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5th Oral Disease - Other > Maxillary Antrum > Flashcards

Maxillary Antrum Flashcards

1
Q

What is the maxillary antrum?

A

The largest paranasal sinus

Pyramidal shaped and bilateral

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2
Q

What is maxillary antrum lined with?

A

Respiratory epithelium = ciliated pseudostratified columnar epithelium

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3
Q

4 functions of maxillary antrum?

A

Reduce weight of skull
Voice resonance
Humidification
Mucous production

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4
Q

How does maxillary antrum drain?

A

Drain into nose via ostium (half way up medial wall)
Efficient cilia beat towards ostium

NOT DEPENDENT ON GRAVITY

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5
Q

What are the anatomical borders of the antrum?

A

Infraorbital border - superior
Alveolar process - inferior
Lateral wall of nose - medial
Zygoma - lateral

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6
Q

What nerve bundle transverse the roof of antrum?

A

Infraorbital bundle in orbital floor

Branch of maxillary nerve from trigeminal

Sensory innervation - skin lower eyelid, side of nose, nasal septum, part of cheek and upper lip
No motor

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7
Q

What features would you see on medial wall of sinus?

A

Middle and inferior turbinates

Ostium - cilia push mucous = drainage

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8
Q

What features would you see on the floor of the sinus?

A

Alveolar process of maxilla and the hard palate

Close to apices of teeth

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9
Q

Is there a difference in the floor of the sinus in children and adults?

A

In children alveolus adjacent to nasal floor

In adults 5-10mm lower

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10
Q

What would you expect to see on the anterior wall of the maxilla?

A

The cheek
Thinnest part - good surgical access
Canine fossa

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11
Q

What is an OAC?

A

Open communication between oral cavity and maxillary sinus

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12
Q

Where does floor of sinus extend?

A

Often molar region to canine

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13
Q

Where is OAC most likely?

A

Palatal root of first molar

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14
Q

What roots have RFs for OAC?

A

Long, divergent, dilacerated or ankylosed roots

Hypercementosis

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15
Q

What are other RFs for OAC?

A 
Lone standing molar
Loss apical periodical bone
Pneumatisation of sinus 
Impacted upper molar
Cleft lip and palate
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16
Q

What operator technique are RF for OAC?

A

Poor technique - excessive force, wrong instruments
Displacement of foreign object into sinus
Tuberosity fracture

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17
Q

What pt factors post surgery could lead to OAC?

A

Failure to follow antra regime

Build up of pressure in cavity - nose blowing, sneezing, altitude

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18
Q

What teeth are at most clinical risk?

A 
Upper second molar (most risk)
Upper first molar
Upper third molar
Upper secondary premolar
Upper first premolar
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19
Q

What are 3 important factors considering risk of OAC?

A

Thickness of antral floor
Bone resorption related periodontitis
Early and complete increase risk of OAC

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20
Q

What are signs and symptoms of OAC?

A 
Purulent discharge
Bad taste
Liquid regurgitation through
nose
Air escape
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21
Q

What test can be used to check for air escape?

A

Valsalvin test

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22
Q

What are clinical signs of OAC?

A

Movement of antra lining during respiraton
Bubble from socket during respiration
Hollow sound when aspirating socket
Fogging of mirror
Extracted tooth attached concave bone or tuberosity

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23
Q

What radiographic sign can indicate OAC?

A

Defect in sinus floor

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24
Q

What is management of OAC less 2mm

A 
Promote spontaneous healing 
Gentle irrigation of socket + debridement of sharp bone 
Resorbable haemostatic agent (Surgicel) 
Suturing loose edges 
Antral regime + review 
Vacuum splint
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25
What is management of OAC that is 2-4m?
Consider conservative vs surgical repair Assess- pt clinical signs, general RFs, MH, SH, OH
26
What is management of OAC >4mm
Surgical repair
27
What is the conservative tx of OACs?
``` Many undetected and will heal spontaneously Ab - broad spec (penicillin) Splint - aid healing Decongestants Pt instructions ```
28
What pt instructions should you give re OAC?
No nose-blowing No flying altitude, don’t suck straws Steam inhalation Good OH
29
What are the active tx options of OAC?
Suture Packing (resorbable/ non-resorbable) Splints w/ conservative regimen
30
What is OAF?
Oral antra fistula Communication of the oral cavity and maxillary sinus lined by epithelium
31
Difference OAC and OAF?
OAF - epithelialised lining develops
32
What are signs/ symptoms of OAF?
``` Purulent discharge Bad taste Liquid regurgitation through nose Air escape Episodic sinusitis Nasal voice Epistaxis (nose bleed) Prolapse antra mucosa into mouth Whistling sound ```
33
How can OAF be surgically repaired?
Buccal advancement flap - most common Buccal fay pad graft Palatal rotation
34
How is buccal advancement flap used to tx OAF?
Excised OAF lining together w/ antra sinus lining or granulation tissue
35
Why is buccal advancement flap most commonly used for tx of OAF?
Good success rate w/ low morbidity | Good blood supply from buccal periosteum
36
Disadv of buccal advancement flap for tx of OAF?
Reduction is vestibular sulcus depth - prosthetic implications
37
What is technique for buccal advancement flap for OAF?
Full thickness buccal mucoperiosteum flap is raised w/ flared margins to allow for advancement Advancement to palatal side – periosteal release required in transverse direction Sutured using vertical mattress Important sits on sound bone Palatal mucosa can be incised OAF need to surgically remove fistula before closed
38
What does buccal fat pad graft for tx of OAF involve?
Involve use of highly vascular fat surrounded by buccinator and masseter Blunt dissection and pulled over to close defect then fat sutured
39
What anatomy do you need to be careful of when using buccal fat pad graft?
Parotid duct and papilla - pierce buccinator at anterior border
40
When is buccal fat pad graft useful?
Useful for delayed closure of larger defects
41
What does palatal rotation rely on?
Greater palatine artery
42
Why is palatal rotation not often used?
Painful donor site Healing by secondary intention Length/ width ratio important - flap necrosis
43
How to avoid displacement of foreign objects?
Awareness - radiograph, awareness of RFs Avoid apical pressure
44
What are RFs for displacement of object into sinus?
RF - age, RCT, ankylosis, proximity
45
What are the most common teeth to be involved in displacement?
Upper 6 palatal root 3rd molar - whole tooth 2nd molar root
46
What are the 3 approaches to management of displaced object?
1. Alveolar approach 2. Caldwell-Luc approach 3. Functional endoscopic sinus surgery - FESS
47
What radiographs are useful when managing displacement?
Intra-oral PA OPT CBCT - assess ability of retrieval Used to diagnose and identify location and extent of displacement
48
When can retrieval be used?
When displacement in closer than think - between mucosa and alveolar bone or between sinus lining and floor Use light and suction
49
What is transalveolar approach?
# Fill sinus w/ saline and use suction to retrieve Use flap w/ bone removal to aid visualisation
50
What is Caldwell-Luc procedure?
If not obviously retrievable by trans alveolar | Required GA
51
What are pros and cons of Caldwell-Luc procedure?
Pro - trapdoor approach = good access and persevere alveolar bone Con - traumatic, loss vitality adjacent teeth, fistula formation, infra-orbital nerve damage
52
What is procedure of Caldwell-Luc?
Raise flap in buccal sulcus above premolar teeth to create lateral window
53
What is FESS?
Conservative approach where sinus access via enlarged middle meatus antrosotomy Minimise associated complications but expensive, time consuming and need skilled operator (ENT)
54
What are 3 management decisions of tx of displaced objects?
Retrieve Delay Refer
55
What to do if delay tx of displaced object?
Document Radiograph Ab Refer
56
Post-op advice when displaced object?
``` Similar conservative regimen Decongestants Abs Avoidance nose blowing OH ```
57
Features of the tuberosity?
Most distal aspect of maxilla | Contains socket of third molar
58
Why are fractures of tuberosity a concern?
Cause large OAC | Stability issue for later prosthetics
59
What are RFs of fractured tuberosity?
``` Upper molar XLA Roots - divergent, dilacerated, ankylosed Lone standing molar Pneumatised sinus Increased age Poor technique ```
60
Why dose increased age increase risk of tuberosity fracture?
Antrum larger, expanded, pneumatised - floor lower down
61
What poor techniques can lead to fractured tuberosity?
Uncontrolled force Inadequate maxillary alveolar support Excessive elevation
62
Clinical signs of fractured tuberosity?
Tooth and tuberosity move synchronously w/ XLA Fracture noise Palatal tear - bleaching mucosa Bleeding
63
What does management of tuberosity fracture depend on?
If tuberosity attached to periosteum or not
64
How to manage fracture if tuberosity attached to periosteum?
1. Splinting to adjacent teeth 2. Conservative management - soft diet, ab and re-book for surgical XLA (6-8 weeks) 3. Section crown to enable roots and tuberosity to heal 4. Remove fractured tuberosity - subperiosteal dissection off fragment
65
How to manage fractured tuberosity if separated from soft tissue +/- OAC?
Smooth sharp edges residual bone No OAC - suture and antra regime OAC - tx according to defect size
66
How can implants cause injury to sinus?
Inadequate height - injury to sinus floor Overcome w/ sinus life procedure - increase vertical volume of bone
67
What is an internal sinus lift?
Use summers technique Aim: maintain integrity of sinus lining, limit graft to restore alveolar bone and avoid impaired sinus drainage
68
What is chronic sinusitis?
When remains persistent | Can be bacterial or viral
69
Symptoms of chronic sinusitis?
Mimic toothache, nasal discharge, pressure/ pain when bending
70
How to tx bacterial sinusitis?
Abs | Decongestants
71
How to tx chronic sinusitis?
Antra wash Nasal surgery ENT referral - esp if recurrent

5th Oral Disease - Other (13 decks)

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