Published on Mar 23, 2021 and last reviewed on Aug 29, 2022 - 5 min read
Maxillary sinusitis is the infection or the inflammation of the maxillary sinus that results in facial pain, headaches, etc., and requires medical attention. Please read the article to know how dental infection is responsible for causing sinusitis and how to manage this condition.
Maxillary sinus, also known as the antrum Highmorianum, was first described by Nathaniel Highmore (1613-1685), a British physician and anatomist who researched extensively into its anatomy.
Development - The sinus is present at the time of birth and develops completely till the age of 14 years.
Anatomy - The largest of all paranasal sinuses, with a volume of nearly 10 ml, the maxillary sinus is of pivotal prominence. The paranasal sinuses of the face are named according to the bones within which they lie. It is described as a pyramidal sinus.
Boundaries - The sides by a nasal cavity (lining of the nose). Its roof or top is the base of the orbital portion (the floor of orbit or eye socket). The floor of the sinus is at a more inferior level than that of the nasal cavities.
Pneumonization - Like the other paranasal sinuses, the maxillary sinus can vary in size. Even the roots of the upper molars can project into this space, especially when the maxillary sinus is large. Growth of the sinus occurs by a process called “pneumonization,” where the roots of the maxillary or upper teeth often project into the air spaces of the sinus. Small arteries and veins from the face pierce the bony walls of the maxillary sinus.
Lymphatic Drainage - The lymphatic drainage of the sinus is into the submandibular group of lymph nodes in the neck.
A sinus is a hollow space that is filled with air and situated behind the facial bones.
They contribute by being a protective zone for the face and brain in traumatic instances (injury to the face and brain).
It has an important role in reducing the weight of the facial skeleton.
It imparts resonance to the voicebox.
The sinus has a mucous lining or layer similar to the nasal passage. The moist mucous lining traps dust and dirt.
When the hollow space or the mucous lining gets inflamed or infected, it is termed sinusitis.
In the case of maxillary sinusitis, the maxillary sinus infection or inflammation is attributed either to a bacterial or a viral origin, but most commonly viral. The symptoms of sinusitis usually occur within one week of an upper respiratory tract infection, often acute by nature.
Chronic sinusitis may often be undetected as the patient presents with facial pain very rarely, except when there is an acute exacerbation of the sinus inflammation.
As mentioned previously, acute sinusitis is much more common owing to its onset after an upper respiratory tract infection or sometimes even an acute cold. These are some of the symptoms and signs you need to watch out for and consult your dental surgeon:
Nasal obstruction or blocked nose feeling.
Mucus discharge that is smelly from the nose (purulent nasal secretions).
Fever and general body fatigue may also be present.
Dull and heavy throbbing pain in the upper teeth or cheeks.
Increased tooth sensitivity to hot sweet, or cold stimuli.
Tooth pain that increases on biting without any apparent dental cause.
Pain increases when you lean your head downwards.
Tenderness of the cheek, especially below the orbit and in the canine region of teeth.
Generalized tooth tenderness to any kind of chewing or pressure.
In rare cases, there may be swelling and inflammation of the cheek area.
These signs and symptoms may be varied from individual to individual. Most importantly, it depends on the cause of sinus inflammation.
The causes of maxillary sinus inflammation are:
Bacterial and viral infections.
Odontogenic sinusitis is the sinus inflammation secondary to dental infections, procedures, and dental disease. There are predominantly two kinds of bacteria in both the oral cavity and the upper respiratory tract, which are:
Aerobic (oxygen requiring).
Anaerobic (surviving in the absence of oxygen).
More than 75% of dental-related sinus infections are found with:
Staphylococcus aureus (aerobic strains).
S.pneumonia (aerobic strains).
This kind of sinusitis through a dental infection accounts for 5 to 70% of all the maxillary sinusitis cases. When the infected upper teeth spread the infection via the roots to the floor of the maxillary sinus, it causes perforation and inflammation of the sinus lining or floor. In the case of maxillary sinusitis, dental infections are a major concern for causing as well as aggravating the symptoms. A decayed tooth that has been left untreated without root canal or gum diseases and certain cysts can also instigate sinus inflammation as the infection spreads through the dental origin. Though not very uncommon, it is possible when dental infections also originate from certain procedures like:
Foreign body reactions.
Certain fillings and restorations.
Communication established after traumatic tooth extractions (an oroantral fistula is an unnatural opening between the oral cavity and the maxillary sinus).
Hence, recognizing any signs and symptoms mentioned earlier, it is always advisable to visit your dental surgeon and confirm the diagnosis.
Your dental surgeon will primarily recommend:
2) Nasal decongestant drops.
3) Steam inhalation.
4) Analgesic medications.
They are alternatively recommended to relieve aggressive symptoms.
5) X-ray imaging (It traces the source of odontogenic or dental infections leading to sinusitis) like:
CBCT (cone-beam computed tomography).
Maxillary Antrostomy - is one of the surgical procedures that enlarge the opening (osteum) of the maxillary sinus to drain the infection. This technique is almost followed from the mid-1980s by many healthcare practitioners and surgeons. It is indicated when the sinusitis is of chronic nature and unresponsive to any medications or therapies suggested. In rare cases, even a maxillary antrostomy procedure cannot help drain the maxillary sinus infection completely. In such cases, the surgeon needs to create a new drainage pathway between the maxillary sinus and the nose (Caldwell-Luc procedure).
Sinusitis is as much of a threat as severe dental infections are leading to it. A timely visit to your dentist or physician without ignoring the signs and symptoms will lead to timely diagnosis and preventive intervention. If surgical management is needed, your healthcare provider can help you manage this condition with post-operative care.
The symptoms of maxillary sinusitis initially present as a discomfort in the nasopharyngeal region. The pain progresses in the maxillary region radiating to the maxillary teeth, eyes, frontal sinus, and ear. For a dental practitioner, the pain presenting in the posterior maxillary teeth is of great significance as, in most cases, there is no identifiable dental cause. Palpation on the canine fossa region produces pain. In children, sometimes, it may be swollen and red over the region of the affected sinus. There will be associated dry cough, fever, headache, nasal resonance, blocking of the nose, nasal discharge, malaise as a result of toxemia, chills, sweats, difficulty in breathing, and nausea.
The home remedies of maxillary sinusitis are taking a hot shower and breathing in the steam to reduce pressure. Allowing the body to take rest may help to reduce sinus pressure. The position of sleep also matters, so place the head up with pillows at night to keep the head above the heart. This helps to prevent sinus buildup and helps to breathe comfortably. Fluids will reduce blockages in the sinuses, so increase the water intake to remain hydrated. Physical activity, yoga, meditation, and other relaxation techniques can help to reduce pain and pressure in sinus infections. Eat foods with antibacterial properties such as garlic, onion, and ginger. Clear the sinuses with eucalyptus oil which helps to open up the sinuses and get rid of mucus. Place warm damp towels around the nose, cheeks, and eyes, which relieves facial pain.
Maxillary sinusitis is an acute or chronic inflammation of the maxillary sinus. It is often due to direct extension of dental infection but also originates from infectious diseases due to bacteria, viruses, or fungi such as common cold, influenza, and exanthematous diseases. It is the local spread of infection in the adjoining frontal or paranasal sinuses or from the traumatic injury of the sinuses with superimposed infection. Maxillary sinusitis clinically presents in three forms as acute, subacute, and chronic.
The clinical signs and symptoms, thickening of the mucosa, transillumination with a strong flashlight in the darkroom, sinus view radiograph shows opacity of the involved sinus, nasal and sinus endoscopy, culture of the discharge from the sinus, rhinoscopy show redness of the nasal and antral mucosa, occlusion of the antrum, and thick pus draining towards the nasopharynx and computed tomography helps in the diagnosis of maxillary sinusitis.
A maxillary sinus cyst is a lesion that develops on the inside of the wall of the maxillary sinus. These cysts usually appear as round, dome-shaped, soft masses and are most often seen on the floor of the maxillary sinus. This cyst is a benign lesion or a non-cancerous condition.
The cyst appears asymptomatic in the majority of cases and can be identified under routine radiographic examinations. In some cases, allergy-related nasal and sinus congestion can lead to dizziness, and the cyst becomes enlarged and causes symptoms as chronic headache, nasal blockage, sensitivity to palpation, and dizziness, or a more severe type of dizziness called vertigo.
Sinus and nasal cavity tumors are benign and do not spread to another part of the body. Sinus tumors or cancerous nasal cavities are rare and are more likely to occur in men than women. They can be identified under radiographic examinations and are reported to occur in between 1.4% to 9.6% of the general population. It commonly occurs on either side of the nose, which results in loss of sense of smell, difficulty in breathing in the nose, and nosebleeds.
In adults, maxillary sinuses are most commonly affected with acute and chronic sinusitis. The prime objective of the treatment of acute sinusitis is the removal of the locus of infection. This is particularly efficacious if the infection is of dental origin. Because of the infection present, antibiotics should be administered. Chronic sinusitis is usually treated by removing the causative factors of the disease. The prognosis is considered good if the disease is of dental origin since it can be eliminated. Infection from other sites may be difficult to eradicate.
Acute sinusitis is mostly caused by the common cold. It can resolve within a week to 10 days and lasts less than a month unless it is caused by a bacterial infection. Home remedies may all be needed to treat acute sinusitis. Sinusitis that lasts more than 12 weeks despite medical treatment is chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. The diagnosis of acute maxillary sinusitis from clinical manifestation alone is quite difficult.
The sinus can be cured permanently by antibiotics such as Amoxycillin 500 mg, Erythromycin or Azithromycin. Decongestants decrease congestion and edema of the nasal mucosa. Xylometazoline hydrochloride, Ephedrine sulfate, or even normal saline nasal drops may be used. Antihistamines in patients with allergy and steam inhalation with Menthol or Tincture benzoin make it more effective. Lukewarm water is irrigated through the sinus, and this drains out through the ostium along with sinus exudate. Surgical procedures like antral lavage assist in the drainage of the sinus, intranasal antrostomy to facilitate the drainage of the sinus, and Caldwell-Luc operation.
The maxillary sinus is located in the maxillary bone, which allows a direct link between the sinus and the oral cavity. The buccal root of the maxillary molars commonly protrudes into the maxillary sinus. Among the roots of posterior maxillary teeth, the mesiobuccal root of the first molar and palatal root of the second premolar were found in close proximity to the floor of the maxillary sinus.
Antimicrobial therapy is the mainstay of medical treatment in sinusitis. The choice of antibiotics depends on whether the sinusitis is acute, chronic, or recurrent. Antibiotics, such as Amoxicillin, Erythromycin, and Azithromycin are acceptable for uncomplicated acute sinus infections. Amoxicillin is effective against most strains of bacteria. In chronic sinusitis, the antibiotics of choice should include the organisms causing acute sinusitis and also cover Staphylococcus species and anaerobes. These include Amoxicillin-Clavulanate and Levofloxacin.
Waters view radiograph occipitomental view (15 degrees) will show opacity or haziness of the involved antrum. It may also show a fluid level, thickened lining membrane, opaque air space may enclose polyps associated with mucosal thickening. In the case of the presence of a tooth or root, the characteristic outline is seen within the sinus. Radiopacities of the antrum should be differentiated from growths in the antrum, cysts, and polyps.
Last reviewed at:
29 Aug 2022 - 5 min read
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