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BDS5 oral disease > antrum > Flashcards

antrum Flashcards

1
Q

describe the growth of the antrum (5)

A
  • rapid 0-4yo then gradual 4-8yo
  • width and length complete by 12yo
  • height increases until 18yo
  • slower growth in females after 8yo, stops earlier
  • loss of upper teeth = antral floor encroaches
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2
Q

describe the drainage of paranasal sinuses (2)

A
  • middle meatus drains frontal, maxillary, anterior and middle ethmoidal sinuses
  • sphenoethmoidal recess drains the posterior ethmoidal and sphenoidal sinuses
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3
Q

what are sinuses lined by?

A

respiratory mucosa (pseudostratified columnar ciliated epithelium)

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4
Q

give some functions of the antrum (5)

A
  • warm and humidify air
  • defence against microbial ingress (cilia)
  • decrease weight of skeleton
  • voice resonance contribution
  • “crumple zone” (protects brain in trauma)
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5
Q

what innervates the sinuses?

A

maxillary nerve branches = superior alveolar nerves and infraorbital nerve

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6
Q

what is the blood supply of the antrum?

A

maxillary artery branches = infraorbital, posterior superior alveolar arteries

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7
Q

what radiographic imaging could be used to view the antrum? (4)

A
  • PA
  • occlusal (limited value)
  • DPT
  • OM view
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8
Q

how to tell the difference between cyst and sinus? (2)

A
  • sinus has radiolucent channels (vascular)
  • sinus has a wiggly line, cyst can be scalloped or rounded
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9
Q

what walls/surfaces of the maxillary sinus can be seen on the DPT?

A
  • floor
  • anterior
  • posterior
  • roof/floor of orbit
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10
Q

what developmental disorders can affect the antrum?

A
  • aplasia (failure to develop)
  • hypoplasia
  • hyperplasia
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11
Q

describe maxillary sinus hypoplasia (what, radiograph, other)

A
  • unilateral >
  • reduction of sinus size and compensatory enlargement of nasal cavity
  • increased radiographic height of alveolar process
  • increased risk of infections due to narrow sinus drainage into ostium
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12
Q

define maxillary sinusitis

A

inflammation of the maxillary sinus with mucosal thickening + mucopus/pus

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13
Q

give some possible causes of acute sinusitis (up to 6)

A
  • URTI (intrinsic)
    dental extrinsic: (maxillary sinusitis of odontogenic origin)
  • PA inflammation/infection
  • endo treatment
  • OAC/OAF
  • root displacement/implant extrusion into sinus
  • surgery (eg ridge augmentation)
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14
Q

give some specific sinogenic s/s (4)

A
  • unilateral nasal obstruction/discharge
  • pus in middle meatus
  • concurrent/recent URTI
  • increased pain on vertical change in head position
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15
Q

give some shared sinogenic and dental s/s (5)

A
  • increased pain with changes in atmospheric pressure
  • unilateral maxillary pain
  • sleep disturbance
  • facial swelling/rare cases of acute ethmoid/frontal sinusitis
  • upper buccal sulcus swelling (rare, large antrum)
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16
Q

how is sinusitis managed? (6)

A
  • steam inhalations (Karvol, Olbas oil)
  • decongestants - ephedrine 0.5% spray/drops (QDS <7 days) or xylometazoline
  • saline irrigation of nasal cavity
  • avoid long haul flights
  • antibiotics ONLY if signs of spreading infection, persistent symptoms >7 days, very severe s/s, immunocompromised, cystic fibrosis
    – amoxicillin, doxycycline or clarithromycin 7/7
  • refer if systemically unwell or orbital involvement
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17
Q

what may be used as a decongestant for sinusitis and what do these do?

A
  • ephedrine 0.5% spray/drops (QDS <7 days)
  • xylometazole
  • constrict nasal lining to widen ostia
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18
Q

why should decongestants not be used for >7 days?

A

to avoid rebound effect of mucosal swelling

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19
Q

when are antibiotics indicated for sinusitis? (4)

A
  • signs of spreading infection
  • persistent symptoms >7 days or very severe s/s
  • immunocompromised
  • cystic fibrosis
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20
Q

what is the difference between acute and chronic sinusitis?

A

acute = up to 4 weeks, self-limiting, symptomatic treatment
chronic = 8-12 weeks, rarely painful

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21
Q

what may cause chronic sinusitis? (4)

A
  • acute infection and decreased ciliary action –> bacterial infection
  • poor draining - high position of ostium
  • poor draining from middle meatus (nasal polyps, deviated nasal septum, concha bullosa)
  • dental causes
22
Q

what is the management of chronic sinusitis (as a GDP)? (2)

A
  • identify and treat any underlying dental cause
  • refer to ENT - steroid nasal sprays, decongestants, surgery to remove obstructions/FESS
23
Q

causes of maxillary sinusitis of odontogenic origin (6)

A

violation of sinus membrane by intimate association of maxillary teeth with antral floor:
- PA disease
- advanced periodontitis
- cysts (radicular, dentigeous)
- pathological jaw lesions
- facial trauma
- iatrogenic = post-XTN/implant/augmentation/maxfax, displaced tooth/foreign body/implant, endo treatment

24
Q

how may endodontic treatment cause maxillary sinusitis?

A
  • over-instrumentation
  • sodium hypochlorite accident
  • extrusion of filling material
25
Q

describe the four stages of maxillary sinusitis of endodontic origin progression

A

1 = asymptomatic with minimal local reaction in antral floor periosteum/mucosa for months-years
- mucosal thickening radiographically
2 = beyond sinus floor, partial/total obstruction of sinus
- similar s/s to sinogenic sinusitis
3 = involvement of nasal cavity, ethmoid and frontal sinuses
4 = spread to other areas

26
Q

what issues can be caused by severe spread of maxillary sinusitis of endodontic origin? (3)

A
  • orbital cellulitis and blindness
  • meningitis, brain abscess
  • cavernous sinus thrombosis
27
Q

how does maxillary sinusitis of endodontic origin usually present? (2)

A

(usually present to GP or ENT)
- unilateral sinusitis on the side of dental pathology
- variable s/s similar to acute sinusitis, endodontic symptoms may be absent (apex within sinus)

28
Q

what may imaging show in maxillary sinusitis of endodontic origin? (4)

A
  • PA RL
  • PA osteoperiostitis (antral halo)
  • PA mucositis (mucosal thickening)
  • sinus obstruction (opacification)
29
Q

how is maxillary sinusitis of endodontic origin managed? (2)

A
  • remove cause of infection (RCT, endodontic microsurgery, intentional reimplantation, XTN)
  • consider adjunctive medical or surgical management and f/u with ENT (esp chronic s/s)
30
Q

management of displaced tooth in the antrum (4)

A
  • saline flush, explore socket with high volume suction and good lighting
  • inform pt and re-radiograph
    – loose in antrum = Caldwell-Luc approach/endoscopic removal
    – absent = check suction, swallowing or inhalation (CXR at A&E)
31
Q

if a tooth fragment is inhaled, where is it likely to end up?

A

right main bronchus

32
Q

what is the Caldwell-Luc approach and what is it used for (3)?

A

surgical procedure involving a MPF and cavity in the upper buccal buttress
- removal of foreign bodies in antrum
- exposure and removal of tumours in/adjacent to antrum
- removal of odontogenic tumours/cysts

33
Q

why is it important to check the antrum on a CBCT pre-implants?

A

higher risk of rhinosinusitis after implant surgery if the pt has pre-operative chronic sinusitis (should be managed before implants)

34
Q

s/s of OAC/OAF

A
  • leakage of fluid into the nose
  • air escape from the nose into the mouth
  • sinusitis s/s
35
Q

management of OACs/OAFs (8)

A
  • majority of OACs resolve without surgical treatment
  • inform pt
  • antral regime:
    – amoxicillin
    – Karvol steam inhalations
    – ephedrine 0.5% nasal drops/spray
    – NO nose blowing or long haul flights
  • review
  • OAC/OAF present 2 weeks later = may need surgical closure with buccal advancement flaps +/- buccal fat pad
36
Q

what type of fungal infection is more common in the sinus?

A

Aspergillus

37
Q

what may sinus infection lead to (life-threatening)? give some s/s

A

orbital cellulitis (esp in young)
- eye swelling, proptosis, diplopia
- pain
- history of common cold/URTI

38
Q

how is orbital cellulitis managed? (2)

A
  • send to A&E for urgent CT scan
  • IV antibiotics and surgical drainage by ophthalmology
39
Q

describe central mucosal thickenings of the antrum (what, causes, types)

A
  • mucosal thickenings >2mm
  • type of inflammatory hyperplasia
  • eg PA infections, RCTs, periodontitis, close relationship of maxillary teeth with sinus
  • types = maxillary pseudocysts, mucous retention cysts, mucoceles
40
Q

describe a maxillary pseudocyst (what, tx, radiograph)

A
  • formed by accumulation of serum beneath periosteum, lifting it off the bone
  • not epithelial-lined
  • asymptomatic, harmless, no treatment needed unless blocking
  • common on DPT as a dome-shaped radiopacity on antral floor
41
Q

describe a sinus mucous retention cyst (what, where, radiograph, tx)

A
  • no epithelial lining
  • inflammation of epithelial lining with secretory duct obstruction and liquid accumulation
  • most common in maxillary sinus
  • common on DPT = dome/ball-shaped, no cortical outline, intact sinus floor, no alveolar expansion or effects on teeth
  • no tx unless blocking
42
Q

how can you tell the difference between central mucosal thickenings of the sinus and an odontogenic cyst?

A

odontogenic cyst would have a bony margin

43
Q

how can you tell the difference between central mucosal thickenings of the sinus and malignancy?

A

malignancy would have bone destruction

44
Q

how can you tell the difference between central mucosal thickenings of the sinus and polyps?

A

polyps are often smaller and multiple

45
Q

describe sinus mucocele (what, s/s, tx, location)

A
  • true cyst (epithelial and mucoperiosteal lining) containing mucinous secretions in blocked/obstructed sinus cavity (blocked ostium)
  • benign, but may erode bone
  • can cause significant pathology in periorbital region
  • endoscopic removal/external surgery
  • usually in frontal sinus, Japan (following external sinus surgery)
46
Q

list some tumours which may involve the maxillary sinus (4)

A
  • odontogenic cysts/tumours, ameloblastoma
  • adenomas, myxomas, fibromas
  • fibrous dysplasia, Paget’s
  • osteoma
47
Q

what are the most malignant tumours involving the maxillary sinus?

A
  • 80% squamous cell carcinoma
  • 10% acinic cell carcinoma (and others)
  • metastases
48
Q

malignant tumours affecting maxillary sinus - common demographic

A

middle-aged to elderly males

49
Q

s/s of malignant tumours affecting the sinus (up to 10)

A
  • space-occupying lesion in antrum
  • orbital displacement, diplopia
  • epistaxis, nasal obstructions
  • unilateral facial pain, infraorbital paraesthesia, cheek numbess
  • unilateral firm, non-infective facial swelling
  • loss of radiopaque sinus outline
  • palatal swelling
  • non-healing extraction site
  • loose maxillary teeth in absence of perio/PA disease
  • trismus
50
Q

what traumatic conditions can affect the maxillary sinus? (2)

A
  • iatrogenic = dental tx
  • middle facial bone fractures
51
Q

list the categories of conditions affecting the antrum (5)

A
  • developmental disorders
  • diseases (inflammatory)
  • tumours
  • diseases outside sinus which may affect sinus as they grow
  • trauma

BDS5 oral disease (26 decks)

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