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BDS4 Oral surgery > Maxillary Sinus > Flashcards

Maxillary Sinus Flashcards

1
Q
A
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2
Q

What sinus’ are present at birth?

A
  • Maxillary and ethmoid are relatively large at birth
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3
Q

When do Sphenoid and frontal sinus expand?

A
  • Within first few years of life
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4
Q

When does the maxillary sinus form?

A
  • Occurs during 3rd and 4th foetal months with evaginations of he mucosa of the nasal cavity
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5
Q

Describe this image

A
  • Maxillary and ethmoid sinus present at birth and 1 year old
  • Sphenoid sinus at 5 yrs
  • Frontal by 12 yrs
  • All sinus fully formed by 20 years old
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6
Q

What are the functions of the paranasal sinus’?

A
  • Resonance to voice
  • Reserve chambers for warming inspired air
  • Reduce weight of the skull
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7
Q

What is the maxillary sinus AKA?

A
  • Maxillary antrum
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8
Q

What is the largest sinus?

A
  • Maxillary
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9
Q

What is the shape and volumetric space of the maxillary sinus?

A
  • Pyramid shaped cavity within body of each maxilla
  • Volumetric space 15ml in average adult
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10
Q

What are the average dimensions of maxillary sinus?

A
  • 37mm high
  • 27mm wide
  • 35mm antero-posteriorly
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11
Q

What is the location and position of the opening of the maxillary sinus (ostium)?

A
  • Middle meatus (hiatus semilunaris)
  • Located superiorly on medial wall of sinus
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12
Q

What is the opening of maxillary sinus diameter?

A
  • approx 4mm diamater
  • Lined with mucosa
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13
Q

During episodes of inflammation or disease what can happen to the ostium of maxillary sinus?

A
  • Become narrowed or blocked
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14
Q

What can be found on the posterior wall of the maxillary sinus cavity?

A
  • The alveolar canals that transport the posterior superior alveolar vessels and nerves to maxillary posterior teeth
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15
Q

In regard to anatomy what can the roots of maxillary molars and sometimes premolars do within maxillary sinus?

A
  • Project into floor of maxillary sinus
  • Roots may perforate bone so only mucosal lining of sinus covers them
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16
Q

What is the epithelium of the sinuses?

A
  • Pseudostratified ciliated columnar epithelium
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17
Q

What is the function of the cilia in the sinuses?

A
  • Mobilise trapped particulate matter and foreign material within sinus
  • Move material toward the ostia for elimination into nasal cavity
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18
Q

What issues can we see in regard to maxillary sinus?

A
  • Oro-antral communication (acute)
  • Oro-antral fistula (Chronic)
  • Root in antrum
  • Sinusitis
  • benign lesion
  • Malignant lesion
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19
Q

How does an OAC/OAF occur?

A
  • when removing a upper molar or premolar that is loosely associated with maxillary sinus lining you can either
  • Break bone or tear the lining of the sinus creating a communication that wasn’t previously there
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20
Q

How can you diagnose an OAC/OAF?

A
  • Size of tooth
  • Radiograph position of roots in relation to antrum
  • Bone at trifurcation of roots (show fracture of plate)
  • Bubbling of blood
  • Nose holding test (careful as can create an OAC)
    Direct vision
  • Good light and suction - gives echo sound
  • Blunt probe but take care not to create OAC (not really done)
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21
Q

What is this image showing?

A
  • Acute Oro-antral communication
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22
Q

What is this image showing?

A
  • Chronic OAF
  • An epithelia lined tract has now formed from sinus into mouth
23
Q

What is this radiograph highlighting?

A
  • OAF
  • Can see loss of bone and communication created
24
Q

What is the management of an OAC you have just created?

A
  • Inform pt
  • If small or sinus lining intact then
  • Encourage clot
  • Suture margins
  • Antibiotics
  • Post op instructions (minimise pressure formation within the sinuses and mouth)
  • If large or lining torn close with buccal advancement flap (mesial and distal relieving incision)
25
Q

What si the post op instructions for OAC management?

A
  • Minimising pressure formation within sinuses and mouth
  • Avoid smoking
  • Avoid blowing nose
  • Avoid sucking through a straw
  • Don’t blow a balloon up
  • Avoid singing
26
Q

What size of OACs will usually heal with normal blood clot formation and routine mucosal healing?

A

<2mm

27
Q

What is the surgical procedure with buccal advancement flap for OAC closure?

A
  • 3 sided flap design with distal and mesial relieving incisions either side of OAC
  • Raise the flap with howarths periosteal elevtaors
  • Trim buccal bone if required
  • Incise the periosteum with clean scalpel
  • Check flap can be brought across defect tension free
  • Suture (can use silk sutures as these stay in place longer than resorbable ones) on distal and mesial incision, OAC area and anymore as required
28
Q

What complaints may a pt have if they have 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
29
Q

What is the management of a Chronic OAF?

A
  • Excise the sinus tract prior to performing buccal advancement flap design (as per OAC)
  • Sometimes can use a Antral washout if pt also has sinusitis (very unpleasant)
30
Q

What other flap designs can be utilised if buccal advancement flap fails?

A
  • Buccal fat pad with buccal advancement flap
  • Palatal flap
  • Bone graft / Collagen membrane
31
Q

What is this picture showing?

A
  • Palatal rotational flap
32
Q

What is the aetiology of fracture of maxillary tuberosity>

A
  • Single standing upper molar (thin bone)
  • Unknown unerupted molar or wisdom tooth
  • Pathological gemination/correspondence
  • Extracting in wrong order
  • Inadequate alveolar support
  • Commonly involves maxillary sinus
33
Q

What does this image show?

A
  • Fractured maxillary tuberosity
34
Q

How can you diagnose a fractured tuberosity?

A
  • Noise
  • Movement noted both visually or with supporting fingers
  • More than one tooth movement
  • Tear in soft tissue of palate
35
Q

What is the management of fractured tuberosity?

A
  • Reduce and stabilise to allow bone to heal
  • Orthodontic buccal arch wire with composite
  • Or Arch bar
  • Or splints made in lab
  • If no way to stabilise then Dissect out and close wound primarily
36
Q

If you splint the tooth during a fractured tuberosity what should you do next?

A
  • Remove or treat pulp as soon as
  • Ensure it is out of occlusion
  • Consider antibiotics and antiseptics
  • Post op instructions of care and cleaning
  • remove tooth surgically 4-8 weeks later
37
Q

If you think there is a root or tooth in the maxillary sinuswhat can you do?

A
  • Confirm radiographically by OPT, occlusal or periapical (+/- CBCT on day of retrieval)
  • Decision on retrieval
  • If in doubt or retrieval difficult then refer
38
Q

What does this image show?

A
  • Root apex has fractured but is under the antral lining
39
Q

What does this image show?

A
  • Root of tooth has fractured and apex of root below antral lining
  • Not interfered with lining therefore will not cause pt symptoms of sinusitis and can be left alone
40
Q

How do you manage a Root in the antrum/sinus?

A
  • OAF type approach / through the extraction socket
  • Open fenestration with care
  • Suction using narrow bore efficiently
  • Small curettes delicately
  • Irrigation or ribbon gauze to get it out
  • Close as for Oro-antral communication
41
Q

If OAF type approach doesn’t work what other approach can you retrieve root in the antrum?

A
  • Caldwell Luc approach
  • Buccal/Labial sulcus
  • Buccal window cut in bone
42
Q

What is the last way to retrieve root in antrum/ sinus if complicated?

A
  • ENT (Endoscopic retrieval)
  • If root bigger than 4mm not possible
43
Q

What is the aetiology of sinusitis?

A
  • Viral infection that causes inflammation and oedema
  • Obstruction of ostia
  • Trapping of debris within sinus cavity
  • Mucociliairy clearance patterns altered by allergens, inflammation, anatomic abnormalities
  • Normal physiological function disrupted by cellular damage to mucosal lining, affecting ciliary function
  • Sinus no longer evacuate contents efficiently and build up of pressure along with opportune situation for bacterial overgrowth of normal flora
44
Q

What are the signs and symptoms 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

45
Q

Most likely pt with sinusitis will present with maxillary dental pain, you need to rule out other dental pain but what are the 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
46
Q

What are the txt aims of sinusitis?

A
  • Treat presenting symptoms
  • Reduce tissue oedema with decongestants
    • 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 (steam/menthol inhalations)
  • Reverse obstruction of the ostia
47
Q

When should antibiotics be given for sinusitis?

A
  • signs and symptoms point to a bacterial sinusitis
  • Antibiotics should only be used if symptomatic treatment is not effective/symptoms worsen
48
Q

What is the antibiotic txt for sinusitis?

A

Amoxicillin 500mg, three times a day, for 7 days
or
Doxycycline 100mg, once a day, for 7 days (200mg loading dose)

49
Q

Can fungal infection cause sinusitis?

A
  • Rarely a non-resolving sinusitis may be due to fungal infection
  • Can cause expansion of bony walls by increased mucous secretion and fungal growth
50
Q

What are some traumatic origins of sinusitis?

A

Sinus wall fractures
Orbital floor fractures
Root canal therapy
Tooth extractions
Dental Implants / Sinus lifts
Deep periodontal treatment
Nasal packing
Nasogastric tubes
Mechanical (nasal) intubation

51
Q

What are some benigh sinus lesions?

A

polyps, papillomas, antral pseudocysts, mucoceles and mucous retention cysts

Odontogenic cysts / odontogenic tumours expanding into the maxillary sinus

52
Q

What malignant lesions can be found in sinus?

A
  • Primary tumours of any tissue in that area
  • Local spread from adjacent sites into the sinus
53
Q
A

BDS4 Oral surgery (15 decks)

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