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Maxillary sinus
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Maxillary sinus

Outline of bones of face, showing position of air sinuses.

Latin sinus maxilliaris
Gray's subject #223 999
Artery infraorbital artery, posterior superior alveolar artery
posterior superior alveolar nerve, medial superior
Nerve alveolar nerve, anterior superior alveolar nerve, and
infraorbital nerve
MeSH Maxillary+Sinus

The pyramid shaped maxillary sinus (or antrum of Highmore) is the largest of the paranasal
sinuses, and drains into the nose. It is present at birth as rudimentary air cells, and develops
throughout childhood.

Contents

1 Discovery
2 General characteristics

3 Nasal wall/base

4 Posterior wall

5 Floor

6 Pathology
o

6.1 Maxillary Sinusitis

6.1.1 Treatment

7 See also

8 References

9 External links

Discovery
The maxillary sinus was first discovered and illustrated by Leonardo da Vinci, but the earliest
attribution of significance was given to Nathaniel Highmore, the British surgeon and anatomist
who described in detail in his 1651 treatise.[1]

General characteristics
Found in the body of the maxilla, this sinus has three recesses: an alveolar recess pointed
inferiorly, bounded by the alveolar process of the maxilla; a zygomatic recess pointed laterally,
bounded by the zygomatic bone; and an infraorbital recess pointed superiorly, bounded by the
inferior orbital surface of the maxilla. The medial wall is composed primarily of cartilage. The
ostia for drainage are located high on the medial wall and open into the semilunar hiatus of the
lateral nasal cavity; because of the position of the ostia, gravity cannot drain the maxillary sinus
contents when the head is erect. The sinus is lined with mucoperiosteum, with cilia that beat
toward the ostia. This membrane is also referred to as the "Schneiderian Membrane", which is
histologically a bilaminar membrane with ciliated columnar epithelial cells on the internal (or
cavernous) side and periosteum on the osseous side. The size of the sinuses varies in different
skulls, and even on the two sides of the same skull.
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 mucous membranes receive their postganglionic parasympathetic nerve innervation for
mucous secretion originating from the greater petrosal nerve (a branch of the facial nerve). The
superior alveolar (anterior, middle, and posterior) nerves, branches of the maxillary nerve
provide sensory innervation.
The maxillary sinus may drain into the mouth via an abnormal opening, an oroantral fistula, a
particular risk after tooth extraction.

Nasal wall/base
Its nasal wall, or base, presents, in the disarticulated bone, a large, irregular aperture,
communicating with the nasal cavity.
In the articulated skull this aperture is much reduced in size by the following bones:

the uncinate process of the ethmoid above,

the ethmoidal process of the inferior nasal concha below,

the vertical part of the palatine behind,

and a small part of the lacrimal above and in front.

The sinus communicates through an opening into the semilunar hiatus on the lateral nasal wall.

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

Floor

The maxillary sinus can normally be seen above the level of the premolar and molar teeth in the
upper jaw. This dental x-ray film shows how, in the absence of the second premolar and first

molar, the sinus became pneumatized and expanded towards the crest of the alveolar process
(location at which the bone meets the gum tissue).
The floor is formed by the alveolar process of the maxilla, and, if the sinus is of an average size,
is on a level with the floor of the nose; if the sinus is large it reaches below this level.
Projecting into the floor of the antrum are several conical processes, corresponding to the roots
of the first and second molar teeth; in some cases the floor is perforated by the apices of the
teeth.

Pathology
Maxillary Sinusitis
Maxillary sinusitis is inflammation of the maxillary sinuses.
Maxillary sinusitis is common due to the close anatomical relation of the frontal sinus, anterior
ethmoidal air sinus and the maxillary teeth, allowing for easy spread of infection. Furthermore,
the drainage orifice lies near the roof of the sinus, and so the maxillary sinus does not drain well,
and infection develops more easily.
Treatment
The treatment of acute maxillary sinusitis is usually prescription of a broad-spectrum
cephalosporin antibiotic resistant to beta-lactamase, administered for 10 days.

See also

Ohngren's line

References
1.

^ Merriam-Webster's Medical Desk Dictionary Revised Ed. 2002, pg 49.

External links

SUNY Radiology Headneck:17Maxill

Cross section at UV skull/x-front

lesson9 at The Anatomy Lesson by Wesley Norman (Georgetown University)

(latnasalwall3, nasalcavitfrontsec)
[show]
v

Bones of head and neck: the facial skeleton of the skull (TA A02.1.0815, GA 2.156
177)
[show]
v
t

Head and neck, upper RT: Nose (TA A06.1, TH H3.05.01, GA 10.992)
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Maxillary Sinusitis
Maxillary sinusitis is a form of paranasal infection that spreads rapidly, if not treated early. The
infection causes terrible headache, pain in throat and fever. Read on to know the details about
maxillary sinusitis.

Maxillary sinus is the largest gland amongst all the paranasal sinuses. The sinus is present in the
body of maxilla having three recesses known as alveolar, zygomatic and infraorbital recess.
Inflammation of these regions is known as maxillary sinusitis. Maxillary sinus is also known as
antrum of Highmore. The infection is quite common due to its closeness with the frontal sinus,
maxillary teeth and anterior ethmoidal air sinus. The details of maxillary sinusitis infection are
elaborated in the following paragraphs.
Complications

Maxillary sinus is vulnerable to infection as its drainage orifice, called ostium lies very close to
the roof of the sinus leading to improper drainage. Thus, infections easily develop in this region.
They are located in an area of the upper jaw below the eye sockets and behind the cheekbone.
The location of maxillary sinus makes it more prone to infection. Obstruction in mucus flow
from the orifice can cause sinus infection. The condition worsens if it's caused by dental or gum
infection. Sometimes, acute sinus infections are not completely cured, which might lead to
maxillary sinus infection. Excessive dryness inside homes and working inside an air-conditioned
room at a stretch are also responsible for maxillary sinusitis.
Enlarged Turbinates: The spongy bones of the nasal passages are known as turbinates. If these
turbinates are abnormally large, they create obstruction in the passage for draining sinuses.
Improper ventilation is one of the most common causes of maxillary sinusitis.
Deviated Septum: The nostrils are separated by a nasal septum. The septum is normally located
centrally for accurate division. Persons suffering from a deviated septum have the ridge, either
leaning towards the right or left. This also affects the pathway for mucus flow and poor
ventilation.
Oral Health: Oral infections, cavities, bleeding gums cause maxillary sinusitis. Bacterial
infection in teeth invades the sinus glands that causes this problem. People having such disorders
suffer from frequent sinus infections. Such infections become severe if associated with toothache
in molar jaws and emission of yellowish green mucus.
Fungal Infection: Infections associated with the fungus Aspergillus occur in the maxillary
cavities that becomes severe if not detected at early stages. Fungal infections also spread in gums
causing tremendous discomfort.
Symptoms
The symptoms become severe if not detected at the initial stage. A person suffers from a runny
rose due to cold attack and then he is gripped with fever and body pain. Sinus pain is felt more in
people suffering from migraine. Chronic headache is felt in case of acute maxillary sinusitis. The
conditions worsen if not diagnosed or treated early. Sometimes, if a severe sinus infection
remains untreated, then it might also cause maxillary sinusitis. The symptoms will be classified
according to the nature of infection.
Early Symptoms
Bad breath
Sore throat

Puffy eyes

Fatigue

Irritation

Continuous throat clearing

Stuffy ears

Chronic cold

Asthma

Fever

Acute Symptoms
Dull pain deep inside eyes
Intermittent headaches everyday

Nasal congestion

Post nasal drip

Obstruction of nasal passage

Raspy voice

Pus like basal discharge

Facial pain, especially around the forehead that increases on bending.

The infection needs early medication to reduce fever and sinus headache. On observing
conditions like runny nose or nasal drip, antibiotics are administered by doctors. The prescribed
composition is usually based on a broad spectrum cephalosporin antibiotic for minimum 10 days.
Any kind of sinus infection should never be neglected because, if the symptoms persist they can
make you confined for some considerable period of time. Try to maintain the humidity inside
your house or your working zone in order to prevent excessive dry nose or any kind of nasal
infection.
By Saptakee Sengupta
Published: 8/4/2010
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