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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
Why may you trim buccal bone when doing a buccal advancement flap
to get flap to fit
26
Why may you incise the periosteum when doing a buccal advancement flap
If flap cant be stitched without tension then periosteum should be incised to loosen it
27
What makes an OAF different from OAC
OAF has epithelial lined tract
28
What may a px complain of for an OAF
* 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
What is the tx of OAF
same as OAC except epithelial lined tract should be exised prior
30
What are the flap design options for OAF
* BAF * buccal fat pad with BAF * palatal flap * bone graft/collagen membrane
31
What should you do if you suspect a root in the maxillary antrum
* confirm via xray (OPT, occlusal, PA, CBCT)
32
How can the root/tooth be retrived from the antrum
* OAF type approach through extraction socket * caldwell luc approach * ENT
33
What is the OAF approach to getting the root/tooth out the antrum
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
What is the caldwell luc approach for getting the tooth/root out the antrum
o Buccal window cut in bone
35
When do you refer to ENT for root/tooth removal from antrum
o If unretrievable o May do endoscopic retrieval
36
When examining a px with maxillary discomfort, what should you remember
* 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
What is the aetiology of sinusitis
* 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
What are the effects precipiated by viral infection that results in sinusitis
o Inflammation and oedema o Obstruction of ostia o Trapping of debris within sinus cavity
39
What may the mucociliary clearance patterns be altered by
o Allergens o Inflammation o Anatomic abnormalities
40
When the sinus can no longer evacuate its contents efficiently, what does this result in
* build up of pressure * opportunistic situation for bacterial overgrwoth of normal flora
41
What are signs/symptoms of sinusitis
* Facial pain * Pressure * Congestion * Nasal obstruction * Paranasal drainae * Hyposmia * Fever * Headache * Dental pain * Halitosis * Fatigure * Cough * Ear pain * Anaesthesia
42
What causes should be ruled out with suspected sinusitis
* Periapical abscess * Periodontal infection * Deep caries * Recent extraction socket * TMD * Neuralgia or atypical facial pain/chronic midfacial pain
43
What are indicators of sinusitis
* 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
What are tx aims of sinusitis
* Treat presenting symptoms * Reduce tissue oedema * Reverse obstruction of the ostia
45
What is tx of sinusitis
Decongestants reduce mucosal oedema humified air
46
What do the decongestants consist of
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
When should AB be used
* Only used if symptomatic treatment not effective or symptoms worsen AND signs and symptoms point to a bacterial sinusitis (superinfection)
48
What is the AB regimen
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
How can trauma result in sinusitis
by violating the integrity of the bony cavity and sinus membrane
50
What are the effects of trauma on the sinus
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
What are benign lesions of the sinus
 Polyps, papilloma, antral pseudocysts, mucoceles, mucous retention cysts  Odontogenic cysts/odontogenic tumours expanding into maxillary sinus
52
What are malignant lesions of the sinus
 Primary tumours  Local spread from adjacent sites
53
What is the aetiology of maxillary tuberosity fracture
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
Why is support important for preventing maxillary tuberosity fractures
 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
How do you diagnose tuberosity fracture
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
How do you manage tuberosity fracture
* reduce and stabilise or * dissect out and close wound primarily
57
How should you reduce and stabilise the tuberosity
 Orthodontic buccal arch wire with composite  Arch bar  Splints (lab made)
58
If you splint the teeth post tuberosity fracture, what should be done
 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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