Presented by:Shiwani gupta

Roll.no: 18Bds 4th yr, 1st batch

RADIOGRAPHY OF MAXILLARY SINUS

CONTENTS: Development of maxillary sinus Introduction• Description of maxillary sinus• Boundaries• Connection with roots• Radiographic appearance Variation within maxillary sinus Radiographic technique(water’s view) Radiographic variations Conclusion References

Development of maxillary sinus

• Develops as invagination from nasl fossae into maxillary bone• Maxillary antra / antra of highmore are the first to develop in

second month of IU life.• An invagination develops in lateral wall of the nasal fossa in

middle meatus, and sinus enlarges laterally into body of maxilla.

• With time, maxilla becomes progressively more pneumatized as the air cavity expands

• Mucosal lining of maxillary is similar as found in nasal cavity but with fewer mucus glands.

Introduction

• an air containing cavity lined with mucus membrane.• Largest among all paranasal sinuses• Occupies virtually all entire body of maxilla• Function is unknown

• Considered as 3-sided pyramid.

• Boundaries: Superior wall forming the floor of orbit. Anterior wall extending above premolars. Posterior wall bulging above molar teeth and maxillary tuberosity.

• In IOPA ,boarders of maxillary sinus appear as a thin , delicate, tenous radiopaque line.

• CONNECTIONS WITH ROOOTS: Roots of maxillary molars lie in close apposition Root apices may project anatomically into floor of sinus ,

causing small elevations/prominences. Intimate relation between sinus and teeth leads to the

possibility that clinical symptoms originating in sinus may be perceived in teeth and vice versa.

• Proximity gradual expansion thins sinus walls opens canals traverse the anterolateral and posterolateral walls and carry the superior alveolar nerves nerves in intimate contact membrane lining sinus acute inflammation of sinus accompained with pain.

RADIOGRAPHIC APPEARANCCE:

• Floor and a minimal portion of inferior aspect of maxillary sinus a are seen on IOPAR in reation to amxillary premolars and molar teeth.

• Appears as uniformly radiolucent structure bounded by well-defined radiopaque line• Roots of maxillary molars appears to project into maxillary

antrum as a result of angulation of x-ray beam• In edentulous spaces, floor dips down and lies close to

alveolar ridge.• occasionally, thin radiolucent lines are seen to traverse sinus

walls.

• Often one or several radiopaque lines traverse th images of the maxillary sinus known as septa.

• Floor of maxillary sinus occasionally shows small radiopaque projections, which are nodules of bones.

Variations of maxillary sinus:

• With greater pneumatization of alveolar process, the floor of maxillary sinus may appear to superimposed over adjacent roots

• Draping----close relationship between tooth root and maxillary sinus

• Considerable pneumatization upto alveolar process , lamina dura of premolar and molar tooth may form a portion of sinus floor

• Hypoplasia-1.7% unilaterally, 7.2% bilaterally

Radiographic technique(water’s view)

• Also known as parietoacanthal view

• INDICATIONS: Evaluation of maxillary sinus and other paranasal sinuses Detection of middle 3rd of facial fracture lefort 1, 2, 3 fracture Zygomatic and nasoethmoidal complex Orbtal blow fracture

• Neck Is hyperextended enough to place the dense petrous immediately below the maxillary sinus floor

• FILM PLACEMENT: Cassette with the film is placed perpendicular to the

floor, with long axis vertically in a cassette holding device.

PATIENT POSITIONING:• patient’s neck is hyperextended and centered over the to acanthion• Patient’s chin is placed resting over cassette and adjust so that MSP is

perpendicualr to plane of cassette• Head is adjusted so that the OML forms an angle of 37°from the

plane of cassette.

CENTRAL RAY: perpendicular to cassette exiting the acanthion.

Diseases associated and its radiographic features:

A. INTRINSIC DISEASES:1. Mucositis2. Sinusitis3. Retention psedocyst4. Polyps5. Antrolith6. MucoceleB.EXTRINSIC DISEASES:7. PeriostitisC.BENIGN NEOPLASM: 8. Papilloma9. OsteomaD.MALIGNANT NEOPLASM:10. Squamous cell carcinoma11. PseudotumorE.BENIGN ODONTOGENIC CYSTS AND TUMORS:12. Odontogenic cysts13. Fibrous dysplasia F.DENTAL STRUCTURE DISPLACED INTO THE SINUS;

MUCOSITIS:

• Normally sinus mucosa not seen, but when inflamed , increased upto 10- 15 times, seen on radiograph.

C/F:• Asymptomatic• Discovered on accidental radiograph

RADIOGRAPHIC FEATURES: detected as noncorticated band , more radiopaque than

air filled sinus, paralleling the bony wall of the sinus.

Sinusitis:

• Generalized inflammation of maxillary sinus mucosa.

C/F:• complication of common cold• Clear nasal discharge or pharyngeal drainage• Pain and tenderness to pressure or swelling• Pain referred to premolars or molar teeth• Fever, chills ,malaise, and elevated leukocyte count

Acute sinusits- painChronic sinusitis- anatomic dearrangements, deviation of nasal septum

Radiographic features:• increased radiopacity due to thickening of sinus mucosa and

accumulation of secretions• Seen in water’s view• Image may be uniform or polyploid• Air fluid level resulting from accumulatin of secretion

Retention pseudocyst:

• synonym- antral psedocyst, retention cyst, etc

Etiology:• Blockage of secretory duct of seromucous gland• Cystic degeneration within an inflammatory,thickend sinus lining

C/F:• Found in any sinus at any time with seasonal temperature change• Common in males• Diagnosed in accidental radiograph• Nasal obstruction and postnatal discharge

Radiographic features:Location:- partial image of retention pseudocyst appears in

maxillary posterior radiograph• Occasionally more than one psedocyst may form in single

sinus• Forms on floor of sinus or lateral walls of roofPeriphery and shape:- appears as well-defined,non-corticated,

smooth, dome shaped radiopaque mass.Internal structure:- homogeneous and more radiopaque than

surrounding air of sinus cavityEffect in surrounding structure:- no characteristics effect seen.

Polyps:

• It is thickened mucus membrane of chronically inflammed sinus frequently forms into irregular folds called polyps.

C/F:• Displacement and destruction of bone.• In ethmoidal sinus, causes destruction of madial wall of orbit

and unilateral proptosis.

Radiographic features:• seen as thickend mucus membrane lining.

Antrolith:

• Results due to deposition of mineral salts such as calcium phosphate.

C/F:• Smaller- asymptomatic• larger- associated with sinusits, blood stained nasal discharge, nasal

obstruction or facial pain.

Radiographic features:• Location: above floor of maxillary anty=rum• Periphery and shape: well defined, hav smooth /irregular shape• Internal structure:ninternal density my be

homogeneous/heterogeneous, alternating layers of radiolucency and radiopacity in form of laminations may be seen.

Mucocele:

• Synonyms: pyocele ,mucopyocele• Is an expanding , destructive lesion that results from blocked

sinus ostium.• Pus filled in cavity- empyema

C/F:• Exert pressure on superior alveolar nerve hence pain• Sensation of fullness in cheek• Loosening of posterior teeth• Nasal airway obstruction

.

Radiographic features:Location: occurs in ethmoid air cells and frontal sinus.

Periphery and shape: more circular, “hydraulic” shape as mucocele enlarges

Internal structure: uniformly radiopaque.

Effect on surounding structure: septa and bony wall may severely thinned, teeth may be displaced or reasorbed.

Papilloma:• Benign neoplasm of respiratory epithelium.C/F:• Recurring sinusitis • Unilateral nasal obstruction• Nasal discharge • Pain and epistaxis

Radiographic feature: • Features not specific, diagnosis is based on histopathologic examination.• Location: usually in ethmiodal air sinus• Internal structure: homogeneous radiopaque mass of soft tissue density.• Effect on surrounding structure: bome destruction results in pressure

erosion.

Osteoma:

• Most common of mesenchymal neoplasm in paranasal sinuses.

C/F:• Common in males, in 2nd to 4th decades of life.• Slow growing and asymptomatic• Symptoms- obstruction of sinus ostium, nasal

obstruction, swelling of side of nose.• Sinus expand and produce swelling of cheek and hard

palate.• Orbit- proptosis

Radiographic features:

• Location: occasionally in maxillary sinus, but also develops in frontal and ethmoidal sinuses.

• Periphery and shape: usually lobulated or rounded, sharply defined margins

• Internal structure: homogeneous and extremely radiopaque

Squamous cell carcinoma:• Originates from metaplastic epithelium of sinus mucosal lining

C/F: • Facial pain or swelling• Nasal obstruction• Lesion in oral cavity• Male predliction, 60 years of age.• Medial wall 1st to be involved, obstruction , drainage, bleeding and pain.• Expansion of alveolar process, altered sensation of teeth , swelling of

palate, ill fitting dentures• Erode the sinus floor and penetrate in oral cavity.• Invasion of psterior wall- invade of muscle of mastication, painful

trismus, obstruction of eustachain tube, hyperesthesia.

Radiographic features: • Location: common in maxillary sinus but involvement of

frontal and sphenoid sinuses,• Internal structure:soft tissue radiopaque appearance.• Effect on surrounding structures: as lesion enlarges- destroy sinus wall, irregular radiolucent

areas in surrounding walls. Bone destruction around teeth, widening of pdl space. Medial wall thinned and destroyed Extends in nasal cavity.

Periostitis:

• Results of exudate from dental inflammatory lesion, diffuse through cortical boundary of antral floor.

• Presence of one or more halo like layers of new bone indicates inflammation of the periosteum.

Radigraphic features:• Although not visible• New bone takes form of one or more radiopaque lines.

Odontogenic tumor:

• More aggrssive growth pattern in maxilla.• Close proximity to vital structure in skull base.

Radiographic features:Periphery and shape: curved, oval, or multilocular

shape, defined by a thin cortical boarder . Internal structure: coarse or fine septae, region of

dystrophic calcifications.Effects on surrounding structures: displaces floor of

maxillary sinus, thinning of peripheral cortex.

Fibrous dysplasia:

• Arise adjacent to any paranasal sinuses• Causes displacement of sinus boarder , smaller sinus on

affected side.C/F: Facial asymmetry Nasal obstruction Proptosis Pituitary gland compression Impingement of cranial nerves Sinus obliteration Displacement of teeth and teeth roots Common in young adults Dysplastic bone growth ceases at age of skelatal maturity.

Radiographic features: Location: posterior maxilla common Periphery: ill defined, blend into surrounding bone. Internal structure:• increased radiopacity.• “ground-glass” appearance • “Orange-peel” appearance Effects on surounding structures: displaces antral

walls, elevating orbital floor, obstructing nasal fossa.

Dental structures displaced into sinuses:

• fracture tooth roots displaced into sinus during extraction.

C/F: Absence of root fragments on examining or

unable to locate them.Sinusitis

`

Radiographic features:Location: displaced in sinus, sometimes may

be submucosal.Periphery and shape: disruption of sinus wall Internal structure: fragments appears as

radiopaque mass Effectson surrounding structures: sinusitis may

result, break in floor of maxillary sinus.

THANK YOU