Maxillary sinus

Last revised by Craig Hacking on 3 May 2023

The maxillary sinus (or antrum of Highmore) is a paired pyramid-shaped paranasal sinus within the maxillary bone which drains via the maxillary ostium into the infundibulum, then through hiatus semilunaris into the middle meatus. It is the largest of the paranasal sinuses.

Described as a pyramid, the maxillary sinuses have a base on the lateral border of the nose, with the apex pointing towards the zygomatic process of the maxilla. The floor is formed by the alveolar process of the maxilla. The roof is the orbital floor. The posterior wall forms the anterior border of the pterygopalatine fossa.

There are several recesses of the maxillary sinus 5:

  • infraorbital recess (superiorly)

  • zygomatic recess (laterally)

  • alveolar recess (inferiorly)

  • palatine recess (variable extension of alveolar recess)

Like the other paranasal air sinuses, these can vary in size. Large maxillary sinuses can extend to the alveolar process of the maxilla to the point where the roots of the molar teeth can project into the space.

Unlike the other paranasal air sinuses, the opening of the sinus is found on its superior end. This ostium communicates with the nasal cavity via the posterior end of the hiatus semilunaris.

Small arteries from the facial, maxillary, infraorbital and greater palatine arteries pierce the bony walls of the maxillary sinus.

Venous drainage anteriorly is via the sphenopalatine vein and posteriorly via the pterygoid venous plexus and the facial vein.

Lymph from the maxillary sinus drains to the submandibular group of lymph nodes via the infraorbital foramen or the aforementioned communication with the nasal cavity. 

Common anatomic variations of maxillary sinuses are 6:

  • pneumatization into the roots of teeth (83.2%)

  • antral septations (44.4%)

  • hypoplasia (4.8%)

  • exostosis (2.6%)

  • total maxillary sinus agenesis - rare

It is present at birth and it develops until around the age of 14 years.

The antrum Highmorianum was first described by Nathaniel Highmore (1613-1685), a British physician and anatomist 3.

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