Underwood's septa: Difference between revisions

Latest revision as of 21:31, 20 February 2025

Underwood's septa are anatomical structures found within the maxillary sinus, which is a pyramidal cavity located within the maxilla of the human skull. These septa are bony partitions that can vary in number, size, and orientation, and they play a significant role in the structural integrity and function of the maxillary sinus.

Anatomy[edit]

Underwood's septa are named after Arthur S. Underwood, who first described them in the late 19th century. They are typically found in the floor of the maxillary sinus and can be classified based on their location and orientation:

Primary septa: These are congenital and are formed during the development of the maxilla. They are usually oriented in a transverse direction.
Secondary septa: These develop as a result of the pneumatization process of the maxillary sinus, which occurs after the eruption of the permanent teeth.

Function[edit]

The primary function of Underwood's septa is to provide structural support to the maxillary sinus. They help in maintaining the shape and volume of the sinus cavity, which is essential for its physiological functions, including:

Respiration: The maxillary sinus plays a role in humidifying and warming the air we breathe.
Olfaction: It contributes to the resonance of the voice and the sense of smell.
Protection: The sinus acts as a buffer against facial trauma.

Clinical Significance[edit]

Underwood's septa are of particular interest in dentistry and oral surgery, especially in procedures involving the maxillary sinus, such as sinus lift surgeries and dental implant placements. The presence of septa can complicate these procedures by increasing the risk of sinus membrane perforation.

Imaging and Diagnosis[edit]

The presence and characteristics of Underwood's septa can be evaluated using various imaging techniques, including:

These imaging modalities help in pre-surgical planning by providing detailed information about the anatomy of the maxillary sinus and the location of septa.

Surgical Considerations[edit]

During sinus lift procedures, the presence of Underwood's septa requires careful surgical planning. Techniques such as the lateral window approach or the transcrestal approach may need to be modified to accommodate the septa and minimize complications.

Research and Studies[edit]

Recent studies have focused on the prevalence and morphological variations of Underwood's septa in different populations. These studies aim to improve the understanding of sinus anatomy and enhance the safety and efficacy of surgical interventions involving the maxillary sinus.

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-[[File:Gray862.png|thumb|right|250px|Specimen from a child eight years, eight months, and one day old. Lateral view of frontal, ethmoidal and maxillary sinus areas, the lateral portion of each having been removed by sagittal cuts. ("Maxillary septa" labeled at center left.)]]
+'''Underwood's septa''' are anatomical structures found within the [[maxillary sinus]], which is a pyramidal cavity located within the [[maxilla]] of the human skull. These septa are bony partitions that can vary in number, size, and orientation, and they play a significant role in the structural integrity and function of the maxillary sinus.
-In [[anatomy]], '''Underwood's septa''' (or '''maxillary sinus septa''', singular '''''septum''''')<ref>Maestre-Ferrín L, et al. <u>[http://www.medicinaoral.com/pubmed/medoralv15_i2_p383.pdf Maxillary sinus septa: a systematic review]</u>. ''Med Oral Patol Oral Cir Bucal'' 2010;'''15'''(2):e383–6. {{PMID|19767706}}</ref><ref>Lee WJ, et al. <u>[http://www.jpis.org/DOIx.php?id=10.5051/jpis.2010.40.2.56 Analysis of location and prevalence of maxillary sinus septa]</u>. ''J Periodontal Implant Sci'' 2010;'''40'''(2):56–60. {{PMID|20498761}}</ref> are fin-shaped projections of [[bone]] that may exist in the [[maxillary sinus]], first described in 1910 by Arthur S. Underwood, an anatomist at [[King's College London|King's College]] in [[London]].<ref name="UNDER">Underwood, AS. <u>An inquiry into the anatomy and pathology of the maxillary sinus</u>. ''J Anat Physiol'' 1910;44:354-369.</ref>  The presence of septa at or near the floor of the sinus are of interest to the [[dentist|dental clinician]] when proposing or performing [[sinus lift|sinus floor elevation procedures]] because of an increased likelihood of [[surgical complication]]s, such as tearing of the [[Schneiderian membrane]].<ref>Boyne, P; James, RA. <u>Grafting of the maxillary sinus floor with autogenous marrow and bone</u>. ''J Oral Maxillofac Surg'' 1980;38:113–116.</ref>
+==Anatomy==
+Underwood's septa are named after Arthur S. Underwood, who first described them in the late 19th century. They are typically found in the floor of the maxillary sinus and can be classified based on their location and orientation:
-The [[prevalence]] of Underwood's septa in relation to the floor of the maxillary sinus has been reported at nearly 32%.<ref name="ULM">Ulm, CW, et al. <u>Incidence and suggested surgical management of septa in sinus-lift procedures</u>. ''Int J Oral Maxillofac Implants'' 1995;10:462–465.</ref>
+* '''Primary septa''': These are congenital and are formed during the development of the maxilla. They are usually oriented in a transverse direction.
+* '''Secondary septa''': These develop as a result of the pneumatization process of the maxillary sinus, which occurs after the eruption of the [[permanent teeth]].
-==Location of septa in the sinus==
+==Function==
-Underwood divided the maxillary sinus into three regions relating to zones of distinct tooth eruption activity: anterior (corresponding to the premolars), middle (corresponding to the first molar) and posterior (corresponding to the second molar).  Thus, he asserted, these septa always arise between teeth and never opposite the middle of a tooth.<ref name="UNDER"/>
+The primary function of Underwood's septa is to provide structural support to the maxillary sinus. They help in maintaining the shape and volume of the sinus cavity, which is essential for its physiological functions, including:
-Different studies reveal a different predisposition for the presence of septa based on sinus region:
+* [[Respiration]]: The maxillary sinus plays a role in humidifying and warming the air we breathe.
-* Anterior: Ulm, et al.,<ref name="ULM"/> Krennmair et al.<ref name="KRENNMAIR">Krennmair G, et al. <u>The incidence, location, and height of maxillary sinus septa in the edentulous and dentate maxilla</u>. ''J Oral Maxillofac Surg'' 1999;57:667-71.</ref>
+* [[Olfaction]]: It contributes to the resonance of the voice and the sense of smell.
-* Middle: Velásquez-Plata et al.,<ref>Velásquez-Plata D, et al. <u>Maxillary sinus septa: a 3-dimensional computerized tomographic scan analysis</u>. ''Int J Oral Maxillofac Implants''. 2002;17:854-60.</ref> Kim et al.<ref>Kim MJ, et al. <u>Maxillary sinus septa: prevalence, height, location, and morphology: A reformatted computed tomography scan analysis</u>. ''J Periodontol'' 2006;77:903-8.</ref> and González-Santana et al.<ref>González-Santana H, et al. <u>A study of the septa in the maxillary sinuses and the subantral alveolar processes in 30 patients</u>. ''J Oral Implantol'' 2007;33:340-3.</ref>
+* [[Protection]]: The sinus acts as a buffer against facial trauma.
-* Posterior: Underwood<ref name="UNDER"/>
-==Primary vs. secondary septa==
+==Clinical Significance==
-Recent studies have classified two types of maxillary sinus septa: primary and secondary.  ''Primary septa'' are those initially described by Underwood and that form as a result of the floor of the sinus sinking along with the roots of [[tooth eruption|erupting teeth]]; these primary septa are thus generally found in the sinus corresponding to the space between teeth, as explained by Underwood.  Conversely, ''secondary septa'' form as a result of irregular pneumatization of the sinus following loss of maxillary posterior teeth.<ref name="KRENNMAIR"/>  ''Sinus pneumatization'' is a poorly understood phenomenon that results in an increased volume of the maxillary sinus, generally following maxillary posterior tooth loss, at the expense of the bone which used to house the roots of the maxillary posterior teeth.
+Underwood's septa are of particular interest in [[dentistry]] and [[oral surgery]], especially in procedures involving the maxillary sinus, such as [[sinus lift]] surgeries and [[dental implant]] placements. The presence of septa can complicate these procedures by increasing the risk of [[sinus membrane]] perforation.
-==References==
+===Imaging and Diagnosis===
-{{reflist}}
+The presence and characteristics of Underwood's septa can be evaluated using various imaging techniques, including:
-{{adapted}}
+* [[Panoramic radiography]]
-{{stub}}
+* [[Computed tomography]] (CT)
-{{dictionary-stub1}}
+* [[Cone beam computed tomography]] (CBCT)
+These imaging modalities help in pre-surgical planning by providing detailed information about the anatomy of the maxillary sinus and the location of septa.
+===Surgical Considerations===
+During sinus lift procedures, the presence of Underwood's septa requires careful surgical planning. Techniques such as the lateral window approach or the transcrestal approach may need to be modified to accommodate the septa and minimize complications.
+==Research and Studies==
+Recent studies have focused on the prevalence and morphological variations of Underwood's septa in different populations. These studies aim to improve the understanding of sinus anatomy and enhance the safety and efficacy of surgical interventions involving the maxillary sinus.
+==See Also==
+* [[Maxillary sinusitis]]
+* [[Dental implant]]
+* [[Sinus lift]]
+{{dentistry}}
+[[Category:Anatomy]]
+[[Category:Dentistry]]
+[[Category:Oral and maxillofacial surgery]]
+<gallery>
+File:UnderwoodCollage.jpg|Underwood's septa
+</gallery>