Maxillary sinus

Question 1

When are maxillary sinuses formed in embryology?

Answer 1

During 3rd and 4th months

Question 2

What are the functions of the paranasal sinuses?

Answer 2

Help give resonance to the voice
Reserve chambers for warming inspired air
Reduce the weight of the skull

Question 3

What is the average volumetric space in the maxillary sinus?

Answer 3

15ml

Question 4

Where is the opening of the maxillary sinus?

Answer 4

Middle meatus - hiatus semilunaris

Question 5

What is the epithelium of the maxillary sinuses?

Answer 5

Pseudostratified ciliated columnar epithelium

Question 6

What is the purpose of the cilia in the maxillary sinuses?

Answer 6

mobilise trapped particulate matter and foreign material within the sinus

move this material toward the ostia for elimination into the nasal cavity

Question 7

What are some possible issues that may arise that are associated with the maxillary sinuses?

Answer 7

OAC - acute
OAF - chronic
Root in antrum
Sinusitis
Benign lesions
Malignant lesion

Question 8

How to manage OAC if small or sinus lining intact?

Answer 8

Encourage clot
Suture margins
Antibiotic
Post-op instructions - minimising pressure formation within the sinuses and mouth

Question 9

How to manage OAC if large or lining torn?

Answer 9

Close with buccal advancement flap (tension-free)

Question 10

What problems that a patient may complain of would indicate a chronic OAF?

Answer 10

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

Question 11

How to treat OAF?

Answer 11

Excision of sinus tract
Antral washout (chronic sinusitis quite often associated - wash out gunk)- not always done.
Buccal advancement flap

Question 12

Aetiology reasons for fracture of maxillary tuberosity

Answer 12

Single standing molar tooth
Unknown un-erupted molar or wisdom tooth
Extracting in wrong order
Inadequate alveolar support

Question 13

Management for a fractured tuberosity

Answer 13

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

Dissect out and close wound primarily

Question 14

How to diagnose a fractured tuberosity/ signs it has happened

Answer 14

Noise
Movement noted visually or with supporting fingers
More than one tooth movement
Tear in soft tissue of palate

Question 15

How to remove a/ retrieve retained root in the antrum/ sinus?

Answer 15

Open with care
Suction - efficient and narrow
Small curettes to remove
Irrigation
Close - buccal advancement

Question 16

What can happen when the sinus can no longer evacuate its content efficiently?

Answer 16

Sinusitis

Build-up of pressure
Opportune situation for bacterial overgrowth of normal flora

Question 17

Signs and symptoms of sinusitis

Answer 17

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

Question 18

What are the treatment aims for sinusitis?

Answer 18

Treat presenting symptoms
Reduce tissue oedema
Reverse obstruction of the ostia (hole)

Question 19

Indicators of sinusitis O/E

Answer 19

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

Question 20

What is the most likely cause of sinusitis?

Answer 20

Viral cause

Question 21

When should antibiotics be given for sinusitis?

Answer 21

Only used if symptomatic treatment is not effective/ symptoms worsen

AND

Signs and symptoms point to bacterial sinusitis

Question 22

If giving antibiotics for sinusitis what should you prescribe?

Answer 22

Amoxicillin 500mg 3x per day for 7 days

Question 23

What are the peri-operative signs of an OAC?

Answer 23

Bone removed at trifurcation
Bubbling at socket
Change in suction sound
Direct vision

Question 24

What are post-operative signs of an OAF?

Answer 24

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

Question 25

What is the sequelae of an OAC/ OAF if left untreated?

Answer 25

Sinusitis
Infection
Impaired healing
Food/ saliva accumulation in socket