maxillary sinus Flashcards

1
Q

What is the opening of the maxillary sinus

A

Middle meatus (Hiatus semilunaris)

Located superiorly on medial wall of sinus

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2
Q

What is the epithelium of the sinuses

A

pseudostratified ciliated columnar epithelium

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3
Q

What issues can arrise with the maxillary sinus

A

Oro-Antral Communication (OAC)
-Acute

Oro-Antral Fistula (OAF)
-Chronic

Root in the antrum

Sinusitis

Benign Lesions

Malignant Lesion

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4
Q

How do you diagnose a OAC

A

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

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5
Q

How would you manage a acute OAC

A

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

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6
Q

What may apatient complain of with a Chronic OAF

A

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

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7
Q

How to manage a chronic OAF

A

Excise sinus tract prior to performing buccal advancement flap

Raise flap

Antral Washout (not always done)

Close and suture

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8
Q

If a buccal advancement flap fails what other flap designs are there

A

Buccal Fat Pad with Buccal Advancement Flap

Palatal Flap

Bone Graft/Collagen Membrane

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9
Q

What is the possible aetiology of a maxillary tuberosity fracture

A

Single standing molar

Unknown unerupted molar or wisdom tooth

Pathological gemination/concrescence

Extracting in wrong order

Inadequate alveolar support

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10
Q

How do you diagnose a maxillary tuberosity fracture

A

Noise

Movement noted both visually or with supporting fingers

More than one tooth movement

Tear in soft tissue of palate

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11
Q

How do you manage a tuberosity fracture

A

Reduce and stabilise
-Orthodontic buccal arch wire with composite
-Arch bar
-Splints (lab-made)

Dissect out and close wound primarily

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12
Q

If you splint the tooth what must you do

A

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

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13
Q

How do you diagnose Root or Tooth in the maxillary sinus

A

Confirm radiographically by OPT, occlusal, or periapical (+/- CBCT)

Decision on retrieval

If in doubt or retrieval difficult - refer

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14
Q

How do you retrieve roots in antrum/sinus

A

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

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15
Q

What is the aetiology of sinusitis

A

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

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16
Q

What are the S&S of sinusitis

A

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

17
Q

What are indicators of sinusitis

A

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

18
Q

What is the treatment of sinusitis

A

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

19
Q

When would you prescribe antibiotics for sinusitis and what

A

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)