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5th Oral Disease - Other > Maxillary Antrum > Flashcards

Maxillary Antrum Flashcards

1
Q

What is the maxillary antrum?

A

The largest paranasal sinus

Pyramidal shaped and bilateral

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2
Q

What is maxillary antrum lined with?

A

Respiratory epithelium = ciliated pseudostratified columnar epithelium

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3
Q

4 functions of maxillary antrum?

A

Reduce weight of skull
Voice resonance
Humidification
Mucous production

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4
Q

How does maxillary antrum drain?

A

Drain into nose via ostium (half way up medial wall)
Efficient cilia beat towards ostium

NOT DEPENDENT ON GRAVITY

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5
Q

What are the anatomical borders of the antrum?

A

Infraorbital border - superior
Alveolar process - inferior
Lateral wall of nose - medial
Zygoma - lateral

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6
Q

What nerve bundle transverse the roof of antrum?

A

Infraorbital bundle in orbital floor

Branch of maxillary nerve from trigeminal

Sensory innervation - skin lower eyelid, side of nose, nasal septum, part of cheek and upper lip
No motor

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7
Q

What features would you see on medial wall of sinus?

A

Middle and inferior turbinates

Ostium - cilia push mucous = drainage

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8
Q

What features would you see on the floor of the sinus?

A

Alveolar process of maxilla and the hard palate

Close to apices of teeth

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9
Q

Is there a difference in the floor of the sinus in children and adults?

A

In children alveolus adjacent to nasal floor

In adults 5-10mm lower

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10
Q

What would you expect to see on the anterior wall of the maxilla?

A

The cheek
Thinnest part - good surgical access
Canine fossa

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11
Q

What is an OAC?

A

Open communication between oral cavity and maxillary sinus

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12
Q

Where does floor of sinus extend?

A

Often molar region to canine

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13
Q

Where is OAC most likely?

A

Palatal root of first molar

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14
Q

What roots have RFs for OAC?

A

Long, divergent, dilacerated or ankylosed roots

Hypercementosis

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15
Q

What are other RFs for OAC?

A 
Lone standing molar
Loss apical periodical bone
Pneumatisation of sinus 
Impacted upper molar
Cleft lip and palate
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16
Q

What operator technique are RF for OAC?

A

Poor technique - excessive force, wrong instruments
Displacement of foreign object into sinus
Tuberosity fracture

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17
Q

What pt factors post surgery could lead to OAC?

A

Failure to follow antra regime

Build up of pressure in cavity - nose blowing, sneezing, altitude

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18
Q

What teeth are at most clinical risk?

A 
Upper second molar (most risk)
Upper first molar
Upper third molar
Upper secondary premolar
Upper first premolar
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19
Q

What are 3 important factors considering risk of OAC?

A

Thickness of antral floor
Bone resorption related periodontitis
Early and complete increase risk of OAC

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20
Q

What are signs and symptoms of OAC?

A 
Purulent discharge
Bad taste
Liquid regurgitation through
nose
Air escape
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21
Q

What test can be used to check for air escape?

A

Valsalvin test

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22
Q

What are clinical signs of OAC?

A

Movement of antra lining during respiraton
Bubble from socket during respiration
Hollow sound when aspirating socket
Fogging of mirror
Extracted tooth attached concave bone or tuberosity

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23
Q

What radiographic sign can indicate OAC?

A

Defect in sinus floor

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24
Q

What is management of OAC less 2mm

A 
Promote spontaneous healing 
Gentle irrigation of socket + debridement of sharp bone 
Resorbable haemostatic agent (Surgicel) 
Suturing loose edges 
Antral regime + review 
Vacuum splint
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25
Q

What is management of OAC that is 2-4m?

A

Consider conservative vs surgical repair

Assess- pt clinical signs, general RFs, MH, SH, OH

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26
Q

What is management of OAC >4mm

A

Surgical repair

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27
Q

What is the conservative tx of OACs?

A 
Many undetected and will heal spontaneously 
Ab - broad spec (penicillin)
Splint - aid healing
Decongestants
Pt instructions
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28
Q

What pt instructions should you give re OAC?

A

No nose-blowing
No flying altitude, don’t suck straws
Steam inhalation
Good OH

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29
Q

What are the active tx options of OAC?

A

Suture
Packing (resorbable/ non-resorbable)
Splints

w/ conservative regimen

30
Q

What is OAF?

A

Oral antra fistula

Communication of the oral cavity and maxillary sinus lined by epithelium

31
Q

Difference OAC and OAF?

A

OAF - epithelialised lining develops

32
Q

What are signs/ symptoms of OAF?

A 
Purulent discharge
Bad taste
Liquid regurgitation through nose
Air escape
Episodic sinusitis
Nasal voice
Epistaxis (nose bleed)
Prolapse antra mucosa into mouth
Whistling sound
33
Q

How can OAF be surgically repaired?

A

Buccal advancement flap - most common
Buccal fay pad graft
Palatal rotation

34
Q

How is buccal advancement flap used to tx OAF?

A

Excised OAF lining together w/ antra sinus lining or granulation tissue

35
Q

Why is buccal advancement flap most commonly used for tx of OAF?

A

Good success rate w/ low morbidity

Good blood supply from buccal periosteum

36
Q

Disadv of buccal advancement flap for tx of OAF?

A

Reduction is vestibular sulcus depth - prosthetic implications

37
Q

What is technique for buccal advancement flap for OAF?

A

Full thickness buccal mucoperiosteum flap is raised w/ flared margins to allow for advancement

Advancement to palatal side – periosteal release required in transverse direction

Sutured using vertical mattress

Important sits on sound bone

Palatal mucosa can be incised

OAF need to surgically remove fistula before closed

38
Q

What does buccal fat pad graft for tx of OAF involve?

A

Involve use of highly vascular fat surrounded by buccinator and masseter

Blunt dissection and pulled over to close defect then fat sutured

39
Q

What anatomy do you need to be careful of when using buccal fat pad graft?

A

Parotid duct and papilla - pierce buccinator at anterior border

40
Q

When is buccal fat pad graft useful?

A

Useful for delayed closure of larger defects

41
Q

What does palatal rotation rely on?

A

Greater palatine artery

42
Q

Why is palatal rotation not often used?

A

Painful donor site
Healing by secondary intention
Length/ width ratio important - flap necrosis

43
Q

How to avoid displacement of foreign objects?

A

Awareness - radiograph, awareness of RFs

Avoid apical pressure

44
Q

What are RFs for displacement of object into sinus?

A

RF - age, RCT, ankylosis, proximity

45
Q

What are the most common teeth to be involved in displacement?

A

Upper 6 palatal root
3rd molar - whole tooth
2nd molar root

46
Q

What are the 3 approaches to management of displaced object?

A
  1. Alveolar approach
  2. Caldwell-Luc approach
  3. Functional endoscopic sinus surgery - FESS
47
Q

What radiographs are useful when managing displacement?

A

Intra-oral PA
OPT
CBCT - assess ability of retrieval

Used to diagnose and identify location and extent of displacement

48
Q

When can retrieval be used?

A

When displacement in closer than think - between mucosa and alveolar bone or between sinus lining and floor

Use light and suction

49
Q

What is transalveolar approach?

A

Fill sinus w/ saline and use suction to retrieve

Use flap w/ bone removal to aid visualisation

50
Q

What is Caldwell-Luc procedure?

A

If not obviously retrievable by trans alveolar

Required GA

51
Q

What are pros and cons of Caldwell-Luc procedure?

A

Pro - trapdoor approach = good access and persevere alveolar bone

Con - traumatic, loss vitality adjacent teeth, fistula formation, infra-orbital nerve damage

52
Q

What is procedure of Caldwell-Luc?

A

Raise flap in buccal sulcus above premolar teeth to create lateral window

53
Q

What is FESS?

A

Conservative approach where sinus access via enlarged middle meatus antrosotomy

Minimise associated complications but expensive, time consuming and need skilled operator (ENT)

54
Q

What are 3 management decisions of tx of displaced objects?

A

Retrieve
Delay
Refer

55
Q

What to do if delay tx of displaced object?

A

Document
Radiograph
Ab
Refer

56
Q

Post-op advice when displaced object?

A 
Similar conservative regimen
Decongestants
Abs
Avoidance nose blowing
OH
57
Q

Features of the tuberosity?

A

Most distal aspect of maxilla

Contains socket of third molar

58
Q

Why are fractures of tuberosity a concern?

A

Cause large OAC

Stability issue for later prosthetics

59
Q

What are RFs of fractured tuberosity?

A 
Upper molar XLA
Roots - divergent, dilacerated, ankylosed
Lone standing molar
Pneumatised sinus 
Increased age
Poor technique
60
Q

Why dose increased age increase risk of tuberosity fracture?

A

Antrum larger, expanded, pneumatised - floor lower down

61
Q

What poor techniques can lead to fractured tuberosity?

A

Uncontrolled force
Inadequate maxillary alveolar support
Excessive elevation

62
Q

Clinical signs of fractured tuberosity?

A

Tooth and tuberosity move synchronously w/ XLA
Fracture noise
Palatal tear - bleaching mucosa
Bleeding

63
Q

What does management of tuberosity fracture depend on?

A

If tuberosity attached to periosteum or not

64
Q

How to manage fracture if tuberosity attached to periosteum?

A
  1. Splinting to adjacent teeth
  2. Conservative management - soft diet, ab and re-book for surgical XLA (6-8 weeks)
  3. Section crown to enable roots and tuberosity to heal
  4. Remove fractured tuberosity - subperiosteal dissection off fragment
65
Q

How to manage fractured tuberosity if separated from soft tissue +/- OAC?

A

Smooth sharp edges residual bone

No OAC - suture and antra regime

OAC - tx according to defect size

66
Q

How can implants cause injury to sinus?

A

Inadequate height - injury to sinus floor

Overcome w/ sinus life procedure - increase vertical volume of bone

67
Q

What is an internal sinus lift?

A

Use summers technique

Aim: maintain integrity of sinus lining, limit graft to restore alveolar bone and avoid impaired sinus drainage

68
Q

What is chronic sinusitis?

A

When remains persistent

Can be bacterial or viral

69
Q

Symptoms of chronic sinusitis?

A

Mimic toothache, nasal discharge, pressure/ pain when bending

70
Q

How to tx bacterial sinusitis?

A

Abs

Decongestants

71
Q

How to tx chronic sinusitis?

A

Antra wash
Nasal surgery
ENT referral - esp if recurrent

5th Oral Disease - Other (13 decks)

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