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BDS4 Oral Surgery > 9 - Maxillary sinuses > Flashcards

9 - Maxillary sinuses Flashcards

1
Q

What are the sinuses in the skull?

A
  • frontal
  • ethmoidal air cells
  • sphenoid
  • maxillary
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2
Q

What is the function of the paranasal sinuses?

A
  • resonance of voice
  • warm inspired air (via their blood supply)
  • reduce weight of skull
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3
Q

Describe the maxillary sinus.

A
  • the largest air sinus
  • also known as the maxillary antrum
  • pyramid shaped cavity within the maxilla
  • average 15ml volume
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4
Q

Describe the openings of the maxillary sinus.

A
  • middle meatus also known as ostia
  • opening is 4mm
  • located superiorly on medial wall of sinus
  • mucosa lined
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5
Q

Describe the relationship of the maxillary roots and the maxillary sinus.

A
  • can sometimes project into floor of maxillary sinus
  • roots can perforate bone so that only mucosa covers them
  • sometimes the bone is very thin, this is only of concern if an extraction is required or there is pathology assoicated with the roots
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6
Q

Describe the epithelium of the sinus.

A

Pseudostratified ciliated columnar epithelium

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7
Q

What is the function of the cilia in the epithelium of the maxillary sinus?

A
  • mobilise trapped particulate matter and foreign material in the sinus
  • move material towards the ostia for elimination via the nasal cavity
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8
Q

What is the clinical significance of the maxillary sinus in dentistry?

A
  • OAC
  • OAF
  • root in antrum
  • sinusitis
  • benign and malignant lesions
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9
Q

How do you diagnose an OAC/F?

A
  • size of tooth
  • radiograph position of roots
  • bone at trifurcation of roots
  • bubbling of blood
  • nose holding test (caution)
  • direct vision with good light
  • echo with suction
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10
Q

How do you manage an OAC?

A
  • inform patient
  • if small or lining intact, encourage clot and suture, give POI
  • if large or lining torn, close with buccal advancement flap
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11
Q

Describe the flap design for a buccal advancement flap.

A
  • relieving incisions should be parallel (ish) medial and distal up towards the buccal sulus
  • raise the flap
  • trimming buccal bone is sometimes required
  • incise/score periosteum to ensure flap can be closed without tension (fresh blade)
  • suture socket and relieving incisions
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12
Q

How may patients present with an OAF?

A
  • fluid comes out their nose when they drink fluids
  • nasal quality of speech
  • issues playing instruments
  • smoking/using straw difficult
  • bad taste/odour or post nasal drip
  • pain/sinusitis symtoms
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13
Q

How do you manage an OAF?

A
  • excise sinus tract prior to performing buccal advancement flap
  • antral washout sometimes performed (unpleasant for patent but aids with sinus cleanse)
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14
Q

What are the different flap design options for closing an OAC/F?

A
  • buccal advancement flap
  • buccal fat pad with buccal advancement flap
  • palatal flap
  • bone graft/collagen membrane
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15
Q

Describe a buccal fat pad with buccal advancement flap.

A
  • incisions are extended into buccal sulcus
  • buccal fat is pulled down from fat pad
  • fat is sutured into socket with dissolving stitches
  • buccal advancement flap as normal
  • can result in facial asymmetries
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16
Q

Describe a palatal flap.

A
  • flap design cut into palate
  • rotated to cover socket
  • sutured into place
  • can be very painful as exposed bone is left where flap was cut
17
Q

What are the causes of maxillary tuberosity fracture?

A
  • single standing molar
  • unknown unerupted molar/wisdom tooth
  • pathological gemination/concrescence
  • extracting in wrong order
  • inadequate alveolar support
18
Q

What is the correct order for extracting upper teeth?

A

Start most posterior

19
Q

How do you diagnose a fractured tuberosity?

A
  • noise
  • movement visually or by supporting hand
  • more than one tooth moving
  • tear in soft tissue of palate
20
Q

How do you manage a fractured tuberosity?

A
  • reduce and stabilise with orthodontic buccal arch wire bonded with acrylic
  • dissect out and close wound primarily
  • if there is adequate support, then fracture can be noted early and intervention put in place (ie reduce rather than dissect)
21
Q

If the fractured tuberosity is splinted, what are the next steps?

A
  • extirpate pulp
  • ensure tooth is out of occlusion
  • consider antibiotics
  • POI
  • remove tooth surgically 4-8 weeks later
22
Q

How do you diagnose a root in the antrum?

A

Confirm radiographically +/- CBCT

23
Q

How can roots in the antrum be retrieved?

A
  • via extraction socket with suction and small curettes (close as OAC)
  • Caldwell-Luc approach via buccal window in buccal sulcus
  • ENT
24
Q

What are the causes of sinusitis?

A
  • viral infection (inflammation and oedema block ostia)
  • mucociliary clearance pattern altered by allergens, inflammation
  • stagnation of normal flora (overgrowth)
25
Q

What are the signs and symptoms of sinusitis?

A
  • facial pain/headache
  • pressure
  • congestion/nasal obstruction
  • paranasal drainage
  • hyposmia
  • fever/fatigue
  • dental pain/ear pain
  • halitosis
  • cough
26
Q

What dental causes can present similarly to sinusitis?

A
  • periapical abscess
  • periodontal infection
  • deep caries
  • recent extraction socket
  • TMD
  • neuralgia
27
Q

What findings on examination indicate sinusitis?

A
  • discomfort on palpation of infraorbital region
  • diffuse pain in maxillary teeth
  • equal TTP of multiple teeth in same region
  • pain worsens with head movement
28
Q

What is the management of sinusitis?

A
  • decongestants to reduce mucosal oedema (ephedrine nasal drops)
  • humidified air
29
Q

What risk is associated with the use of ephedrine nasal drops?

A

Causes atrophy of the lining (do not use for more than 7 days)

30
Q

When can antibiotics be prescribed for sinusitis?

A
  • signs and symptoms point to bacterial sinusitis (usually viral cause)
  • amoxicillin 500mg TID for 7 days
  • doxycycline 100mg once daily for 7 days with 200mg loading dose
31
Q

How do fungal infections affect the sinuses?

A
  • rare
  • can be cause of non resolving sinusitis
  • can cause expansion of bony walls by increased mucus secretion and fungal growth
32
Q

How does trauma cause sinusitis?

A

Violating the integrity of the bony cavity and sinus membrane

33
Q

What can cause trauma to the maxillary sinuses?

A
  • sinus wall fracture
  • orbital floor fracture
  • RCT
  • tooth extractions
  • dental implants/sinus lifts
  • deep perio treatment
  • nasal packing
  • NG tubes
  • nasal intubation
34
Q

What other pathology should be considered in the sinuses?

A
  • bengin sinus lesions (polyps, mucoceles, mucous retention cysts)
  • odontogenic cysts/odontogenic tumours expanding into sinus
  • malignant lesions

BDS4 Oral Surgery (22 decks)

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