imaging of the maxillary sinus and maxillary pathology Flashcards
What are the symptoms of maxillary sinusitis?
Extra orally: May be lymphadenopathy & pyrexia
- History of nasal stuffiness, post nasal drip
- Several teeth may be tender to pressure. No hypersensitivity. No obvious pathology • Exclude dental pathology with periapical radiographs.
May see thickening of sinus floor or opacity.
• Do not undertake specific radiological sinus views
what is the management of maxillary sinusitis?
– Analgesics
– Decongestants (Ephedrine/ Antihistamines/ Steroids)
– Mucolytics (Inhalnations)
– Antibiotics (Amoxycillin/ Tetracycline (Doxycycline)
what are the acquired abnormalities of the maxillary sinus?
– Inflammatory
– Trauma
– Cysts
• Intrinsic • Extrinsic
– Neoplasms
• Intrinsic • Extrinsic
What are the other abnoramalities of the maxillary sinus?
– Fibrous Dysplasia
– Pajets Disease
– Ostopetrosis
– Thalassemi
what are the intrinsic diseases which affect the antrum?
Benign mucous retention cysts
Polyps
Osteomas
SCC
Melanoma
Lymphoma
what are the extrinsic diseases affecting the antrum?
- Odontogenic cysts
- Odontogenic tumours
- Fibrous dysplasia
- Malignancy
- Salivary gland tumours
Is the maxillary antrum present at birth, what is the volume of an adult male.
Yes, it is present and birth.
It is the first paranasal sinus to be present
it is half its adult size by the age of 3
15 ml in a adult male
What is the anatomy of the maxillary sinus. (triangle depiction of borders of the sinus)
Where does the sphenoid sinus drain?
Sphenoethmoidal recess
where does the posterior ethmoid drain?
superior meatus ( between superior and middle concha)
where does the frontal, maxillary, anterior and middle ethmoid drain?
Middle meatus (between the middle and inferior concha)
where does the nasolacrimal duct drain?
The inferior meatus ( below the inferior concha)
what is the osteomeatal complex and where is it?
where is the pterygopalatine fossa in relation to the maxillary sinus and what does it communicate with?
Posterior wall of maxillary antrum
Communications:
Masticator space laterally (pterygomaxillary fissure)
F. Rotundum to middle cranial fossa
Vidian canal to F Lacerum
Infra orbital fissue
Pterygopalatine canal
what does this show?
label the normal anatomy of this DPT?
what should you look for in a plain radiograph?
• Check
– Positioning/Exposure
• Look for
– Opacity within the antrum
– Alteration in integrity of antral walls
– Alteration in antral outline
– Presence of a foreign body
what is this and what are its features?
Benign retention cyst.
Often and accidental finding and upto 13% of the pop will have them.
what is this?
It is a odontogenic cyst and therefore extrinsic pathology.
50% of antral opacities are odontogenic cysts.
Radicular > Dentigerous > Keratocysts
what are the radiological features of small odontogenic cysts?
– Round domed shaped opacity
– Base of antrum
– Well defined
– Corticated margin (halo effect)
– Lateral expansion of alveolus
– Maybe displacement of teeth
what are the radiological features of large odontogenic cysts?
– Total opacity of the antrum
– Loss of antral outline
– Maybe displacement of teeth
what is this?
It is a dentigerous cyst
what imaging should be done for inflamatory disease of the antrum?
if signs and symptoms suggest acute sinusitis then no need for imaging.
If signs and symptoms suggest chronic sinusitis( 3 months of signs and symptoms) then consider a CT
what is an antral carcinoma?
It is rare
Most tumours of the antrum are SCC.
Any unexplained radiopacity in sinus >40 years should be biopsied
Symptoms dependent upon walls involved
what are the radiological features of a Antral carcinoma?
Alteration ? Destruction of antral outline
Opacification of the antrum
Occasionally displacement &/or resoption of teeth
What does this show?
Zygomatic fracture.
This DPT is of a condition which causes opacification of the antrum? What could it be?
Thalassemia
What condition would present like this?
Fibrous dysplasia
What condition would present like this?
Pagets disease
when should you refer a patient?
Persistent nasal stuffiness/ post nasal drip
Bloody nasal discharge
Paraesthesia cheek/ palate
Abnormalities eye
Trismus
Loss of bony outline of antrum on radiograph
If you have concern re malignancy fast track
Which walls of the maxillary antrum can you see on a DPT
Posterior/ Floor/ Medial.
YOU CANNOT SEE THE LATERAL WALL ON A DPT.
