maxillary sinus in dx and trauma Flashcards
(34 cards)
Maxillary Sinus - Anatomic considerations
Proximity of the sinus floor to the root apices
x rays for sinus
pano
PA
Water’s view=gold standard
CT scans
Maxillary Sinus - Anatomical facts and location
The largest?
Located in?
shape?
what bone forms its base.
The largest para-nasal sinuses.
Located in the maxilla.
Is pyramidal in shape.
The Lateral nasal bone forms its base.
Maxillary Sinus - Physiological Functions
- Not clearly known but the following functions have been proposed:
Speech and voice resonance.
Reduces weight of skull.
Warms the inspired air.
Filtration of inspired air.
Immunologic barrier ( body defense).
Maxillary Sinus - Anatomical Morphology
- Size?
- Asymmetry?
- with aging?
- compartments?
- Size varies from one person to another.
- Asymmetry between the sinuses exists in the same individual.
- Small in children and increases in size with aging.
- Divided into several compartments by bony septa (Underwood’s septa).
Maxillary Sinus Bony Septa
Ostium open point
Opens at postero-inferior end of semi lunar hiatus lying in the middle meatus
sinus histo
The Schneiderian membrane is the membranous lining of the maxillary sinus cavity.
Microscopically there is a bilaminar membrane with mucous secreting pseudostratified ciliated columnar epithelial cells on the internal side and periosteum on the osseous side.
Lining contains osteoclasts which contribute to pneumatisation.
Mucociliary Clearance
Impairment of Ciliary Function in Sinus Infections
Maxillary Sinus Disorders
- Congenital anomalies.
- Inflammatory diseases.
- Odontogenic infection.
- Cysts .
- Neoplasia.
- Bone metaplasia and benign tumors
- Trauma.
Inflammatory diseases of Maxillary Sinus
Bacterial infection.
Bacterial infection secondary to viral infection.
Fungal infection.
About 10% of inflammatory episodes are extensions of dental infections.
classes of sinusitis
Acute sinusitis (<2 weeks),
Subacute sinusitis (2 weeks to 3 months),
Chronic sinusitis (>3 months).
Acute Maxillary Sinusitis
There is suppurative or non -suppurative inflammation of the mucosal lining of the
maxillary sinus.
Acute sinusitis (<2 weeks),
It involves one or both of the Maxillary sinuses.
causes of acute max sinusitis
Secondary to hay fever and allergic rhinitis.
Secondary to acute rhinitis (common cold) and Upper Respiratory Tract infection.
Bacterial infection due to:
Dental infections Foreign body dislodgment into the maxillary sinus
Acute Maxillary Sinusitis - Signs and Symptoms
Headache.
Pain and tenderness.
Nasal obstruction.
Nasal discharge.
Toxic manifestations.
Heavy filling with bending.
Nasal congestion.
Acute Maxillary Sinusitis - Clinical Exam
Examine the nasal cavity: discharge–pus–blood -polyps….
Palpate the anterior wall of the maxilla (Intra and extra-oral approach)
Rule out odontogenic cause (through clinical and radiographic exam)
Acute Maxillary Sinusitis - Treatment
- Rest and fluid and oral hygiene.
- Antibiotics (Augmentin) after C&S is done; pneumococci and streptococci are the most causative organisms.
- Analgesics and NSAIDS
- Antihistamines
- Local treatment
- Nasal Decongestant
- e.g. Afrin Sinus decongestant, 2 to 3 Nasal puffs 2 times daily for 3 to 4 days
- Steam inhalation
Chronic sinusitis
It is a chronic type of infection that affects the mucosal lining of one or both sinuses, resulting
inmucous or pus collection.
Chronic sinusitis (>3 months).
Mucosal Polyps in the Sinus
- A polypoidal type of inflammation can lead to formation of multiple or single mucosal
polyps inside the sinus
Chronic Maxillary Sinusitis - Causes
As a consequence of non resolved acute maxillary sinusitis.
Dental abscesses.
Virulent organism with low resistance.
Foreign body dislodgement or trauma.
Chronic Maxillary Sinusitis - Signs and symptoms
Headache.
Nasal obstruction
Nasal discharge.
Fatigue.
Hyposmia/ Anosmia.
Chronic Maxillary Sinusitis – Surgical Treatment
Sinus wash-out.
Chronic Maxillary Sinusitis - Treatment
- Rest and fluid and oral hygiene.
- Antibiotics (Augmentin) after C&S is done; pneumococci and streptococci are the most causative organisms.
- Analgesics and NSAIDS
- Antihistamines
- Local treatment
- Nasal Decongestant
- e.g. Afrin Sinus decongestant, 2 to 3 Nasal puffs 2 times daily for 3 to 4 days
- Steam inhalation
Complications of Maxillary Sinusitis
- Orbital abscess and orbital cellulitis.
- Intracranial abscesses / Meningitis.
- Cavernous sinus thrombosis.
- Spread of infection to neighboring sinuses, structures and organs.
- Osteomyelitis.
