In the course of development the maxillary sinus often pneumatizes the maxilla beyond the boundaries
of the maxillary body. Some of the processes of the maxilla consequently become invaded by the air
space. These expansions, referred to as the recesses, are found in the alveolar process (50% of all
instances), zygomatic process (41.5% of all instances), frontal process (40.5% of all instances), and
palatine process (1.75% of all instances) of the maxilla. The occurrence of the zygomatic recess usually
brings the superior alveolar neurovascular bundles into proximity with the space of the sinus. The
frontal recess invades and sometimes surrounds the content of the infraorbital canal, whereas the
alveolopalatine recesses reduce the amount of the bone between the dental apices and the sinus space.
The latter development most often pneumatizes the floor of the sinus adjacent to the roots of the first
molar (Fig. 16.4) and less often to the roots of the second premolar, first premolar, and second molar, in
that order of frequency. The fully developed alveolar recess is characterized by three depressions
separated by two incomplete bony septa. The anterior depression, or fossa, corresponds to the original
site of premolar buds, the middle to the molar buds, and the posterior to the third molar bud.

SUMMARY

It is generally described as a four-sided pyramid with its base towards nasal cavity medially and apex
pointing towards zygomatic bone laterally. Its four sides are related to the maxilla in the following
manner; anterior to the facial surface, posterior to the infratemporal surface, superior to the orbital
surface, and inferior to the alveolar process. The bony wall in the base of the sinus is the thinnest. The
sinus opening called the ostium, is located near the base and it opens into the middle meatus of the
nose. The sinus often expands beyond its normal anatomy and they are known as recesses. These
extend most often to the alveolar processes and to a lesser extent to frontal, zygomatic, or palatine
processes of the maxilla.

...........................12

Normal anatomy

The maxillary antrum or sinus is an approximately pyramidal cavity. It contains air, is lined by
mucoperiosteum with a pseudostratified ciliated columnar epithelium and occupies most of the body of
the maxillary bone.

The internal surface can be smooth or ridged with prominent bony septa. The lateral wall contains
canals or grooves for the nerves and blood vessels supplying the upper posterior teeth.

The main anatomical parts of the antra (see Fig. 27.1) can be divided into:

• A central air-filled cavity

• A roof or upper border, bounded by the orbit

• A medial wall, bounded by the nasal cavity

• A posterior wall, related to the pterygopalatine fossa

• A lateral wall, related to the zygoma and cheek

• An anterior wall, related to the cheek

• A floor, related to the apices of the upper posterior teeth.

................................13

Anatomy of the maxillary sinus

The maxillary sinus is the largest of the four bilateral air-filled cavities in the skull. It is located in the
body of the maxilla and is a pyramidal-shaped structure having as its base the medial wall (the lateral
nasal wall). This important complex structure will be discussed later in greater detail. The pyramid has
three main processes or projections: (1) the alveolar process inferiorly (bounded by the alveolar ridge),
(2) the zygomatic recess (bounded by the zygomatic bone), and (3) the infraorbital process pointing
superiorly (bounded by the bony floor of the orbit, and below it, the canine fossa). The alveolar and
palatine processes form the floor of the maxillary sinus, which after the age of 16 usually lies 1–1.2 cm
below the floor of the nasal cavity (Figure 1.1).1–3

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.

The zygomatic process or projection is largely unremarkable. Occasionally the maxillary sinus may be
divided into two or even three separate compartments by bony septa.4

....................................14