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xD3 Oral Surgery Ex1 > Maxillary Sinus Disease (Deeb) > Flashcards

Maxillary Sinus Disease (Deeb) Flashcards

(65 cards)

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1
Q

How does the maxillary sinus develop?

A

Arises as an out pouching of the nasal mucosa

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2
Q

Does the size of the maxillary sinus increase or decrease in adolescence?

A

Increased

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3
Q

When the sinus expands during adulthood, which direction does it go?

A

The floor expands into the alveolus

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4
Q

What is the anterior wall of the maxillary sinus?

A

The anterior surface of the maxilla

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5
Q

What is the superior wall of the maxillary sinus?

A

The floor of the orbit

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6
Q

What is the posteriolateral wall of the maxillary sinus?

A

The maxillary tuberosity and the infra temporal fossa

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7
Q

What makes up the floor of the sinus?

A

The confluence of the posterolateral (maxillary tuberosity and the infra temporal fossa) and anterior (anterior surface of the maxilla) walls

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8
Q

Where does the maxillary sinus drain?

A

The osmium in the medial wall at the superior midpoint OR posteriorly

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9
Q

Where does the maxillary sinus empty INTO?

A

The ethmoid infundibulum

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10
Q

Where is the ethmoid infundibulum located?

A

Under the middle turbinate in the posterior middle meatus

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11
Q

What is the hallmark of a sinus infection?

A

Purulence

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12
Q

What type of epithelium lines the sinus?

A

Respiratory epithelium (pseudocolumnar squamous epithelium with numerous goblet cells and cilia)

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13
Q

What are the cilia of the sinus mucousa programmed to do?

A

Move toward the natural ostium

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14
Q

Where is most of the normal airflow in the maxillary sinus?

A

Around the middle turbinate

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15
Q

What happens when an obstruction occurs in the maxillary sinus?

A

You get a cycle of flow

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16
Q

What is the fifth-most common medical diagnosis for which antibiotics are prescribed?

A

Sinusitis

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17
Q

What percent of completely asymptomatic adults have abnormalities on the sinus CT?

A

Up to 40 percent

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18
Q

What percent of adults with minor colds have abnormalities on sinus CT?

A

Over 80 percent

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19
Q

What is the criteria for acute sinusitis?

A

Symptoms for 1-4 weeks (symptoms for less than 1 week are almost always viral)

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20
Q

What is the criteria for chronic sinusitis?

A

Symptoms for more then 12 weeks

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21
Q

What are MAJOR factors for sinusitis?

A
  1. Facial pain / pressure
  2. Facial congestion / fullness
  3. Nasal drainage / discharge
  4. Postnasal drip
  5. Nasal obstruction / blockage
  6. Hyposmia / anosmia
    7 Fever (acute only)
  7. Purulence on endoscopy (automatic)
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22
Q

What are MINOR factors for sinusitis?

A
  1. Headahce
  2. Maxillary dental pain
  3. Cough
  4. Halitosis
  5. Fatigue
  6. Ear pain, pressure, or fulness
  7. Fever
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23
Q

What are the requirements to reach a diagnosis of sinusitis?

A

“Strong history for sinusitis with…”
2 major factors
1 major factor and 2 minor factors
Purulence at midde meatus or in sinus cavity

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24
Q

Is swelling common in sinusitis?

A

No. That is usually indicative of a dental etiology

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25
What is usually present upon palpation when a patient has sinusitis?
Tenderness over the sinus cavities.
26
What is the most valuable sinus imaging technique for a sinusitis diagnosis?
CT Coronal Sections without contrast
27
What does cloudiness in the sinuses on the CT image indicate?
Fluid in that portion of the sinus
28
What is the tallest point in the lower 48 states?
Mt Whitney
29
What are 4 causes of inflammation at the osteomeatal complex (OMC) causing obstruction in sinusitis?
1. Infections 2. Immunologic 3. Allergic 4. Anatomical
30
Is routine endodontic treatment an issue with sinusitis (i guess this means in causing it)?
No. it is rarely an issue.
31
Will perforation of the sinus during endodontic treatment create an additional risk?
No, it creates no additional risk
32
What type of endodontic filling material may lead to chronic inflammatory response in sinus lining?
Sargenti type filling material
33
What effect does periodontal disease have on the sinus mucosa?
May thicken in the area of disease but will reduce with periodontal therapy
34
What are the most common acute sinusitis pathogens?
1. Haemophilus influenzae 2. Streptococcus pneumoniae 3. Moraxella (Branhamella) catarrhalis (rare in adults, 20% in children)
35
Chronic pathogens include the same as the acute pathogens as well as what?
Multiple anaerobes (although their contribution is unclear)
36
What will a paranasal sinus CT or cone beam show around the affected tooth in odontogenic sinusitis?
Mucosal thickening
37
What percent of sinusitis have dental causes?
12%
38
What treatment is indicated with odontogenic sinusitis?
Endodontic therapy or extraction
39
What are some viral causes of sinusitis?
Rhinovirus, influenze virus, RSV in children
40
What are two causes of fungal sinusitis?
1. Allergic (immunocompetent) | 2. Invasive (immunocompromised)
41
What are some genetic disease that contribute to sinusitis?
Cystic fibrosis, congenital immunologic, metabolic, ciliary function deficits
42
What are some allergy-related sinusitis etiologies?
Environmental, Asthma/ASA/nasal polyp triad
43
What type of anatomic variation would predispose a patient to sinusitis?
Variation in osteomeatal complex anatomy
44
What are the 4 portions of the sinusitis cycle?
1. Stasis 2. Infection 3. Inflammation 4. Impaired mucociliary clearance
45
What is the typical medical therapy for sinusitis?
Antibiotics 10-14 day course (cover typical organisms for acute disease; culture-guided for chronic disease)
46
What is the medical therapy for chronic sinusitis?
1. Decongestants 2. Mucolytics (guaifenesin) 3. Topical steroids 4. Saline lavage 5. Oral steroids (less commonly given) 6. Antifungals (for AFS or invasive fungal infection)
47
What is a historical debridement surgery for sinusitis?
Caldwell-Luc Operation 1. Antrostomy in anterior wall (canine fossa) 2. Inferior meatus antrostomy for drainage 3. Gauze packing
48
What are the principles of contemporary therapy for sinusitis?
1. Break the cycle 2. Preserve native tissue 3. Restore natural function
49
What is FESS?
Functional endoscopic sinus surgery
50
What is the goal of FESS?
Restore natural drainage path of sinuses
51
What are three main components of FESS?
1. Diseased tissue is removed 2. Natural osmium is enlarged 3. Maxillary sinus mucosa is preserved
52
What are three other sinus pathologies common in the maxillary sinus?
1. Mucous retention cyst 2. Mucocele 3. Neoplastic disease
53
What percent of the population has mucous retention cysts in their maxillary sinus?
Up to 8% (which Dr Deeb says is "very common")
54
What treatment is necessary for a mucous retention cyst?
No treatment necessary
55
What is a dome-shape opacity usually on the floor of the sinus?
Mucous retention cyst
56
What is an expansile cystic lesion almost always in the ethmoid, frontal or sphenoid sinuses?
Mucocele
57
May serious complications result from a mucocele?
Yes
58
May a mucocele require surgical exploration?
Yes
59
What are some other "nasal" pathology?
1. Nasopharyngeal carcinoma | 2. Nosebleeds
60
Are nasopharyngeal carcinomas associated with the usual SCC risks?
No
61
Are nasopharyngeal carcinomas common in young adults?
Yes
62
What must be disproven for a cervical mass (adenopathy) in a young adult without other explanation?
Nasopharyngeal carcinoma
63
Which nosebleeds are more common and easier to control: anterior or posterior?
Anterior
64
What nosebleeds are less common and harder to manage: anterior or posterior?
Posterior
65
Do nasopharyngeal carcinomas have relatively poor outcomes?
Yes

xD3 Oral Surgery Ex1 (4 decks)

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