Maxillary Sinusitis: Why Cheekbone Pain and Blocked Nose May Be Coming from Your Sinuses

By Dr Vyas M.N. Prasad, FRCS (ORL-HNS) Consultant Otolaryngologist & Head and Neck Surgeon, Camden Medical Centre, Singapore

The maxillary sinuses are the largest of the four sinus pairs and the most commonly affected in sinusitis — causing cheekbone pressure, nasal blockage, and tooth pain that is frequently misattributed to dental problems. Dr Vyas Prasad explains the causes, including the underrecognised dental connection, how maxillary sinusitis is diagnosed, and when surgery is the right next step.

• The maxillary sinuses are the largest and most commonly affected in sinusitis

• Symptoms include cheekbone pressure, nasal blockage, and tooth pain often mistaken for dental problems

• A dental connection is frequently overlooked as a trigger

• This post explains causes, diagnosis, and when surgery is considered

The maxillary sinuses sit behind the cheekbones on either side of the face. When their drainage pathways become blocked — through infection, allergy, polyps, or anatomical factors — mucus accumulates, producing the characteristic pressure, pain, and nasal blockage of maxillary sinusitis.

The maxillary sinuses are the largest of the four paired sinus cavities — and the most commonly affected in sinusitis. They sit behind the cheekbones, one on each side, and when they become inflamed or infected, the symptoms are often mistaken for toothache, tension headache, or a persistent cold that won't resolve.

This matters because the treatment for sinusitis is fundamentally different from the treatment for those other conditions. Patients who spend months on dental referrals or analgesics for what is actually maxillary sinus disease are not uncommon in my clinic. The diagnosis, once made, often comes as a relief — because it explains a great deal, and because the options for treatment are clear.

What are the maxillary sinuses?

The sinuses are air-filled spaces within the facial bones. There are four pairs: maxillary (cheekbones), frontal (forehead), ethmoid (between the eyes), and sphenoid (deeper, behind the nose). The maxillary sinuses are the largest, with a volume of around 15ml each in adults.

They connect to the nasal cavity through a small opening called the ostium. When this drainage pathway becomes blocked — through inflammation, infection, polyps, or anatomical narrowing — mucus accumulates within the sinus, creating the environment for infection and the characteristic pressure symptoms that patients describe.

What causes maxillary sinusitis?

Sinusitis is inflammation of the sinus lining. In the maxillary sinuses specifically, the most common triggers are:

Viral upper respiratory infections — the common cold frequently causes temporary sinus inflammation. In most cases this is self-limiting. When it persists beyond ten days, or worsens after initial improvement, bacterial infection should be considered.

Allergic rhinitis — ongoing nasal allergy causes chronic mucosal swelling that can obstruct the sinus ostia, creating conditions for recurrent or persistent sinusitis. Managing the underlying allergy is a key part of managing the sinusitis.

Anatomical factors — a deviated septum, enlarged turbinates, or a narrowed drainage pathway can impair normal sinus ventilation and mucus clearance, making some individuals structurally predisposed to recurrent episodes.

Nasal polyps — benign, non-cancerous growths from the sinus or nasal lining that can obstruct drainage. They are strongly associated with chronic sinusitis and, in some patients, with aspirin sensitivity and asthma.

Dental causes — the roots of the upper back teeth sit in close proximity to the floor of the maxillary sinus. Dental infections, failed root canal treatment, or previous extractions can seed bacteria directly into the sinus — a pattern called odontogenic sinusitis, which typically affects one side only and is more common than many clinicians expect.

What does maxillary sinusitis feel like?

The symptoms vary depending on whether the episode is acute or chronic, but the most consistent features are:

• Facial pressure or pain over the cheeks, sometimes radiating to the upper teeth or the forehead

• Nasal blockage, often worse on one side

• Thick or discoloured nasal discharge, or post-nasal drip

• Reduced or altered sense of smell

• A sense of fullness or heaviness across the mid-face

• Fatigue, particularly in chronic cases

In acute sinusitis, symptoms are typically more pronounced and may be accompanied by fever. Chronic sinusitis — defined as symptoms persisting beyond twelve weeks — tends to produce a lower-grade, persistent burden of symptoms that patients often adapt to without realising how much it is affecting their daily function and sleep.

The cheekbone pain is frequently described as a dull, deep ache that worsens on bending forward or lying down — positions that increase pressure within the sinus cavity. When upper tooth pain is the dominant symptom without any obvious dental cause, maxillary sinusitis should be on the differential.

How is it diagnosed?

Clinical history and examination are the starting point. In clinic, nasal endoscopy — a brief, well-tolerated procedure using a thin telescope — allows direct visualisation of the nasal cavity, the drainage pathways, and the area around the maxillary sinus opening. This takes only a few minutes and provides information that examination alone cannot.

Where symptoms are persistent or surgical treatment is being considered, a CT scan of the sinuses is the imaging of choice. It defines the anatomy clearly — the extent of mucosal disease, the drainage pathways, the position of the septum, and any anatomical variants that are relevant to management. It is not routinely needed for a first episode of uncomplicated acute sinusitis.

What are the treatment options?

Treatment is guided by the underlying cause, the duration and severity of symptoms, and what has already been tried.

For acute sinusitis, the majority of cases are viral and resolve without antibiotics. Saline nasal irrigation, steam inhalation, and nasal decongestants for short-term use support symptom management while the infection resolves. Antibiotics are appropriate when bacterial infection is confirmed or strongly suspected, and when symptoms are severe or deteriorating.

For chronic sinusitis, the approach is more structured. Nasal steroid sprays are the cornerstone of medical management — they reduce mucosal inflammation and can significantly improve symptoms over weeks to months. Saline irrigation supports mucosal clearance. Allergy assessment and management is important where allergic rhinitis is a contributing factor.

When medical management does not deliver adequate control, or when anatomical factors are clearly contributing, surgery is considered. Functional Endoscopic Sinus Surgery (FESS) is performed entirely through the nostrils — no external incision — and aims to widen the natural drainage pathways of the sinuses, restore ventilation, and allow mucosal recovery. It is performed under general anaesthesia and most patients go home the same day.

For odontogenic maxillary sinusitis, the dental cause must be addressed as part of treatment — sinus surgery alone is insufficient if a dental source of infection remains.

When should you see a specialist?

A GP is an appropriate first point of contact for an initial episode of sinusitis. Consider ENT assessment if:

• Symptoms have persisted beyond twelve weeks despite treatment

• You have had more than three or four episodes in a year

• Facial pain or pressure is severe or worsening

• There is one-sided nasal blockage or discharge (particularly if blood-stained)

• Smell has been significantly affected

• You are considering surgery or want a clearer anatomical picture of what is happening

One-sided symptoms in particular warrant timely assessment — while the cause is usually benign, it is important to exclude less common but significant diagnoses.

A note on the Maxillary Sinusitis Masterclass

I delivered a clinical masterclass on maxillary sinusitis through Nuffield Academy, which has been shared widely on social media. It covers the anatomy, the diagnostic approach, and the surgical considerations for complex cases in more depth than is appropriate for a patient-facing post. If you are a clinician who has come across this article, the masterclass is available here.

If you have persistent sinus symptoms

The most important step is an accurate diagnosis. Maxillary sinusitis is very treatable — but treating it effectively depends on understanding why it is happening. A thorough assessment, including nasal endoscopy and imaging where appropriate, gives a much clearer picture than symptoms alone.

For a broader overview of nasal and sinus conditions and the treatment options available at Absolute ENT, visit the Nose and Sinus page.

Dr Vyas M.N. Prasad, FRCS (ORL-HNS), is a UK- and fellowship-trained Senior Consultant Otolaryngologist and Head & Neck Surgeon based at Camden Medical Centre, Singapore. He has subspecialty expertise in sinus surgery, voice, thyroid, and head and neck conditions, and has contributed to international publications and conferences in ENT.

Absolute ENT — Camden Medical Centre, 1 Orchard Boulevard #09-08, Singapore 248649 WhatsApp: +65 8060 8079 | Email: camden.mmc@gmail.com