Lesions of the Maxillary Sinus Relating to Dentistry

Question 1

What are the paranasal sinuses?

Answer 1

Hollow spaces in the skull and facial bones

Air filled cavities within the frontal, ethmoid, sphenoid and maxillary bones!

All drain into superior lateral aspect of nose

Sinus lining continuous with nasal mucosa

Question 2

Relations of the maxillary sinus

Answer 2

Base - lateral wall of nose
Roof - floor of orbit
Apex - extends into zygoma
Floor - alveolar process
Posterior wall - extends length of maxilla
Anterior wall - anterior wall of maxilla

Question 3

Descriptions of maxillary sinus

Answer 3

Largest sinus
4 sided pyramid in shape
Drains into middle meatus of nose through an ostium, into the inferior end of the semilunar hiatus
Volume of sinus is 15-20ml
Lined with mucous-secreting ciliated pseudostratified columnar epithelium with goblet cells
Cilia sweeps mucus from sinus to the osteomeatal complex

Question 4

Blood supply and innervation of maxillary sinus

Answer 4

Branches of the maxillary artery: posterior superior alveolar artery, infraorbital artery, descending palatine artery

Middle superior alveolar nerve

Question 5

How to investigate maxillary sinus diseases

Answer 5

Clinical exam :
> redness of upper sulcus or on face
> swelling in face, redness on skin
> nasal discharge
> pain on palpation of lateral surface of maxilla
> percussion of maxillary teeth

Transillumination: if empty sinus glows but if got fluid it doesn’t glow

Endoscopy, functional nasal endoscopy (go to ostium from nasal cavity, enter sinus)

Question 6

What is maxillary sinusitis

Answer 6

Inflammation of the mucosa lining the sinus
Can be due to virus, bacteria, fungus or after an allergic reaction
Causes hyperplasia and hypertrophy of the mucosa, blocking the ostium so cannot drain mucous into nose
Could be non-odontogenic or odontogenic

Question 7

Symptoms of acute maxillary sinusitis

Answer 7

Headache, nasal obstruction, purulent nasal discharge (post-nasal drip), malaise, fever

Dull heavy throbbing pain over cheek and maxillary teeth

Swelling of cheek in children

Usually lasts 10 days

Commonly caused by viral infection, otherwise bacterial infection by aerobes such as S aureus, S pneumoniae, H influenza, E coli etc

Question 8

What is odontogenic sinusitis

Answer 8

10-12% of all max sinusitis cases

Periapical infection? Periodontal infection?

Usually anaerobic bacteria like Bacteroides, enterobacteria, porphyromonas, prevotella etc

Question 9

Treatment of maxillary sinusitis

Answer 9

For non-odontogenic:
> antibiotics (amox, azithro etc)
> nasal decongestant
> analgesic (like paracetamol) for pain and fever

For odontogenic:
> same but can add metronidazole
> remove cause of irritation
> antral washout if chronic

Question 10

Oroantral perforation management

Answer 10

If small (<3mm) and no antral infection:
> establish blood clot and suture
> gauze pack for 1h
> instruct px not to blow nose or suck with straw/smoke
> prescribe antibiotics and nasal decongestant

If large:
> buccal advancement flap or palatal rotation flap to close oroantral communication

Question 11

Neoplasms associated with maxillary sinus

Answer 11

Generally rarer than other HN tumours
Mostly SCC
Also get adenoid cystic CA, mucoepidermoid CA, melanoma etc

Ulcerated palatal lesion
Fungating appearance

Do maxillectomy

Question 12

What is chronic maxillary sinusitis

Answer 12

Thickened sinus lining
Headache, lasting 12 weeks+
Different treatment

Question 13

What is antral irrigation?

Answer 13

Irrigation with saline
15-20ml (size of sinus)
Washes out pus, exits via mouth