The maxillary sinus, one of four pairs of paranasal sinuses,[i] is a pyramid-shaped structure with its base pointing towards the nasal sidewall and its apex pointing towards the zygomatic region of the maxilla. It contains the maxillary sinus ostium, located towards the cranial side which connects it to the nasal cavity, enabling the drainage of its content.[ii]
Diseases affecting the maxillary sinus can cause a great deal of discomfort in a patient’s orofacial region. As this can present as tooth pain, dentists may often be the primary diagnostician, encountering conditions, such as sinusitis, polyps, cysts, mucocele and other lesions[iii] via radiographs.[iv]
Ear, nose and throat specialists (ENT), or otolaryngologists, are also concerned with this area, and due to their related areas of interest, oral and maxillofacial surgeons may often find themselves collaborating with ENT surgeons when planning treatment for some diseases of the maxillary sinus.[v] An understanding of the maxillary sinus region, the neurovascular systems and alveolar bone is essential for effective surgery, as well as management of complications related to oral surgical procedures.[vi]
Dental disorders and the maxillary sinus
Dental disorders can be associated with alterations of the sinus mucosa due to the close anatomical relationship between some premolars and upper molars and the maxillary sinus floor.[vii]
Maxillary sinusitis (MS) is the most common pathology of the maxillary sinus, and can be rhinogenic, traumatic, allergic or neoplastic – but it can also be odontogenic. A significant proportion of MS is associated with odontogenic infection from posterior maxillary teeth as a result of their close proximity to the sinuses.[viii]
Odontogenic infection and sinusitis can result from dental caries, dentigerous cysts, retained tooth roots, periapical diseases, and periodontal disease. These may also result from surgery in the posterior maxilla, including the removal of teeth, sinus lift grafting and implant placement. Maxillary sinus infections of odontogenic origin are likely to be caused by the same kinds of bacteria as typically seen with dental infections.[ix]
Apical periodontitis (AP) is a major risk factor for odontogenic maxillary sinusitis (OMS). The progression of periapical lesions (PALs) from the posterior maxillary teeth can lead to inflammatory changes in the mucosal lining of the maxillary sinus, leading to OMS, as well as structural changes in the Schneiderian mucosal sinus membrane and possibly the entire sinus.[x]
The upper second and the first molar are also more prone to furcation involvement (FI) compared to other teeth which can lead to tooth loss.[xi] The loss of the maxillary second molar, particularly, is thought to be a cause of maxillary sinus pneumatization (MSP), which in severe cases can lead to an engagement between the sinus floor and the alveolar crest.[xii]
Tooth loss can cause alveolar process resorption. When bone volume or height decreases, implant treatment becomes more complex. In addition, maxillary sinus diseases decrease the elasticity of the Schneiderian membrane. This increases the technical difficulty of surgery, as well as the risk of complications.[xiii]
A multidisciplinary approach to diagnosis and management
OMS and non-odontogenic MS are sometimes difficult to diagnose correctly, and one can be confused with the other. Due to the complexity of the paranasal regions, collaboration between otolaryngologists and dentists optimises outcomes once OMS, or other conditions affecting the maxillary sinus, have been diagnosed.[xiv] Radiographic images, including panoramic and cone-beam computed tomography (CBCT) scans which are often used in oral and maxillofacial surgery can help with the diagnosis of maxillary sinus diseases, including OMS.[xv]
Surgical approaches to OMS are based essentially on dental surgery, often combined with endoscopic sinus surgery. These techniques remove any infection, and restore the drainage ability of the sinus, preventing any recurrence of sinusitis. This approach draws upon dental as well as ENT expertise, which is essential to successfully manage the dental pathology and any possible complications resulting from interventions.[xvi]
ICE Postgraduate Dental Institute & Hospital and the University of Salford will address maxillary sinus anatomy, pathology, and treatment in an advanced course in bone and tissue regeneration, and sinus grafting this autumn. Led by eminent specialist oral surgeon, Professor Cemal Ucer, along with a stellar group of ENT consultants, this course will provide a deeper clinical understanding of sinus pathology and management, as well as a comprehensive combination of hands-on and theoretical training for the experienced implant surgeon in reconstructive pre-prosthetic oral surgery.
Identifying the relationship between dental and sinus pathologies is essential to establish the correct diagnosis, and the subsequent management of the patient experiencing maxillary sinus diseases requires close cooperation between professionals.[xvii] For over eighty years, OMS has represented a positive common ground for otolaryngologists and dental surgeons.[xviii] Interdisciplinary collaboration not only provides an additional medico-legal safeguard for practitioners, but offers patients the benefits of uniting two fields of knowledge and expertise.[xix]
To find out more, contact Ucer Education today. Contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co ; call 01612 371842 or visit www.ucer-clinic.dental.
[i] Whyte A, Boeddinghaus R. The maxillary sinus: physiology, development and imaging anatomy. Dentomaxillofac Radiol. 2019 Dec;48(8):20190205. doi: 10.1259/dmfr.20190205. Epub 2019 Aug 13. Erratum in: Dentomaxillofac Radiol. 2019 Dec;48(8):20190205c. doi: 10.1259/dmfr.20190205.c. PMID: 31386556; PMCID: PMC6951102.
[ii] Pérez-Sayáns M, Suárez Peñaranda JM, Quintanilla JAS, Chamorro Petronacci CM, García AG, Carrión AB, Vila PG, Sánchez YG. Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study. Head Face Med. 2020 Oct 13;16(1):24. doi: 10.1186/s13005-020-00239-x. PMID: 33050926; PMCID: PMC7552481.
[iii] Pérez-Sayáns M, Suárez Peñaranda JM, Quintanilla JAS, Chamorro Petronacci CM, García AG, Carrión AB, Vila PG, Sánchez YG. Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study. Head Face Med. 2020 Oct 13;16(1):24. doi: 10.1186/s13005-020-00239-x. PMID: 33050926; PMCID: PMC7552481.
[iv] Bell, G., Joshi, B. & Macleod, R. Maxillary sinus disease: diagnosis and treatment. Br Dent J 210, 113–118 (2011). https://doi.org/10.1038/sj.bdj.2011.47
[v] Saibene AM, Pipolo C, Borloni R, Felisati G. ENT and dentist cooperation in the management of odontogenic sinusitis. A review. Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S116-S123. doi: 10.14639/0392-100X-suppl.1-41-2021-12. PMID: 34060527; PMCID: PMC8172100.
[vi] Whyte A, Boeddinghaus R. The maxillary sinus: physiology, development and imaging anatomy. Dentomaxillofac Radiol. 2019 Dec;48(8):20190205. doi: 10.1259/dmfr.20190205. Epub 2019 Aug 13. Erratum in: Dentomaxillofac Radiol. 2019 Dec;48(8):20190205c. doi: 10.1259/dmfr.20190205.c. PMID: 31386556; PMCID: PMC6951102.
[vii] Peñarrocha-Oltra S, Soto-Peñaloza D, Bagán-Debón L, Bagan JV, Peñarrocha-Oltra D. Association between maxillary sinus pathology and odontogenic lesions in patients evaluated by cone beam computed tomography. A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2020 Jan 1;25(1):e34-e48. doi: 10.4317/medoral.23172. PMID: 31880293; PMCID: PMC6982991.
[viii] Alghofaily M, Alsufyani N, Althumairy RI, AlSuhaibani A, Alfawzan F, AlSadhan L. Odontogenic Factors Associated with Maxillary Sinus Schneiderian Membrane Thickness and their Relationship to Chronic Sinonasal Symptoms: An Ambispective Cohort Study. Diagnostics. 2023; 13(16):2710. https://doi.org/10.3390/diagnostics13162710
[ix] Han SJ. The role of oral and maxillofacial surgeons in maxillary sinus diseases related to dental implants. J Korean Assoc Oral Maxillofac Surg. 2023 Oct 31;49(5):241-242. doi: 10.5125/jkaoms.2023.49.5.241. PMID: 37907338; PMCID: PMC10618662.
[x] Alghofaily M, Alsufyani N, Althumairy RI, AlSuhaibani A, Alfawzan F, AlSadhan L. Odontogenic Factors Associated with Maxillary Sinus Schneiderian Membrane Thickness and their Relationship to Chronic Sinonasal Symptoms: An Ambispective Cohort Study. Diagnostics. 2023; 13(16):2710. https://doi.org/10.3390/diagnostics13162710
[xi] Peeran SW, Ramalingam K, Sethuraman S, Thiruneervannan M. Furcation Involvement in Periodontal Disease: A Narrative Review. Cureus. 2024 Mar 10;16(3):e55924. doi: 10.7759/cureus.55924. PMID: 38601385; PMCID: PMC11004587.
[xii] Elsayed SA, Alassaf MS, Elboraey MO, Mohamado LL, Huwaykim DA, Albouq AK, Shahada MO. The Impact of Maxillary Sinus Pneumatization on the Quality of the Alveolar Bone in Dentated and Edentulous Patients: A Cone-Beam Computed Tomography Radiographic Analysis. Cureus. 2023 Sep 26;15(9):e46005. doi: 10.7759/cureus.46005. PMID: 37900530; PMCID: PMC10602014.
[xiii] Lyu, M., Xu, D., Zhang, X. et al. Maxillary sinus floor augmentation: a review of current evidence on anatomical factors and a decision tree. Int J Oral Sci 15, 41 (2023). https://doi.org/10.1038/s41368-023-00248-x
[xiv] Lin, J., Wang, C., Wang, X. et al. Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment. Int J Oral Sci 16, 11 (2024). https://doi.org/10.1038/s41368-024-00278-z
[xv] Psillas G, Papaioannou D, Petsali S, Dimas GG, Constantinidis J. Odontogenic maxillary sinusitis: A comprehensive review. J Dent Sci. 2021 Jan;16(1):474-481. doi: 10.1016/j.jds.2020.08.001. Epub 2020 Aug 22. PMID: 33384837; PMCID: PMC7770314.
[xvi] Psillas G, Papaioannou D, Petsali S, Dimas GG, Constantinidis J. Odontogenic maxillary sinusitis: A comprehensive review. J Dent Sci. 2021 Jan;16(1):474-481. doi: 10.1016/j.jds.2020.08.001. Epub 2020 Aug 22. PMID: 33384837; PMCID: PMC7770314.
[xvii] Han SJ. The role of oral and maxillofacial surgeons in maxillary sinus diseases related to dental implants. J Korean Assoc Oral Maxillofac Surg. 2023 Oct 31;49(5):241-242. doi: 10.5125/jkaoms.2023.49.5.241. PMID: 37907338; PMCID: PMC10618662.
[xviii] Saibene AM, Pipolo C, Borloni R, Felisati G. ENT and dentist cooperation in the management of odontogenic sinusitis. A review. Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S116-S123. doi: 10.14639/0392-100X-suppl.1-41-2021-12. PMID: 34060527; PMCID: PMC8172100.
[xix] Saibene AM, Pipolo C, Borloni R, Felisati G. ENT and dentist cooperation in the management of odontogenic sinusitis. A review. Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S116-S123. doi: 10.14639/0392-100X-suppl.1-41-2021-12. PMID: 34060527; PMCID: PMC8172100.
