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16 I I case report _ cavernous sinus infection of the permanent dentition. The maxillary sinus, also knownastheantrumofHighmore,isthelargestofthe paranasal sinuses. The roof of the maxillary sinus is formed by the alveolar part of the maxilla. The roots ofthemaxillaryteeth,particularlythefirsttwomolars, often produce conical elevations in the floor of the sinus. Infectionofthemaxillarysinuses Maxillary sinusitis (inflammation of maxillary sinus) may be of dental origin. The dental causes of maxillarysinusitisincludeperi-apicalinfection,perio- dontal disease or perforation of the antral floor and antral mucosa at the time of dental extraction. Roots and foreign objects forced into the maxillary sinus at thetimeofoperationmayalsobethecausativefactors ofsinusitis.Thenon-dentalsourceofmaxillarysinusi- tis includes allergic conditions, chemical irritation or facial trauma (fracture involving a wall or walls of the maxillary sinus). The patient may complain of a sense of fullness over the cheek, especially on bending forward. Other complaints with regard to maxillary sinusitis may include headache, facial pain and tenderness to pres- sure. The pain may also be referred to the premolar and molar teeth, which may be sensitive or painful to percussion. Relationshipoftheteethtothemaxillarysinus The close proximity of the three maxillary molar teeth to the floor of the maxillary sinus poses po- tentially serious problems. During removal of a molar tooth or root-canal treatment, root fracture may oc- cur. If proper retrieval methods are not used, a piece oftherootmaybedrivensuperiorlyintothemaxillary sinus, while in the case of endodontic treatment overextensionorover-obturationofthematerialmay drive material into the sinus. A communication may be created between the oral cavity and the maxillary sinus as a result and an infection may occur. Because thesuperioralveolarnerves(branchesofthemaxillary nerve)supplyboththemaxillaryteethandthemucous membrane of the maxillary sinuses, inflammation of themucosaofthesinusisfrequentlyaccompaniedby a sensation of toothache in the molar teeth. _Cavernous sinus The cavernous sinus is located on each side of the sella turcica on the upper surface of the body of thesphenoid,whichcontainsthesphenoid(air)sinus. The cavernous sinus consists of a venous plexus of extremely thin-walled veins that extends from the superior orbital fissure anteriorly to the apex of the petrous part of the temporal bone posteriorly. The venous channels in these sinuses communicate with each other through venous channels anterior and posteriortothestalkofthepituitaryglands,theinter- cavernous sinuses and sometimes through the supe- rior and inferior petrosal sinuses and emissary veins to the pterygoid plexuses. Inside each cavernous sinus is the internal carotid artery with its small branches, surrounded by the carotid plexus of sympathetic nerve(s), and the abdu- cent nerve (cranial nerve VI). The oculomotor (cranial nerve III) and trochlear (cranial nerve IV) nerves, plus two of the three divisions of the trigeminal nerve (cranial nerve V) are embedded in the lateral wall of the sinus. The artery, carrying warm blood from the body’score,traversesthesinusfilledwithcoolerblood returning from the capillaries of the body’s periphery, allowing for heat exchange to conserve energy or cool the arterial blood. Pulsations of the artery within thecavernoussinusaresaidtopromotepropulsionof venous blood from the sinus, as does gravity.2 Cavernous sinus thrombosis usually results from infections in the orbit, nasal sinuses and superior part of the face (the danger triangle). In persons with thrombophlebitis of the facial vein, pieces of an in- roots4_2010 Figs. 7 & 8_i-CAT scan showing healing of the sinuses. Fig. 7 Fig. 8