the maxillary sinuses/antrum

Question 1

what are the paranasal sinuses?

Answer 1

• Air containing sacs lined by ciliated epithelium, communicating with the nasal cavity

Question 2

name the 4 pairs of paranasal sinuses

Answer 2

frontal
ethmoidal
sphenoidal
maxillary

Question 3

paranasal sinuses can drain into each other, why is this significant?

Answer 3

infection of one can spread to the others - pan-sinusitis

Question 4

what is the function of the paranasal sinuses?

Answer 4

unknown

Question 5

the maxillary sinus drains ? gravity through a ? ostium ? up the ? wall of the sinus into the ??

Answer 5

against
2.4mm
2/3
mesial
middle meatus

Question 6

Common peri-operative complications to do with maxillary sinuses 5

Answer 6

Maxillary molar and premolar roots can be within sinus

Endodontic materials can extrude into sinus

OACs can lead to infection of the sinus

Displacement of tooth into sinus

Tuberosity fracture can create an OAC

Question 7

sinusitis has similar symptoms to what?

Answer 7

dental pain

Question 8

remember
sinus pathology can present in the mouth

Question 9

how are maxillary sinus infections investigated? 4

Answer 9

Radiographs: DPT, periapical

CT scan/MRI

Antral trap (not done anymore - hole created for drainage)

Transillumination - endoscopy

Question 10

what is acute infective sinusitis?

Answer 10

Bacterial infection which follows from a viral infection

Question 11

is there a need of radiographs to diagnose acute infective sinusitis?

Answer 11

no, clinical evidence is needed only

Question 12

signs and symptoms of acute infective sinusitis 4

Answer 12

Pain worsens on bending

Posterior teeth tend to be TTP

Bad smell and taste

Decongestants don’t work

Question 13

what is the management for acute infective sinusitis 3

Answer 13

inhalations - menthol
epinephrine nasal drops
antibiotic if the above don’t work

Question 14

what antibiotics are used for acute infective sinusitis?

Answer 14

pen V
doxycycline

Question 15

what is the dosage for Pen V for acute infective sinusitis?

Answer 15

500mg 4 times daily for 5 days

Question 16

what is the dosage for doxycycline for acute infective sinusitis

Answer 16

100mg for 5 days
200mg on first day

Question 17

pt are predisposed to recurrent sinusitis if they have what? 2

Answer 17

mechanical obstruction of ostium
or
impaired mucosal clearance

Question 18

give 3 examples of things that can cause mechanical obstruction of the ostium

Answer 18

oedema, polyps, septal deviation

Question 19

give 2 examples of things that impair mucosal clearance

Answer 19

poor ciliary action, sticky/thick mucus (cystic fibrosis)

Question 20

what is chronic sinusitis?

Answer 20

Ongoing low grade symptoms

Question 21

treatment for chronic sinusitis

Answer 21

drainage and metronidazole with amoxicillin/erythromycin

Question 22

chronic sinusitis suggests what? 2

Answer 22

Immunocompromised if no oral antral fistula

Anatomical drainage problems e.g. deviated nasal septum

Question 23

complications of sinusitis? 3

Answer 23

Brain abscesses

Orbital cellulitis

Cavernous sinus thrombosis which can lead to death

Question 24

signs and symptoms of oral antral communication 5

Answer 24

Passage of fluid down nose

passage of air into mouth

alteration of voice

unilateral epistaxis (nosebleed of one nostril)

nasal obstruction

Question 25

what happens if an oral astral communication is not treated? 6

Answer 25

epithelializes into a fistula persistent sinusitis unilateral nasal discharge intra-oral antral polyp cacoguesia (bad taste) facial pain

Question 26

what do u tell the patient to look out for, for an OAC? 4

Answer 26

difference in the feeling of one side top the other the fluids may come through the nose bad taste from the area or back of throat bad smell indicates infection

Question 27

how is an OAC managed?

Answer 27

surgical approach which needs to be referred to oral surgery or a specialist dental school

Question 28

remember If an OAC is small <5mm it will support a clot and will often heal on its own and go unnoticed