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BDS4 Oral Surgery > Maxillary Sinus > Flashcards

Maxillary Sinus Flashcards

1
Q

What are the paranasal sinuses lined with

A

mucous membrane

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2
Q

What type of epithelium are paranasal sinuses lined with

A

pseudostratified ciliated columnar epithelium

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3
Q

What is the function of cilia

A

o Mobilise the trapped particular matter and foreign material withint he sinus
o Move this material towards the ostia for elimination into the nasal cavity

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4
Q

What is the function of the paranasal sinuses

A

o Lighten the skull bones
o Act as sound resonators
o Provide mucous for the nasal activity
o Reserve chambers for warming inspired air due to good blood supply

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5
Q

What are the 4 pairs of paranasal sinuses

A

maxillary
frontal
sphenoidal
ethmoidal

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6
Q

What shape is the maxillary sinus

A

pyramid

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7
Q

Where does the maxillary sinus drain

A

middle meatus

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8
Q

What part of the maxillary sinus anatomy promotes sinusitis

A

ostium of sinus is higher than the floor of the sinus cavity

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9
Q

What is the maxillary sinus opening to the middle meatus called

A

hiatus semilunaris

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10
Q

What does the posterior wall of the maxillary sinus contain

A

the alveolar canals that transport the posterior superior alveolar nerves and vessels to the maxillary posterior teeth

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11
Q

Describe the frontal sinuses

A

 In frontal bone
 Communicates with nasal cavity via frontonasal duct

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12
Q

Describe the sphenoidal sinuses

A

 Located in sphenoid bone
 Communicate with nasal cavity via opening superior to each superior nasal concha

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13
Q

Describe the ethmoidal sinuses

A

 Aka ethmoid air cells
 In the lateral mass of each ethmoid bone
 Open into superior meatus and middle meatus

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14
Q

When are the sinuses formed

A

Formation occurs during 3rd and 4th foetal months with evaginations of the mucosa of the nasal cavity

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15
Q

What are the most common issues associated with the maxillary sinus

A
  • OAC
  • OAF
  • root/tooth in antrum
  • sinusitis
  • benign lesions
  • malignant lesions
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16
Q

How is an OAC created

A

by tooth removal resulting in creation of a communication due to bone breakage or tearing of the lining

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17
Q

What is diagnosis of OAC based on

A
  • Size of tooth
  • Radiographic position of roots in relation to antrum
  • Bone at trifurcation of roots
  • Bubbling at blood
  • Nose holding test (careful as can create OAC)
  • Direct vision
  • Good lighting and suction, look out for an echo
  • Blunt probe (can create OAC)
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18
Q

What radiographic signs may indicate a tooth of being mroe problematic

A

o Big splayed roots can be more problematic
o Low standing molars have increased chance of fractured tuberosity and OAC

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19
Q

What is management of OAC

A

inform px
depends on size

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20
Q

What is the management for a small OAC or if the lining is intact

A

o Encourage clot
o Suture margins
o Antibiotic (area of debate)
o Post-op instructions

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21
Q

What are the post-op instructions for OAC

A

 Minimising pressure formation with the sinuses and mouth

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22
Q

What size of OAC usually heal with normal blood clot formation and routine mucosal healing

A

<2mm

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23
Q

If the OAC is large, how should it be managed

A

close with buccal advancement flap

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24
Q

What is the buccal advancement flap

A

broad based trapezoid flap with 2 relieving incisions which are less flared, flap should be lifted so bare bone exposed

25
Q

Why may you trim buccal bone when doing a buccal advancement flap

A

to get flap to fit

26
Q

Why may you incise the periosteum when doing a buccal advancement flap

A

If flap cant be stitched without tension then periosteum should be incised to loosen it

27
Q

What makes an OAF different from OAC

A

OAF has epithelial lined tract

28
Q

What may a px complain of for an OAF

A
  • Problems with fluid consumption (coming out of nose)
  • Problem with speech/singing (nasal quality)
  • Problems playing brass/wind instruments (hard to create pressure)
  • Problems smoking or using a straw
  • Bad taste/odour/halitosis/pus discharge
  • Pain/sinusitis type symptoms
29
Q

What is the tx of OAF

A

same as OAC except epithelial lined tract should be exised prior

30
Q

What are the flap design options for OAF

A
  • BAF
  • buccal fat pad with BAF
  • palatal flap
  • bone graft/collagen membrane
31
Q

What should you do if you suspect a root in the maxillary antrum

A
  • confirm via xray (OPT, occlusal, PA, CBCT)
32
Q

How can the root/tooth be retrived from the antrum

A
  • OAF type approach through extraction socket
  • caldwell luc approach
  • ENT
33
Q

What is the OAF approach to getting the root/tooth out the antrum

A

o Open fenestration with care
o Suction using narrow bore
o Small curettes used
o Irrigation or ribbon gauze should be used
o Close as for OAC

34
Q

What is the caldwell luc approach for getting the tooth/root out the antrum

A

o Buccal window cut in bone

35
Q

When do you refer to ENT for root/tooth removal from antrum

A

o If unretrievable
o May do endoscopic retrieval

36
Q

When examining a px with maxillary discomfort, what should you remember

A
  • The close relationship of the sinuses and the posterior maxillary teeth
  • The aetiology of paranasal sinus inflammation and infection
  • Patients with sinusitis often present to the dentist first
37
Q

What is the aetiology of sinusitis

A
  • most precipiated by effects of a viral infection
  • mucociliary clearance patterns may be altered
  • normal physiological function is further disrupted
  • sinus can no longer evacuate its contents efficiently
38
Q

What are the effects precipiated by viral infection that results in sinusitis

A

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

39
Q

What may the mucociliary clearance patterns be altered by

A

o Allergens
o Inflammation
o Anatomic abnormalities

40
Q

When the sinus can no longer evacuate its contents efficiently, what does this result in

A
  • build up of pressure
  • opportunistic situation for bacterial overgrwoth of normal flora
41
Q

What are signs/symptoms of sinusitis

A
  • Facial pain
  • Pressure
  • Congestion
  • Nasal obstruction
  • Paranasal drainae
  • Hyposmia
  • Fever
  • Headache
  • Dental pain
  • Halitosis
  • Fatigure
  • Cough
  • Ear pain
  • Anaesthesia
42
Q

What causes should be ruled out with suspected sinusitis

A
  • Periapical abscess
  • Periodontal infection
  • Deep caries
  • Recent extraction socket
  • TMD
  • Neuralgia or atypical facial pain/chronic midfacial pain
43
Q

What are indicators of sinusitis

A
  • Discomfort on palpation of infraorbital region
  • A diffuse pain in the maxillary teeth (all TTP)
  • Equal sensitivity from percussion of multiple teeth in same region
  • Paint that worsens with head or facial movements
44
Q

What are tx aims of sinusitis

A
  • Treat presenting symptoms
  • Reduce tissue oedema
  • Reverse obstruction of the ostia
45
Q

What is tx of sinusitis

A

Decongestants reduce mucosal oedema
humified air

46
Q

What do the decongestants consist of

A

Ephedrine nasal drops 0.5% one drop each nostril up to 3x daily when required (use for up to 7 days, otherwise can cause atrophy of nose lining)

47
Q

When should AB be used

A
  • Only used if symptomatic treatment not effective or symptoms worsen AND signs and symptoms point to a bacterial sinusitis (superinfection)
48
Q

What is the AB regimen

A

o Amoxicillin 500mg TID 7 days (first line)
o Doxycycline 100mg once a day for 7 day, 8 tablets given as 200mg loading dose (first day)

49
Q

How can trauma result in sinusitis

A

by violating the integrity of the bony cavity and sinus membrane

50
Q

What are the effects of trauma on the sinus

A

o Sinus wall fractures
o Orbital floor fractures
o Root canal therapy
o Tooth extractions
o Dental implants/sinus lift
o Deep periodontal treatment
o Nasal packing
o Nasogastric tubes
o Mechanical (nasal) intubation

51
Q

What are benign lesions of the sinus

A

 Polyps, papilloma, antral pseudocysts, mucoceles, mucous retention cysts
 Odontogenic cysts/odontogenic tumours expanding into maxillary sinus

52
Q

What are malignant lesions of the sinus

A

 Primary tumours
 Local spread from adjacent sites

53
Q

What is the aetiology of maxillary tuberosity fracture

A

o Single standing molar (thin bone)
o Unknown unerupted molar or wisdom tooth
o Pathological gemination/concrescence
o Extracting in wrong order (should start with posterior)
o Inadequate alveolar support

54
Q

Why is support important for preventing maxillary tuberosity fractures

A

 Providing support means that you can feel the bone moving before the tooth is taken out which means you can stop before the real damage is done

55
Q

How do you diagnose tuberosity fracture

A

o Noise
o Movement noted both visually or with supporting fingers
 If felt prior to tooth removal, can splint the tooth in place
o More than one tooth movement
o Tera in soft tissue of palate

56
Q

How do you manage tuberosity fracture

A
  • reduce and stabilise
    or
  • dissect out and close wound primarily
57
Q

How should you reduce and stabilise the tuberosity

A

 Orthodontic buccal arch wire with composite
 Arch bar
 Splints (lab made)

58
Q

If you splint the teeth post tuberosity fracture, what should be done

A

 Remove/treat pulp
 Ensure it is out of occlusion
 Consider antibiotics and antiseptics
 Post-operative instructions
 Remove the tooth surgically 4-8 weeks later

BDS4 Oral Surgery (15 decks)

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