max sinus Flashcards
what is management if root tip is trapped below antrum lining
- raise buccal flap
- enlarge socket
- remove root
- close with buccal flap
- standard sinus precautions
mx if root tip penetrated into sinus
- OAP
- caldwell luc procedure
immediate and delayed signs of OAP after exo
immediate
- direct visualisation of sinus using mirror
- misting of mirror or bubbles at socket when patient exhales through nose
- hollow whistling suction sound
- water enters nose on irrigation of socket
- post op epistaxis
delayed
- symptoms of sinusitis
- unilateral nasal congestion
- unilateral purulent nasal discharge
- water goes into nose when drinking
- change in voice/ air escaping from nose when speaking
how to manage moderate OAP
2-6mm
- gelfoam/surgicel and secure with figure of 8 suture
- sinus precautions for 1-2 weeks (open mouth when sneezing, no blowing nose, no swimming, no smokin, no straws)
- antibiotics (usually amox)
- decongestants
- return if OAC symptoms develop
how to manage large OAP
> 4mm
- surgical closure required (buccal advancement flap, palatal rotation flap, buccal fat pad)
- sinus precautions
- antibotics
- decongestants
how to manage OAF
- eliminate sinusitis before closing
- daily antral irrigation with 15-20ml warm saline, patient leans forward, repeat until liquid is clear then 2 more days
- medication for sinusitis (antibiotics, painkillers, decongestants)
- splint can be constructed to cover and protect socket
- surgical closure of OAF (techniques are the same as closure of large OAP but fistulous tract must be excised first)
how to prevent OAP
- if radiographs show a pneumatised sinus/ widely divergent long roots, can consider doing an open extraction and sectioning the tooth to remove one root at a time
- warn patient of possibility of OAC as patients who are flying within the week of surgery may choose to defer it
- when fractured root fragment is stuck in socket, to retrieve via closed technique only if the top of the root can be visualised. if not should raise flap and remove it surgically
defn of sinusitis, and the difference between acute and chronic
sinusitis is the inflammation of the mucous membrane that lines the sinuses caused by infection (bacteria/virus) or non infectious means (allergy)
acute sinusitis lasts for less than 3 weeks while chronic sinusitis lasts for 3 months or more
how to differentiate between bacterial or viral sinusitis
viral sinusitis typically lasts 20 days, so symptoms that are longer are typically suggestive of bacterial sinusitis
possible complications of maxillary sinusitis
if the infection spreads to other paranasal sinuses, can cause:
- cavernous sinus thrombosis
- meningitis
- osteomyelitis (frontal sinus)
steps to diagnose odontogenic maxillary sinusitis
1) hx taking
- s&s
- duration
- hx of exo, endo, surgery
2) clinical exam
- inspect: swelling or erythema at cheek area, check for any potential odontogenic aetiology
- palpate: lateral walls of sinus overlying cheekbones for any tenderness. intraorally, palpate lateral surface of maxilla between canine fossa and ZMC
- percussion: maxillary posterior teeth
- transillumination: compare transmission of light of L and R max sinus in a dark room
3) radiographic examination
will be able to see
- partial or total opacity in antral cavity on OPG/CBCT
- on CBCT might be able to see thickening of antral walls
- fluid
4) dx by inclusion of dental pathology
what AB to give for odontogenic maxillary sinusitis
1) Augmentin 500mg BD 5/7 + Metro 400mg TDS 5/7
2) for px with penicillin allergy, use respiratory fluoroquinolones ie cipro combined with metronidazole
how long should we prescribe decongestants for
not more than 5 days as it induces vasoconstriction to reduce secretion
what will we see in water’s view when there is maxillary sinusitis
- radiopacity
- removes the superimposition of the mastoid process
how to manage small OAP
<2mm
- gauze pressure for hemostasis
- advise sinus precautions for 10-14 days
- follow up within 48-72 hours or earlier if symptomatic
- dont need to pack gelfoam
what is the rationale of prescribing AB for OAP
prophylactic measure to prevent entry of oral bacteria into sinus (give 2 week course)
what decongestants to prescribe
- topical pseudoephedrine, phenylephrine, oxymetazoline
all 5 day course
what are some mucolytics to prescribe
flumucil (components are acetylcysteine, bromhexine, carbocysteine)w
what is an example of intra nasal steroid
fluticasone
when can we STO after surgery of sinus eg to close a large OAP?
must be 10 days or more because sinus mucosa takes 10-14 days to form
why do we have to excise fistulous tract completely in OAF before closing
because remnant epithelial lining may proliferate to reform tract
what are the 4 buttresses of the face that we can see from waters view
- supraorbital ridge (most superior)
- inferior orbital, nasal bones
- zygomaticomaxillary buttress
- inferior border of mandible
