maxillary sinus Flashcards
What is the opening of the maxillary sinus
Middle meatus (Hiatus semilunaris)
Located superiorly on medial wall of sinus
What is the epithelium of the sinuses
pseudostratified ciliated columnar epithelium
What issues can arrise with the maxillary sinus
Oro-Antral Communication (OAC)
-Acute
Oro-Antral Fistula (OAF)
-Chronic
Root in the antrum
Sinusitis
Benign Lesions
Malignant Lesion
How do you diagnose a OAC
Size of tooth
Radiographic position of roots in relation to antrum
Bone at trifurcation of roots
Bubbling of blood
Nose holding test
Direct vision
Good light and suction - echo
How would you manage a acute OAC
Inform patient
If small or sinus lining intact:
-Encourage clot
-Suture margins
-Antibiotic (area of debate)
-Post-op instructions
Small OACs <2mm usually heal with normal blood clot formation and routine mucosal healing
If large or lining torn:
-Close with buccal advancement flap
What may apatient complain of with a Chronic OAF
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
How to manage a chronic OAF
Excise sinus tract prior to performing buccal advancement flap
Raise flap
Antral Washout (not always done)
Close and suture
If a buccal advancement flap fails what other flap designs are there
Buccal Fat Pad with Buccal Advancement Flap
Palatal Flap
Bone Graft/Collagen Membrane
What is the possible aetiology of a maxillary tuberosity fracture
Single standing molar
Unknown unerupted molar or wisdom tooth
Pathological gemination/concrescence
Extracting in wrong order
Inadequate alveolar support
How do you diagnose a maxillary tuberosity fracture
Noise
Movement noted both visually or with supporting fingers
More than one tooth movement
Tear in soft tissue of palate
How do you manage a tuberosity fracture
Reduce and stabilise
-Orthodontic buccal arch wire with composite
-Arch bar
-Splints (lab-made)
Dissect out and close wound primarily
If you splint the tooth what must you do
Remove or treat pulp
Ensure it is out of occlusion
Consider antibiotic and antiseptics
Post-op instructions
Remove the tooth surgically 4-8 weeks later
How do you diagnose Root or Tooth in the maxillary sinus
Confirm radiographically by OPT, occlusal, or periapical (+/- CBCT)
Decision on retrieval
If in doubt or retrieval difficult - refer
How do you retrieve roots in antrum/sinus
OAF-type approach / through the extraction socket
-Open fenestration with care
-Suction – efficient and narrow bore
-Small curettes
-Irrigation or ribbon gauze
-Close as for Oro-Antral communication
Caldwell-Luc approach
-Buccal/Labial sulcus
-Buccal window cut in bone
ENT
-Endoscopic Retrieval
What is the aetiology of sinusitis
Most are precipitated by the effects of a viral infection
-Inflammation and oedema
-Obstruction of ostia
-Trapping of debris within sinus cavity
Mucociliary clearance patterns may be altered by Allergens, Inflammation,
anatomic abnormalities
Normal physiological function is further disrupted by the cellular damage that occurs to the mucosal lining, this affects normal ciliary function
When the sinus can no longer evacuate its contents efficiently
build up of pressure
opportune situation for bacterial overgrowth of normal flora
What are the S&S of sinusitis
Facial pain
Pressure
Congestion (fullness)
Nasal obstruction
Paranasal drainage
Hyposmia
Fever
Headache
Dental pain
Halitosis
Fatigue
Cough
Ear pain
Anaesthesia / paraesthesia over cheek
What are indicators of sinusitis
Discomfort on palpation of infraorbital region
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
What is the treatment of sinusitis
Decongestants reduce mucosal oedema
-Ephedrine nasal drops 0.5% one drop each nostril up to three times daily when required (use for a maximum of 7 days)
Humidified air is also helpful
When would you prescribe antibiotics for sinusitis and what
Antibiotics should only be used if symptomatic treatment is not effective/symptoms worsen AND signs and symptoms point to a bacterial sinusitis
Amoxicillin 500mg, three times a day, for 7 days
or
Doxycycline 100mg, once a day, for 7 days (200mg loading dose)
