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BDS4 Oral Surgery > maxillary sinus > Flashcards

maxillary sinus Flashcards

1
Q

when does maxillary sinus formation occur?

A

3rd and 4th foetal months

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2
Q
  • what are the functions of the paranasal sinuses?
  • what are they?
A
  • Resonance to the voice
    Reserve chambers for warming inspired air
    Reduce the weight of the skull
  • frontal
    sphenoid
    ethmoid air cells
    maxillary
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3
Q
  • what is the volumetric space and dimensions of maxillary sinus?
  • epithelium of sinuses?
A
  • 15ml volume
    37mm high
    27mm wide
    35mm antero-posteriorly
    opening of maxillary sinus middle meatus approx 4mm diameter
  • pseudo-stratified ciliated columnar epithelium
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4
Q

what are possible issues with 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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5
Q

how do you diagnose OAC/F
what is difference between oac and oaf?

A
  • Size of tooth
    Radiographic position of roots in relation to antrum
    Bone at trifurcation of roots
    Bubbling of blood
    Nose holding test (careful as can create an OAC)
    Direct vision
    Good light and suction - echo
    Blunt probe (take care not to create an OAC) (doesn’t recommend)
  • fistula - chronic
    communication created you manage it but doesn’t heal

communication - has just happened so you manage it

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6
Q

how can you tell this is an oac

A

still bleeding so must just been made

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7
Q

how can you tell this is oaf

A

less bone there where communication happened

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8
Q

what is manage for OAC?
- small (when do these usually heal)
- large

A

firstly inform patient

  • If small or sinus lining intact:
    Encourage clot
    Suture margins
    Antibiotic (area of debate)
    Post-op instructions
    Minimising pressure formation within the sinuses and mouth

Small OACs <2mm usually heal with normal blood clot formation and routine mucosal healing

  • If large or lining torn:
    Close with buccal advancement flap
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9
Q

what is manage for OAC?
- large

A

firstly inform patient

  • If large or lining torn:
    Close with buccal advancement flap
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10
Q
  • what kind of sided flap should buccall advancement flap be ?
  • what are steps of buccal advancement flap?
A
  • 3 sided flap with 2 reliving incisions that are parallel and 1 creft incision
  • flap design
    raising flap
    trimming of buccal bone
    incising the periosteum
    checking can be brought across the defect tension free
    suturing
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11
Q
  • how to treat an OAF?
A
  • excision of sinus tract prior to buccal advancement flap
    raising flap
    antral washout (OAF cases) - not always done
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12
Q

what may patients complain of for chronic 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 (discussed later)

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13
Q
  • what is diagnosis for fractured tuberosity?
A
  • Noise
    Movement noted both visually or with supporting fingers
    More than one tooth movement
    Tear in soft tissue of palate
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14
Q
  • what is management for fractured tuberoisity?
A
  • Reduce and stabilise
    >Orthodontic buccal arch wire with composite
    >Arch bar
    >Splints (lab-made)

Dissect out and close wound primarily

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15
Q
  • what are flap design options for oaf?
A
  • Buccal Advancement Flap

Buccal Fat Pad with Buccal Advancement Flap

Palatal Flap

Bone Graft/Collagen Membrane

Rotated Tongue Flap (Historical)

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16
Q

what is aetiology for fracture of maxillary tuberosity?

A
  • Single standing molar
    Unknown unerupted molar or wisdom tooth
    Pathological gemination/concrescence
    Extracting in wrong order
    Inadequate alveolar support
17
Q

what do you do if you splint it?

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
18
Q
  • what should you rule out before you diagnose sinusitis?
A
  • rule out a dental cause such as
    Periapical abscess
    Periodontal infection
    Deep caries
    Recent extraction socket
    TMD
    Neuralgia or atypical facial pain / chronic midfacial pain
19
Q
  • what are aims of treatment for sinusitis?
  • what is treatment for sinusitis
A
  • Treat presenting symptoms
    Reduce tissue oedema
    Reverse obstruction of the ostia
  • 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

20
Q
  • what are antibiotics for sinusitis?
A
  • Antibiotics should only be used if symptomatic treatment is not effective/symptoms worsen
    AND
    signs and symptoms point to a bacterial sinusitis

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

21
Q

what do you do if root or tooth in maxillary sinus?

A

Confirm radiographically by OPT, occlusal, or periapical (+/- CBCT)
Decision on retrieval
If in doubt or retrieval difficult - refer

22
Q

how do you retrieve root in antrum/sinus?

A

OAF-type approach / through the extraction socket
- Open fenestration with care
- Suction – efficient and narrow bore
- Small curettes
- Irrigation or ribbon gauze
- Close as for Oro-Antral communication

Caldwell-Luc approach
- Buccal/Labial sulcus
- Buccal window cut in bone

ENT
- Endoscopic Retrieval

23
Q

what is aetiology of sinusitis?
- effects of viral infection

A

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

24
Q

what is aetiology of sinusitis?
- mucocillary cleareance patterns

A

Mucociliary clearance patterns may be altered by:
- Allergens
- Inflammation
- anatomic abnormalities

Normal physiological function is further disrupted by the cellular damage that occurs to the mucosal lining, this affects normal ciliary function

25
Q

what is aetiology of sinusitis?
- sinus contents

A

When the sinus can no longer evacuate its contents efficiently
- build up of pressure
- opportune situation for bacterial overgrowth of normal flora

26
Q

what are signs and symptoms of sinusitis?

A

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

27
Q
  • what are indicators for sinusitis?
A
  • Discomfort on palpation of infraorbital region
    A diffuse pain in the maxillary teeth
    Equal sensitivity from percussion of multiple teeth in the same region
    Pain that worsens with head or facial movements
28
Q

what can occasionally cause sinusitis and how?

A

Very occasionally a non-resolving sinusitis may be due to a fungal infection

This can cause expansion of the bony walls by increased mucus secretion and fungal growth

29
Q

what trauma’s can cause 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

BDS4 Oral Surgery (7 decks)

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