Maxillary Sinus Case Study

Maxillary sinus is the pneumatic space that is lodged inside the body of maxilla and that communicates with the environment by way of the the middle meatus and nasal vestibule.

Brief Anatomy:

-Base-lateral wall of nose .
-Apex: projects laterally into zygomatic process of maxilla .
-Roof: orbital floor.
-Floor: alveolar process of maxilla which supports premolars and molars.
-Posterior wall: infra-temporal and pterygopalatine fossa.
-Anterior wall: facial surface of maxilla.

Radiographic Examination
Radiograph is the most important supplementary investigation to clinical examination of the sinuses Intra-oral:
-Periapical - Occlusal -Lateral occlusal

Also associated with allergoc rhinitis, asthma, cystic fibrosis, and dental infections.
-Radiographic Features: Mucosa thickens – accumulation of fluids/secretions reducing the air content causing t to be radioopaque
a)The most common radiopaque patterns that occur in the Waters view are localized mucosal thickening along the sinus floor,
b) generalized thickening of the mucosal lining around the entire wall of sinus and near-complete or complete radiopacification of the sinus.

c) Scrutinizing the area around the maxillary ostium on any of the views from Waters projections to CT images may reveal the presence of thickened mucosal tissue, which may cause blockage of the ostium.
a) b) c)

Mucosal thickening in just the base of the sinus may not represent sinusitis.
Rather, it may represent the more localized thickening that can occur in association with rarefying osteitis from a tooth with a nonvital pulp. This may, however, progress to involve the entire sinus.The image of thickened sinus mucosa on the radiograph may be uniform or polypoid. In case of allergic reaction: mucosa tends to be more lobulated. In case of infection: thickened mucosal outline

If they continue to grow, the patient may have associated sinusitis, bloodstained nasal discharge, nasal obstruction, or facial pain.

-Radiographic Features:
Antroliths occur within the maxillary sinus and thus are positioned above the fl oor of the maxillary antrum in either periapical or panoramic radiographs
Antroliths have a well-defined periphery and may have a smooth or irregular shape.
The internal aspect may vary in density from a barely perceptible radiopacity to an extremely radiopaque structure.The internal density may be homogenous or heterogeneous, and in some instances alternating layers of radiolucency and radiopacity in the form of laminations may be seen.
a) b)

a)The alternating circular radiopaque and radiolucent pattern of an antrolith is seen on a panoramic image superimposed over the posterior wall of the right maxillary sinus.
b)The coronal multidirectional tomographic image confirms the location of the antrolith within the sinus and, furthermore, shows the antrolith not to be attached to the adjacent sinus