Maxillary Sinus

Question 1

When does formation of the maxillary sinus occur?

Answer 1

3rd and 4th fetal months

Question 2

What is the function of the maxillary sinus?

Answer 2

Resonance to the voice, reserve chamber for warming inspired air, reduced weight of skull

Question 3

Where is the opening of the maxillary sinus?

Answer 3

Middle meatus (hiatus semilunaris) - on medial wall.

Question 4

What is the volume of the maxillary sinus?

Answer 4

15ml

Question 5

What is the lining of the maxillary sinus?

Answer 5

Pseudostratified ciliated columnar epithelium

Question 6

What is the purpose of cilia?

Answer 6

Mobilise trapped matter and moves towards ostia for removal

Question 7

What is the management for a small OAC (<2mm)?

Answer 7

Encourage clot
Suture margins
Antibiotics
Post op instructions

Question 8

What is the aim of the post op instructions for OAC?

Answer 8

To minimise pressure in the mouth

Question 9

What are the post op instructions for OAC?

Answer 9

Avoid smoking, using a straw, nose blowing

Question 10

What is the management of a large OAC?

Answer 10

Close with a buccal advancement flap

Question 11

What are the principles of flap design?

Answer 11

Wider base to ensure adequate blood supply
Incisions over intact bone only
Rounded corners
Vertical releases at line angles
Avoid vital structures

Question 12

When does an OAC become an OAF?

Answer 12

After 6 weeks

Question 13

What might the patient complain of if they have an OAF?

Answer 13

Problems with drinking
Problems with speech/ smoking/ using a straw
Based taste in mouth/ bad smell
Pain/sinusitis like symptoms

Question 14

What is the management of an OAF?

Answer 14

Excise sinus tract prior top buccal advancement flap.
If sinusitis symptoms - may wash out with slaine

Question 15

What are some benign lesions which may present in the maxillary sinus?

Answer 15

Polyps, papillomas, mucoceles, Odontogenic cyst

Question 16

What are malignant lesions which may present in the maxillary sinus?

Answer 16

Primary tumour (SSC) or local spread from adjacent sites.

Question 17

How is a fractured tuberosity diagnosed?

Answer 17

Noise
Visual movement (>1 tooth movement)
Tear in soft tissue of palate

Question 18

What is the management of a fractured tuberosity?

Answer 18

Reduce and stabilise.

Stabilise with ortho buccal arch wire and composite/ splint.
Ensure the tooth is out of occlusion, remove or treat pulp. Remove tooth surgically after 4-8 weeks.

Question 19

What are the 3 options for retrieval of a root in the sinus?

Answer 19

OAF approach- open fenestration, efficient suction, use small curettes and close
Caldwell-Luc approach- anterior incision in buccal/ labial sulcus and drill into maxillary sinus (better access)
ENT- endoscopic retrieval