Maxillary Sinus

Question 1

what are the functions of the sinuses

Answer 1

resonance of voice
reserve chambers for warming inspired air
reduce the weight of the skull

Question 2

what is the volume of the maxillary sinus

Answer 2

15ml

Question 3

where is the opening of the maxillary sinus

Answer 3

middle meatus superiorly on the medial wall of the sinus

Question 4

what epithelium lines the maxillary sinus

Answer 4

pseudostratified ciliated columnar

Question 5

what is the function of the cilia in the sinus

Answer 5

mobilise trapped particulate matter and foreign material within the sinus
move material toward ostia for elimination into the nasal cavity

Question 6

what are the possible issues with maxillary sinus

Answer 6

OAC
OAF
root in antrum
sinusitis
benign lesions
malignant lesions

Question 7

how do you diagnose and OAC

Answer 7

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
blunt probe

Question 8

how do you manage an OAC

Answer 8

inform patient
if small - encourage clot, suture margins, antibiotic (maybe), post op instructions
if large - buccal flap

Question 9

what flap is most commonly used to fix OAC

Answer 9

buccal advancement flap

Question 10

what is the process of creating a flap

Answer 10

incise with 3 sides
raise full thickness
trim buccal bone if needed
incise the periosteum with fresh blade
check flap can be brought across tension free
suture

Question 11

what does the patient complain of with an OAC

Answer 11

problems with fluid consumption
problems with speech or singing
problems playing brass/wind instruments
problems smoking or using straw
bad taste/odour/halitosis
pain/sinusitis type symptoms

Question 12

how do you manage an OAF

Answer 12

need to excise sinus tract
buccal advancement flap
sometimes antral washout

Question 13

what are the available types of flap design

Answer 13

buccal advancement
buccal fat pad
palatal flap
bone graft/collagen membrane
rotated tongue flap

Question 14

what is the aetiology of a maxillary tuberosity fracture

Answer 14

single standing molar
unknown unerupted molar or wisdom tooth
pathological gemination
extracting in wrong order
inadequate alveolar support

Question 15

how do you diagnose maxillary tuberosity fracture

Answer 15

noise
movement noted both visually or with supporting fingers
more than one tooth movement
tear in soft tissue palate

Question 16

how do you manage maxillary tuberosity fracture

Answer 16

reduce and stabilise with splint
dissect out and close wound

Question 17

what do you do if you splint the tooth when a tuberosity fracture occurs

Answer 17

remove or treat pulp
ensure it is out of occlusion
consider antibiotic and antiseptics
post-op instructions
remove tooth surgically 4-8 weeks later

Question 18

what do you do if the root goes into the sinus

Answer 18

confirm radiographically
decision on retrieval
refer

Question 19

how do you retrieve the root through the sinus

Answer 19

through extraction socket with suction/curettes/irrigation
make buccal/labial sulcus window in bone
endoscopic retrieval

Question 20

what is sinusitis

Answer 20

inflammation and oedema
obstruction of ostia
trapping of debris within sinus cavity

Question 21

what can mucociliary clearance patterns be altered by

Answer 21

allergens
inflammation
anatomic abnormalities

Question 22

what happens when the sinus can no longer evacuate its contents

Answer 22

build up of pressure
opportunistic situation for bacterial overgrowth

Question 23

what are the signs and symptoms of sinusitis

Answer 23

facial pain
pressure
congestion
nasal obstruction
paranasal drainage
hyposmia
fever
headache
dental pain
halitosis
fatigue
cough
ear pain

Question 24

what dental causes must be ruled out with sinusitis

Answer 24

periapical abscess
periodontal infection
deep caries
recent extraction socket
TMD
neuralgia

Question 25

what are the indicators of sinusitis

Answer 25

discomfort on palpation of infraorbital region
diffuse pain in maxillary teeth
equal sensitivity from percussion on multiple teeth
pain that worsens with head or facial movement

Question 26

what are the treatment aims of sinusitis

Answer 26

treat presenting symptoms
reduce tissue oedema
reverse obstruction of ostia

Question 27

how do you treat sinusitis

Answer 27

decongestants to reduce mucosal oedema - ephedrine nasal drops 0.5% one drop each nostril TID
humidified air

Question 28

when would you use antibiotics for sinusitis

Answer 28

if symptomatic treatment not effective/symptoms worsen AND signs and symptoms point of bacterial sinusitis

Question 29

what antibiotics are used for bacterial sinusitis

Answer 29

amoxicillin 500mg TID 7 days
doxycycline 100mg OD 7 days (200mg first day then 100mg each day)

Question 30

what does fungal infection of the sinus cause

Answer 30

expansion of bony walls by increased mucous secretion and fungal growth

Question 31

what trauma can cause sinusitis

Answer 31

sinus wall fracture
orbital floor fracture
RCT
extractions
implants
perio treatment
nasal packing
nasograstric tubes
mechanical intubation

Question 32

what benign lesions can be present in the sinus

Answer 32

polyp, papilloma, mucoceles, mucous retention cyst

Question 33

what malignant lesions can be present in the sinus

Answer 33

primary tumours
local spread from adjacent sites