Maxillary sinusitis (sinusitis) is a disease caused by an inflammatory process in the mucous membrane of the maxillary sinus.
The spread of inflammation to the mucous membrane of the maxillary sinuses in most cases occurs from the nasal cavity through the natural anastomosis. However, the close topographic-anatomical relationship of the maxillary sinus with the teeth of the upper jaw is the cause of the development of odontogenic maxillary sinusitis.
The maxillary sinus (sinus maxillaries) is located in the body of the upper jaw and is the largest air cavity of the skull. It is formed as a result of the ingrowth of the mucous membrane of the middle nasal meatus into the spongy bone tissue of the upper jaw.
(after Racoveanu V. [et al.], 1964)
Stages of development of the maxillary sinus:
1 - in a newborn; 2 - at the age of 1 year; 3 - at 4 years old; 4 - at 7 years old; 5 - at 12 years old; 6 - in adults; 7 - in old people; 8 - average turbinate; 9 - nasal septum; 10 - inferior nasal concha
Simultaneously with the formation of the maxillary sinuses, the nerve trunks that innervate them grow in the tissue, a network of arterial, venous and lymphatic vessels, a complex mucoglandular and reticular apparatus is formed. According to A.G. Likhachev (1962), the volume of the sinus in an adult ranges from 3 to 30 cm 3, on average 10-12 cm 3. The inner, or nasal, wall of the maxillary sinus is the lateral wall of the nose and corresponds to most of the lower and middle nasal passages. The maxillary sinus opens into the nasal cavity through an opening located in the posterior part of the semilunar notch in the middle meatus under the middle turbinate. In approximately 10% of cases, in addition to the main hole, there is an additional one (hiatus accessorms maxillaries). The medial wall of the maxillary sinus, with the exception of its lower parts, is quite thin, which makes it easy to puncture it (in the middle third of the arch of the lower nasal passage under the inferior nasal concha), but often its thickness in this place is so significant that it is very difficult to puncture it. In the middle meatus, the bony wall becomes thinner or may be absent. In this case, the upper sections of the sinus are separated from the nasal cavity by a duplicate - a swarm of mucous membrane.
The upper, or orbital, wall of the maxillary sinus is the thinnest, especially in the posterior section, where bone clefts are often observed or even bone tissue is absent altogether. The canal of the infraorbital nerve passes through the thickness of the orbital wall, opening
An opening at the upper edge of the canine fossa of the anterior wall of the maxillary sinus (foramen infraorbitale). Sometimes the bony canal is absent, while the infraorbital nerve and accompanying blood vessels are directly adjacent to the sinus mucosa. This structure of the wall of the maxillary sinus increases the risk of intraorbital and intracranial complications in inflammatory diseases of this sinus (Onodi A., 1908).
The lower wall, or floor, of the maxillary sinus is located near the posterior part of the alveolar process of the upper jaw and usually corresponds to the sockets of the four posterior upper teeth, the roots of which are sometimes separated from the sinus only by soft tissue. Variants of the bays of the maxillary sinus that arise in ontogenesis in the process of resorption of the spongy bone of the body of the upper jaw during the formation of the sinus are shown in the figure.
(after Portmann G., 1966):
1 - palatine bay; 2 - orbital-ethmoidal bay; 3 - molar bay; 4 - maxillary sinus; 5 - alveolar bay
With the pneumatic type of the non-maxillary sinus, its bottom is low and can descend into the alveolar process and form an alveolar bay.
The low location of the bottom determines the location of the roots of the teeth and their sockets near or even inside the maxillary cavity. The sockets of the roots of the molars, especially the first and second, and sometimes the second premolar, protrude into the maxillary cavity with their relief, either separated from it by a thin layer of bone substance at the bottom of the socket, or directly adjacent to the mucous membrane lining the bottom. The sockets of the teeth protruding into the sinus have holes through which the periosteum of the root comes into contact with the mucous membrane of the sinuses. In this case, odontogenic infection in the corresponding teeth easily spreads to the mucous membrane of the maxillary sinus.
If the bottom of the maxillary sinus is low, it can be opened during tooth extraction.
Innervation of the maxillary sinuses is carried out complex system nerve endings represented by sensory, sympathetic and parasympathetic nerves. Sensitive innervation of the maxillary sinuses is carried out by the second branch (nervus maxillaries - maxillary nerve) trigeminal nerve(V pair of cranial nerves).
The maxillary nerve exits the cranial cavity through the foramen rotundum 4 into the pterygopalatine fossa.
(according to Krylova N.V., Nekrepko I.A., 1986):
A - pterygopalatine nerves; B - zygomatic nerve; 1 - trigeminal node; 2 - maxillary nerve; 3 - middle branch meninges; 4 - round hole; 5 - pterygopalatine node; 6 - greater petrosal nerve; 7 - parasympathetic fibers - secretory; 8 - inferior orbital fissure; 9,10 - zygomaticotemporal and zygomaticofacial branches of the zygomatic nerve; 11 - connecting branch; 12a, 12b, 12c - superior alveolar nerves; 13 - upper dental plexus; 14 - inferior orbital foramen; 15 - branches of the lower eyelid; 16 - external nasal branches - innervate the skin of the lateral surface of the nose; 17 - branches upper lip
Here the pterygopalatine nerves A depart, which enter the pterygopalatine ganglion 5. As part of these nerves, postganglionic parasympathetic fibers pass (dashed line), which join the maxillary nerve 2, then as part of the zygomatic nerve B and then the connecting branch 11 and unite with the frontal nerve and sympathetic fibers from the orbital plexus and provide secretory innervation to the lacrimal gland. The zygomatic nerve is divided into two branches: zygomaticotemporal 9 and zygomaticofacial 10. Both branches emerge from zygomatic bone through the holes of the same name 13 and innervate the skin of the lateral part of the forehead, temporal region, cheek, and lateral corner of the eye.
The lower orbital nerve (n. infraobritalis), like the zygomatic nerve, enters the orbital cavity through the lower orbital fissure 8, runs along its lower wall in the inferior orbital groove and canal (sulcus et canalis infraorbital), in which the superior alveolar nerves (nn. alveolares superiores) depart from the nerve. The infraorbital nerve exits to the skin of the face through the infraorbital foramen 14, which ends the infraorbital canal. Upon exiting the canal, the infraorbital nerve branches and innervates the skin lower eyelids(ramipalpebrales inferiores) 15, skin of the lateral surface of the nose (rami nasales externi) 16 and skin of the wings of the nose and upper lip, mucous membrane of the gums and upper lip (rami labiates superiores) 17.
The extensive reflexogenic zone of the maxillary sinus with its numerous arterial, venous and lymphatic plexuses, rich in glandular apparatus, is provided by parasympathetic and sympathetic innervation.
Parasympathetic innervation of the maxillary sinuses is carried out by the peripheral part of the parasympathetic nervous system; its fibers go as part of the greater petrosal nerve, which departs from the facial nerve and enters the pterygopalatine ganglion. This is a parasympathetic node that provides stimulation of the cholinoreactive structures of the maxillary sinuses, manifested by vasodilation, increased secretion of mucous glands, increased permeability of the vascular wall, which leads to tissue edema. These signs are characteristic of vasomotor-allergic sinusopathy.
Sympathetic innervation of the maxillary sinuses, stimulating the corresponding adrenergic structures, ensures their trophism.
It is carried out in two ways: 1) through the nerve plexuses surrounding the numerous vascular branches of the sphenopalatine and ethmoidal arteries (see below); 2) along the branch of the internal carotid plexus (plexus caroticus internus), constituting the deep petrosal nerve (n. petrosus profundus), which, together with the greater petrosal nerve 6, forms the nerve of the pterygoid canal (n. canalis pterygoidei), entering through the canal of the same name into the pterygopalatine hole.
Thus, the maxillary nerve innervates the dura mater (DRM), the skin of the cheek, lower eyelid, upper lip, lateral surface and wings of the nose; mucous membrane of the posterior parts of the nasal cavity, maxillary sinus, palate, upper lip and gums of the upper jaw; upper teeth. Through connections with the VII pair it provides proprioceptive innervation of facial muscles.
The blood supply to the maxillary sinuses provides a number of primary and secondary physiological processes in them. The first includes the supply of fabrics nutrients, oxygen, immunity factors, etc. The second includes those secondary functions of the blood supply that create certain conditions for optimizing the respiratory function, in which the maxillary sinuses participate (humidification, warming, regulation of air flow speed, removal of foreign particles from the sinuses by the ciliated epithelium) .
The main vessel supplying the tissues of the maxillary sinuses is the sphenopalatine artery (a. sphenopalatina) - a branch of the maxillary artery (a. maxillaris). It enters the nasal cavity through the pterygopalatine opening, accompanied by the vein and nerve of the same name. The main trunk of the pterygopalatine artery is divided into medial and lateral branches, which vascularize the maxillary sinuses. Speaking about the blood supply to the maxillary sinuses, it should be noted the presence of anastomoses between the external and internal systems carotid arteries, supplying blood to the orbits and the anterior cranial fossa.
The venous network of the maxillary sinuses is also associated with the anatomical formations mentioned above. The veins of the maxillary sinuses follow the course of the arteries of the same name, and also form a large number of plexuses connecting the veins of the maxillary sinuses with the veins of the orbits and face. The veins of the maxillary sinuses are also connected to the veins of the pterygoid plexus, the blood from which flows into the cavernous sinus and veins of the dura mater. All this plays an exceptional role in the occurrence and implementation of inflammatory processes in this area, the development of intraorbital and intracranial complications in particularly virulent and chronic infections of the maxillary sinuses. The lymphatic vessels of the maxillary sinuses, along with the veins, play an important physiological role in the processes of trophism, metabolism and immune defense those anatomical areas of which they are collectors. The lymphatic system of the maxillary sinuses consists of superficial and deep layers. The direction of the draining lymphatic vessels of the mucous membrane of the maxillary sinuses corresponds to the course of the main trunks and branches of the arteries feeding the mucous membrane.
(according to Denker A., Kaller O., 1912):
1 - nasofrontal; 2 - corner; 3 - anastomosis between the inferior orbital vein and the pterygoid plexus; 4 - front facial; 5 - chin; 6 general facial; 7 - internal jugular; 8 - back front; 9 - superficial temporal; 10 - pterygoid plexus; 11 - lower orbital; 12 - cavernous plexus; 13 - superior orbital
The commonality of innervation, arterial, venous and lymphatic vessels of the maxillary sinus and the alveolar process of the upper jaw and the sockets of the four posterior upper teeth located in it contributes to the transition of inflammation from odontogenic foci to the mucous membrane of the maxillary sinuses.
The transition of inflammation from odontogenic foci to the mucous membrane of the maxillary sinus can occur through the lymphatic tract without direct contact of its mucous membrane with the lesion by involving the nerve branches through the superior dental plexus, which is intimately connected with the mucous membrane of the sinuses. The richness of the arterial network of vessels of the upper jaw and the richness of anastomoses between individual branches also determine the possibility of the spread of odontogenic processes along the blood vessels.
The maxillary sinuses are lined with mucous membrane covered with multirow prismatic ciliated epithelium. The main morphofunctional units of the epithelium in the sinuses are ciliated, intercalary and goblet cells.
(according to Maran A., Lund V., 1979):
1 - ciliated cell; 2- basal cell; 3 - goblet cell; 4 - insertion cell; 5 - eyelashes; 6 - microforks; 7 - mitochondria; 8 - mucus granules; 9 - cell nucleus
Ciliated cells have on their surface 50-200 cilia, 5-8 in length, 0.15-0.3 microns in diameter (Richelman G., Lopatin A.S., 1994). Each cilium has its own motor device - an axoneme, which is a complex complex consisting of 9 pairs (doublets) of peripheral microtubules arranged in the form of a ring around two unpaired central microtubules. The movement of cilia is carried out thanks to the myosin-like protein they contain (Vinnikov Ya. L., 1979). The beating frequency of the cilia is 10-15 strokes per minute, the motor activity of the cilia of the ciliated epithelium ensures the movement of nasal secretions and particles of dust and microorganisms settled on it in the maxillary sinuses in the direction from their bottom towards the excretory anastomosis.
(according to Fred S., Herzon M., 1983):
1 - ciliary membrane;
2 - central pair of microtubules;
3 - peripheral pair of microtubules (doublet); 4, 5, 6 - subunits of the peripheral doublet
Modern ideas about the movement of cilia of the ciliated epithelium are based on the results of studies by A. M. Lucas and L. C. Douglas, published in 1934.
(after Lucas A. and Douglas L., 1934):
a - effective phase of cilia movement; b - phase of return movement; 1 - upper viscous layer of mucus; 2 - lower less viscous (periciliary) layer of mucus; 3 - microorganisms and foreign bodies
According to A.M. Lucas and L.C. Douglas (1934), each cycle of this movement resembles a rowing stroke and consists of two phases: effective and return. In the first phase, the cilia move like a straight, rigid rod, the upper end of which describes an arc of 180°, reaching the surface of the mucus layer covering it. In the second phase of movement, the cilia move like flexible threads, pressing their free ends to the surface of the cell.
Mutations that cause changes in the structure of cilia proteins lead to disruption of their function. Thus, with Kartagener syndrome, which is an autosomal recessive hereditary disease accompanied by a triad of symptoms: 1) bronchiectasis with chronic bronchopneumonia; 2) chronic polypous rhinosinusitis and 3) inversion of internal organs, immobility of the cilia of the ciliated epithelium of the entire respiratory tract occurs. The latter is caused by the absence of denenin arms (subunits of peripheral doublets) of the cilia axoneme (Bykova V.P., 1998). This lack of normal physiological locomotion of the ciliated epithelium leads to disruption of the drainage function of the maxillary sinus and causes its numerous diseases.
Under the influence of various unfavorable factors (aerosols, toxins, concentrated solutions of antibiotics, changes in pH in the acidic direction, a decrease in the temperature of inhaled air, as well as the presence of contact between the opposing surfaces of the ciliated epithelium), the movements of the cilia slow down and may stop completely.
Normally, ciliated cells are renewed every 4-8 weeks. (Herson F. S., 1983). When exposed to pathological factors, they quickly undergo degeneration.
The intercalary cells, located between the ciliated ones, have 200-400 microvilli on their surface, facing the lumen of the respiratory organ. Together with ciliated cells, intercalary cells carry out and regulate the production of periciliary fluid, determining the viscosity of the secretion of the mucous membrane of the maxillary sinus.
Goblet cells are modified columnar epithelial cells and are single-celled glands that produce viscous mucus (Baslanum S.V., 1986). Ciliated cells are related to goblet cells in a 5:1 ratio (Naumann N., 1996; Herzon F., 1983).
In the lamina propria of the mucous membrane there are glands that produce serous and mucous secretions. In the secretion covering the epithelium of the maxillary sinuses, two layers are distinguished: a less viscous periciliary layer, adjacent to the surface of the epithelial cells, and a more viscous upper layer, located at the level of the tips of the cilia (Reissing M. A., 1978; Kaliner M. A., 1988) .
Ciliated and mucous cells form the so-called mucociliary apparatus, the normal functioning of which ensures the capture, envelopment of mucus and movement of most particles with a diameter of up to 5-6 microns, including particles containing viruses, bacteria, aerosols, from the sinus cavity to the excretory opening. Dysfunction of the mucociliary apparatus is considered one of the important factors, facilitating the introduction of an infectious pathogen into the mucous membrane, giving rise to the development of maxillary sinusitis (Drettner B., 1984).
Nasal mucus healthy people has an alkaline reaction (pH 7.4 ± 0.3). It contains a number of nonspecific (lysozyme, complement, protease inhibitors) and specific (immunoglobulins) protective factors (Naumann N., 1978).
The maxillary sinuses open into the nasal cavity through openings known as the ostium. The openings of the maxillary sinuses are located on the lateral walls of the nasal cavity in the ethmoidal funnels of the middle nasal passage. The area in the nasal cavity where the maxillary sinus opens is called the ostio-meatal, or bone-canal complex.
The ostio-meatal complex is the region of the lateral wall of the nasal cavity where the uncinate process, the maxillary foramen, the middle turbinate, the ethmoidal vesicle and the ethmoidal infundibulum are located.
The uncinate process is a small and thin piece of bone with periosteum, covered with mucous membrane, which runs parallel and medial to the lateral wall of the nose in the anterior part of the middle meatus.
In front and below, the bone connects to the side wall of the nose. The rear upper edge ends freely without connecting to other structures. This posterior edge is concave and runs parallel to the anterior surface of the spherical protrusion of the ethmoid bone. The flat gap between the greater ethmoid vesicle and the uncinate process is known as the hiatus semilunaris. It is the entrance to a cavity connected medially with the uncinate process and laterally with the lateral wall of the nose. This three-dimensional cavity is known as the ethmoidal funnel (ethnzoid infimdibulurri). The maxillary sinus, as well as the frontal sinus and the anterior cells of the ethmoid sinus open into the ethmoidal funnel, and then into the semilunar fissure.
The complex is important because all sinuses are drained through its very narrow slits. When the mucous membrane thickens or with any congenital anomaly, there is a very high probability of congestion, stagnation and recurrent infection entering the maxillary sinus. Functional endoscopic surgery of the maxillary sinuses is based on the concept that this complex must be drained to restore normal drainage function of the sinuses.
Inflammatory diseases of the paranasal sinuses (sinusitis) are among the most frequent illnesses upper respiratory tract. According to the literature, patients with sinusitis make up about 1/3 of the total number of people hospitalized in ENT hospitals (Kozlov M. Ya., 1985; Soldatov I. B., 1990; Piskunov G. Z. [et al.], 1992; Arefieva N A., 1994). Most authors, in terms of the frequency of involvement in the inflammatory process, put the maxillary sinus (maxillary sinusitis) in first place. According to the course, acute and chronic sinusitis are distinguished. In the etiology of both acute and chronic sinusitis, infection penetrating the sinuses is of primary importance. The most common route is through the natural anastomosis that connects the sinus with the nasal cavity. For acute infectious diseases(typhoid fever, diphtheria, scarlet fever, measles) infection of the sinuses is possible by hematogenous route. In the etiology of maxillary sinusitis, purulent foci of the dental system, especially large and small molars adjacent to the lower wall of the sinus, also play a role. The most common cause of odontogenic maxillary sinusitis is foreign bodies penetrating into the sinus from the oral cavity, filling material, fragments of broken dental instruments, fallen tooth roots, and turundas. Granulomas at the root of the tooth, subperiosteal abscesses, and periodontal disease can also lead to the occurrence of odontogenic maxillary sinusitis (Ovchinnikov Yu. M., 1995).
Acute odontogenic maxillary sinusitis(sinusitis) is one of the most well-known diseases of the paranasal sinuses. With this sinusitis, patients are bothered by a headache localized in the area of the projections of the maxillary sinus. However, in many cases its distribution is noted in the forehead, zygomatic bone, and temple. It can radiate to the orbital region and to the upper teeth, that is, the pain practically covers the entire half of the face.
A very characteristic increase and sensation of a “tide” of heaviness in the corresponding half of the face when the head is tilted forward. Headache is associated with secondary trigeminal neuralgia and impaired sinus barofunction as a result of swelling of the mucous membrane and blockage of the anastomosis. There may be swelling of the cheek on the affected side.
Palpation in the area of the sinus projection increases pain. Severe swelling of the face and eyelids is more typical for complicated sinusitis. Patients note nasal congestion and mucous or purulent discharge, as well as a decreased sense of smell on the side of inflammation.
Anterior rhinoscopy allows you to establish hyperemia and swelling of the mucous membrane of the lower and especially the middle nasal concha. The presence of serous or purulent discharge (purulent track) in the middle nasal meatus is characteristic, which can also be determined by posterior rhinoscopy. In cases where the purulent path is not detected (with severe swelling of the mucous membrane overlying the anastomosis), it is also recommended to anemize the area of the middle nasal passage and turn the patient's head in the healthy direction. In this position, the outlet of the sinus is at the bottom, and pus (if any) will appear in the middle nasal meatus.
The diagnosis of acute odontogenic sinusitis is established on the basis of complaints, analysis of the described symptoms and the results of an X-ray examination. X-ray examination currently continues to be the leader among radiation and other non-invasive diagnostic methods. For X-ray examination of the maxillary sinuses, nasofrontal and nasomental placement are used, as well as an orthopantomogram and targeted photographs of the teeth. A more informative x-ray examination is linear tomography. Computed tomography (CT) and magnetic resonance imaging (MRI) are even more informative.
. Frontal (coronal) projection. The slice passes through the maxillary sinuses (1) and the cells of the ethmoidal labyrinth (2):
a - the anastomosis of the maxillary sinuses with the nasal cavity (arrow), the uncinate process (two arrows), forming the ostio-meatal complex, are clearly visible; b - in the left maxillary sinus and the left ethmoidal labyrinth there is an inflammatory process involving the structures of the ostio-meatal complex. Gaperostosis of the left maxillary sinus is noted, indicating chronic inflammation (arrow)
X-ray and CT examination methods produce a known radiation dose. Therefore, in cases where it is not desirable (for example, for persons who have received radiation damage), it is advisable to use methods that are not based on ionizing radiation. The most famous and simple method is diaphanoscopy. A diaphanoscope is a small-sized device that allows local illumination of the paranasal sinuses. In a dark room, the diaphanoscope illuminator is inserted into the patient’s mouth. Normally, the air-containing maxillary sinuses are well illuminated and appear as pink fields under the eye sockets. If there is pus or tumor in these sinuses, they are not visible. The results of the study during diaphanoscopy are indicative. In recent years, methods of ultrasonic dowsing, thermography and thermal imaging have been introduced into outpatient practice. These methods are distinguished by their safety and speed of obtaining results. However, their information content is inferior to X-ray, CT and MRI studies.
When examining the maxillary sinuses, puncture and trephine puncture are also used.
The most common manipulation is puncture of the maxillary sinus. The puncture is performed under epimucosal (application) anesthesia with a 2% dicaine solution or a 3-5% cocaine solution with the addition of a few drops of a 0.1% adrenaline solution. The sinus is punctured with a Kulikovsky needle, which is inserted under the inferior nasal concha, 2 cm from its anterior end at the point where the concha attaches to the lateral wall, where its thickness is the smallest. Possible complications (among them a needle getting into the eye socket) are described in the monograph by I. Ya. Temkin (1963). The puncture can be performed with a trocar, through which an endoscope can be inserted to view the sinus.
For acute sinusitis characterized by homogeneous darkening of the sinuses involved in the inflammatory. If the photograph is taken in vertical position subject, then if there is exudate in the sinus, it is possible to observe the fluid level. Treatment of uncomplicated acute odontogenic maxillary sinusitis is usually conservative. It can be performed on an outpatient basis and in inpatient conditions. Polysinusitis, as well as maxillary odontogenic sinusitis, accompanied by severe headache, swelling of the soft tissues of the face and the threat of developing orbital and intracranial complications, should be treated in a hospital. Treatment of acute odontogenic sinusitis, as well as other focal infections, consists of a combination of general and local methods. The local treatment of acute sinusitis is based on the well-known principle “ubi pus bi evacuo” (if there is pus, remove it).
All therapeutic measures, underlying this principle, are aimed at treating teeth adjacent to the lower wall of the maxillary sinuses and improving the outflow of purulent secretions from the sinuses. The first and simplest of them is anemization of the nasal mucosa, which can be accomplished using official vasoconstrictors (naphthyzin, sanorin, galazolin). It is more effective for a doctor to specifically coat the mucous membrane in the area of the middle nasal passage with a 3-5% solution of cocaine or an anesthetic - a 2% solution of dicaine with 3-4 drops of a 0.1% solution of adrenaline per 1 ml of the drug. Anemization of the mucous membrane and a decrease in its volume contribute to the expansion of sinus anastomosis and facilitate the outflow of exudate. This is also facilitated thermal procedures(Solux, diathermy, UHF). However, they should be prescribed provided there is good outflow from the sinuses. The compress has not lost its meaning either. Correctly applied to the corresponding half of the face, the compress improves microcirculation in the area inflammatory process, reduces swelling of the soft tissues of the face and nasal mucosa, restoring the patency of the anastomosis and drainage of the sinuses. UHF is poorly tolerated by patients with vascular disorders, including vegetative-vascular dystonia.
The range of physiotherapy treatments has expanded in recent years. New devices for microwave therapy have appeared (for example, “Luch-2”), which make it possible not only to increase tissue heating, but also to localize precisely dosed energy to a limited area, which reduces the risk of unwanted side effects. These requirements are also met by new methods such as laser therapy, magnetic and magnetic laser therapy.
Puncture of the maxillary sinuses, despite the known dangers (Temkina I. Ya., 1963), continues to be one of the most common methods conservative treatment and is used in both inpatient and outpatient practice.
If repeated punctures of the maxillary sinuses are necessary, permanent drainages are used, which are thin polyethylene or fluoroplastic tubes that are inserted into the sinus for the entire period of treatment, relieving the patient of unpleasant manipulations.
Through the inserted drainage tube, the sinus is systematically washed with an isotonic or furatsilin solution (1: 5000) and other medications(usually antibiotics).
The introduction of medicinal solutions into the maxillary sinuses is possible using the “movement” method according to Proetz. With this method, a vacuum is created in the nasal cavity using surgical suction. It allows you to remove pathological contents from the sinuses, and after infusing medicinal solutions into the nasal cavity, the latter rush into the opened sinuses.
More successful non-puncture treatment inflammatory diseases paranasal sinuses, especially with polysinusitis, is carried out using the YamiK sinucateter (Markov G.I., Kozlov V.S., 1990; Kozlov V.S., 1997). This device allows you to create controlled pressure in the nasal cavity and paranasal sinuses and thereby evacuate pathological exudate from the sinuses, followed by the introduction of medicinal solutions into them through the opened anastomosis.
As general treatment patients with acute odontogenic maxillary sinusitis are prescribed analgesics, antipyretics, antihistamines and antibacterial drugs. Currently, due to the known adverse side effects of antibiotics (dysbacteriosis, development of fungal flora, allergization, inhibition of antibody production), there is a tendency to narrow the indications for their use. However, if necessary, penicillin 500,000 units 4-6 times a day, as well as other antibiotics with a wider spectrum of action (zeporin, keflin, kefzol, etc.) can be prescribed. The prescription of antibiotics should be adjusted in accordance with the sensitivity of the microflora obtained from the site of inflammation. Sulfonamide drugs (sulfadimethoxine, sulfalene, biseptol, etc.) are prescribed both independently and in combination with antibiotics. Considering the likelihood of anaerobic flora, usually in acute sinusitis with severe clinical form It is recommended to strengthen antibacterial therapy with drugs that have an etiotropic effect on anaerobic infection (Trichopol, Metragil).
With odontogenic maxillary sinusitis, when it is necessary to remove the “causal” teeth (complicated caries, periodontitis), an unwanted opening of the maxillary sinus is possible. The resulting canal connecting the sinus to the oral cavity (oroantral fistula) can close on its own or after repeated lubrication with iodine tincture. Otherwise, they resort to plastic closure of the fistula by moving a flap cut from soft gum tissue, which is a difficult operation, most successfully performed by maxillofacial surgeons.
IN Lately To close fresh oroantral communications, implantation materials are used (collagen films with methyluracil and hydroxyapatite-honsuride compositions), which significantly reduces the time and increases the effectiveness of its treatment (Rozhdestvenskaya E. D., 1998). R. G. Anyutin (1999) for this purpose uses other composite materials created on the basis of hydroxyapatite - hydroxyapol and kolapol.
Chronic odontogenic maxillary sinusitis usually arise as a result of repeated and insufficiently cured acute sinusitis. Of significant importance in their development is a combination of unfavorable factors of a general and local nature - such as a decrease in the body's reactivity, impaired drainage and aeration of the sinuses, caused by anatomical abnormalities and pathological processes in the nasal cavity, as well as dental diseases.
The variety of pathomorphological changes in chronic sinusitis, representing various variants of exudative, proliferative and alternative processes, determines the diversity of clinical and morphological forms and the difficulties of their classification.
At present, the classification of chronic sinusitis proposed by B. S. Preobrazhensky (1956) continues to be the most acceptable. According to this classification, there are exudative (catarrhal, serous, purulent) and productive (parietal hyperplastic, polypous) forms of sinusitis, as well as cholesteatoma, necrotic (alterative), atrophic and allergic sinusitis.
In exudative forms, a picture of diffuse inflammatory infiltration with lymphocytes, neutrophils and plasma cells is observed. It is more pronounced in purulent than in catarrhal and serous forms. In these cases, the epithelium is flattened and metaplastic in places. Edema is observed in areas of greatest inflammation.
In hyperplastic forms, the thickening of the mucous membrane is more pronounced than in previous forms. Pathomorphological changes are predominantly proliferative in nature due to the proliferation of connective tissue elements of the own layer of the mucous membrane. The formation of granulation tissue and polyps is noted. The development of connective tissue in some areas can be combined with sclerosis and hardening of the mucous membrane in other places (Voyachek V.I., 1953). The inflammatory process spreads to all its layers, in some cases including the periosteal layer. This leads to periostitis, and if the process develops unfavorably, to osteomyelitis. Due to the development of sclerosis of the mucous membrane and the delay of resorptive processes in bone disease, the formation of pseudocholesteatoma, which is thickened mucus without cholesterol inclusions and with a large number of leukocytes, as well as colonies of putrefactive microbes, is possible. The accumulation of pseudocholesteatoma and caseous masses and the pressure they exert on the walls of the maxillary sinuses lead to resorption bone tissue and the formation of fistulas (Khilov K.L., 1960). It has now been established that such forms of sinusitis can also develop as a result of fungal infections of the sinuses (L. B. Dainyak, N. Ya. Kunelskaya, 1979; A. S. Lopatin, 1995). A special place is occupied by allergic forms of sinusitis, which are combined with similar processes in the nasal cavity and are called allergic rhinosinusitis (rhinosinusopathies). This form is characterized by the appearance of round-shaped formations in the maxillary sinuses. They represent local swelling of the mucous membrane and are often incorrectly called cysts. In these cases, during puncture of the maxillary sinus, the needle pierces this cyst-like formation and serous fluid is poured into the syringe amber color, and the walls of the bubble collapse.
The fundamental difference between such a pseudocyst and a true cyst of odontogenic origin is that it has only an outer epithelial lining formed by the sinus mucosa. The pseudocyst cavity is formed as a result of the splitting of the own layer of the mucous membrane by the transudate accumulating in its thickness. A true cyst of odontogenic origin also has an internal epithelial membrane emanating from the periodontium.
:
1 - internal epithelial membrane emanating from the periodontium; 2 - mucous membrane lining the sinus
The size of the pseudocyst (allergic swelling of the mucous membrane) can change under the influence of hyposensitizing therapy and the administration of glucocorticoids.
On radiographs, in cases of odontogenic cysts, a thin, partially resorbed bone layer may be seen contouring the cyst. It is formed as a result of displacement of the lower wall of the maxillary sinus by a developing cyst.
Clinical symptoms in chronic odontogenic maxillary sinusitis outside the acute stage are less pronounced than in acute ones. Some patients may experience decreased ability to work. The nature of the symptoms and their severity largely depend on the form of sinusitis, the localization of the process and its prevalence. Headache with chronic sinusitis is less severe and may be of an uncertain nature. However, in some cases, patients precisely localize the pain in the area of the affected sinus. Nasal congestion is usually moderate, more pronounced in polypous allergic and fungal forms of sinusitis, which is associated with similar lesions of the nasal mucosa. Patients often note a disturbance in their sense of smell.
The nature of nasal discharge also depends on the form of sinusitis. With fungal infections, they have certain characteristic differences. Thus, with mold mycoses, the discharge is usually viscous, sometimes jelly-like, and has a whitish-gray or yellowish color. With aspergillosis, discharge gray, blackish inclusions are possible, which can be thick, resembling cholesteatoma masses. With candidiasis, the discharge is similar to a cheesy, whitish mass.
With fungal sinusitis, there are often neurological pain in the area of the affected sinus. More often than with other forms of sinusitis, swelling of the soft tissues of the face is observed, usually in the area of the maxillary sinus (Dainyak L. B., Kunelskaya V. Ya., 1979).
With exacerbation of chronic odontogenic maxillary sinusitis, the clinical picture resembles an acute process of sinus damage and often depends on the presence or absence of complications. It is necessary to pay attention to the ability of chronic sinusitis to occur in a mild latent form, when the clinical symptoms are not clear enough. This state indicates the presence of a certain balance in development pathological process- balance between the body and the disease. Causing overstrain and exhaustion of immune mechanisms, it usually leads to the development of certain, often very serious, complications. It was precisely this feature of latent sinusitis that A.I. Feldman (1929) pointed out, giving them not only an impeccable definition, but also emphasizing their hidden danger. “Latent sinusitis,” according to the author, are those that pass secretly, unnoticed by the patient and even the doctor; their physical symptoms are almost absent, and only some complication from neighboring organs forces both the patient and the doctor to pay attention to the nose. It is interesting to note that back in 1857, Professor of the Medical-Surgical Academy Zablotsky-Desyatovsky, in his work “On diseases of the nose and nasal cavities,” noted that their chronic diseases are often asymptomatic or have few symptoms.
The diagnosis of chronic odontogenic maxillary sinusitis is established on the basis of clinical and radiological data. X-ray, as well as CT and MRI studies are the most important diagnostic methods for identifying various forms of chronic sinusitis. They are supplemented by punctures of the sinuses and laboratory research received content.
It should be noted that carrying out the described diagnostic procedures requires the doctor to have good orientation in the deep parts of the nose and high technique of manipulation.
The treatment tactics for chronic odontogenic maxillary sinusitis is determined by the clinical form of the disease. During exacerbation of chronic sinusitis, its exudative forms (catarrhal, serous, purulent) are treated, as a rule, conservatively. In this case, the same means and treatment methods are used that are used in the treatment of acute sinusitis. Productive forms of chronic odontogenic maxillary sinusitis (polypous, polypous-purulent) are treated surgically. Regardless of the form of chronic sinusitis in the presence of visual and intracranial complications, the main method should be surgical treatment.
At polypous sinusitis, combined with nasal polyposis, preliminary nasal polypotomy is indicated.
The main goal of surgical treatment for chronic odontogenic maxillary sinusitis is to remove the affected teeth and create conditions for recovery normal function affected maxillary sinus. To do this, regardless of the surgical approach, the damaged sinus anastomosis with the nasal cavity is created anew or restored, ensuring its free drainage and ventilation. Thus, we are talking about restoring the impaired function of the ostio-meatal complex.
Modern ideas about the functional significance of the mucous membrane (the transport function of the ciliated epithelium) determine the maximum sparing of tissues. In this regard, some authors (Proetz, 1953) compare curettage of the sinus mucosa during surgery for chronic sinusitis with removal of the bronchial mucosa during bronchitis. Other authors adhere to a similar position (Voyachek V.I., 1953; Khilov K.L., 1960; Piskunov S.Z., Piskunov G.Z., 1991).
There are a significant number of different options and modifications of surgical interventions on the maxillary sinuses, proposed for the treatment of sinusitis. All of them, depending on the approach, are divided into extranasal and endonasal.
The nature of anesthesia during sinus surgery depends on the age of the patient, his general condition, presence of concomitant diseases, complications and extent of surgical intervention. Anesthesia can be local (a combination of epimucosal, infiltrative and conductive) and general.
Extranasal operations - operations on the maxillary sinus. The most common in clinical practice are Caldwell-Luc, A.I. Ivanov and Denker operations, which are performed through the vestibule of the mouth.
Caldwell-Luke operation. After retracting the upper lip with blunt hooks, an incision is made in the mucous membrane and periosteum along the transitional fold, starting from the second incisor (at a distance of 3-4 mm from the frenulum) and ending at the level of the second large molar.
:
a - incision of the mucous membrane along the anterior wall of the sinus; b - expansion of the burr hole; c - overlap of the sinus anastomosis with the lower nasal meatus
The mucous membrane and periosteum are separated upward until fossa canina is exposed. Using a Voyachek grooved chisel or a grooved chisel, a small hole is made in the thinnest part of the anterior wall of the sinus, allowing a preliminary examination of the sinus with a button probe. After orientation, it is expanded using Gaek's forceps or wider Vojacek's chisels to the size necessary for a detailed revision of the sinus and subsequent manipulations. Pathological contents are removed (purulent and necrotic masses, granulations and polyps), as well as the mucous membrane in a limited area of the medial wall of the sinus, where the anastomosis is supposed to overlap with the nasal cavity. Most of the slightly changed sinus mucosa is preserved. Using a chisel or chisel, part of the bone wall between the sinus and the nasal cavity is removed. An elliptical hole is formed. Its upper edge should not be higher than the attachment of the inferior turbinate. The lower edge of the hole is smoothed with a sharp spoon so that there is no threshold between the bottom of the nose and the bottom of the sinus. A curved button-shaped probe is inserted into the lower nasal passage, with which the mucous membrane of the lateral wall of the nose protrudes into the maxillary sinus. Using a sharp eye scalpel, a U-shaped flap is cut out from the side of the sinus, which is placed on the lower edge of the formed anastomosis. However, in most cases, if the mucous membrane in the sinus is preserved, there is no need for a U-shaped flap and it is removed. To prevent postoperative bleeding, the sinus cavity is loosely tamponed with a long tampon soaked in an antiseptic with vaseline oil. The end of the tampon is brought out through the formed anastomosis and fixed with a cotton “anchor” along with loop tampons of the corresponding half of the nose. The wound is sutured with catgut sutures. Tampons are removed after 2 days.
Operations on the maxillary sinus according to A.F. Ivanov and Denker are variants of operations according to Caldwell-Luc. A.F. Ivanov suggests making a hole on the anterior wall of the sinus somewhat laterally, and Denker, on the contrary, more medially. In this case, part of the wall of the pyriform opening is removed. The Denker operation is performed in cases where a broader approach is needed not only to the maxillary sinus, but also to the deeper parts of the nasal cavity and nasopharynx.
It should be noted that most maxillofacial surgeons, when surgically treating odontogenic maxillary sinusitis, especially in the presence of persistent oroantral communication, operate using traditional methods radical maxillotomy and communication plastic surgery.
However, an analysis of the study of complaints from patients in the long term after surgery shows that most often patients complain of nasal discharge on the side of the operation, a feeling of heaviness and discomfort in the area of the operated upper jaw, disturbances in the sensitivity of the skin and mucous membrane of the upper lip on the corresponding side, on numbness of the mucous membrane of the gums and a feeling of numbness in the teeth of the upper jaw (Tsvigailo D. A., 2001). In this case, an important role is played by postoperative cicatricial changes in the lining mucous membrane of the maxillary sinus, as a result of which zones of stagnation are formed that prevent the advancement of secretion in the sinus, normally directed to the natural anastomosis due to the oscillatory movements of the villi of the ciliated epithelium. All this creates favorable conditions for the development of a chronic inflammatory process in the operated sinus. In such a situation, swelling of the nasal mucosa, which occurs during colds, is the trigger for the exacerbation of chronic odontogenic maxillary sinusitis.
Therefore at present surgery Chronic odontogenic maxillary sinusitis with the presence of persistent oroantral communication in specialized clinics is carried out using a gentle endoscopic maxillotomy technique with simultaneous plastic surgery of the oroantral communication.
Endonasal operations of the paranasal sinuses were developed almost simultaneously with extranasal ones. However, only with the advent of modern endoscopes with fiber optics and long-focus operating microscopes, endonasal operations began to be introduced into clinical practice.
Modern endonasal sinusotomies are based on surgical techniques developed at the beginning of the 20th century. Galle, O. Girsch, A.F. Ivanov, F.S. Bokshtein, etc. It is appropriate to add that endonasal operations are the real embodiment of V.I. Voyachek’s sparing principle in otorhinolaryngology, which he promoted throughout his long clinical career.
Here is a description of modern endonasal polysinsotomy. The operation begins with a preliminary examination of the nasal cavity using an endoscope (with 0° optics). A detailed average rhinoscopy is performed with the identification of all anatomical formations and identification points. Then the middle turbinate is pushed medially with a rasp. The uncinate process is identified by inserting the tip of a button probe behind it. Posterior to the process is the anterior wall of the ethmoid bulla. These formations form the semilunar fissure. Using a sickle-shaped knife, the uncinate process is cut off from top to bottom and removed with nasal forceps. The same forceps are used to perforate the anterior wall of the ethmoidal bulla, and the instrument penetrates into its cavity. By removing the bone bridges, all the cells of the ethmoidal labyrinth are sequentially opened. Its roof, which is the base of the skull, is exposed. The bone in this area tends to have a whiter hue. It should be remembered that too medial manipulation of the skull base may cause damage to the cribriform plate and lead to penetration of the instrument into the anterior cranial fossa. On the other hand, too lateral direction of the instrument can lead to damage to the paper plate and the contents of the orbit; to expand the anastomosis of the maxillary sinus, after preliminary removal of the uncinate process, it is preferable to use an endoscope with 30° optics. It is placed in the middle nasal meatus. Using a button probe, the natural anastomosis of the maxillary sinus is identified. Using anthrotomy nippers, the so-called reverse nipper or a sharp spoon (curette), the anastomosis is widened.
:
a - nasal forceps-nippers (reverse pliers) for antrotomy (opening the maxillary sinus); b - spoon type Siebermann - Yu. B. Preobrazhensky; c - a spoon with sharp edges (the so-called catfish), proposed at the Department of Otolaryngology of the Academy
It should extend posteriorly from the upper edge of the inferior turbinate and anteriorly to the level of the lacrimal tubercle, having a diameter of 5-7 mm. It should be taken into account that expansion of the anastomosis anteriorly beyond the level of the lacrimal tubercle is fraught with damage to the lacrimal ducts, and posteriorly to the level of the posterior end of the middle turbinate is dangerous with damage to a. sphenopalatina. Excessive upward expansion of the anastomosis can lead to orbital injury.
"Diseases, injuries and tumors of the maxillofacial region"
edited by A.K. Iordanishvili
The facial part of the skull contains several hollow formations - the nasal sinuses (paranasal sinuses). They are paired air cavities and are located near the nose. The largest of them are the maxillary or maxillary sinuses.
Anatomy
A pair of maxillary sinuses is located, as the name implies, in the upper jaw, namely in the space between the lower edge of the orbit and a row of teeth in the upper jaw. The volume of each of these cavities is approximately 10–17 cm3. They may not be the same size.
The maxillary sinuses appear in a child even during intrauterine development(at about the tenth week of embryonic life), but their formation continues until adolescence.
Each maxillary sinus has several walls:
- Front.
- Rear.
- Upper.
- Lower.
- Medial.
However, this structure is typical only for adults. In newborn babies, the maxillary sinuses look like small diverticula (protrusions) of the mucous membranes into the thickness of the upper jaw.
Only by the age of six do these sinuses acquire the usual pyramidal shape, but differ in their small size.
Sinus walls
The walls of the maxillary sinus are covered with a thin layer of mucous membrane - no more than 0.1 mm, which consists of columnar cells of the ciliated epithelium. Each cell has many microscopic motile cilia, and they continuously vibrate in a certain direction. This feature of the ciliated epithelium contributes to the effective removal of mucus and dust particles. These elements inside the maxillary sinuses move in a circle, heading upward - to the region of the medial corner of the cavity, where the anastomosis connecting it with the middle nasal meatus is located.
The walls of the maxillary sinus differ in their structure and features. In particular:
- Doctors consider the medial wall to be the most important component; it is also called the nasal wall. It is located in the projection of the lower as well as the middle nasal passage. Its basis is a bone plate, which gradually thins as it extends and becomes a double mucous membrane towards the area of the middle nasal meatus.
After this tissue reaches the anterior zone of the middle nasal passage, it forms a funnel, the bottom of which is the anastomosis (opening), forming a connection between the sinus and the nasal cavity itself. Its average length is from three to fifteen millimeters, and its width is no more than six millimeters. The upper localization of the anastomosis somewhat complicates the outflow of contents from the maxillary sinuses. This explains the difficulties in treating inflammatory lesions of these sinuses. - The anterior or facial wall extends from the lower edge of the orbit to the alveolar process, which is localized in the upper jaw. This structural unit has the highest density in the maxillary sinus; it is covered soft fabrics cheeks, so you can easily feel it. On the anterior surface of such a septum, a small flat depression in the bone is localized; it is called the canine or canine fossa and is a place in the anterior wall with minimal thickness. The average depth of such a recess is seven millimeters. In certain cases, the canine fossa is particularly pronounced and therefore closely adjacent to the medial wall of the sinus, which can complicate diagnostic and therapeutic manipulations. Near the upper edge of the recess, the infraorbital foramen is located, through which the infraorbital nerve passes.
- The thinnest wall in the maxillary sinus is the superior, or orbital, wall. It is in its thickness that the lumen of the infraorbital nerve tube is localized, which sometimes is directly adjacent to the mucous membranes covering the surface of this wall. This fact must be taken into account during curettage of mucous tissues during surgical interventions. The posterosuperior sections of this sinus touch the ethmoidal labyrinth, as well as the sphenoid sinus. Therefore, doctors can use them as an access to these sinuses. In the medial section there is a venous plexus, which is closely connected with the structures of the visual apparatus, which increases the risk of infectious processes transferring to them.
- The posterior wall of the maxillary sinus is thick, consists of bone tissue and is located in the projection of the tubercle of the upper jaw. Its posterior surface is turned into the pterygopalatine fossa, and there, in turn, the maxillary nerve with the maxillary artery, pterygopalatine ganglion and pterygopalatine venous plexus is localized.
- The bottom of the maxillary sinus is its lower wall, which in its structure is an anatomical part of the upper jaw. It has a fairly small thickness, so punctures or surgical interventions are often performed through it. With the average size of the maxillary sinuses, their bottom is localized approximately level with the bottom of the nasal cavity, but can drop lower. In some cases, the roots of the teeth emerge through the lower wall - this is anatomical feature(not pathology), which increases the risk of developing odontogenic sinusitis.
The maxillary sinuses are the largest sinuses. They border many important parts of the body, so the inflammatory process in them can be very dangerous.
The largest paranasal sinus is the maxillary sinus or, as it is also called, the maxillary sinus. It received its name due to its special location: this cavity fills almost the entire body of the upper jaw. The shape and volume of the maxillary sinuses vary depending on age and individual characteristics person.
Structure of the maxillary sinus
The maxillary sinuses appear earlier than the other paranasal cavities. In newborn babies they are small pits. The maxillary sinuses develop fully by the time of puberty. However, they reach their maximum size in old age, since bone tissue is sometimes reabsorbed at this time.
The maxillary sinuses communicate with the nasal cavity through the anastomosis– a narrow connecting channel. In their normal state they are filled with air, i.e. pneumatized.
From the inside, these recesses are lined with a rather thin mucous membrane, which is extremely poor in nerve endings and blood vessels. That is why diseases of the maxillary cavities are often long time are asymptomatic.
There are upper, lower, internal, anterior and posterior walls of the maxillary sinus. Each of them has its own characteristics, knowledge of which allows us to understand how and why the inflammatory process occurs. This means that the patient has the opportunity to promptly suspect problems in the paranasal sinuses and other organs located close to them, and also to properly prevent the disease.
Top and bottom walls
The upper wall of the maxillary sinus has a thickness of 0.7-1.2 mm. It borders on the orbit, so the inflammatory process in the maxillary cavity often negatively affects vision and the eyes in general. Moreover, the consequences may be unpredictable.
The bottom wall is quite thin. Sometimes in some areas of the bone it is completely absent, and the vessels and nerve endings passing here are separated from the mucous membrane of the paranasal sinus only by the periosteum. Such conditions contribute to the development of odontogenic sinusitis - an inflammatory process that occurs due to damage to teeth, the roots of which are adjacent to the maxillary cavity or penetrate into it.
Inner wall
The inner, or medial, wall borders the middle and lower nasal passages. In the first case, the adjacent zone is continuous, but quite thin. It is quite easy to puncture the maxillary sinus through it.
The wall adjacent to the lower nasal meatus has a membranous structure over a considerable length. At the same time, there is an opening through which communication occurs between the maxillary sinus and the nasal cavity.
When it becomes clogged, an inflammatory process begins to form. That's why even common runny nose must be treated promptly.
Both the right and left maxillary sinus can have an anastomosis up to 1 cm long. Due to its location in the upper section and relative narrowness, sinusitis sometimes becomes chronic. After all, the outflow of the contents of the cavities is significantly difficult.
Front and back walls
The anterior, or facial, wall of the maxillary sinus is considered the thickest. It is covered by the soft tissues of the cheek and is accessible for palpation. In the center of the front wall there is a special depression - the canine fossa, which is used to guide the opening of the mandibular cavity.
This depression can be of varying depths. Moreover, in the case when she has quite big sizes, when puncturing the maxillary sinus from the lower nasal passage, the needle can even penetrate the eye socket or the soft tissue of the cheek. This often leads to purulent complications, so it is important that such a procedure is carried out by an experienced specialist.
The posterior wall of the maxillary cavity corresponds to the maxillary tubercle. Its dorsal surface faces the pterygopalatine fossa, where a specific venous plexus is located. Therefore, when the paranasal sinuses are inflamed, there is a risk of blood poisoning.
Functions of the maxillary sinus
The maxillary sinuses serve several purposes. The main functions among them are the following:
- formation of nasal breathing. Before air enters the body, it is purified, moistened and warmed. It is these tasks that are carried out by the paranasal sinuses;
- the formation of resonance when creating a voice. Thanks to the paranasal cavities, an individual timbre and sonority are developed;
- development of sense of smell.The special surface of the maxillary sinuses is involved in the recognition of odors..
Besides, ciliated epithelium maxillary cavities performs a cleansing function. This becomes possible due to the presence of specific cilia moving in the direction of the anastomosis.
Diseases of the maxillary sinuses
The private name for inflammation of the maxillary sinuses is sinusitis. The term that summarizes the damage to the paranasal cavities is sinusitis. It is usually used until a definitive diagnosis is made. This formulation indicates the localization of the inflammatory process - the paranasal sinuses or, in other words, the sinuses.
Depending on the concentration of the disease, several types of sinusitis are distinguished:
- right-sided, when only the right maxillary sinus is affected;
- left-sided, if the inflammation occurs in the left paranasal cavity;
- bilateral. This implies infection of both areas.
Under certain circumstances, inflammation is even visible in the photo: The maxillary sinus, in case of damage, has pronounced swelling. This symptom requires an immediate visit to a qualified doctor and taking the measures recommended by a specialist. Although, even in the absence of visual signs, it is necessary to promptly treat sinusitis. Otherwise, there is a risk of complications.
The maxillary sinus is the largest of all the paranasal sinuses. It is commonly called the maxillary sinus. The first name is associated with its location - it occupies almost the entire space above the upper jaw.
At birth, the baby's maxillary cavities are in their infancy - they are only two small pits. Gradually, as the child grows, they increase in size and form. A full-fledged state is reached during puberty.
The changes in them do not end there, and by old age they reach their maximum size due to the resorption of bone tissue. Both sinuses are not always the same size, asymmetry is very common, because the dimensions directly depend on the thickness of their walls.
Important. There are anomalous cases (approximately 5% of the total population of the planet) when the maxillary sinuses may be completely absent.
The anatomy of the maxillary sinus is as follows:
The structure of the maxillary sinus includes several bays:
- alveolar The bay of the maxillary sinus is formed due to the filling of the spongy tissue of the alveolar process with air. It provides a connection between the maxillary cavity and the dental roots;
- infraorbital The bay appears due to the protrusion of the bottom of the infraorbital canal into the cavity. This bay connects the maxillary cavity with the orbit;
- spheroidal the bay is located closest to the cavity;
- prelacrimal the bay from behind covers the lacrimal sac.
You can see the photo of the maxillary sinus.
Functions
External Features:
- cleaning, warming and humidifying the air entering the nose when inhaling.
- formation of an individual timbre and sound of the voice due to the formation of resonance.
- maxillaries have special surfaces that are involved in the recognition of odors.
- the structural function is to give a certain shape to the frontal bone.
Domestic Features:
- ventilation
- drainage
- protective: eyelashes epithelial tissue promote the removal of mucus.
The maxillary sinus is located in the human skull in the area of the upper jaw (on both sides of the nose). From an anatomical point of view, it is considered the largest appendage of the nasal cavity. The average volume of the maxillary sinus of an adult can be 10-13 cm³.
Anatomy of the maxillary sinuses
The sizes and shapes of the maxillary sinuses tend to change depending on the age of the person. Most often, their shape may resemble something like a four-sided irregular pyramid. The boundaries of these pyramids are determined by four walls:
- upper (ocular);
- anterior (facial);
- back;
- internal.
At its base, the pyramid has a so-called bottom (or bottom wall). There are often cases when its outlines have an asymmetrical shape. Their volume depends on the thickness of the walls of these cavities. If the maxillary sinus has thick walls, then its volume will be significantly less. In the case of thin walls, the volume will be larger accordingly.
At normal conditions The formation of the maxillary sinuses communicates with the nasal cavity. This, in turn, is of no small importance for the formation of the sense of smell. A special section of the maxillary sinuses takes part in determining smell, performs the respiratory functions of the nose, and even has a resonating effect during the stages of human voice formation. Due to the cavities located near the nose, a unique sound and timbre are formed for each person.
The inner wall of the maxillary sinuses, closest to the nose, has an opening connecting the sinus and the middle meatus. Each person has four pairs of sinuses: ethmoid, frontal, maxillary and sphenoid.
The bottom of the maxillary cavities is formed by the alveolar process, which separates it from the oral cavity. The lower wall of the sinuses is located in close proximity to the molars. This often leads to the fact that the teeth can reach the bottom of the sinuses with their roots and become covered with mucous membrane. It is based on a small number of vessels, goblet-shaped cells and nerve endings. This leads to the fact that inflammatory processes and sinusitis can exist a long period without serious symptoms.
Walls of the maxillary cavities
The eye (upper) wall is thinner compared to other walls. The thinnest section of this wall is located in the area of the posterior compartment.
In the case of sinusitis (an inflammatory process accompanied by filling of the maxillary cavities with mucus and pus), the affected areas will be in direct proximity to the eye socket area, which is very dangerous. This is due to the fact that in the wall of the orbit itself there is a canal with the infraorbital nerve. Very often there are cases when this nerve and important vessels located at a close distance from the mucous membranes of the maxillary sinuses.
The nasal (inner) wall is of particular importance (based on many clinical studies). This is due to the position that it has in accordance with the main part of the middle and lower nasal passages. Its peculiarity is that it is quite thin. The exception is Bottom part walls. In this case, gradual thinning occurs from the bottom to the top of the wall. Near the very bottom of the eye sockets there is an opening through which the nasal cavity communicates with the maxillary sinuses. This often leads to the inflammatory secretion stagnating in them. In the area of the posterior part of the nasal wall there are lattice-shaped cells, and the place of the nasolacrimal duct is located near the anterior parts of the nasal wall.
The bottom area in these cavities is located close to the alveolar process. The lower wall of the maxillary sinuses is often located above the sockets of the last four teeth of the upper row. In case of urgent need, the maxillary sinus is opened through the appropriate dental socket. Very often the bottom of the sinuses is located at the same level as the bottom of the nasal cavity, but this is with the usual volume of the maxillary sinuses. In other cases, it is located slightly lower.
The formation of the facial (anterior) wall of the maxillary sinuses occurs in the area of the alveolar process and the infraorbital margin. The upper jaw plays an important role in this process. Compared to other walls of the maxillary sinuses, the facial wall is considered thicker.
It is covered with soft tissue of the cheeks and can even be felt. The so-called canine pit, which refers to the flat pits located in the central part of the front wall, is the thinnest part. On top edge This area contains the exit for the optic nerves. The trigeminal nerve passes through the facial wall of the maxillary sinus.
Relationship between maxillary sinuses and teeth
Very often there are cases when there is a need surgical intervention in the area of the upper teeth, which is influenced by the anatomical characteristics of the maxillary sinuses. This also applies to implants.
There are three types of relationships between the lower wall of the maxillary sinuses and the upper row of teeth:
- the bottom of the nasal cavity is lower than the lower wall of the maxillary cavities;
- the bottom of the nasal cavity is located at the same level with the bottom of the maxillary sinuses;
- The nasal cavity with its bottom is located above the lower walls of the maxillary sinuses, which allows the dental roots to have a free fit to the cavities.
When a tooth is removed in the area of the maxillary sinus, the process of atrophy begins. The bilateral nature of this process results in rapid quantitative and qualitative deterioration of the maxillary bones, as a result of which further dental implantation can be considered very difficult.
Inflammation of the maxillary cavities
In the case of an inflammatory process (most often, inflammatory lesions affect more than one cavity), the disease is diagnosed by doctors as sinusitis. The symptoms of the disease are as follows:
- pain in the cavity area;
- respiratory and olfactory dysfunction of the nose;
- prolonged runny nose;
- heat;
- irritable reaction to light and noise;
- tearfulness.
In some cases, swelling of the cheek of the affected side is observed. When you feel your cheek, there may be a dull pain. Sometimes the pain can cover the entire part of the face on the side of the inflamed sinuses.
In order to more correctly diagnose the disease and prescribe appropriate treatment, it is necessary to take an x-ray of the maxillary cavities affected by inflammation. This disease is treated by an ENT doctor. To prevent the occurrence of sinusitis, it is necessary to carry out certain preventive measures in order to improve immunity.
Prevention and treatment of inflammatory processes
There are several simple ways to treat sinusitis:
- warming up;
- washing;
- compress.
When the maxillary sinuses are inflamed, they fill with inflammatory mucus and pus. In this regard, the most important step on the path to recovery is the procedure for cleaning the maxillary cavities from purulent accumulation.
The cleansing process itself can be organized at home. In this case, you must first plunge your head into extremely hot water for 3-5 minutes, then immerse your head in cold water. After 3-5 such manipulations, you should take a horizontal position, lying on your back, throwing your head back so that the nostrils are vertical. Due to the sharp temperature contrast, inflamed areas are the easiest to clean.
You should not take your health lightly, even if you have a slight runny nose.
Sinusitis or sinusitis poses a serious threat to a person’s general well-being, and in some cases, life, especially if the disease acquires chronic symptoms.
Sinusitis of the maxillary cavities often contributes to the appearance of diseases such as bronchial asthma, chronic bronchitis or pneumonia. Due to the fact that anatomically the maxillary cavities border the brain and eye sockets, this disease has a high risk of causing serious complications in the form of inflammation of the meninges, and in some cases, a brain abscess.
