Maxillary sinus Flashcards
When are maxillary sinuses formed in embryology?
During 3rd and 4th months
What are the functions of the paranasal sinuses?
Help give resonance to the voice
Reserve chambers for warming inspired air
Reduce the weight of the skull
What is the average volumetric space in the maxillary sinus?
15ml
Where is the opening of the maxillary sinus?
Middle meatus - hiatus semilunaris
What is the epithelium of the maxillary sinuses?
Pseudostratified ciliated columnar epithelium
What is the purpose of the cilia in the maxillary sinuses?
mobilise trapped particulate matter and foreign material within the sinus
move this material toward the ostia for elimination into the nasal cavity
What are some possible issues that may arise that are associated with the maxillary sinuses?
OAC - acute
OAF - chronic
Root in antrum
Sinusitis
Benign lesions
Malignant lesion
How to manage OAC if small or sinus lining intact?
Encourage clot
Suture margins
Antibiotic
Post-op instructions - minimising pressure formation within the sinuses and mouth
How to manage OAC if large or lining torn?
Close with buccal advancement flap (tension-free)
What problems that a patient may complain of would indicate 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 treat OAF?
Excision of sinus tract
Antral washout (chronic sinusitis quite often associated - wash out gunk)- not always done.
Buccal advancement flap
Aetiology reasons for fracture of maxillary tuberosity
Single standing molar tooth
Unknown un-erupted molar or wisdom tooth
Extracting in wrong order
Inadequate alveolar support
Management for a fractured tuberosity
Reduce and stabilise
- Orthodontic buccal arch wire with composite
- Arch bar
- Splints (lab-made)
Dissect out and close wound primarily
How to diagnose a fractured tuberosity/ signs it has happened
Noise
Movement noted visually or with supporting fingers
More than one tooth movement
Tear in soft tissue of palate
How to remove a/ retrieve retained root in the antrum/ sinus?
Open with care
Suction - efficient and narrow
Small curettes to remove
Irrigation
Close - buccal advancement
What can happen when the sinus can no longer evacuate its content efficiently?
Sinusitis
Build-up of pressure
Opportune situation for bacterial overgrowth of normal flora
Signs and symptoms 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 the treatment aims for sinusitis?
Treat presenting symptoms
Reduce tissue oedema
Reverse obstruction of the ostia (hole)
Indicators of sinusitis O/E
Discomfort on palpation of infraorbital region
Diffuse pain in maxillary teeth
Equal sensitivity from percussion of multiple teeth in same region
Pain that worsens with head or facial movements
What is the most likely cause of sinusitis?
Viral cause
When should antibiotics be given for sinusitis?
Only used if symptomatic treatment is not effective/ symptoms worsen
AND
Signs and symptoms point to bacterial sinusitis
If giving antibiotics for sinusitis what should you prescribe?
Amoxicillin 500mg 3x per day for 7 days
What are the peri-operative signs of an OAC?
Bone removed at trifurcation
Bubbling at socket
Change in suction sound
Direct vision
What are post-operative signs of an OAF?
Unilateral discharge
Fluid from nose when drinking
Salty discharge
Difficulty smoking/ drinking through a straw
Non-healing socket
Problems with singing/ nasal quality
Bad taste/ halitosis
What is the sequelae of an OAC/ OAF if left untreated?
Sinusitis
Infection
Impaired healing
Food/ saliva accumulation in socket
