Maxillary Sinus Flashcards
what are the functions of the sinuses
resonance of voice
reserve chambers for warming inspired air
reduce the weight of the skull
what is the volume of the maxillary sinus
15ml
where is the opening of the maxillary sinus
middle meatus superiorly on the medial wall of the sinus
what epithelium lines the maxillary sinus
pseudostratified ciliated columnar
what is the function of the cilia in the sinus
mobilise trapped particulate matter and foreign material within the sinus
move material toward ostia for elimination into the nasal cavity
what are the possible issues with maxillary sinus
OAC
OAF
root in antrum
sinusitis
benign lesions
malignant lesions
how do you diagnose and 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
blunt probe
how do you manage an OAC
inform patient
if small - encourage clot, suture margins, antibiotic (maybe), post op instructions
if large - buccal flap
what flap is most commonly used to fix OAC
buccal advancement flap
what is the process of creating a flap
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
what does the patient complain of with an OAC
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
how do you manage an OAF
need to excise sinus tract
buccal advancement flap
sometimes antral washout
what are the available types of flap design for covering an OAC
buccal advancement
buccal fat pad
palatal flap
bone graft/collagen membrane
rotated tongue flap
what is the aetiology of a maxillary tuberosity fracture
single standing molar
unknown unerupted molar or wisdom tooth
pathological gemination
extracting in wrong order
inadequate alveolar support
how do you diagnose maxillary tuberosity fracture
noise
movement noted both visually or with supporting fingers
more than one tooth movement
tear in soft tissue palate
how do you manage maxillary tuberosity fracture
reduce and stabilise with splint
dissect out and close wound
what do you do if you splint the tooth when a tuberosity fracture occurs
remove or treat pulp
ensure it is out of occlusion
consider antibiotic and antiseptics
post-op instructions
remove tooth surgically 4-8 weeks later
what do you do if the root goes into the sinus
confirm radiographically
decision on retrieval
refer
how do you retrieve the root through the sinus
through extraction socket with suction/curettes/irrigation
make buccal/labial sulcus window in bone
endoscopic retrieval
what is sinusitis
inflammation and oedema
obstruction of ostia
trapping of debris within sinus cavity
what can mucociliary clearance patterns be altered by
allergens
inflammation
anatomic abnormalities
what happens when the sinus can no longer evacuate its contents
build up of pressure
opportunistic situation for bacterial overgrowth
what are the signs and symptoms of sinusitis
facial pain
pressure
congestion
nasal obstruction
paranasal drainage
hyposmia
fever
headache
dental pain
halitosis
fatigue
cough
ear pain
what dental causes must be ruled out with sinusitis
periapical abscess
periodontal infection
deep caries
recent extraction socket
TMD
neuralgia
what are the indicators of sinusitis
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
what are the treatment aims of sinusitis
treat presenting symptoms
reduce tissue oedema
reverse obstruction of ostia
how do you treat sinusitis
decongestants to reduce mucosal oedema - ephedrine nasal drops 0.5% one drop each nostril TID
humidified air
when would you use antibiotics for sinusitis
if symptomatic treatment not effective/symptoms worsen AND signs and symptoms point of bacterial sinusitis
what antibiotics are used for bacterial sinusitis
phenoxymethylpenicillin 250mg 2 tablets 4x/ day for 5 days
doxycycline 100mg OD 7 days (200mg first day then 100mg each day)
what does fungal infection of the sinus cause
expansion of bony walls by increased mucous secretion and fungal growth
what trauma can cause sinusitis
sinus wall fracture
orbital floor fracture
RCT
extractions
implants
perio treatment
nasal packing
nasograstric tubes
mechanical intubation
what benign lesions can be present in the sinus
polyp, papilloma, mucoceles, mucous retention cyst
what malignant lesions can be present in the sinus
primary tumours
local spread from adjacent sites
