MAXILLA Upper jaw § Anatomy (repetition), widespread description § § Clinical notes § § Dentoalveolar topography § § Nerve and blood supply (repetition) IMG_0684- ØViscerocranial (splanchnocr.) bone Ø ØPaired b. Ø ØIrregular shape Ø ØPneumatized b. Ø ØOsseous basis of ventral part of the face Ø ØInvolved in formation of the orbit, nasal cavity and hard palate Ø ØHolds upper teeth Ø ØPlays an important role in mastication and communication Ø ØConsists of maxillar body and four processes Ø Ø ØWe distinguish 4 planes (surfaces) on maxillar body – facies anterior, orbitalis, posterior = infratemporalis and nasalis Ø ØThe body contains air-filled space , Øa cavity – paranasal sinus called ØAntrum Highmori Ø Ø ØFacies anterior ØMargo infraorbitalis (infrao. rim, margin) ØForamen infraorbitale (opening of canalis infraorbitalis, contains infraorbit. neuro-vascular bundle) – a landmark for the administration of the infraorbital local anest. block – 2 cm inferior to the midpoint of the lower margin of orbit ØCanine fossa, canine eminence (ridge over root of canine) ØCrista infrazygomatica (to M1) ØIncisura nasalis (nasal notch)– apertura piriformis nasi ØSpina nasalis ant. (short thorn in the middle line, over incisor roots) Ø Ø maxilla 004 ØFacies orbitalis -Together with facies orbitalis ossis zygomatici it forms an orbital floor -Sulcus infraorbitalis (infraorbital groove) which is deepend into canalis infraorbit. -In the course of canalis infraorbitalis canales alveolares sup. ant. divide themselves in the direction towards the roots of anterior teeth -Inferior orbital fissure – separates from sphenoid bone maxilla 009 maxilla 009 Corpus maxillae - facies orbitalis - canalis infraorbitalis CAVE ! Maxillary sinus disease can lead to dehiscence of the orbital floor → secondary neuralgia of trigeminal nerve ØFacies post. Ø(f. infratemporalis) Ø Ø- Crista infrazygomatica Ø- Tuberositas maxillae Ø- Tuber maxillae ØForamina alv. post. sup. (1-3) with canales alv. post. sup. - Convey nerves and vessels to mollars, leading in the direction of molar roots maxilla 017 maxilla 017 Corpus maxillae - facies post. (tuber maxillae) CAVE! § Alveolar foramens: a.,v.,n. alveolaris sup. post. - local anesthesia § § Thin bone → during molar teeth extraction can occur maxillary tuberosity fractures Ø maxilla 026 ØFacies nasalis Ø- Hiatus (sinus) maxillaris (a large defect in the wall) Ø Ø Sinus maxillaris - Big air-filled cavity in maxillar body, also reaches into processus maxillae - Largest of paranasal sinuses, paired, lined with mucous membrane - Opening (ostium) in the lateral nasal wall – drainage may be complicated, because the ostium of sinus is higher than the floor of the sinus cavity !!! - The size varies according to individuals and their age - Pyramid shaped, three walls, a roof and a floor, apex points into zygomatic arch Sinus maxillaris, antrum Highmori Figure2a Capacity: 15 (25) ml Patological content in the right maxil. sinus maxilla 026 Below pr. uncinatus form the medial wall of sinus the collagenous tissue = fontanella ant. et post. in which for. accessoria may be occure Sinus maxillaris - foramina accessoria xr10 xr67 The toothless jaw – thinning of bony floor The toothed jaw CAVE! before instalation of implants, maxillary sinus lift (augmentation) is needed Sinus maxillaris – decrease of floor Variable layer of spongy bone between sinus and roots of teeth maxilla 023 25% - 35% Sinus maxillaris - septa Full septa, incompl. s. Corpus maxillae - facies ant. Caldwell-Luc antrostomy Intraoral procedure for entering the maxillary antrum through the canine fossa above the maxillary premolar teeth FES functional endoscopic surgery FESS functional endoscopic SINUS surgery – usually to enlarge the ostia and provide adequate drainage chirurgie-des-sinus-caldwell-luc-181-2 Caldwell Luc Operation Caldwell Luc operation is another method of treating sinusitis and is a surgical method that is especially used for clearing a blocked or infected maxillary sinus and involves entering the sinus through the mouth by way of an incision into the canine fossa above a canine tooth, cleaning the sinus, and creating a new and enlarged opening for drainage through the nose. The maxillary sinus is entered through the upper jaw above one of the second molar teeth. A route is created to connect the maxillary sinus with the nose, thus improving drainage. The operation is named after American physician George Caldwell and French laryngologist Henry Luc and is most often performed when a malignancy is present in the sinus cavity CAVE! Clinical signifikance: § separated maxillary sinus puncture § Dental implants Processus frontalis – forms the medial orbital rim; on its dorsal margin, it has crista lacrimalis ant. (sulcus lacrimalis) maxilla 009 ØProcessus alveolaris – form of a half of a horseshoe -Functional extension of a bone, conditioned by the presence of teeth (after loosing of teeth, proc. alv. is reabsorbing and diminishing) -Juga alveolaria – on the external side, they mark the position of roots of teeth -Alveoli dentales – Ø on caudal side -Septa interalveolaria -septa intraalveol. Ø = interradicularia maxilla 021 Proc. Palatini of both upper jaws form anterior ¾ of palatum durum Connected together in sutura palatina mediana, sometimes the bone mass – torus palatinus protrudes Sulci palatini conditioned by presence of palatal vessels and nerves Foramen incisivum – in ventral part of sutura palat. Med. (for a. and n. nasopalatini) Os incisivum, premaxilla, sutura incisiva (usually obliterates in childhood) Facies cranialis proc. palat. is an integral part of the bottom of nasal cavity, crista nasalis + vomer Palatum – zones of mucous membrane 1 – the marginal zone 2 – the incisive papilla 3 – the adipose zone 4 – the zone of the palatine seam, mucoperiosteum 5 – the glandular zone 6 – the soft palate Palatum: A and H line H A A line localized on the line between hard and soft palate H line line between mobile and immobile parts of the soft palate Newborn maxilla -is low -without a developed proc. alveolaris -in its basis, there are crowns of deciduous teeth embeded -sinus maxillaris is only outlined by a little depression, into which mucous membrane of nasal cavity invaginates during the jaw growth Important for anesthesia, extraction, injury, implantology, endodontic treatment ... 1. Dental and skeletal arch 2. The rate of the spongy and the compact bone 3. The relationship between the roots of the teeth of upper jaw and neighbouring structures Dentoalveolar topography maxilla 018 1.The position of alveolus in the skeletal arch § The dental and skeletal arch are asymmetric ! § Roots of the teeth: 1-5 excentric towards vestibular part 6-7 in alveolar process axis 2. The rate of the spongy and the compact bone § The layer of compact bone is thinner than in the lower jaw § § Roots of the 1-5 are surrounded by the compact bone on labial side. On palatinal side, there is a variable layer of retroalveolar spongy bone. §The width of the alveolus depend on the shape of palate maxilla 019 2 L P Ø Roots of the molars are surrounded just by thin layer of the compact bone (except infrazygomatic crest – M1) Ø 7 B P maxilla 003 Molars Compact bone only maxilla 019 maxilla 006 Incisivi, canini, premolars Compact bone and variable thickness of spongy bone on palatinal side 3. The relationship between the roots of teeth of the upper jaw and neighbouring structures § Nasal cavity § Infraorbital foramen § Maxillary sinus Nasal cavity Infraorbital foramen CAVE! Radices 1,2: periapical inflammation may lead to abscess of the floor of nasal cavity Radix 3: relation to a.,v., n. infraorbitalis and - possible trombophebitis of cavernous sinus § Variable layer of spongy bone between nasal cavity and roots of incisivi § § Root of 3 localized between nasal cavity and sinus maxillaris CAVE! § Periapical inflammation developing at the root apices of maxillary molars and premolars are very close to the floor of the maxillary sinus - sinusitis or empyema § § Potential oro-antral communication by the extraction Maxillary sinus Variable layer of spongy bone between maxillary sinus and roots of posterior teeth Nerve and blood supply Maxillar nerve - infraorbital nerve ant. sup. alv. nerve middle sup. alv. nerve post. sup. alv. nerve Trigeminal nerve Obrázek1 Post. sup. alveolar a. Infraorbital a. ant. sup. alveolar a. Maxillary artery ØReferences: •Čihák, R.: Anatomie 1,2,3, Praha, Grada, 2001 •Netter, F.: Atlas of HumanAnatomy, 4th ed., Elseviesr, USA, 2006 •Naňka, Elišková: Přehled anatomie. Galén, Praha 2009 •Seidl et al.: Radiologie pro studium i praxi, Grada publishing, 2013 •Mrázková, Doskočil: Klinická anatomie pro stomatology, Alberta, Praha, 1994 •Brand, Isselhard: Anatomy of orofacial structures, 8th edition, Elsevier, USA, 2019 •Fehrenbach, Herring: Illustrated anatomy of the head and neck, 5th edition, Elsevier, USA, 2017 •Moore, Dalley: Clinically oriented anatomy, 5th edition, USA, 2006 Ø