Maxillary Antrum

Question 1

what does sinusitis pain present as? what nerve is infamed?

Answer 1

hard to localise dental pain
inflammation of maxillary division of trigeminal nerve

Question 2

what epithelium are sinuses lined with?

Answer 2

ciliated resp epithelium

Question 3

where does antrum drain? what meatus does it drain into?

Answer 3

ostium 2/3rds of way up antrum wall
drains into middle meatus

Question 4

is a radiograph required for sinusitis diagnosis?

Answer 4

no - can be diagnosed from symptoms

Question 5

what % of infective sinusitis cases are dental related?

Answer 5

10%

Question 6

what 2 bacteria cause acute infective sinusitis?

Answer 6

Strep Pneumoniae & H. influenza

Question 7

list symptoms of acute infective sinusitis

Answer 7

pain worse on bending
no swellings
maxillary posterior teeth are TTP
headache
nasal drip
coloured discharge from nose

Question 8

what 2 non antimicrobial drugs can be given for sinusitis?

Answer 8

mucolytics - ephendrine nasal drops 0.5% for 1 week
menthol inhalations for 2 weeks

Question 9

when are antibiotics given for acute sinusitis? what antibiotics are prescribed? if allergy?

Answer 9

prolonged/ severe cases or if pt immunosuppressed

pen V - 500mg 4x a day for 5 days
doxycycline if penicillin allergy - 200mg loading dose fo first day, 100mg for remaining 4 days

Question 10

name 3 causes of sinusitis from mechanical obstruction to ostium

Answer 10

oedema of nasal mucosa
nasal polyps
septal deviation

Question 11

when can sinusitis be caused by impaired mucous clearance? (2)

Answer 11

poor ciliary action
CF (abnormally thick or sticky mucous)

Question 12

give 2 causes of chronic sinusitis

Answer 12

deviated septum - causes issue w/ drainage
OAF - requires surgical closure

Question 13

what local measures & antibiotics are given for chronic sinusitis?

Answer 13

drainage
metranidazole w/ amoxicillin or erythromycin

Question 14

what is an OAF? what condition does it cause?

Answer 14

“oral antral fistula”
epithelial lined tract - when OAC left open for few weeks and epithelialises
causes recurrent/chronic sinusitis

Question 15

what is an antral mucocele? why do they develop? how do they affect sinusitis? what complications can arise?

Answer 15

a cyst formed in atrum lining
large cysts can develop in shniderian membrane due to its mucous producing capabilities
the formed mucoceles extenuate chronic sinusitis and ostium obstruction
brain abscess, orbital cellulitis, cavernous sinus thrombosis

Question 16

list symptoms of an OAC

Answer 16

fluid down nose
air passing into mouth
altered voice
pt feels change in pressure on one side unilateral nosebleed
unilateral nasal obstruction
bad taste
facial pain

Question 17

what size OAC should spontaneously close?

Answer 17

<5mm

Question 18

what clinical observation confirms no OAC?

Answer 18

blood clot formed

Question 19

management of OAC - what flap should be raised? post op appliance? 3 types of drugs prescribed? what should pt avoid doing?

Answer 19

buccal advancement flap
plate or modified denture
antibiotics, ephendrine drops (0.5% 1 week), mucolytic inhalations
avoid nose blowing - may cause wound breakdown

ephendrine vasoconstricts blood vessels in nose causing reduction in nasal swelling and reduced congestion

Question 20

what antibiotics for OAC?

Answer 20

pen V or clindamycin
decongestant nasal drops