Maxillary Sinus Flashcards
What is the function of the paranasal sinuses?
Resonance to the voice
Reserve chambers for warming inspired air
Reduce the weight of the skull
What is the volumetric space of the maxillary sinus?
15ml in average skull
Where is the opening of the maxillary sinus?
Middle meatus (hiatus semilunaris) in the nose
Opening is approx 4mm diameter
Located superiorly on medial wall of sinus
What is the epithelium of the maxillary sinus?
What does the cilia do?
Pseudostratified ciliated columnar epithelium
Cilia function;
–Mobilise trapped particulate matter and foreign material within the sinus
–Move the material toward the ostia for elimination into the nasal cavity
What possible issues can a dentist encounter with the maxillary sinus?
Oro-antral communication
Oro-antral fistula
Root in the antrum or sometimes the entire tooth
Sinusitis
Benign lesions
Malignant lesions
What is the difference between an OAC and OAF?
OAC is an acute communication between the sinus and the oral cavity where the communication has just been made and not present for a long time
OAF is a chronic communication between the sinus and the oral cavity, where the communication doesn’t close up and persists as an opening and a sinus tract forms
How do you diagnose an OAC?
Radiographic position of roots in relation to the sinus
Bone at the trifurcation of the roots
Bubbling of blood- air is coming out of the sinus
Nose holding test (careful as can create an OAC) —if broke the bone but not tore the lining this can cause this to then tear
Direct vision
Good light and suction- echo sound
What is the management of an OAC?
Inform the patient
If small or sinus lining is intact
–encourage clot or help plug the hole
–suture margins
Small OACs <2mm usually heal with normal blood clot formation and routine mucosal healing
What post-op instructions should you give to someone who has an OAC?
Minimising pressure formation within the sinuses and mouth
Avoid blowing your nose
Avoid sucking through a straw
Avoid smoking
Avoid singing
Avoid blowing up balloons
What can patients complain of if they have a chronic OAF?
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
Pain/sinusitis type symptoms
What is the treatment for an OAF?
Remove the epithelial lined tract and then raise the flap for buccal advancement flap to close over the hole
What are the flap design options for closing and OAC/OAF?
Buccal advancement flap (most common)
Buccal fat pad with buccal advancement flap
Palatal flap
Bone graft/collagen membrane (only used when all other cases have failed)
What is a buccal fat pad with buccal advancement flap?
3 sided flap
Raise the flap
Release the periosteum
Go further up into the sulcus until you hit the yellow globular tissue (fatty tissue) grab some and pull it down into the hole and then close the advancement flap
What is a palatal flap?
Incision on the palate and raise it and then twist it over to cover the hole
Leaves raw exposed bone on the palate
Good at plugging holes
What is the aetiology of a fracture of the maxillary tuberosity?
Single standing upper molars (bone tends to be thinner)
Pathological gemination/concrescence
Extracting in wrong order (extract most posterior and then move forward)
Inadequate alveolar support
