The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Anatomy of the maxilla and its surgical implications /cosmetic dentistry courses
1. ANATOMY OF THE MAXILLA AND ITS
SURGICAL IMPLICATIONS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
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2. CONTENTS
Gross anatomy
Surgical anatomy
Development
Maxilla in fractures
Maxillary osteotomies
Maxillectomy
Infections of maxilla
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3. INTRODUCTION
Paired bone
Second largest bone of face
Contributes to formation of several
structures
Whole of upper jaw
Roof of oral cavity
Floor and lateral wall of nasal cavity
Floor of each orbit
Infratemporal and pterygopalatine
fossae
Inferior orbital and pterygomaxillary
fissures
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12. SURGICAL LAYERS
SMAS is a meshwork of fibrous septae
Which envelopes fat lobules Overlies
fascia
Blends into facial muscles
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17. INNERVATION OF MAXILLARY REGION - MOTOR
Predominantly
zygomatic and
buccal branches
of facial nerve
Proximal trunks
located relatively
deep to skin
Several
anastomoses of
branches
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19. DEVELOPMENT OF MAXILLA
Develops from the mesenchyme of the
maxillary process (derivative of first arch)
Cartilages:
No primary cartilage seen
Associated closely with cartilage of nasal
capsule
Secondary cartilage: zygomatic or malar
cartilage aids in growth
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20. Centre of ossification appears at angle between
anterior superior alveolar nerve and infraorbital nerve
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21. CENTRE OF
OSSIFICATION
(B/W 2 NERVES)
FRONTAL
PROCESS
TOWARD
DEVELOPING
ZYGOMA
TOWARD FUTURE
INCISOR REGION
LATERAL ALVEOLAR PLATE
BONY TROUGH FOR
NERVE
PALATINE
PROCESS
MEDIAN ALVEOLAR PLATE
Sinus – develops by sixteenth week by pneumatization
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22. FRACTURES OF MAXILLA
Maxilla varies from mandible in geometric
distribition of bone
Thin laminae
Increased surface area : bone volume ratio
Good blood supply – excellent healing
potential
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23. BUTTRESSES OF MIDFACE ARCHITECTURE
Was elucidated by Le fort in fracture lines
Sicher and Tandler in 1928 gave concept of
vertical buttresses
These help in transmission of forces
3 buttresses are identified:
Pterygomaxillary
Zygomatic
nasomaxillary
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24. Nasomaxillary buttress:
From maxillary canine area
Through lateral piriform rim
Through frontal process of maxilla
To superior orbital rim
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25. Zygomaticomaxillary buttress:
From zygomaticoalveolar crest
Through the zygoma
To posterior aspect of superior orbital rim and
temporal bone
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26. Pterygomaxillary buttress:
Through palatine bone
To pterygoid plates
Base of sphenoid
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34. FIXATION OF MAXILLARY #
Le fort I : lateral
and medial
buttress
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35. Le fort II :
nasofrontal
suture,
orbital rim
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36. Le fort III :
nasoethmoid,
fronto -
zygomatic
suture,
orbital rim,
zygoma
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37. PATHOLOGIES OF MAXILLA
Squamous cell carcinoma of sinus and oral
mucosa
Desmoplastic ameloblastoma
Adenomatoid odontogenic tumor
Squamous odontogenic tumor
Melanotic neuroectodermal tumor
Osteosarcoma – secondary to Paget’s disease
Chondrosarcoma
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38. LATEARL RHINOTOMY APPROACH
Tumors of lower part
of nasal cavity/maxilla
Polyps, papillomas
Starts at philtrum
Around vestibule, ala
Nasolabial crease
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39. WEBER FERGEUSON INCISION (DIEFFENBACH)
More exposure
partial/total maxillectomy
Midline upper lip
Philtrum columella
Around vestibule, ala
Nasolabial crease
Medial canthus
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40. LYNCH EXTENSION
Exposure of ethmoid
air cells
Extends till medial
edge of eyebrow
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41. LATERAL SUBCILIARY EXTENSION SUBCILIARY AND
SUPRACILIARY EXTN.
Total and radical maxillectomy
Along tarsal margin of lower eyelid to lateral canthus
Along upper eyelid
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43. PARTIAL MAXILLECTOMY
Tumors in floor of sinus
Lower half of maxilla
Intra oral incision
Antral lining is removed
to prevent chronic
inflammation
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44. SUBTOTAL MAXILLECTOMY
Tumors extending to superior part of sinus
Tumors extending beyond the sinus borders
Weber fergeuson approach
Palatine vessels and maxillary artery
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45. MEDIAL MAXILLECTOMY
Tumors of:
lateral wall of nasal
cavity
medial wall of maxillary
sinus
Infra orbital nerve is
preserved
Medial canthal ligament
is detatched
Lacrimal duct
transected
Anterior ethmoidal
artery ligated
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46. TOTAL MAXILLECTOMY
Complete removal
Primary
mesenchymal
tumors
Subciliary extension
Periosteum
elevated from floor
of orbit
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47. RADICAL MAXILLECTOMY
Orbital exenteration is done
For tumors that have spread into orbit
through orbital periosteum
Weber fergeuson approach with subciliary
and supraciliary extension
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48. MAXILLARY OSTEOTOMIES
Le fort I osteotomy
Segmental osteotomy
High level osteotomies – le fort II and III
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49. ANATOMICAL CONSIDERATIONS IN LE FORT 1
OSTEOTOMY
Incision – intraoral
from
zygomaticomaxillary
buttress anteriorly
across the midline
Posterior maxilla –
dissection is tunneled
to preserve an intact
mucosal pedicle
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50. Infra orbital nerve exposed
on subperiosteal
dissection
Descending palatine
vessels – usually ligated
as they are source of
bleeding
Internal maxillary artery –
may be damaged during
downfracture. Posterior
osteotomy is directed
inferiorly to prevent this.
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53. WASSMUND METHOD
Two buccal verical incision
No transpalatal incision
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54. CUPAR METHOD
Only vestibular incision
Non vitality of teeth – minimum 1mm of bone over
roots
Oronasal & oroantral communication.
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55. LE FORT II OSTEOTOMY
Indications :
Cleft palate, binder’s
syndrome
Dish face deformity due
to trauma
Incision – mucogingival
Anatomical structures :
Infraorbital nerve
Nasolacrimal duct
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56. LE FORT III OSTEOTOMY
Total midface hypoplasia:
craniofacial synostosis
Degree of proptosis and
hypoplasia
Incision – coronal
Anatomical structures:
Infraorbital nerve
Lacrimal apparatus and orbit
Pterygoid venous plexus
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57. INFECTIONS OF MAXILLA
Sinus infections
Space infections
Infantile osteomyelitis
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58. CHRONIC MAXILLARY SINUSITIS
Approaches:
Caldwell Luc approach
incision over canine fossa
Exposes anterolateral wall of sinus
Above – infraorbital foramen and nerve
Below – apex of premolar teeth, middle superior
alveolar nerve
Posteriorly – zygomatic buttress
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59. Intranasal antrostomy:
Antrum punctured through inferior meatus
The inferior turbinate must be protected
Denker’s procedure:
Antrum exposed via caldwell luc approach
The lateral nasal wall is trephined and nasal mucosa sutured to
the sinus
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60. SPACE INFECTIONS
Canine space
Infected maxillary
canine
Between maxilla and
muscles of face
Drainage – intraoral
through vestibule
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61. INFANTILE OSTEOMYELITIS
Rare but involves maxilla
Etiology :
Due to perinatal trauma
use of suction bulb or contaminated fingers
May involve eye, dural sinuses and teeth
Maxilla is swollen both buccally and
palatally
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