Maxillary Antrum Flashcards
Function of paranasal sinuses (3)
-resonance to voice
-warming inspired air
-reduce weight of skull
Diagnosing an OAF/OAC
– Size of tooth
– Radiographic position of roots in relation to antrum
– Bone at trifurcation of roots
– Bubbling of blood
– Nose holding test (careful as can create an OAC)
– Direct vision
– Good light and suction - echo
– Blunt probe (take care not to create an OAC)
Management of OAC (acute)
-inform patient
-if small/sinus line intact - encourage clot/suture margins
-antibiotics
-post op instructions
What are the post op instructions for OAC
-refrain from blowing nose
-steam/menthol inhalers
-avoid straw use
-NO smoking
If large OAC/F - what to do.
-close with Buccal Adv Flap
-antibiotics
-post op instructions
Indications that patient is suffering with OAF
-issues with fluid consumption
-issues with speech/singing
-issues with instrument playing
-issues with straw use and smoking
-bad taste/odour/halitosis
-pain/sinusitis symps
Chronic OAF management
Excise sinus tract/fistula
• Buccal Advancement Flap
• Buccal Fat Pad with Buccal Advancement
Flap
• Palatal Flap
• Bone Graft/Collagen Membrane
• Tongue Flap (Historical)
Aetiology of tuberosity #
-Single standing molar
- Unknown unerupted molar or wisdom tooth
- Pathological gemination/concrescence
- Extracting in wrong order
- Inadequate alveolar support
Diagnosis of tuberosity #
– Noise
– Movement noted both visually or with
supporting fingers
– More than one tooth movement
– Tear on palate
Management of tuberosity #
– Dissect out and close wound
– Or reduce and stabilise
• Reduction:
– Fingers or forceps
• Fixation:
– Orthodontic buccal arch wire spot – welded
with composite
– Arch bar
– Splints
Important aftercare for Tuberosity #
– Remove or treat pulp
– Ensure occlusion free
– Antibiotic and antiseptics
– Instructions post-op
– Remove tooth 8 weeks later (SR)
Root in antrum retrieval
Original method of retrieval name
Modern surgery name
Caldwell Luc approach - old
Functional Endoscopic Sinus Surgery (FESS)
OAF type approach/through the socket:
• Flap Design
• Open fenestration with care
• Suction – efficient and narrow bore
• Small curettes
• Irrigation or ribbon gauze
• Close as for oro-antral communication
