MAXILLA Upper jaw § Anatomy (repetition), widespread description § § Clinical notes § § Dentoalveolar topography: - transverse asymmetry of alveolus - rate of spongy and compact bone - the relationship of root to neighouring struct. § Nerve and blood supply (repetition) 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 25-30% § Solitary or multiple § Congenital or secondary to disease process xr10 xr67 The edentulous jaw The toothed jaw CAVE! By the maxillary sinus lift (augmentation) before instalation of implants Sinus maxillaris – decrease of floor Variable layer of spongy bone between sinus and roots of teeth maxilla 023 25% - 35% Sinus maxillaris - septa Primary: arising from the development of the maxilla Secondary: arising from the pneumatization of the sinuss floor following tooth septa CAVE! § The separately maxillary sinus puncture § Dental implants Corpus maxillae - facies ant. (fossa canina) maxilla 004 Caldwell-Luc antrostomy 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 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 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 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 Important for anesthesia, extraction, injury, implantology, endodontic treatment ... 1. The transverse asymmetry of alveolus 2. The rate of the spongy and the compact bone 3. The relationship the roots the lower jaw to neighbouring structures Dentoalveolar topography maxilla 018 1. The transverse asymmetry of alveolus § The dental and skeletal arch are asymmetric ! § Roots of the teeth: 1-5 eccentric směrem vestibulárním 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. Posterior there are variable layer of retroalveolar spongy bone. The width of the alveolus depend on the arching palate § § Roots of the molars are surrounded by thin layer of the compact bone (except infrazygomatic crest) maxilla 003 Molars Compact bone only maxilla 019 maxilla 006 Incisivi, canini, premolars Compact bone and variable thickness of spongy bone lingually 3. The relationship the roots the upper jaw to neighbouring structures § Nasal cavity § Infraorbital foramen § Maxillary sinus Nasal cavity Infraorbital foramen CAVE! Radices 1,2: periapical inflammatory may led 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 Figure2a Inflammation in sinus maxillaris 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