6. Paranasal Sinus Disease Flashcards
Paranasal Sinus Anatomy
Sinuses – invaginations from the nasal cavity into the surrounding ____
All sinuses are lined with ____
Shapes and sizes ____ considerably
Functions:
• ____, humidification and filtering of inspired air
• Accessory olfactory organs
• Contribute to ____ response
• Reduce skull weight
• Voice ____
• Assist with intracranial pressure regulation
• Enhance craniofacial resistance to shock
bones respiratory epithelium vary warming immune resonance
Paranasal Sinuses
• Air-filled cavities in the ____ complex
• ____ paired paranasal sinuses
• Part or all of the structures may appear on ____ commonly taken by dentists
– ____ radiograph
b – ____ radiograph
• All of the paranasal sinuses can appear
– ____ skull radiograph
– ____ cephalometric skull radiograph
3– All of ____ volumes
craniofacial four radiographs panoramic maxillary PA
lateral ceph
posterior-anterior
CBCT
Lateral ceph view
• note here you can also see ____ sinus
sphenoid
• Here is an example of what you ll be seeing on a day to day basis
On FMX:
• you can appreciate these maxillary posterior views, you see:
◦ ____ and a hint of the ____ ( you
will appreciate the maxillary sinus, specially in your ____ PA)
zygomatic process
maxillary sinus
post max
•
On the panoramic film, you can appreciate the ____ more (in orange)
◦ there will be some ____, ghosting, and air spaces on the pano because how it matches a 3D image on a ____ image
◦ Pano is regarded as a ____. study of the sinuses. What you really wanna do is …
maxillary sinus
distortion
2D
prelim
• ..is look at the sinuses w/ ____
These pics below highlight normal sinus anatomy
• Another view that you can get is a normal occlusal view ◦ this involves telling the pt to bite down on a large
____ film and we shoot the rays –> can appreciate the max sinus (orange)
• Here what dr Mel would want us to appreciate is that although this looks like pathology, it is NOT!
• #13 is root canal treated and there was an inflammation at the apex of root
◦ infiltrate from inflammation will go to the max. sinus and lift the ____ layer –> have new ____ formation
◦ NOT a pathology, sort of a reaction!
CBCT
occlusal
periosteal
bone
Post-developmental pneumatization of maxillary sinus
• this is another example of something normal
• At first, she though that this was a cyst.. but in fact it is a ____ of the maxillary sinus due to an ____ space; no tooth to prevent the sinus from dipping into the empty space.
◦ this is rather extreme occurrence!
• this here. although looks like the maxillary sinus, it is actually the floor of the nasal fossa (purple)
pneumatization
edentulous
MDCT - coronal views showing normal variations
• Here we have some MDCT coronal views showing some normal variations of the sinuses
(A) frontal sinus is more ____
(B).. more exuberant frontal sinus here (maybe due to different slicing, shows the frontal sinus going up)
(C) here we have a more ____ frontal sinus (blue) and enlarged ethmoid air cells (green)
These are all normal, NOT pathology!!
conservative
exuberant
CBCT- ethmoid sinus anatomy
• Just to review some ethmoid sinus anatomy in CBCT
(A) this is a sagittal view; cut this way d you can appreciate the ethmoid sinus, frontal sinus, and behind that the sphenoid sinus, and the sphenoethmoidal recess
◦ You can appreciate that it is well aerated, ____ because of the
air
(B) This is an axial view; can, again appreciate well aerated sinuses: the ____ bisecting (NS, dividing the ethmoid sinus into anterior and posterior see the label)
• * –> indicates the sphenoethmoidal recess
• Can see the sphenoid sinus (labeled SpS)
• Can also see the carotid canal (labeled CC)
hypo dense
nasal septum
Coronal CBCT - pneumatized lateral recesses of sphenoid sinus
- Here is a coronal CBCT –> showing *reads the title
- So you can see SpS here (see name label below) pneumatized ____
- ..and what this picture is trying to point out that the SpS is so pneumatized that ____=is bulging into the sinus.
• So this is all normal anatomy, with a lot of variations from individual to individual
laterally
foramen rotundum
Hypoplastic right max sinus
• Here is an example of a hypoplastic max sinus.
◦ On the left, the maxillary sinus is normal size ( ) and
the ethmoid sinus looks well aerated
◦ on the right tho, the max sinus is ____, not well-
developed
‣ NOT a ____!! just variation from normal
anatomy
Pneumatized means larger
◦ Again, pnuematized sinuses are not due to a pathology,
just ____ from normal
smaller
pathology
variation
Spheno-ethmoidal disease
• Remember in the normal CBCT, it was a little more dark cause you could see the aeration.
• Here, this is demonstrating ethmoidal sinus disease. You can see inflammation of the soft tissue, or perhaps fluid (like for example, you have a stuffy nose). Here is some anterior posterior ethmoid sinus disease.
◦ (A) In axial view –> pointed to ethmoid sinus (small white arrows)
◦ (B) In the sagittal view –> you can appreciate the presence of inflammatory fluid.
‣ points to SpS and ethmoid sinus
‣ Arrows –> pointing to the drainage; not able to ____ very well
so you have some backup of the ____ (note the grayish areas)
drain
mucus
Mucositis vs Antrolith
• So what do u see in a PA film, something that you might encounter as a dentist.
• This is a a maxillary PA premolar-molar view.
Normally when you see this area (max sinus) it is more radiolucent. However, what you see here is a radiopaque area.
◦ The arrows indicate –> mucositis, a slightly ____ mucosa.
‣ Pt won’t know they have it. it tends to be an ____ finding,
when you taking a FMS. You don’t have to do ____ about it
•
So if the mucosa in pic A has mucus plugs that are ____ –> you get antrolith
◦ you might find it in the max. sinus ◦ there is no need to treat an antrolith
inflamed
incidental
anything
calcified
CBCT mucositis
- The gold standard for diagnosing a mucositis is ____ and here is an axial view.
- You can appreciate that its not just on the floor of the sinus, but you see in the PA film, its following the contours of the ____ cavity
CBCT
max sinus
Antroliths
• •
Here just more examples of antroliths that you may see on your ____ (more whitish compared to surrounding sinus).
You can appreciate the slight ____ areas in the max sinus
films
radiodense
MDCT coronal view
• Here is an MDCT coronal view
◦ Normal max sinus on the right; well-aerated, ethmoid sinus here,
◦ On Left, you can see the mucositis (orange arrow) ◦ Antrolith (black arrow)
ya
Sagittal MDCT: antrolith or ???
• On this sagittal MDCT, we have a hyper-dense area in the max sinus, do you think its an antrolith or something else??
◦ Ans: its a ____ in the max sinus
◦ you can appreciate that the tooth is not uniform in density due to its
variation in its structures (enamel, dentin,..)
tooth
Tooth within the left sinus
•
How would that look (from previous slide) on a pano; you can see normal max sinus and there you see a particular dense area, with radiopacity similar to that of rest of teeth
•
◦ tooth within the left sinus (green circle)
Someone asks a question:
◦ A: for an antrolith, you have to have a history of mucositis, but you
don’t have to have mucositis concurrent with the antrolith
◦ Mucositis and the antrolith may ____; we do not treat them
resolve
Dentigerous cysts with teeth in the sinus
• •
This is just to show us what dentigerous cysts looks like in the max sinus
We can see in the soft tissue window coronal view this is a tooth (in green, where arrows is pointing)
◦ Can actually say its a cyst because there is ____ in the area.
◦ Both together make a dentigerous cyst
Here is a different pt in the bone window in the axial view
We know its a cyst cause its filled w/ fluid (black arrow)
Cysts are benign; they tend to ____ adjacent structures not destroy it (unlike ____ which cause destruction of structures). Can tell that this is expanded compared to the sinus on the other side
fluid
expand
malignancies
Odontoma
• This is an example of an odontoma
• Odontoma will be ____ (more white) on the
CBCT
• This is the normal max sinus and you see the odontoma here
• On the sagittal view, we can also see an odontoma
• We call it complex odontoma –> cause we do NOT see ____ within it
◦ Called compound odontoma if there IS ____ associated w/ it
hyperdense
teeth
teeth
Odontoma
- This is how an odontoma looks like on a pano. Here is a rather exuberant odontoma on the left
- This will probably be complex cause I don’t see ____-like structure there
tooth
CT coronal view
Here is an example of coronal CT view
Everything looks normal but in the max sinus, you notice a mucus retention cyst on the right (orange arrow):
◦ this is cyst-like; generally appears ____-like
◦ there is no ____ to it; if you sneeze or blow your nose, it might go away
◦ incidental finding
•
On the left, you can see a cyst that probably is chronic, and ultimately became ____ (green arrow)
◦ we don’t know whether its:
‣ Radicular cyst –> has ____ associated w/ it OR
‣ Residual cyst –> has no ____ associated; from a tooth that has been
extracted
mucous retention cyst
always look for the ____-like shape
calcified radicular or residual cyst
◦ radicular cyst that had been calcified
◦ looks ____ like a mushroom
dome
treatment
calcified
tooth
tooth
dome
pedunculated
Bilateral mucous retention cysts
- This is how a mucous retention cyst will look like on a pano film; its pretty subtle.
- You can appreciate the dome-like appearance of the cyst (present within both max. sinuses L & R; just R circled below)
- in this case, you see the ridge; there is a lot ____ where the sinus is very close to the ridge
pneumatization
CBCT & endoscopy views of left and right sinuses
• Here is an example of CBCT, and you find these strange objects in the max sinus. They don’t really look like teeth, they are quite ____ so you do an ____ ..
• each colored pic highlights the endoscopy of the right and left sides of the sinus on the CBCT
• Anybody have any idea of what these (white areas) are?
◦ what do you commonly put in the maxilla to restore a teeth and you went too far…. Ans: an implant that went wrong!!
Most common foreign body found in the maxillary sinus is an ____
hypo-dense
endoscopy
implant
