Maxillary Sinusitis - Symptoms, Causes, and Treatment

What Is Maxillary Sinus?

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.

What Are the Functions of Maxillary Sinus?

• 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.

What Is Maxillary Sinusitis?

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.

What Are the Signs and Symptoms of Maxillary Sinusitis?

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:

• Facial pain.

• Headache.

• 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.

What Are the Causes of Sinusitis?

The causes of maxillary sinus inflammation are:

• Fever.

• Allergy.

• Bacterial and viral infections.

• Common cold.

• Influenza flu.

What Is Odontogenic Sinusitis?

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).

• Prevotella spp.

• Peptostreptococcus.

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:

• Sinus lift.

• 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.

How Is Maxillary Sinusitis Treated by a Dental Surgeon?

Your dental surgeon will primarily recommend:

1) Antibiotic prophylaxis.

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).

• CT scan (computed tomography).

• Transillumination test.

Surgical Management:

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).

Conclusion:

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.