Management of Antral Disease

Question 1

What are the functions of maxillary sinus?

Answer 1

Warm air, defence against microbial ingress (cilia), decrease weight of skeleton, voice

Question 2

What blood vessels supply the maxillary sinus?

Answer 2

• Infraorbital & posterior superior alveolar artery

Question 3

How long can sinusitis?

Answer 3

4 weeks

Question 4

What is the treatment for maxillary sinusitis?

Answer 4

• Symptomatic relief
• Steam Inhalations
• Decongestants e.g. Ephedrone
• Avoid long haul flights
• Amoxicillin - 7 days

Question 5

Why does sinusitis become chronic?

Answer 5

• Reduced ciliary activity following acute infection
• Poor drainage due to high position of ostium
• Poor drainage from the middle meatus e.g. nasal polyps, deviated nasal septum

Question 6

Do these symptoms suggest simply sinogenic, shared singoenic and dental or simply dental?
- Increased pain with changes in atmospheric pain
- Disturbance of sleep
- Facial swelling
- Buccal sulcus swelling

Answer 6

Shared sinogenic and dental

Question 7

Why does hyperplasia of the mucus lining in the sinus occur?
Is treatment needed?

Answer 7

• Increase in periapical infection, RCTs, periodontitis
• Treatment needed only if encroaches on ostium blocking drainage predisposing to antral disease

Question 8

What is a mucocele?
What is the treatment for this?

Answer 8

• True cyst lined by epithelium
• Treatment: surgical removal using endoscopic removal / external surgery

Question 9

What are some dental causes of maxillary sinusitis?

Answer 9

• Pulpal necrosis
• Periapical disease
• Advanced periodontal disease
• Radicular / dentigerous cysts
• Pathological jaw fractures
• Facial trauma

Question 10

What are some iatrogenic causes of maxillary sinusitis?

Answer 10

• Complications following extraction, implant or sinus augmentation procedures
• Displaced teeth or foreign body in antrum
• Implant extrusion into antrum
• Endodontic treatment (over-instumentation, over-filling, sodium hypo extrusion)

Question 11

Once the inflammation in the maxillary sinuses has exceeded the sinus, where will it go?

Answer 11

• Nasal cavity
• Ethmoid & frontal sinus
• SEVERE = orbital cellulitis, blindness, meningitis, brain abscess, cavernous sinus thrombosis

Question 12

Is maxillary sinusitis from endodontic origin bilateral or unilateral?

Answer 12

Unilateral

Question 13

What is the management if a tooth displaces into the maxillary sinus after extraction?

Answer 13

Flush the socket with saline.
Explore the socket with good lighting.
Re-radiograph to see where tooth is
If not there, check suction or swallowed or inhaled (chest X ray needed)

Question 14

What is the antral regime for a OAC?

Answer 14

• Amoxicillin
• Steam Inhalation
• 0.5% ephedrine nasal drops / spray
• No nose blowing / long haul flights

Question 15

What are some signs of zygomaticomaxillary fracture?

Answer 15

• Infraorbital haematoma
• Conjunctival haemorrhage
• Step defect
• Trismus
• Double vision
• Malocclusion
• Numb cheek

Question 16

We treat cysts in the antrum in the normal way that we would treat each cyst.
How do we treat each of these cysts?
1. Radicular
2. Dentigerous
3. Keratocyst
4. Odontoma

Answer 16

1. Monitor / enucleation of cyst / XLA / RCT/ apical microsurgery of affected tooth
2. Enucleation of cyst / marsupialisation of cyst / transplantation of tooth
3. Enucleation of cyst or resection
4. Surgical removal in way of treatment, otherwise monitor

Question 17

Name some squamous cell carcinomas of the maxillary sinus

Answer 17

• Squamous cell carcinoma
• Acinic cell carcinoma
• Nasopharyngeal carcinoma
• Lymphoma
• Adenocarcinoma

Question 18

What are some signs and symptoms of malignant neoplasia?

Answer 18

• Space occupying lesion in maxillary antrum
• Orbital displacement: diplopia
• Nasal obstruction
• Unilateral facial pain
• Infraorbital paraesthesia
• Unilateral non-infective facial swelling
• Palatal swelling
• Epistaxis
• Non healing extraction site
• Resorption of teeth
• Cheek numbness
• Trismus