MAXILLA
Upper jaw
▪ Anatomy (repetition), detailed
description
▪ Clinical notes
▪ Dentoalveolar topography
➢ Viscerocranial
(splanchnocr.)
bone
➢ Paired b.
➢ Irregular formed
b.
➢ Pneumatized b.
➢ Osseous basis
of ventral part of
the face
➢ Consists of
maxillar body
and four
processes
We distinguish 4
planes on maxillar
body – facies
- anterior,
- orbitalis,
- posterior =
infratemporalis and
- nasalis
The body contains air-filled space, cavity – paranasal sinus
We distinguish 4 processes
- zygomaticus, frontalis, palatinus, alveolaris
Facies anterior
➢ Margo infraorbitalis (rim)
➢ Foramen 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
➢ Canine fossa, canine eminence
(ridge over root of canine)
➢ Crista infrazygomatica (to M1)
➢ Incisura nasalis – apertura
piriformis nasi
➢ Spina nasalis ant. (short thorn in
the middle line, over incisor
roots)
Facies 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
Corpus maxillae - facies orbitalis - canalis
infraorbitalis
CAVE !
Maxillary sinus disease
can lead to dehiscence
of the orbital floor →
secondary neuralgia of
trigeminal nerve
Facies post.
(f. infratemporalis)
- Crista infrazygomatica
- Tuber maxillae
➢ Foramina alv. post. sup.
(1-3) with canales alv. post.
sup. leading in the
direction of molar roots
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
Facies nasalis
- Hiatus (sinus) maxillaris
- Canalis nasolacrimalis
Reduction of hiatus
maxillaris by
surrounding bones:
Pr. uncinatus
Bulla ethmoidalis
Conchae nasales
> Hiatus semilunaris
et infundibulum
The bottom of the
sinus lies lower
than the opening!
Sinus maxillaris
- Big 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
1yo, 4yo, 8yo, 12yo, 20yo, 60yo
Sinus maxillaris, antrum Highmori
Capacity: 15 (25) ml
Patological content in the right
maxil. sinus
The toothless jaw –
thinning of bony floor
The toothed jaw
CAVE! before implant
application, maxillary
sinus lift (augmentation)
is needed
Sinus maxillaris – decrease of floor
Variable layer of spongy
bone between sinus and
roots of teeth
25% - 35%
Sinus maxillaris - septa
Full septa, incompl. s.
Most often in the
bottom area
CAVE! Clinical significance:
▪ separated maxillary sinus puncture
▪ dental implants
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
A intraoral imaging of implantation area B complete septa separating the sinus
into 2 compartments C two dental implants and graft material in sinus
D septa between the implants
Anatomic evaluation of maxillary sinus septa: surgery and
radiology. Koymen et al., 2009. Clinical Anatomy 22:563-570.
Processus frontalis – forms the medial orbital rim;
on its dorsal margin, it has crista lacrimalis ant. (sulcus
lacrimalis)
Processus 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 –
on caudal side
- Septa interalveolaria
- septa intraalveol.
= interradicularia
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
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
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
8 takes a natural place, deviates from the arch
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
2
LP
Molars
Compact bone
only
Incisivi, canini, premolars
Compact bone and variable
thickness of spongy bone on
palatinal side
➢ Roots of the
molars are
surrounded just by
thin layer of the
compact bone
(except
infrazygomatic crest
– M1)
7
BP
8
BP
tuber maxillae area:
Bucally and palatally
compact + spongy bone
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
trombophlebitis 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