Maxillary Sinutitis Flashcards
How can we get odontogenic maxillary sinusitis ?
(A) Periapical abscess
(B) Chronic apical or extensive marginal periodontitis, or
(C) After dental extraction
- Dental or Alveolar Trauma
- Odontogenic Cysts
- Maxillary Osteomyelitis
- Iatrogenic or accidental displacement of foreign bodies
- Sinus exposure during extraction
Odontogenic origin bilaterally or unilaterally?
unilaterally
Acute Odontogenic Maxillary Sinusitis Forms ?
Catarrhal
purulent
Chronic Odontogenic Maxillary Sinusitis forms ?
limited and diffuse
Polypous and nonpolypous
Acute sinusitis symptoms ?
1.Dull or intense pressure-like pain
2.Swelling of the cheek and anterior maxilla 3.Pressure or fullness in the vicinity of the maxillary sinus
4. Mucopurulent rhinorrhea
5.Oral malodour
6.Unilateral nasal Congestion or Obstruction
7.altered sense of smell
8.painfull percussion of posterior teeth
9.Regional Lymphadenitis
Fever malaise headache
Chronic form symptoms ?
• Persistent pus discharge from one half of the nose
• Toothache during chewing
•Increased tooth mobility
• Migraine
• Dull headache
• Heaviness in the occipital region
• Fatigue, weakness,letargy
What’s the characteristics of chronic phase ?
The antral mucosa is thickened with edema, infiltration of leukocytes and fibers, sometimes accompanied by polyps.
Results from prolonged low-grade inflammation in antral mucosa following acute phase (or) recurrence of acute sinusitis.
What we need for diagnosis ?
1.Standard dental radiographs include periapical radiography and panoramic radiography.
2.sinus ultrasonography
3.CT scans
4.Endoscopy can be used to visualize and evaluate inflammatory changeswithin the nasal passage
What we will see in X-ray ?
X-ray shows a decrease in the transparency of the maxillary sinus
The management consist of ?
1.control of infection and pain
2.reduction of tissue edema
3.facilitation of drainage
4. and maintenance of sinus ostia patency
5. Dental treatment
How does acute sinusitis get treated by drugs ?
Antibiotic therapy (Penicillin, clindamycin, and metronidazole are adequate drugs of initial choice), For moderate to severe cases an increase drug dose and intravenous administration of antibiotics are especially recommended.
How does acute sinusitis get treated by puncture and other methods ?
A puncture is performed with washing and introduction of antibiotics and enzyms into the sinus.
If there is an oro-antral communication, the sinus also is washed through the dental alveolus.
Vasoconstrictors should be instilled into the nasal cavity to anemize the mucous membrane and create an outflow from the sinus through the natural opening.
Drainage reduces pain intensity, prevents disease progression, and encourages resolution.
How do we treat chronic form ?
Antibiotic therapy and surgery
Elimination of Dental Source by tooth extraction, apicoectomy, endodontic therapy, removal of any involved foreign body, might lead to full recovery.
If an oroantral fistula is present, frequent irrigation of sinus cavity via fistula can prove effective, although surgical closure of the fistula is required after sinusitis is cured.
if complete resolution if chronic form is not achieved by these treatments what should we do ?
then sinus surgery will be required.
What’s the benefits of Endoscopic sinus surgery (ESS) ?
endoscope is passed through the nose and provides the view of the infected sinus mucosa, osteomeatal complex condition, polyps and etc.
The natural ostium is widened surgically, and only infected sinus mucosa is removed, leaving the basement membrane intact.
Thus, natural sinus mucosa is preserved and mucocilliary clearance is not disturbed.
