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aa BDS M6 - Oral surgery > Management of the maxillary antrum > Flashcards

Management of the maxillary antrum Flashcards

1
Q

Why is the maxillary sinus important in dentistry?

A
  • roots of the upper molars/ premolars closely related to the antrum and share a common innervation
  • peri-operative complications such as OA communication, roots in antrum, fracture tuberosity, extruded root canal materials
  • sinus pathology can cause symptoms like toothache - most commonly dentists are asked to establish if the pain is of dental or antral origin
  • sinus pathology can present in the mouth or may be seen on a dental radiograph
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2
Q

What is a worrying sinus pathology that can present inside the mouth?

A

maxillary sinus cancer - can cause erosion of the bone into the mouth and present as an intra-oral lesion

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3
Q

What may a maxillary sinus cyst cause in the mouth?

A

displacement of teeth and a communication between the sinus and the mouth

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4
Q

What are the paranasal sinuses?

A
  • air-containing sacs lines by ciliated epithelium communicating with the nasal cavity
  • 4 pairs - frontal, ethmoid, sphenoid, maxillary
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5
Q

Label these

A
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6
Q

What is the general shape and volume of the maxillary sinus?

A

pyramidal shape, volume of 15-30ml

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7
Q

What measurements is the largest maxillary sinus?

A

3.5 x 2.5 x 3.2cm

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8
Q

Where is the floor of the maxillary sinus in relation to the nasal floor?

A

12mm below

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9
Q

When does the maxillary antrum develop, and at what ages does it reach key sizes?

A

develops at 3 months IUL, 30% size by 9yrs, full size 18yrs and continues to enlarge as we age

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10
Q

What anatomy is the maxillary sinus related to?

A

the orbit, infra-orbital nerve, nasolacrimal duct, posterior teeth and lateral wall of the nose, pterygopalatine fossa and maxillary artery

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11
Q

Where does the maxillary sinus drain?

A

into the middle meatus through a 2.4mm diameter ostium which is two thirds up the medial wall of the sinus

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12
Q

What is the physiological role of the maxillary sinus?

A

poorly understood

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13
Q

What radiographs would be used to view the maxillary sinus?

A
  • occipitomental
  • DPT, periapicals
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14
Q

What imaging techniques would be used to view the maxillary sinus if you believed something was occupying it?

A

CT scan/MRI

endoscopy also commonly used now, antral tap used to be used to allow drainage

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15
Q

What pattern do the ciliated epithelium of the maxillary sinus beat in?

A

beat in spiralling pattern up to the ostium, against gravity

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16
Q

What is transillumination of sinuses?

A

scope with light put up the patient’s nose, if the sinus illuminates it is healthy, if not then it indicates there is something present in the sinus

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17
Q

What will extrusion of material through the root apex into the antrum result in?

A

as you have introduced a foreign body into a sterile cavity an inflammatory reaction will happen and the patient will likely get infection/sinusitis

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18
Q

What is the consequence and treatment of root displacement into the maxillary antrum?

A

by introducing foreign body covered in bacterial contaminants into the sterile antrum it will cause a bacterial infection, so you wouldn’t want to leave a displaced root in the sinus so surgery would be required to remove it, and because a communication has been created this will need to be closed

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19
Q

What does this CT scan show?

A

molar tooth displaced into the maxillary antrum

20
Q

What are the common pathologies of the maxillary sinuses?

A
  • infective sinusitis - bacterial, viral, fungal, 10% dental origin, OAF
  • non-infective sinusitis - allergic, vasomotor, septal deviation predisposes, foreign body (roots/teeth)
  • fractures
  • tumours/cysts
21
Q

What do most infective sinusitises follow on from?

A

viral infection e.g. a cold or the flu

22
Q

Usually what is acute infective sinusitis, and what bacteria commonly cause it?

A
  • bacterial infection which follows a viral infection
  • commonly caused by Strep. Pneumoniae, H. influenzae but Moraxella catarrhalis, Staph. Auereus and alpha haemolytic strep also found
23
Q

How is acute infective sinusitis diagnosed?

A

diagnosis on clinical grounds no need for radiograph other than radiographs used to rule out odontogenic infection

24
Q

Why does leaning forward worsen the pain felt in acute infective sinusitis?

A

the fluid in the sinuses will move forward and put pressure on the anterior superior alveolar nerve

25
Q

What are the signs and symptoms of acute infective sinusitis?

A

pain, tenderness across area worsens on bending over, without swelling, posterior teeth TTP, post nasal drip, mucoputulent discharge
- maxillary toothache
- poor response to nasal decongestants
- history of coloured discharge
- purulent nasal secretion

26
Q

What does this image show about the maxillary sinuses?

A

sinus on left full of mucopurelent discharge that isn’t discharging through the ostium

sinus on right also has a fluid level but not as full

27
Q

How is acute sinusitis managed?

A

most fit and healthy people only need something to encourage discharge of the sinus, something that will open up the ostium
- mucolytics, inhalation for 2 weeks
- antimicrobials only in severe cases or immunocompromised - need to be effective against penicillinase producing bacteria therefore augmentin, doxycycline, clarithromycin

28
Q

In order, what does the SDCEP ‘drug prescribing for dentists’ suggest to use for management of acute sinusitis?

A
  • inhalations to facilitate draining of the sinuses
  • epinephrine nasal drops 0.5% 3/day for 1 week
  • Pen V 500mg 4/day for 7 days
  • doxycycline 100mg for 1 week, 200mg on the first day
29
Q

What issues may predispose someone to sinusitis?

A

mechanical obstruction of ostium
- oedema of nasal mucosa
- polyps
- septal deviation

impaired mucus clearance
- poor ciliary action
- abnormally thick or sticky mucus (e.g. in cystic fibrosis)

30
Q

What is chronic sinusitis?

A

ongoing low-grade symptoms of sinusitis

31
Q

How may chronic sinusitis be treated?

A

drainage (antral lavage, intranasal antrostomy) and metronidazole with amoxycillin/erythromycin

32
Q

If an OAF is not present, what may chronic sinusitis be suggestive of?

A

immunocompromise

33
Q

What may chronic sinusitis be caused by?

A

OAF, possible anatomical drainage problem e.g. deviated nasal septum etc.

34
Q

What would be done if chronic sinusitis is being caused by an OAF?

A

surgical closure of OAF defect

35
Q

What is this?

A

antral mucocoele- cyst that has formed in the antral lining

36
Q

What may an antral cyst/mucocoele cause?

A

mechanical blockage of ostium restricting drainage, may result in chronic sinusitis

37
Q

What does this show?

A

mechanical obstruction of the ostium by a displaced root

38
Q

What are some significant complications of sinusitis?

A
  • brain abscesses
  • orbital cellulitis
  • cavernous sinus thrombosis
39
Q

What is OAC caused by?

A

caused following extraction of posterior teeth, tuberosity fracture, middle third fracture, also malignancy/pathology

40
Q

What are the symptoms of an OAC?

A

passage of fluid down nose, passage of air into mouth, alteration of voice, unilateral apistaxsis or nasal obstruction

41
Q

What will happen if an OAC which has not spontaneously closed by itself is left untreated?

A

fistula develops which can cause persistent sinusitis, unilateral nasal discharge, intra-oral antral polyp, cacogeusia and facial pain

42
Q

How is the risk of OAC assessed and consented for?

A
  • extracting any upper molars and occasionally premolars, particularly older patients as sinus increases in size as we age
  • if the radiograph suggests a close relationship
  • inform the patient of the risk, what to expect afterwards if this happens
  • outline how this complication is managed
43
Q

What do the yellow and blue arrows point to and what does this indicate?

A

yellow - where alveolus stops
blue - floor of sinus

superimposition of root apices over sinus

44
Q

If you know you have created an oro-antral communication what should you do?

A
  • ideally close immediately - buccal advancement flap
  • plate or modified denture
  • antibiotics, ephedrine drops, mucolytic inhalations
  • avoid nose blowing
  • if communication of greater than 5mm spontaneous closure unlikely
45
Q

Summary of management of maxillary sinuses lecture

A

aa BDS M6 - Oral surgery (10 decks)

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