Surgical management of diseases of the maxillary antrum Flashcards Preview

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Flashcards in Surgical management of diseases of the maxillary antrum Deck (19)
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1

How does the maxillary antrum change with age?

• at birth a small space on lateral wall of nose
• 9 years - floor = floor of nose
• 23-25 years - fully developed

2

What are the borders of the maxillary antrum?

- superior = floor of orbit
- inferior = hard palate, roots of posterior teeth
- medial = lateral wall of nose

3

What lines the maxillary sinus?

ciliated columnar epithelium

4

What is sinusitis?

Inflammation of the lining epithelium of the sinuses

5

What's the aetiology of sinusitis?

- extension of nasal infection
- blockage of middle meatus
- nasal allergies
- infection from roots
- infection from OAF

6

What's the pathology of sinusitis?

– increased secretion from lining
– increase in ciliary activity which is initially effective and then cilia are destroyed
– thickening of mucous membrane
– fibrosis

7

What are the signs and symptoms of sinusitis?

Acute:
- acute pain in upper teeth
- beating sensation in cheek
- fullness below eyes
- nasal discharge

Chronic:
- incomplete resolution
- thickened or polypoid mucous membrane
- purulent nasal discharge
- recurrent sinusitis
- OAF

8

What investigations can be done for sinusitis?

1. Radiographs to assess:
- fluid levels
- mucosal thickening
- radiopaque sinus
2. Transillumination
3. Intranasal antrostomy

9

What's the treatment for sinusitis?

bed rest
nasal decongestants
analgesics
antibiotics

10

What's the treatment of an oro antral fistula? (OAF)

At time of extraction:
• Suture across socket - horizontal mattress or...
• Construct protective splint
• Close fistula:
1. buccal flap with bilateral relieving incisions
2. trim buccal plate
3. remove root
4. advance buccal flap
5. incise through periosteum at base of flap
6. antibiotics & nasal decongestants
7. no nose blowing

11

How do you treat a chronic/recurring OAF?

- Buccal flap repair
- Buccal pad of fat
- Palatal flap repair
- Intranasal antrostomy
- antibiotics, analgesics, decongestants, no nose blowing

12

What's the common 'complaining of' for a patient with OAF?

bad taste in a quadrant,
spontaneous pain on/off,
eating/drinking NAD,
recent deafness in ear corresponding to the quadrant the bad taste is coming from

13

What is the frontal sinus?

• birth - absent
• age 5 begins to develop
• great variation in size and shape
• lined by columnar epithelium

14

What problems related to the frontal sinus?

• Sinusitis
• tap frontal bone - very sore
• accompanies acute ethmoiditis
• early stages - ‘vacuum frontal headache’
• pain above eyes - 10am to 4/5pm
• dull and boring in nature
• pull on trochlea due to inflammation - problems with vision
• oedema of brow and upper eyelid swelling

15

What complications can occur from the frontal sinus?

spread to cranium inner third of upper part of orbit
middle third of orbital roof - abscess
chronic infection - polyps

16

What can radiographs of the frontal sinus (paranasal sinus) show?

fluid levels
opacity
lining thickness

17

What are the ethmoidal sinuses?

• many small air spaces
• upper part of lateral wall of nose
• lateral - orbits
• inferior - maxillary sinus
• lined by ciliated columnar epithelium

18

What problems can occur to do with the ethmoidal sinuses (paranasal sinus)?

• pain behind the eyes
• tender medial canthus
• spread to involve orbit
• subperiosteal swelling
• complete eyelid closure

19

What are the sphenoidal sinuses (paranasal sinus) and what's the pathology associated with them?

• occupies the body of the sphenoid
• lateral - cavernous sinus
• superior - pituitary
• floor - nerve of the pterygoid canal
• usually a generalised sinusitis
• pus in the sphenoethmoidal recess
• pain in the middle of the skull, temporal region and down the neck