42. Sinusitis Of Odondogenic Origin Flashcards
Sinusitis of odontogenic origin
- Inflammation of the paranasal sinuses =>
- Dental infections =>
- Due to its proximity to the upper teeth
Etiological factors of sinusitis
- Dental Infections=> Periapical abscesses, severe periodontitis, peri-implantitis, and post-extraction infections
- Trauma=>displacement of foreign bodies (teeth, roots, implants, bone fragments, bone grafts, endodontic materials, broken instruments)
- Proximity of Tooth Roots to the Sinus Floor=> Premolar and molar roots are closest to the sinus floor
Clinical features of acute odontogenic sinusitis
- Dull or intense pressure-like pain=>
- Erythema, swelling of the cheek and anterior maxilla
- Full like symptoms
- Postnasal drip, nasal congestion
- Tooth ache=> If periapical cause
Post nassal drip-drainage of foul-smelling mucopurulent material into the nasal cavity and nasopharynx
Symptoms of chronic odontogenic sinusitis
- Little or no systemic upset
- Persistent malodor
- Pus discharge from oroantral fistula,
- Nasal congestion=> discharge
- Toothache during chewing=>
- Increased mobility of teeth
- Some cases may be symptom-free
Odontogenic sinusitis diagnosis
- Clinical Examination
- Imaging panoramic and CT scans=>
- show thickened antral mucosa and fluid accumulation with lower translucency in the affected sinus
- Blood Tests=>Increased leukocyte count and elevated CRP level=>
- Acute cases
- Otolaryngological Evaluation=>Rhinoscopy, nasal and sinus endoscopy
- Chronic cases generally show little change in blood test parameters.
Treatment for acute odontogenic sinusitis
- Antimicrobial Therapy
- Analgesics and antihistamines=>Pain Relief and Edema Reduction
- Drainage: To reduce pain, prevent progression
- Dental Procedures=>Early extraction or endodontic treatment
- Nasal Treatment
- Sinus Endoscopy
-Antimicrobials-penicillin, clindamycin, and metronidazole
-Nasal Treatment: Insertion of gauze with ephedrine and lidocaine into the nasal mucosa to relieve congestion and promote pus drainage.
-Sinus Endoscopy enlarge and drain channels if necessary
Treatment for chronic odontogenic sinusitis
- Antibiotic Therapy and Surgery=> Similar to acute
- Frequent Irrigation=>Of sinus cavity via oroantral fistula=>
- Surgical closure once sinusitis cured
- Surgery
Surgical treatments for odontogenic sinusitis
- Caldwell-Luc Procedure
- Endoscopic Surgery
Caldwell-Luc Procedure
- Removal of the antral lining and creation of a new drainage opening=>
- Allows inspection and removal of abnormal tissue or foreign bodies
- Disadvantage=> Increased recovery time
- Blood loss, postoperative pain
- Facial swelling, and potential recurrence due to sinus scarring
Endoscopic Surgery
- Using fiberoptic technology=>
- Visualize and clear the antral condition with minimal surgical wounds
- Opens natural drainage channels and restores normal sinus function=>
- Less swelling and discomfort post-surgery
Adjuvant treatments for odontogenic sinusitis
- Surgical Removal of Foreign Bodies=>
- Small retrieved with forceps or suction
- If difficult=>the Caldwell-Luc operation
- After removal=> sinus washed with saline, and antibiotics are administered
Sinus walls
- Upper wall (facies orbitalis)
- Lower wall (facies alveolaris)
- Posterior wall (facies dorsalis)
- Front wall (facies anterior)
- Medial wall (facies nasalis)
- Lateral wall (facies lateralis)
Membrane of the maxillary sinus
Schneiderian membrane→ covered
by pseudo - stratified columnar ciliated epithelium
Vascularisation of Maxillary sinus
- Posterior superior alveolar artery
- Greater palatine artery
- Infraorbital artery
- Posterior lateral nasal artery
Innervation of maxillary sinus
Posterior, middle and anterior superior alveolar nerves
