Maxillary Sinus Flashcards
name the 4 sinuses in the head?
- Frontal Sinus
- Sphenoid sinus
- Ethmoid sinus
- Maxillary sinus
what are the functions of the paranasal sinuses?
- resonance to the voice
- reserve chambers for warming inspired air
- reduce weight of the skull
what sinus is the largest?
maxillary sinus
what is the type of the epithelium found on sinuses?
pseudostratified ciliated columnar epithelium
why do sinuses have cilia on their epithelium?
- mobilise trapped particles & foreign material within sinus
- moved towards the nose for elimination out of nostrils
what are the clinical significances of sinuses?
- Oro-antral communication (OAC) [ACUTE]
- Oro-antral fistula (OAF) [Chronic]
- root in sinus
- sinusitis
- benign & malignant lesions
how can you diagnose an oro-antral communication/fistula?
- size of tooth XLA’d
- radiographic position of roots in relation to sinus
- bone at trifurcation of roots
- bubbling of blood
- nose holding test (be careful)
- direct vision
- blunt probe (be careful)
Acute OAC
Chronic OAF
how do you manage an OAC (acute)?
- inform pt
If small or sinus lining intact:
- encourage clot
- suture margins
- post op instructions (minimising pressure)
Difference in managing a large vs small OAC in the mouth?
Large:
- Buccal advancement flap
Small:
- Encourage blood clot formation & suture margins
what may a patient complain of IF they have a chronic oroantral fistula?
- fluid consumption -> into nose
- problems with speech/singing
- problems playing brass/wind instruments
- problems smoking or using straw
- bad taste/halitosis/post-nasal drip
- pain/sinusitis type symptoms
what are the different flap design options for closure of a OAC/OAF?
- buccal advancement flat
- buccal fat pad with buccal advancement flap
- palatal flap
- bone graft/collagen membrane
what can cause fracture of maxillary tuberosity?
- single standing molar
- unknown unerupted molar/or wisdom tooth
- extracting in the wrong order
- inadequate alveolar support
how do you diagnose a fractured tuberosity?
- noise
- movement noted both visually or with supporting fingers
- more than 1 tooth movement
- tear in soft tissue of palate
how do you manage a fractured tuberosity?
- reduce & stabilise (arch wise with composite)
- Close wound
if you splint a tooth in a fractured tuberosity, what do you need to do afterwards?
- remove/treat pulp
- ensure its out of occlusion
- consider antibiotics/antiseptics IF large wound or immunocompromised
- post op instructions
- remove tooth surgically 4-8weeks later?
what causes sinusitis?
- Viral infection (inflammation/oedema/obstruction of ostia where sinus opens to nose)
- allergens
- when the sinus can no longer evacuate its contents efficiently
what are signs & symptoms of sinusitis?
- facial pain/pressure
- congestion
- paranasal drainage
- fever
- headache
- dental pain
- halitosis
- cough
- ear pain
[IMPORTANT TO RULE OUT DENTAL CAUSE]
Indicators that high chance its sinusitis and not a dental cause?
- 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/facial movements
whats the tx option for sinusitis?
- decongestants reduce the mucosal oedema (nasal drops)
- humidified air (steam/menthol inhalations)
Should antibiotics be used for sinusitis?
ONLY if normal tx not effective
AND
Signs & symptoms pointing to BACTERIAL SINUSITIS!
SDCEP [Amoxycillin 500mg, 3x/day, 7 days]
