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BDS4 Oral Surgery > Maxillary Sinus > Flashcards

Maxillary Sinus Flashcards

1
Q

What are the different air sinus present in the skull?

A

Frontal

Ethmoid

Sphenoid

Maxillary

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2
Q

When does formation of the sinuses occur?

A

During 3rd and 4th foetal months, with evaginations of the mucosa of the nasal cavity

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3
Q

Which sinuses are most well formed at birth?

A

Maxillary and ethmoid

-> others undergo expansion in first few years of life

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4
Q

What are the functions of the sinuses?

A

Provide resonance to the voice

Reserve chambers for warming inspired air

Reduce the weight of the skull

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5
Q

Which sinuses are the largest?

A

Maxillary

-> pyramid shaped cavity in both sides of maxilla

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6
Q

What are the dimensions of the maxillary sinus?

A

Volumetric space- 15ml in average adult

Average dimensions:
37mm high
27mm wide
35mm antero-posteriorly

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7
Q

What is the name for the opening of the maxillary sinus and where is it located?

A

Ostium- located in the medial wall and opens into middle meatus at the hiatus semilunaris

-> approx 4mm in diameter

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8
Q

What can disease and inflammation within the sinus do to the ostium?

A

Cause blockage or narrowing

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9
Q

Where is the alveolar canal found, what is contained within it?

A

Posterior wall of sinus cavity
-> contains posterior superior alveolar nerves and vessels

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10
Q

How are the roots of the teeth related to the floor of maxillary sinus?

A

Roots of maxillary molars and sometimes premolars may project into the floor of the maxillary sinus

The roots may perforate the bone so that only the mucosal lining of the sinus covers them

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11
Q

Which type of epithelium lines the maxillary sinus?

A

Pseudostratified ciliated columnar epithelium

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12
Q

What are the functions of cilia in maxillary sinus?

A

Mobilise trapped particulate matter and foreign material within the sinus
-> cilia beat to move this material toward the ostia for elimination into the nasal cavity

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13
Q

What are the potential dental related pathologies associated with the maxillary sinus?

A

Oro-Antral Communication (OAC)- Acute

Oro-Antral Fistula (OAF)- Chronic

Root in the antrum

Sinusitis

Benign Lesions

Malignant Lesions

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14
Q

When can an OAC occur?

A

When roots are closely associated/perforate sinus and extraction causes communication (breaking bone or lining) between maxillary sinus and oral cavity

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15
Q

What are the clinical signs of an OAC?

A

 Splayed roots/trifurcations (problematic)- you may see bone on removal
 Bubbling of blood in socket- air coming from socket
 Nose holding test- hold nose and get patient to blow (be gentle as this can tear the lining)
 Direct vision- seen as black hole
 Echo on suction
 Prolapsed lining coming through into socket

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16
Q

What aspects on radiographs or clinical examination suggest an OAC is more likely to occur?

A

Lone standing molars (predictor for OAC or fractured tuberosity)

Bone of sinus may be wrapped around/closely associated with tooth roots

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17
Q

How are small OACs managed?

A

Inform patient

If less than 2mm:
Encourage clot
Suture margins

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18
Q

Which post-op instructions are given following the closure of an OAC?

A

Avoid blowing nose, avoid balloons, avoid singing, avoid sucking through straws (avoid extra pressure)

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19
Q

How are larger OACs managed?

A

Closed with buccal advancement flap- 3 sided 2 relieving (less flared than normal) and one crestal

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20
Q

How is a buccal advancement flap carried out?

A

 Raise full thickness-incise periosteum with 15 blade to loosen
 Bring flap across communication with minimal tension (should stay in position freely)
 Buccal bone may need to be trimmed
 Suture- previously using silk stitches (2 weeks), now dissolvable can be used (may loosen too soon)
 1st stitch- tacking, then placed on relieving incisions etc (aiming for primary closure)

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21
Q

What can occur to the sulcus when you take a BAF?

A

It can reduce in depth

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22
Q

What is an OAF?

A

Chronic version of an OAC (fails to heal)- occurs when communication becomes an epithelium lined tract

-> no bleeding
-> appears as small hole

23
Q

What are the symptoms of an OAF?

A

Problems with fluid consumption (fluids from nose)

Problems with speech or singing (nasal quality)

Problems playing brass/wind instruments

Problems smoking cigarettes or using a straw

Bad taste/odour/halitosis/pus discharge (post-nasal drip)

Pain/sinusitis type symptoms (

24
Q

How is an OAF managed?

A

 Manage in the same way as OAC (close with BAF) but excise tract first
 Cut vertically to remove this tube of epithelium which facilitated the chronic communication
 Often associated with pus and sinusitis (flush the antrum with water and suction)- can be unpleasant for patient

25
Q

What other flap options may be used if BAF fails?

A

Buccal Fat Pad with Buccal Advancement Flap

Palatal Flap

Bone Graft/Collagen Membrane

Rotated Tongue Flap (Historical)

26
Q

How is a buccal fat pad with BAF flap carried out?

A

 When incising Include buccal fat pad- go further into sulcus and reach fatty tissue (yellow/globular) and pull this down and suture (then put buccal flap on top)

-> May get more bruising, can get more prominent cheek bone following

27
Q

How is a palatal flap carried out, why is it less likely to be used?

A

Incise finger shaped flap on palate and put over hole
-> pain due to exposed bone on palate

28
Q

Which factors are involved in the aetiology of fractured maxillary tuberosity?

A

Extraction of single standing molar

Unknown unerupted molar or wisdom tooth

Pathological gemination/concrescence

Extracting in wrong order (should extract back to front to avoid this)

Inadequate alveolar support

29
Q

What is also likely to occur upon fracture of the tuberosity?

A

OAC formation

30
Q

Why is it so important to support the alveolar bone when extracting molars in the maxilla?

A

Helps you notice if maxilla is moving with tooth- you can stop and manage at this point

31
Q

What are the signs of a fractured tuberosity?

A

Noise

Movement noted both visually or with supporting fingers

More than one tooth movement

Tear in soft tissue of palate

32
Q

What are the management options for fractured tubersotiy?

A

If caught before extraction- reduce and stabilise with:
Orthodontic buccal arch wire with composite
Arch bar
Splints (lab-made)

Dissect out and close wound primarily

33
Q

What are the steps of managing a fractured tuberosity if it has been splinted?

A

Remove or treat pulp

Ensure it is out of occlusion

Consider antibiotic and antiseptics

Post-op instructions

Remove the tooth surgically 4-8 weeks later

34
Q

How is management of root/tooth in the antrum decided on?

A

 Localise using radiographs- usually OPT, occlusal or PA
 If planning to retrieve CBCT (ideally on day of surgery- so tooth hasn’t moved)
 If in doubt/difficult retrieval- refer

35
Q

When may a root lost in the area of the antrum be left?

A

If wedged between bone and lining of antrum (least likely to cause problems/sinusitis)

36
Q

What are the stages in the retrieval of root in the antrum via the socket approach?

A

Open fenestration with care

Suction – efficient and narrow bore

Use of Small curettes, irrigation or ribbon gauze

Close as for Oro-Antral communication

37
Q

What is the Caldwell Luc approach?

A

 Caldwell Luc approach- Incise sulcus and drill hole (buccal window) in bone

38
Q

What can be done if all other approaches fail when trying to retrieve root from antrum?

A

ENT- endoscopic retrieval

39
Q

What are the causes of sinusitis?

A

Most are precipitated by the effects of a viral infection
-> Inflammation and oedema
-> Obstruction of ostia
-> Trapping of debris within sinus cavity

Alteration of mucociliary clearance patterns caused by:
-> Allergens
-> Inflammation
-> Anatomic abnormalities

40
Q

What can occur as a result of sinusitis?

A

Pressure build up

Bacteria (normal flora) can stagnate and grow in the sinus and cause super-infection (Opportunistic- AB may help at this point)

41
Q

What are the signs and symptoms of sinusitis?

A

Facial pain
Pressure
Congestion (fullness)
Nasal obstruction
Paranasal drainage
Hyponosmia
Fever
Headache
Dental pain
Halitosis
Fatigue
Cough
Ear pain
Anaesthesia / paraesthesia over cheek

42
Q

What are the dental causes which can produce similar symptoms to sinusitis?

A

Periapical abscess

Periodontal infection

Deep caries

Recent extraction socket

TMD

Neuralgia or atypical facial pain / chronic midfacial pain

43
Q

What are the indicators for diagnosis of sinusitis in a dental setting?

A

Discomfort on palpation of infraorbital region

Diffuse pain in the maxillary teeth- all TTP

Pain that worsens with head or facial movements (on jumping)

44
Q

What are the treatment aims when managing sinusitis?

A

Treat presenting symptoms

Reduce tissue oedema

Reverse obstruction of the ostia

45
Q

What treatments are available for sinusitis?

A

Decongestants reduce mucosal oedema
-> Ephedrine nasal drops 0.5% one drop each nostril up to three times daily when required (use for a maximum of 7 days)

Humidified air is also helpful (steam/menthol inhalations)

46
Q

Why can ephedrine only be used short term?

A

Causes atrophy in lining of nose and sinuses

47
Q

When are AB considered to treat sinusitis?

A

If symptomatic treatment is not effective/symptoms worsen

AND

Signs and symptoms point to a bacterial sinusitis

48
Q

Which AB are used to treat bacterial sinsuitis?

A

Amoxicillin 500mg, three times a day, for 7 days
or
Doxycycline 100mg, once a day, for 7 days (200mg loading dose)

49
Q

What can fungal sinusitis result in?

A

Expansion of the bony walls by increased mucus secretion and fungal growth

50
Q

How can trauma cause sinusitis?

A

When the integrity of the bony cavity and sinus membrane is violated

51
Q

What are examples of traumatic causes of sinusitis?

A

Sinus wall fractures

Orbital floor fractures

Root canal therapy

Tooth extractions

Dental Implants / Sinus lifts

Deep periodontal treatment

Nasal packing

Nasogastric tubes

Mechanical (nasal) intubation (GA for dental treatment)

52
Q

Which benign lesions can occur in maxillary sinus?

A

Polyps

Papillomas
Antral pseudocysts

Mucoceles

Mucous retention cysts

Odontogenic cysts /odontogenic tumours expanding into the maxillary sinus

53
Q

Which malignant lesions can occur in maxillary sinus?

A

Primary tumours- of bone or lining

Local spread from adjacent sites

BDS4 Oral Surgery (19 decks)

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