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BDS 4: Oral Surgery > Diseases of The Maxillary Antrum > Flashcards

Diseases of The Maxillary Antrum Flashcards

1
Q

What are some clinical features of a OAC?

A
  • Characteristic hollow sound when using suction in socket
  • Bubbling bleeding
  • Air entry into mouth on holding nose
  • Bone/antral lining on roots of teeth
  • Radiographs show a defect in antral floor
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2
Q

When should large OACs be closed?

A

Ideally close at time to avoid sinus contamination and nasal regurgitation

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3
Q

What is this an example of?

A

Palatal rotational flap surgical closure of a OAF
Stronger tissue but needs GA

avoid doing due to the greater palatine

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4
Q

What is superior to the maxillary sinus?

A

Orbital contents
Infra-orbital vessels

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5
Q

How does fluid drain from the maxillary sinus?

A

All sinuses are connected
Fluid drains via the osteum

(This is high on the medial wall, about 3 to 4mm in diameter and opens into the end of the hiatus semilunaris in the middle meatus of the lateral wall of the nose)

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6
Q

What shape is the maxillary sinus and what is it lined with?

A

Pyramidal shape

Lined by respiratory epithelieum (ciliated)

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7
Q

Define sinusitis

What can cause this?

A

Inflammation of the sinus
Infection or can be odontogenic in origin

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8
Q

Why may a healthy and vital 6 be TTP?

A

As patient has a very inflammed sinus (sinusitis)

Can present as tooth ache

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9
Q

What is inferior to the maxillary sinus?

A

Hard palate
Roots of maxillary teeth

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10
Q

Why are pts put on abx before and after OAF tx?

A

The antrum must be clean to avoid infection

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11
Q

How do you manage a large fractured tuberosity?

A
  1. Leave and allow fracture to heal for 8 weeks
  2. Then plan a surgical extraction +/- closure OAC if necessary
  3. Antibiotics
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12
Q

What age range has the highest incidence of OACs?

A

3-4th Decade

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13
Q

What features of teeth are potential predisposing factors for OACs?

Not what tooth is the most likley OAC

A

Submerged teeth
Lone standing teeth
Hypercementosis
Loss of bone (perio)

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14
Q

Comment on the alveolar height in relation to molar teeth roots

A

Alveolar height decreases from mesial to distal

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15
Q

How do you manage a displaced tooth?

A

2 radiographs – parallax or CBCT (best option)
GA for removal
Caldwell Luc procedure
May need intranasal antrostomy
Antral regime

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16
Q

A tx option for an OAC is to put a pt on an antral regime. What do you tell a pt to not do?

A

Do not:
- Smoke for at least 72 hours
- Blow your nose or forcefully sneeze – sneeze with mouth open
- Use straws or whistle for 72 hours
- Blowing up balloons
- Play wind instruments
- Go flying for the next 4-6 weeks

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17
Q

What is this an example of?

A

Caldwell Luc Procedure
(cutting through lateral antral wall)

18
Q

Why may a pt need a sinus lift?

A

To create space for an implant

19
Q

What gender has the highest incidence of OACs?

A

Males > Females

20
Q

Why do we no longer tell a patient to blow through their nose (whilst holding their nose) to prove an OAC?

A

As this can make the OAC bigger

21
Q

List some congenital conditions involving the sinus

A

Cleft lip/palate
Deflected nasal septum

22
Q

What are some functions of paranasal sinuses?

A
  • Moistens inhaled air
  • Warms inhaled air
  • Lighten skull
  • Resonance
  • Immunological function for upper respiratory tract
23
Q

What XLAs have the highest incidence of OACs?

A

Upper molars

24
Q

What patient factors are potential predisposing factors for OACs?

A

Relationship of tooth to antrum
Large antrum
Increasing age
Hypercementosis

25
Q

How would you manage a small OAC?

A
  1. Raise flap
  2. Dissect out tooth and bone
  3. Suture with Surgicel
26
Q

What is the tx for sinusitis? (4)

A

Bed rest
Antibiotics
Nasal decongestants
Steam Inhalations

27
Q

What flaps can be used to treat a large OAC?

A

Buccal advancement flap
Palatal rotational flap
Tongue flap

28
Q

A tx option for an OAC is to put a pt on an antral regime. What do you tell a pt to do and be aware of?

A

You should:
- Use nasal decongestants (to reduce the degree of swelling of the nasal lining and reduces the risk of sneezing)
- Use steam inhalations (Olbas oil/Karvol)
- Chlorhexidine wash to reduce oral bacterial load

Beware rebound congestion (rhinitis medicamentosa) – after 7-10 days of decongestant use (SO DO NOT OVERUSE)

29
Q

What is anterior to the maxillary sinus?

A

Buccal sulcus

30
Q

What is the difference between an OAC and OAF?

A

OAC - Communication between oral cavity and antrum
OAF - An OAC that has epithelialized

31
Q

How do you manage a small fractured tuberosity?

A

Raise buccal flap
Dissect fractured bone and tooth out under direct vision
Suture with surgicel
Antral regime

32
Q

What is posterior to the maxillary sinus?

A

Pterygopalatine fossa
Maxillary artery

33
Q

What is this an example of?

A

Buccal advancement flap

34
Q

What are some risk factors of a fractured tuberosity?

A

Lond standing upper molars
Hypercementosis
Bulbous roots
Splayed roots
Large antrum (pneumatised)
Excessive force

35
Q

What operator factors are potential predisposing factors for OACs?

A
  • Excessive force
  • Conducting operations near sinus for removal of cysts etc
36
Q

Define an OAC

A

Oro-antral communications (OACs) is a communictaion between mouth and sinus

37
Q

What is medial to the maxillary sinus?

A

Lateral nasal wall
Nasolacrimal duct

38
Q

Name the four paranasal sinuses

A

Spehnoidal sinus
Frontal sinus
Ethmoidal sinus
Maxillary sinus

39
Q

Why do we no longer tell a patient to blow through their nose (whilst holding their nose) to prove an OAC?

A

As this can make the OAC bigger

40
Q

Why may a healthy and vital 6 be TTP?

A

As patient has a very inflammed sinus (sinusitis)

Can present as tooth ache

41
Q

What are some signs/symptoms of an OAF?

A
  • Regurgitation of fluids/food into the nose
  • Nose bleeds
  • Chronic sinusitis
  • Antral mucosa may prolapse into the mouth
  • Fluid in sinus shown on radiographs (radioopacity instead of black)
  • Pain worse when head is forward/when lying on one side

BDS 4: Oral Surgery (8 decks)

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