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
Q

How does the maxillary antrum change with age?

A
  • at birth a small space on lateral wall of nose
  • 9 years - floor = floor of nose
  • 23-25 years - fully developed
2
Q

What are the borders of the maxillary antrum?

A
  • superior = floor of orbit
  • inferior = hard palate, roots of posterior teeth
  • medial = lateral wall of nose
3
Q

What lines the maxillary sinus?

A

ciliated columnar epithelium

4
Q

What is sinusitis?

A

Inflammation of the lining epithelium of the sinuses

5
Q

What’s the aetiology of sinusitis?

A
  • extension of nasal infection
  • blockage of middle meatus
  • nasal allergies
  • infection from roots
  • infection from OAF
6
Q

What’s the pathology of sinusitis?

A

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

7
Q

What are the signs and symptoms of sinusitis?

A

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
Q

What investigations can be done for sinusitis?

A
  1. Radiographs to assess:
    - fluid levels
    - mucosal thickening
    - radiopaque sinus
  2. Transillumination
  3. Intranasal antrostomy
9
Q

What’s the treatment for sinusitis?

A

bed rest
nasal decongestants
analgesics
antibiotics

10
Q

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

A

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
Q

How do you treat a chronic/recurring OAF?

A
  • Buccal flap repair
  • Buccal pad of fat
  • Palatal flap repair
  • Intranasal antrostomy
  • antibiotics, analgesics, decongestants, no nose blowing
12
Q

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

A

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
Q

What is the frontal sinus?

A
  • birth - absent
  • age 5 begins to develop
  • great variation in size and shape
  • lined by columnar epithelium
14
Q

What problems related to the frontal sinus?

A
  • 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
Q

What complications can occur from the frontal sinus?

A

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

16
Q

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

A

fluid levels
opacity
lining thickness

17
Q

What are the ethmoidal sinuses?

A
  • many small air spaces
  • upper part of lateral wall of nose
  • lateral - orbits
  • inferior - maxillary sinus
  • lined by ciliated columnar epithelium
18
Q

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

A
  • pain behind the eyes
  • tender medial canthus
  • spread to involve orbit
  • subperiosteal swelling
  • complete eyelid closure
19
Q

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

A
  • 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