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My BDS4 > Maxillary Sinus > Flashcards

Maxillary Sinus Flashcards

1
Q

When does formation of the maxillary sinus begin in utero?

A

3/4 foetal months

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2
Q

What sinuses are relatively large and well formed at birth? (2)

A

maxillary
ethmoid

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3
Q

What are the functions of the paranasal sinuses? (3)

A
  • Resonance to the voice
  • Reserve chambers for warming inspired air
  • Reduce the weight of the skull
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4
Q

What is the average volumetric space of an adult maxillary sinus?

A

15ml

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5
Q

What are the average dimensions of the maxillary sinus? (3)

A
  • 37mm high
  • 27mm wide
  • 35mm antero-posteriorly
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6
Q

Where is the opening of the maxillary sinus located?

A

Middle meatus (hiatus semilunaris)

superiorly on medial wall of sinus

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7
Q

What length is the opening to the maxillary sinus?

A

4mm

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8
Q

Where is the alveolar canal that transports the posterior superior alveolar nerve located in relation to the sinus?

A

generally found on the posterior wall of the sinus cavity

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9
Q

What epithelium lines the maxillary sinus?

A

pseudostratified ciliated columnar epithelium

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10
Q

What is the function of the cilia that lines the sinus? (2)

A

mobilise trapped particulate matter and foreign material within the sinus

move this material toward the ostia for elimination into the nasal cavity

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11
Q

What complications are associated with the maxillary sinus? (6)

A
  1. Oro-Antral Communication (OAC) = Acute
  2. Oro-Antral Fistula (OAF) = Chronic
  3. Root in the antrum (iatrogenic)
  4. Sinusitis
  5. Benign Lesions
  6. Malignant Lesions
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12
Q

How do we diagnose an oro-antral communication? (8)

A
  • can predict by the Size of tooth/roots
  • predict via the radiographic position of roots in relation to antrum during pre-op assessment
  • Bone at trifurcation of roots of removal
  • Bubbling of blood post extraction
  • Nose holding test
  • Direct vision
  • Good light and suction (suction can sometimes create an echo)
  • Blunt probe (take care not to create an OAC) = X don’t use
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13
Q

Define a fistula.

A

epithelial lines tract

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14
Q

How do we manage a small OAC/OAC with sinus lining intact? (5)

A
  • Inform patient
  • Encourage clot
  • Suture margins to hold clot in place
  • Antibiotic (area of debate)
  • Post-op instructions
    = Minimising pressure formation within the sinuses and mouth
    Avoid nose blowing, sucking a straw, inflating balloons, smoking, singing.
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15
Q

How do we manage a large OAC? (6)

A

Inform patient

create a buccal advancement flap

possible trimming of buccal bone

incise the periosteum

ensure the BAF closes the communication with NO tension

suture and close BAF.

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16
Q

What post-op instructions do we provide after and OAC? (1)

A

Minimising pressure formation within the sinuses and mouth;

Avoid nose blowing, sucking a straw, inflating balloons, smoking, singing.

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17
Q

What do patients complain of if they have a chronic OAF? (6)

A

(Hx of upper extraction)

  • Problems with fluid consumption = fluids from nose
  • Problems with speech or singing (nasal quality)
  • Problems playing brass/wind instruments
  • Problems smoking cigarettes or using a straw
  • Bad taste/odour/halitosis/pus discharge (post-nasal drip)
  • Pain/sinusitis type symptoms
18
Q

How do we treat a chronic OAF? (4)

A

Remove the tract

Raise a flap

washout the antrum

close the flap

19
Q

What types of flaps can we use to close OAF/C? (4)

A
  • Buccal Advancement Flap
  • Buccal Fat Pad with Buccal Advancement Flap
  • Palatal Flap = thicke tissue
  • Bone Graft/Collagen Membrane
20
Q

What is the advnatge of a buccal fat pad buccal advancement flap?

A

it is a reinforced/thicker flap

21
Q

What are the disadvantages of using a buccal fat pad advancement flap? (2)

A
  • More bruising/swelling
  • Can cause asymmetry (one side more boney looking)
22
Q

What can cause fracture of the maxillary tuberosity? (5)

A
  • XLA of Single standing molar
  • Unknown unerupted molar or wisdom tooth
  • Pathological gemination/concrescence
  • Extracting in wrong order (start from back to front)
  • Inadequate alveolar support
23
Q

How do we diagnose/identify a fractured maxillary tuberosity? (4)

A
  • Noise “cracking”
  • Movement noted both visually or with supporting fingers
  • More than one tooth movement
  • Tear in soft tissue of palate
24
Q

How do we manage a fractured maxillary tuberosity? (2)

A

If noticed early enough;
* Reduce the section and stabilise the bone and teeth by splinting

or

If not noticed early and the blood supply has been lost;
* Dissect out the bone and the tooth and close the wound primarily – no BAF needed

25
Q

What can we use to splint teeth/bone after a maxillary tuberosity fracture? (3)

A
  • Orthodontic buccal arch wire with composite
  • 8-12 weeks with rigid HSSW and composite
  • Arch bar
26
Q

If a tooth is splinted after a maxillary tuberosity fracture, what must we do next? (5)

A
  • Dissect out the tooth or treat the pulp = ensure no symptoms
  • Ensure it is out of occlusion by reducing the occlusal height (once oedema occurs = no occlusal interference)
  • Consider antibiotic and antiseptics
  • Provide post-op instructions
  • If tooth not dissected out, Remove the tooth surgically 4-8 weeks later
27
Q

If there are roots/teeth in the antrum why must we take a CBCT on the day of surgery and not before?

A

roots/teeth can travel

28
Q

What options do we have for root/teeth retrieval from the maxillary antrum? (3)

A

OAF-type approach / through the extraction socket

Caldwell-Luc approach:
- Access via Buccal/Labial sulcus
- Buccal window cut in bone more anteriorly (premolar region)

  • ENT = Endoscopic Retrieval
29
Q

What causes sinusitis? (3)

A

(Most are precipitated by the effects of a viral infection)

Inflammation and oedema = Obstruction of ostia
= Trapping of debris within sinus cavity

Alteration of mucociliary clearance patterns by:
- Allergens
- Inflammation
- anatomic abnormalities

Normal physiological function is disrupted by the cellular damage that occurs to the mucosal lining = this affects normal ciliary function

30
Q

What can occur when the maxillary sinus cannot evacuate its contents and there is a build up of pressure?

A

opportune situation for bacterial overgrowth of normal flora
(bacterial infection)

31
Q

What are the three main characteristics signs and symptoms of sinusitis?

A

Discomfort on palpation of infraorbital region - bilateral or unilateral

A diffuse pain in the maxillary teeth
- Equal sensitivity from percussion of multiple teeth in the same region

Pain that worsens with head or facial movements – ask to jump/swing head up and down

32
Q

What are general signs and symptoms associated with sinusitis? (14)

A
  • Facial pain
  • Pressure
  • Congestion (fullness)
  • Nasal obstruction
  • Paranasal drainage
  • Hyposmia
  • Fever
  • Headache
  • Dental pain
  • Halitosis
  • Fatigue
  • Cough
  • Ear pain
    *Anaesthesia/paraesthesia over cheek
33
Q

What other diagnosis should we rule out before diagnosing sinusitis? (6)

A
  • Periapical abscess
  • Periodontal infection
  • Deep caries
  • Recent extraction socket
  • TMD
  • Neuralgia or atypical facial pain / chronic midfacial pain
34
Q

How do we manage sinusitis? (5)

A

Treat presenting symptoms

  • Reduce tissue oedema
  • Decongestants to reduce mucosal oedema
    Ephedrine nasal drops 0.5% one drop each nostril up to three times daily when required
  • Reverse obstruction of the ostia
  • Humidified air is also helpful (steam/menthol inhalations)
35
Q

Why can we only prescribe Ephedrine for up to 7 days?

A

it can cause atrophy to the nasal lining

36
Q

When should we prescribe antibiotics for sinusitis? (2)

A

Antibiotics should only be used if symptomatic treatment is not effective/symptoms worsen

AND

signs and symptoms point to a bacterial sinusitis

37
Q

What antibiotics do we prescribe for bacterial sinusitis? (2)

A

Pen V tablets 250mg, 2x tablets 4x times a day
8 tablets for 5 days
or
Doxycycline capsules 100mg, once a day, for 7 days (initial 200mg loading dose = 2x tablets)

38
Q

What is a non-resolving sinusitis usually caused by?
What can a non-resolving sinusitis lead to?

A

fungal sinusitis
- can cause expansion of the bony walls by increased mucus secretion and fungal growth

39
Q

What can cause a traumatic sinusitis? (9)

A
  • Sinus wall fractures
  • Orbital floor fractures
  • Root canal therapy
  • Tooth extractions
  • Dental Implants / Sinus lifts
  • Deep periodontal treatment
  • Nasal packing
  • Nasogastric tubes
  • Mechanical (nasal) intubation
40
Q

What other factors can contribute to sinusitis? provide examples (3)

A
  • Benign sinus lesions
    e.g. polyps, papillomas, antral pseudocysts, mucoceles and mucous retention cysts
  • Odontogenic cysts / odontogenic tumours expanding into the maxillary sinus
  • Malignant lesions (rare)
  • Primary tumours of bone or epithelial sinus lining
  • Local spread from adjacent sites

My BDS4 (57 decks)

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