Diseases of The Maxillary Antrum Flashcards
What are some clinical features of a OAC?
- 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
When should large OACs be closed?
Ideally close at time to avoid sinus contamination and nasal regurgitation
What is this an example of?
Palatal rotational flap surgical closure of a OAF
Stronger tissue but needs GA
avoid doing due to the greater palatine
What is superior to the maxillary sinus?
Orbital contents
Infra-orbital vessels
How does fluid drain from the maxillary sinus?
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)
What shape is the maxillary sinus and what is it lined with?
Pyramidal shape
Lined by respiratory epithelieum (ciliated)
Define sinusitis
What can cause this?
Inflammation of the sinus
Infection or can be odontogenic in origin
Why may a healthy and vital 6 be TTP?
As patient has a very inflammed sinus (sinusitis)
Can present as tooth ache
What is inferior to the maxillary sinus?
Hard palate
Roots of maxillary teeth
Why are pts put on abx before and after OAF tx?
The antrum must be clean to avoid infection
How do you manage a large fractured tuberosity?
- Leave and allow fracture to heal for 8 weeks
- Then plan a surgical extraction +/- closure OAC if necessary
- Antibiotics
What age range has the highest incidence of OACs?
3-4th Decade
What features of teeth are potential predisposing factors for OACs?
Not what tooth is the most likley OAC
Submerged teeth
Lone standing teeth
Hypercementosis
Loss of bone (perio)
Comment on the alveolar height in relation to molar teeth roots
Alveolar height decreases from mesial to distal
How do you manage a displaced tooth?
2 radiographs – parallax or CBCT (best option)
GA for removal
Caldwell Luc procedure
May need intranasal antrostomy
Antral regime
A tx option for an OAC is to put a pt on an antral regime. What do you tell a pt to not do?
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
What is this an example of?
Caldwell Luc Procedure
(cutting through lateral antral wall)
Why may a pt need a sinus lift?
To create space for an implant
What gender has the highest incidence of OACs?
Males > Females
Why do we no longer tell a patient to blow through their nose (whilst holding their nose) to prove an OAC?
As this can make the OAC bigger
List some congenital conditions involving the sinus
Cleft lip/palate
Deflected nasal septum
What are some functions of paranasal sinuses?
- Moistens inhaled air
- Warms inhaled air
- Lighten skull
- Resonance
- Immunological function for upper respiratory tract
What XLAs have the highest incidence of OACs?
Upper molars
What patient factors are potential predisposing factors for OACs?
Relationship of tooth to antrum
Large antrum
Increasing age
Hypercementosis
How would you manage a small OAC?
- Raise flap
- Dissect out tooth and bone
- Suture with Surgicel
What is the tx for sinusitis? (4)
Bed rest
Antibiotics
Nasal decongestants
Steam Inhalations
What flaps can be used to treat a large OAC?
Buccal advancement flap
Palatal rotational flap
Tongue flap
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?
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)
What is anterior to the maxillary sinus?
Buccal sulcus
What is the difference between an OAC and OAF?
OAC - Communication between oral cavity and antrum
OAF - An OAC that has epithelialized
How do you manage a small fractured tuberosity?
Raise buccal flap
Dissect fractured bone and tooth out under direct vision
Suture with surgicel
Antral regime
What is posterior to the maxillary sinus?
Pterygopalatine fossa
Maxillary artery
What is this an example of?
Buccal advancement flap
What are some risk factors of a fractured tuberosity?
Lond standing upper molars
Hypercementosis
Bulbous roots
Splayed roots
Large antrum (pneumatised)
Excessive force
What operator factors are potential predisposing factors for OACs?
- Excessive force
- Conducting operations near sinus for removal of cysts etc
Define an OAC
Oro-antral communications (OACs) is a communictaion between mouth and sinus
What is medial to the maxillary sinus?
Lateral nasal wall
Nasolacrimal duct
Name the four paranasal sinuses
Spehnoidal sinus
Frontal sinus
Ethmoidal sinus
Maxillary sinus
Why do we no longer tell a patient to blow through their nose (whilst holding their nose) to prove an OAC?
As this can make the OAC bigger
Why may a healthy and vital 6 be TTP?
As patient has a very inflammed sinus (sinusitis)
Can present as tooth ache
What are some signs/symptoms of an OAF?
- 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
