Maxillary sinus Flashcards
3 main functions of the paranasal sinuses
Resonance to the voice, reserve chamber for warming inspired air, reduce the weight of the skull
Where is the ostium located?
Superiorly on medial wall of sinus - makes more difficult to drain, some peoples even higher and smaller
What can happen to ostium during episodes of inflammation/infection (colds/allergies)
Can become narrow or blocked
What epithelium covers the sinuses?
Pseudostratified ciliated columnar epithelium
What is the function of the cilia in the sinuses?
Mobilise trapped particulate matter and foreign material within sinus and move this material towards the ostia for elimination into nasal cavity
Diagnose OAC/OAF by:
Size of tooth, radiographic position of roots in relation to sinus, bone at trifurcation of roots, Blood bubbling, nose holding test, direct vision (good light and suction), run blunt probe over base of pocket (be careful not to create an OAC)
Management of acute OAC if small and lining intact
Encourage clot
Suture margins (of socket) - makes heal more quickly
Antibiotic
Post-op instructions
Post op instructions after OAC management
- Instructions about prescribed medicines
- Refrain from forcibly blowing nose or stifling a sneeze (by pinching nose) - or try sneeze with mouth open
- Don’t prod area - Don't vigorously use mouthwash (could create hole or make small hole bigger) - Steam or menthol inhalations (to keep sinuses clear) - Avoid use of straw - Refrain from smoking
Acute management of OAC if large or lining torn
Close with buccal advancement flap (to close socket), antibiotic and nose blowing instructions
What antibiotic would be given and OAC and what regime?
Amoxicillin 500mg 3xdaily for 7 days
Or doxycycline 100mg - 2 tablets on 1st day then 1 tablet daily for 7 days
When doing a buccal advancement flap why do you want no tension when closing?
So that it doesn’t break down again because of poor blood supply due to pressure
What suture for OAC closure?
Non resorbable suture e.g. proline
Explain the suturing of an OAC
Combination of horizontal mattress suture and normal interrupted suture - if combination more likely to stay closed/less likely to all come out. Mattress suture turns edges of wound out against each other for better healing and interrupted suture lends extra support. Want complete closure - no part of socket left open
If there is chronic OAC only noticed later on what might the patient complain of?
Problems with fluid consumption (fluids
from nose) (also happens with cleft palate patients)
Problems with speech or singing (nasal
quality, sound like have cold)
Problems playing brass/wind instruments
Problems smoking cigarettes or using a straw
Bad taste/odour/halitosis/pus discharge
May not be able to see communication but when squeeze area see bead of pus on socket area
Pain/sinusitis type symptoms (see later)
If pt has a single standing upper 8 to be extracted what would you warn the pt they are at increased risk of?
Fracture of maxillary tuberosity
What signs would make you diagnose a maxillary tuberosity fracture?
Noise (hear bone cracking)
Movement noted both visually or with supporting fingers
More than one tooth movement
Tear on palate
Management of fractured tuberosity if small bit of bone
Dissect out and close wound
Remove or treat pulp if in pain
Remove tooth 8 weeks later
Management of fractured tuberosity if bigger bit of bone e.g. big bit that has other teeth on it as well as one you’re taking out
Reduce and stabilise
Reduction - fingers or forceps to put bone back where it was
Fixation - splint (needs to be as rigid as possible, the more teeth you splint the more rigid it is, orthodontic arch wire spot welded with composite)
Remove or treat pulp if in pain
Remove tooth 8 weeks later
How would you retrieve a root from the maxillary sinus?
OAF type approach/through the socket:
May need to cut away some bits of bone
Bone nibblers or surgical electrical drill (not air rotor)
Flap Design
Open fenestration with care
Suction – efficient and narrow bore (sometimes just suction gets root out)
Small curettes
Irrigation (with water may get root out) or ribbon gauze (pack gently into socket then pull out and root/tooth might come with it)
Close as for oro-antral communication
Caldwell-Luc approach (once referred patient):
Buccal sulcus
Buccal window cut in bone
Go in and look for root
ENT (refer to ENT for this)
Endoscopic retrieval
Go in through ostium
Signs/symptoms of sinusitis
Facial pain and pressure, headaches, toothache/dental pain (dull ache even if nothing wrong with teeth), congestion, nasal obstruction, paranasal drainage, hyposmia, fever, halitosis, fatigue, cough, ear pain, anaesthesia/paraesthesia over cheek
What happens when the sinus can no longer evacuate its contents efficiently?
Build up of pressure, opportune situation for bacterial overgrowth of normal flora, get infection
What can be used to reduce tissue oedema in sinusitis?
Decongestants:
- Pseudoephidrine (ephidrine nasal drops 0.5% one drop each nostril 3x daily when required)
- Oxymetazoline (nasal spray - may be doctor that prescribes)
- Humidified air also helpful (steam/menthol inhalations)
