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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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


What are the borders of the maxillary antrum?

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


What lines the maxillary sinus?

ciliated columnar epithelium


What is sinusitis?

Inflammation of the lining epithelium of the sinuses


What's the aetiology of sinusitis?

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


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


What are the signs and symptoms of sinusitis?

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

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


What investigations can be done for sinusitis?

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


What's the treatment for sinusitis?

bed rest
nasal decongestants


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


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


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


What is the frontal sinus?

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


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


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


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

fluid levels
lining thickness


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


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


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