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Orban B. Oral Histology and Embryology (1944) The C.V. Mosby Company, St. Louis.

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Chapter XIV - The Maxillary Sinus

1. Introduction

The relation of the maxillary sinus to the dentition was ﬁrst recognized by Nathaniel Highmore. In his Work Carports Humawi Disquisitio Anatomicaﬁ (1651) he described the adult state of the cavity in detail, and pointed out that his attention had been called to it because a patient had an abscess there which was drained by the extraction of a cuspid tooth. This proved to be one of those misleading ﬁrst observations, since it is now known that the cuspid‘ root seldom is related to this space in such a way that its simple extraction would drain it. However, the erroneous idea still persists that this relationship is generally true. The molar roots most often, and the bicuspid roots less frequently, are the dental structures which lie closest to the sinus (Fig. 259). Individual variations are great and can be determined only by careful interpretation of good roentgenographs.

2. Development

The maxillary sinus begins its development in about the third monthof fetal life. It arises by a lateral evagination of the mucous membrane of the middle nasal meatus, forming a slitlike space. In the newborn its measurements are about 8 x 4 x 6 mm. (Fig. 260); thereafter, it gradually expands by pneumatization of the body of the maxilla. The sinus is well developed when the second dentition has erupted, but it may continue to expand, probably throughout life.5

3. Anatomic Remarks

The maxillary sinus, or antrum of Highmore, is situated in the body of the maxilla. It is pyramidal in shape; the base of the pyramid is formed by the lateral wall of the nasal cavity; the apex extends into the zygomatic process; the anterior wall corresponds to the facial surface of the maxilla, and the roof to its orbital surface. The posterior wall is formed by the infratemporal surface of the maxilla; the ﬂoor, usually, reaches into the alveolar process (Fig. 261).

First draft submitted by Paul C. Kitchin in collaboration with L. F. Edwards. Department of Anatomy, Ohio State University.

There is a considerable variation in size, shape and position of the maxillary sinus, not only in different individuals, but also on the two sides of the same individual. Its average capacity in the adult is about one-half of one ﬂuid ounce (14.75 c.c.) with average dimensions as follows: anteroposteriorly, 3.4 cm.; transversely, 2.3 cm.; and vertically, 3.35 cm. The maxillary sinus communicates with a recess of the middle meatus of the nasal cavity (semilunar hiatus) by means of an aperture, the ostium maxillare, which is located high on its nasal or medial wall and is, therefore, unfavorably situated for drainage (Fig. 261). An accessory ostium may occur which is, usually, lower and thus more advantageously placed for drainage than is the normal ostium.

Fig. 259. Buccolingual section throu h n t b‘ ‘d. ' ; fzéom the sinusg by is thiirgpgfatenbisliione. The apex ls iepamted

Variations in the size of the maxillary sinus are explained on the basis of the degree or extent of pneumatization of the body of the maxilla (ho11owing—out by an air-ﬁlled pouch of the nasal cavity). In genera], the greater the pneumatization the thinner the walls of the sinus will be, since pneumatization occurs at the expense of bone. During enlargement of the sinus various recesses or accessory fossae may form. Thus, subcompartments or recesses may be present in the palatine, zygomatic, frontal and alveolar processes. The ﬂoor of the sinus may extend downward not only between adjacent teeth but also between the roots of individual teeth so that their apices cause elevations in the ﬂoor and appear to protrude into the sinus. The type and number of teeth whose apices indent the ﬂoor of the space depend upon the degree and shape ofpneumatization. In the majority of cases the roots are covered by a. thin layer of bone (Fig. 259). In some instances, they are covered only by the mucous membrane which lines the cavity and by the periodontal membrane of the root of the tooth. The ﬂoor of the sinus may be on the same level with that of the nasal cavity, or higher or lower than that. In some cases the sinus may be incompletely divided by osseous and membranous ridges, commonly known as septa.

Fig. 260. Frontal sections through the head. A. Newborn infant B. Nine-month-old child. Compare the size of maxillary sinus.

Fig. 261. Relation or the maxillary sinus and its opening into the nasal cavity. A. Frontal section showing marked asymmetry between right and left sinus. B. Relation of sinus to root apicea.

Unilateral supplemental maxillary sinuses have been observed.‘ They occur posteriorly to the sinus proper and are, from the standpoint of origin, overdeveloped posterior ethmoid cells. Clinically, they must be considered as maxillary sinus.

4. Function

In the past, various functions have been ascribed to the maxillary sinus and the other accessory nasal sinuses. It has been claimed by some, for instance, that they aid in warming and moistening inhaled air, thus acting as air-conditioning chambers. Others believe that the sinus plays an important role in vocalization. However, the most probable explanation of the development of all nasal sinuses is that bone which has lost its mechanical function is resorbed. An example is the marrow cavity in long bones where fatty tissue develops in the place of the disappearing bone. The disappearance of useless bony substance in the neighborhood of the air-ﬁlled nasal cavity leads to development of air-ﬁlled pouches which grow into the bone and occupy the place of bony tissue which is no longer needed to withstand mechanical stresses. The supporting function of bone is maintained but with a minimum of material. This is in accord with principles of economy which exist in the animal body.

5. Histology

The maxillary sinus is lined by a mucosa covered with an epithelium typical of the respiratory passages. It is thinner and more delicate than that of the nasal cavity.

The lamina propria of the mucosa is fused to the periosteum of the underlying bone and consists of loose bundles of collagenous ﬁbers with very few elastic ﬁbers; it is only moderately vascular (Fig. 262, A). Glands of the mucous and serous type are conﬁned largely to that part of the tunica propria which is located around the opening, or openings, into the nasal cavity.

The epithelium is pseudostratiﬁed ciliated columnar, rich in goblet cells (Fig. 262, B). The nuclei of the individual columnar cells are‘located at different distances from a delicate basement membrane. Actually, each columnar cell rests upon the basement membrane, but not all the cells reach the surface. The goblet cells secrete mucus which moistens the surface of the sinus mucosa. The cilia beat in such a way as to move any surface material toward the opening communicating with the nasal cavity, and hence act to clear the sinus cavity of inhaled substances, and mucus.

6. Clinical Considerations

Pulpal infection in teeth whose root apices are in close approximation to the ﬂoor of the sinus are dangerous because it can be a cause of sinus Maxillary sinus Epithelium infection.

Fig. 262. Mucous membrane and epithelium of maxillary sinus.

A. Apical region of a second bicuspid. The lining oi.’ the sinus is continuous with the periapicsl tissue through openings in the bony floor of the sinus.

B. High magniﬁcation of the epithelium of maxillary sinus. (Courtesy W. 11. Bauer.‘ St. Louis University School of Dentistry.)

Fig 263. Roentgenogrs.m or upper jaw. Maxillary sinus extends toward alveolar crest after loss of ﬂrst molar.

3 Thus, the prevention of the dental type of sinusitis is possible by prevention or elimination of pulpal infection. Any root canal operation in maxillary bicuspid or molar areas should be carried out with particular care, in order to prevent infection of the sinus.

The dentist should always keep in mind that disease of the maxillary sinus may produce referred dental pain. The superior alveolar nerves run in narrow canals in the thin wall of the sinus and, frequently, these canals are partly open toward the sinus. When this happens the nerves which supply the teeth are in contact with the lining of the sinus where they may become involved in an inﬂammation affecting the mucosa. In such cases, the pain resembles pulpal pain but involves a group of teeth or even all the teeth in one maxilla. If apices of some roots are in contact with the lining of the sinus the affected teeth may show symptoms of periodontitis during sinus infection. In cases where there is doubt whether the teeth or sinus are the cause of pain, the patient should be referred to a rhinologist before an extraction is performed.

In the course of an extraction a root may be forced into the sinus. If it cannot be easily removed through the socket the patient should be informed of the circumstances and be referred to a rhinologist. Even if it is possible for the dentist to remove the root of the tooth, subsequent treatment by the sinus specialist is advisable. Any invasion of the ﬁeld of sinus surgery by the dentist operating through the alveolar wall should be discouraged by both dental and medical professions.

After loss of a single maxillary molar or, more rarely, bicuspid, the bony scar is, sometimes, hollowed out by the sinus (Fig. 263). The risk of opening the sinus during extraction of a tooth adjacent to such an extension has to be recognized. If a single molar remains in the maxilla for a long time after loss of the neighboring teeth, downward extensions, of the maxillary sinus may occur mesially and distally to this tooth. If greater force is applied in extracting such a tooth, tooth and socket are removed together rather than extracting the tooth from its socket. To minimize the necessary force the crown should be removed, the roots separated and extracted singly. The expansion of the maxillary sinus (and other sinuses) in old individuals should not be considered a process of growth. It is rather the consequence of progressive disuse atrophy of the bones, especially after loss of teeth, or of senile osteoporosis. The senile expansion of sinuses strengthens the belief that they develop as ﬁll-ins in bones whose core is under reduced mechanical stress.

References

1. Bauer. W. ‘EL: Maxillary Sinusitis of Dental Origin, Am. J. Orthodont. & Oral Surg. 29: 133, 1943.

2. Ennis, L. M., and Batson, 0.: Variations of the Maxillary Sinus as Seen in the Roentgenogram, J. A. D. A. 23: 201, 1936.

3. Hofer, 0.: Dental Diseases and Their Relation to Maxillary Antrum, J. Dent. Research 17: 321, 1938 (Abstract).

4. MacMilla.n, H. W.: The Relationship of the Teeth to the Maxillary Sinus; Anatomic Factors glnderlying the Diagnosis and Surgery of This Region, J‘. A. D. A. 14.: 1635, 19 7.

5. Schaeﬁer, J. I’.: The Sinus Maxillaris and Its Relations in the Embryo, Child and Adult Man, Am. J. Anat. 10: 313, 1910.

6. Schaeﬂer, J. P.: The Nose, Paranasal Sinuses, Nasolacrymal Passageways and Olfactory Organ in Man, Philadelphia, 1920, P. B1a.kiston’s Son & Co.

7. Sedwick, H. .1'.: Form, Size and Position of the Maxillary Sinus at Various Ages Studied by Means of Roentgenograms of the Skull, Am. J. Roentgenol. 32: 154, 1934.

8. Zuckerhandl, E.: Normale und pathologische Anatomie der N asenhiihle und ihrer pneumatischen Anhiinge (Anatomy of the Nasal Cavity), Leipzig, 1893.

Cite this page: Hill, M.A. (2024, April 27) Embryology Book - Oral Histology and Embryology (1944) 14. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_Oral_Histology_and_Embryology_(1944)_14

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