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Definition of sinusitis :

  • The term Sinusitis was earlier used to describe the inflammation of the mucosa of the sinuses.
  • However, the condition sinusitis is associated invariably with the inflammation of the nasal mucosa also.
  • Moreover the inflammation of the maxillary sinus is called Maxillary sinusitis.
  • And so the condition is called Rhinosinusitis.
  • And also sinusitis that occurs in one of the largest sinuses that is maxillary sinus is called Maxillary sinusitis.

What are Maxillary sinus ?

  • The largest paranasal sinuses in pair is the maxillary sinus.
  • It lies with the base directed towards lateral wall of nose and also apex directed laterally into the zygomatic process of maxilla and sometimes they are present within the zygomatic bone itself.
  • Moreover the maxillary sinus is 33 mm high, 35 mm deep and also 25 mm wide.
  • And also on an average the maxillary sinus holds the capacity of 15 mL in adults.

MAxillary sinus

 

Maxillary sinus
Relation of the Maxillary sinus :

  • Anterior wall :
    • Facial surface of the Maxilla forms the anterior wall.
    • And also the soft tissues of cheek forms the anterior relation of the Maxillary sinus.
  • Posterior wall :
    • Infratemporal and also Pterygopalatine fossae forms the relation to the posterior wall.
  • Medial wall :
    • Middle and Inferior meatuses forms the relation to the medial wall.
    • And also at some places, the middle wall is thin and also membranous.
    • Moreover the uncinate process, anterior and posterior fontanelle, and inferior turbinate and meatuses also forms the relations to the medial wall.
  • Floor :
    • The alveolar and also palatine processes forms the floor of the maxillary sinuses.
    • The floor lies 1cm below the level of floor of the nose.
    • The roots of the second premolar and also first molar teeth forms the relation to the floor of the maxillary sinus.
    • And also depending upon the age of the person and pneumatization of the sinus the roots of all the molars, sometimes the premolars and canine are in close relation to the floor of the maxillary sinus.
    • It is usually separated from the floor of the maxillary sinus by thin lamina of bone or even no bone at all.
    • Moreover the extraction of the tooth may also lead to the formation of Oroantral fistulae.
    • And also Dental infection is also an important risk factor the maxillary sinusitis.
  • Roof :
    • The floor of the orbit forms the roof the maxillary sinus.
    • Moreover the Infraorbital nerve and vessels traverses the roof of the maxillary sinus.

Development and growth of maxillary sinus :

Paranasal sinus Status at birth Growth First radiologic evidence
Maxillary sinus Present at birth
Volume 6-8 mL
Rapid growth from 3 years and also from 7 years to 12 years
Adult size – 15 years
4 -5 months after birth

Drainage of Maxillary sinus :

  • The maxillary sinus drains through the middle meatus.
  • The mucus always drains through the natural ostium.
  • It always drains through the natural ostium even though the accesory ostium is present in the fontanelle.
  • Moreover one of the obseravations from the inferior meatal antrostomy made in Caldwell-Luc operation is that it provides ventilation to the sinuses but it does not help in the mucociliary clearance which still takes place through the natural ostium.

Aetiology of Maxillary sinusitis :

  • Firsly, Most common aetiological factor is viruses that is it causes viral rhinitis.
  • This spreads to involve the sinus mucosa.
  • And moreover this is followed by the bacterial invasion.
  • Secondly, Diving and Swimming in the contaminated water.
  • Thirdly, the dental infections are the important source of the maxillary sinusitis.
  • Finally, trauma to the sinus such as compound fractures, penetrating injuries or gunshot wounds leads to sinusitis.

Predisposing factors of Maxillary sinusitis:

  • Anatomic structural deformities obstructing the sinus ostia.
  • Smoking
  • Snuff dipping
  • Prolonged intranasal medications.
  • Primary ciliary dyskinesia
  • And also aspirin sensitivity etc..
  • Moreover the environmental factors include aeroallergens and also pathogens like bacteria, fungi, mycobateria.

Clinical features of Maxillary sinusitis :

  • The clinical features depends upon
    • Severity of inflammatory process
    • Efficiency of the ostium to drain the exudates (Mucopurulent secretions)
  • The closed ostium leads to stagnation os the secretions from the sinuses.
  • And that is of greater severity and also leads more often to complications.
  • Constitutional symptoms :
  • It consists of fever, general malaise and also body ache.
  • Moreover they are the result of toxaemia.
  • Headache :
    • Headache is usually confined to the forehead.
    • And hence it may be wrongly diagosed as frontal sinusitis.
  • Pain :
    • Pain confines to the area above the upper jaw and also occurs in the gums and teeth.
    • It aggravates by stooping, coughing or chewing.
    • It may also occur as the referred pain at ipsilateral supraorbital region.
    • And therefore it may stimulate the frontal sinus infection.
  • Tenderness :
    • Pressure or the tapping over the anterior wall of the antrum produces tenderness.
  • Redness and Oedema of the cheek :
    • Usually the children present with the redness and also oedema over the cheek.
    • Moreover the lower eyelid may become puffy.
  • Nasal discharge :
    • The investigatory procedures like Anterior rhinoscopy/ nasal endoscopy shows pus or mucopus in the middle meatus.
    • Mucosa of the middle meatus and turbinate may appear red and also swollen.
  • Postnasal discharge :
    • Posterior rhinoscopy reveals pus on the upper soft palate.

Diagnosis :

  • Transillumination test :
    • The infected sinus will show opaqueness.
    • But this is not currently in use.
  • X-Rays :
    • Waters view shows either opacity or fluid level in the involved sinus.
    • Moreover computed tomography is the best imaging modality to investigate the sinuses.
  • Treatment :
    • Medications :
      • Antimicrobial dugs
      • Nasal decongestant drops
      • Steam inhalation
      • Analgesics
      • And also Hot fomentation
    • Surgical :
      • Antral lavage

Complications :

  • Firstly, Maxillary sinusitis may progress to subacute sinusitis or chronic sinusitis.
  • Secondly, Frontal sinusitis – This occurs mainly due to the obstruction of the frontal sinus drainage pathway beacuse of oedema.
  • Thirdly, Osteitis or Osteomyelitis of the maxilla.
  • Finally, Orbital cellulitis or abscess – This occurs beacuse of oedema.
  • And also it spreads either directly from the roof of the maxillary sinus or indirectly, after involvement of ethmoid sinuses

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