Maxillary Sinus

Question 1

name the 4 sinuses in the head?

Answer 1

• Frontal Sinus
• Sphenoid sinus
• Ethmoid sinus
• Maxillary sinus

Question 2

what are the functions of the paranasal sinuses?

Answer 2

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

Question 3

what sinus is the largest?

Answer 3

maxillary sinus

Question 4

what is the type of the epithelium found on sinuses?

Answer 4

pseudostratified ciliated columnar epithelium

Question 5

why do sinuses have cilia on their epithelium?

Answer 5

• mobilise trapped particles & foreign material within sinus
• moved towards the nose for elimination out of nostrils

Question 6

what are the clinical significances of sinuses?

Answer 6

• Oro-antral communication (OAC) [ACUTE]
• Oro-antral fistula (OAF) [Chronic]
• root in sinus
• sinusitis
• benign & malignant lesions

Question 7

how can you diagnose an oro-antral communication/fistula?

Answer 7

• 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)

Question 8

Acute OAC

Answer 8

Question 9

Chronic OAF

Answer 9

Question 10

how do you manage an OAC (acute)?

Answer 10

• inform pt

If small or sinus lining intact:
- encourage clot
- suture margins
- post op instructions (minimising pressure)

Question 11

Difference in managing a large vs small OAC in the mouth?

Answer 11

Large:
- Buccal advancement flap

Small:
- Encourage blood clot formation & suture margins

Question 12

what may a patient complain of IF they have a chronic oroantral fistula?

Answer 12

• 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

Question 13

what are the different flap design options for closure of a OAC/OAF?

Answer 13

• buccal advancement flat
• buccal fat pad with buccal advancement flap
• palatal flap
• bone graft/collagen membrane

Question 14

what can cause fracture of maxillary tuberosity?

Answer 14

• single standing molar
• unknown unerupted molar/or wisdom tooth
• extracting in the wrong order
• inadequate alveolar support

Question 15

how do you diagnose a fractured tuberosity?

Answer 15

• noise
• movement noted both visually or with supporting fingers
• more than 1 tooth movement
• tear in soft tissue of palate

Question 16

how do you manage a fractured tuberosity?

Answer 16

• reduce & stabilise (arch wise with composite)
• Close wound

Question 17

if you splint a tooth in a fractured tuberosity, what do you need to do afterwards?

Answer 17

• 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?

Question 18

what causes sinusitis?

Answer 18

• Viral infection (inflammation/oedema/obstruction of ostia where sinus opens to nose)
• allergens
• when the sinus can no longer evacuate its contents efficiently

Question 19

what are signs & symptoms of sinusitis?

Answer 19

• facial pain/pressure
• congestion
• paranasal drainage
• fever
• headache
• dental pain
• halitosis
• cough
• ear pain

[IMPORTANT TO RULE OUT DENTAL CAUSE]

Question 20

Indicators that high chance its sinusitis and not a dental cause?

Answer 20

• 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

Question 21

whats the tx option for sinusitis?

Answer 21

• decongestants reduce the mucosal oedema (nasal drops)
• humidified air (steam/menthol inhalations)

Question 22

Should antibiotics be used for sinusitis?

Answer 22

ONLY if normal tx not effective

AND

Signs & symptoms pointing to BACTERIAL SINUSITIS!

SDCEP [Amoxycillin 500mg, 3x/day, 7 days]