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Module 6 - Oral Surgery > Maxillary Sinus > Flashcards

Maxillary Sinus Flashcards

1
Q

What sinuses can transillumination be used for?

A
  • Frontal.
  • Maxillary.
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2
Q

What is the management for acute infective sinusitis?

A

In most fit and healthy adults (no immunocompromise) this should be SELF-LIMITING thus inhalations recommended

  1. Inhalations 3 times a day for 1 week(ex. menthol).
  2. Epinephrine nasal drops 0.5% 2 time a day for 1 week.
  3. Penicillin V 500mg 4 times a day for 7 days.
  4. Doxycycline 10mmg for 1 week, 200mg on first day.
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3
Q

What happens if a patient completes a round of antibiotics to treat maxillary sinusitis yet this fails?

A

Likely undergo 3D imaging to see if there is some obstruction.

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4
Q

What is chronic sinusitis? What often causes it?

A
  • Ongoing, low-grade symptoms.
  • Often indicates a MECHANICAL obstruction (ex. deviated septum).
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5
Q

How to assess for OAC and consent (4)?

A
  • Extracting any upper molars (especially P root) and occasionally premolars.
  • If the film suggests a close relationship.
  • Inform the patient of the risk, what to expect if this happens.
  • Outline how the complication is managed.
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6
Q

Calcified material in the antrum?

A

Antrolith.

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7
Q

When does the maxillary sinus stop growing?

A

Continues enlarging as we get older, thus increases the risk of OAC and fractured tuberosities.

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8
Q

When is a CT/ MRI indicated for a maxillary sinus?

A

When you are worried something is occupying the sinus.

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9
Q

5 bacterial species associated with acute infective sinusitis?

A
  • Strep pneumoniae.
  • H.Influenzae.
  • Moraxella catarrhalis.
  • Staph aureus.
  • Alpha hemolutic strept
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10
Q

What would you see clinically after XLA when an OAC has been formed?

A
  • CANNOT see base of socket.
  • Will not hold a clot and base will look dark as you are looking into the antrum.
  • Communication CLINICALLY APPARENT, will not hold a consolidating clot.
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11
Q

Another name for maxillary sinus?

A

Sinus of highmore

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12
Q

Why do we ask patients to avoid nose blowing after OAC treatment?

A

Blowing air through the antrum can place pressure on the wound and cause WOUND BREAKDOWN.

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13
Q

What is it called when the maxillary sinus lining stays intact but falls down?

A

Antral lining collapse.

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14
Q

3 serious complications of sinusitis?

A
  • Brain abscesses.
  • Orbital cellulitis.
  • Cavernous sinus thrombosis.
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15
Q

What is it called when all the sinuses become infected?

A

PANSINUSISITIS due to the proximity of the draining osteum from the sinuses.

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16
Q

8 clinical symptoms of acute infective maxillary sinusitis?

A
  • Pain.
  • Tenderness worse on bending.
  • Maxillary posterior teeth TTP/ maxillary tooth toothache.
  • Bad taste/ smell.
  • Post nasal drip.
  • Mucopurulent nasal discharge.
  • History of coloured discharge.
  • Poor response to decongestants.
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17
Q

How is endoscopy applied to maxillary sinuses?

A

Small endoscope placed through the ostium on the lateral wall of the nose to view the sinus.

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18
Q

What is an antral tap?

A

Uses a small instrument to make a hole in the antrum to drain it - NOT DONE OFTEN NOAWADAYS.

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19
Q

5 symptoms of OAC?

A
  • Passage of fluid down nose.
  • Passage of air into mouth.
  • Alteration of voice.
  • Unilateral epistaxis.
  • Nasal obstruction.
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20
Q

Mucocele in the antrum?

A

Antrocele.

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21
Q

What is the management for chronic sinutitis?

A
  • Antral lavage (wash out antrum).
  • Intranasal antrostomy (increase the size of the ostium).
  • Metronidazole with amoxicillin, erythromycin.
  • If OAF must surgically close defect.
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22
Q

What are antral mucoceles? What is their clinical importance?

A
  • CYSTS.
  • Can become so large that they obstruct the ostium, causing mechanical blockage and CHRONIC SINUSITIS.
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23
Q

How does the maxillary sinus drain?

A
  • Drains into the MIDDLE MEATUS through a 2.4mm OSTEUM which is 2/3rds up the MEDIAL wall of the sinus.
  • Thus mucous must go AGAINST gravity.
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24
Q

4 common pathologies of the maxillary sinus?

A
  1. Infective maxillary sinusitis.
  2. Non infective maxillary sinusitis.
  3. Fractures (maxilla or zygoma).
  4. Tumors/ cysts.
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25
Q

Increase the size of the ostium?

A

Intranasal antrostomy.

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26
Q

How is the displacement of a tooth/ tooth piece into the maxillary sinus managed?

A

Managed SURGICALLY by removing the foreign body and closing the OAC.

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27
Q

4 causes of OAC?

A
  • XLA of maxillary posterior teeth.
  • Tuberosity fracture.
  • Middle third fracture.
  • Pathology/ malignancy
28
Q

How is OAC managed (4)?

A
  • Ideally close immediately using BUCCAL ADVANCEMENT FLAP.
  • Plate or modified denture.
  • Antibiotics, epinephrine frops and mucolytic inhalations to avoid developing sinusitis.
  • Avoid nose blowing.
29
Q

what % of acute infective maxillary sinusitis is of dental origin?

A

10%

30
Q

What is a PATHOGNOMONIC SIGN OF OAC?

A

Fluids coming down the nose after drinking.

31
Q

What teeth are close to the maxillary sinus?

A

Maxillary molars and premolars.
- Especially PALATAL roots of MAXILLARY MOLAR TEETH.

32
Q

7 functions of the paranasal sinuses?

A
  • Humidification of inspired air.
  • Filtering the air.
  • Production/ quality of voice.
  • Lightening the head.
  • Crumple zone of the face.
  • Olfactory sense.
  • Immunological defense role.
33
Q

2 reasons why someone may be predisposed to recurrent sinusitis?

A
  • Mechanical obstruction (polyp, deviated septum, oedema of nasal mucosa).
  • Impaired mucous clearance (poor ciliary action, abnormally thick or sticky mucous).
34
Q

What are the paranasal sinuses?

A
  • Air-containing sacs lined by ciliated epithelium, communicating with the nasal cavity.
  • Frontal, ethmoidal, sphenoidal, maxillary.
35
Q

What would you see on radiograph if a maxillary sinusitis?

A
  • Opaque sinus.
  • Fluid level.
36
Q

Where do the paranasal sinuses drain into?

A

All drain into the LATERAL WALL OF THE NOSE.

37
Q

What is the scheiderian membrane?

A

The lining of the maxillary sinus.

38
Q

What is the shape and volume of the maxillary sinus?

A
  • PYRAMIDAL shape.
  • Volume 15-30mls.
39
Q

What kind of epithelium lines the maxillary sinus?

A

Respiratory epithelium.

40
Q

What causes infective sinusitis?

A

Can be bacterial, viral, fungal.

Most sinusitis follow from a VIRAL infection (ex. cold/flu). Inflamed sinuses and buildup of mucous, it becomes BACTERIALLY infected.

41
Q

Wash out the antrum?

A

Antral lavage.

42
Q

How does sinus pathology produce symptoms like toothache?

A
  • Toothache affecting upper quadrant that patient finds difficult to localize.
  • Inflammation in sinus causes stimulation of the MAXILLARY DIVISION OF THE TRIGEMINAL NERVE which innervates both the teeth and sinus.
43
Q

What patients are at higher risk of OAC?

A

Elderly, partially dentate patients who undergo XLA of upper molars/ premolars (due to pneumatization of maxillary antrum).

44
Q

Why does maxillary sinusitis pain get worse on bending?

A

Mucopurulent materials sits on top of the ANTERIOR SUPERIOR ALVEOLAR NERVE, pressing it and making pain worse.

45
Q

2 impaired mucous clearance causes of the maxillary sinus?

A
  • Poor ciliary action.
  • Abnormally thick or sticky mucous (cystic fibrosis).
46
Q

A clinical test that can help assess the maxillary sinus?

A

TRANSILLUMINATION.
- Endoscope with a light source placed up the pts nose.
- Illuminates –> healthy.
- Less bright –> pathology, would likely see the outline if there is something in the sinus.
Can be done for FRONTAL and MAXILLARY sinuses.

47
Q

4 peri-operative complications associated with dentistry and the maxillary sinus?

A
  1. Extrusion of endodontic material .
  2. Oro-antral communication.
  3. Displacmeent of tooth/ pieces into the sinus.
  4. Fracture of maxillary tuberosity (large OAC).
48
Q

2 ways in which sinus pathology can present in the mouth?

A
  • Cancer of maxillary antrum can cause EROSION of bone into the mouth.
  • CYST in the antrum can enlarge and DISPLACE TEETH.
49
Q

How does mucous from the sinuses drain?

A

Ciliated epithelium beats in SPIRALING PATTERN to OSTIUM.

50
Q

Why do nasal decongestants work poorly for acute infective maxillary sinusitis?

A

Osteum is small (2.4mm) + thickened scheniderian membrane narrows it even more –> cannot get in.

51
Q

What can happen when a foreign body (ex. endodontic material) enters the sinus?

A
  • Foreign body into STERILE cavity.
  • Inflammatory reaction and likely INFECTION.
  • Thus **SINUSITIS*.
52
Q

When may an OAC spontaneously close?

A

If around 5mm.

53
Q

What imaging is recommended for maxillary sinuses (6)?

A
  • Occipitomental (Water’s view).
  • DPT, periapicals.
  • CT scan, MRI.
  • Endoscopy
54
Q

3 mechanical obstruction of the maxillary sinus?

A
  • Deviated septum.
  • Polyps.
  • Oedema of nasal mucosa.
55
Q

What is the pathognomonic sign of acute/chronic sinusitis?

A

Pain gets worse when the patient bends forward.

56
Q

Tooth fragment causes obstruciton of osteum and thus drainage. Acute or chronic sinusitis?

A

Chronic.

57
Q

How is a sinusitis confirmed?

A

Through CLINICAL SIGNS and SYMPTOMS.

  • NOT recommended to take a radiograph.
58
Q

4 types of non infective sinusitis?

A
  • Allergic.
  • Vasomotor.
  • Septal deviation predisposes.
  • Foreign body (teeth/ roots).
59
Q

What is the membrane of the maxillary sinus called?

A

SCHNEIDERIAN MEMBRANE, 0.25mm thick.

60
Q

What is chronic sinusitis suggestive of (2)?

A
  • IMMUNOCOMPROMISE (in the absence of OAF).
  • Possible anatomical drainage problem (ex. deviated septum).
61
Q

What happens after an OAC?

A
  • Often maxillary sinusitis.
  • If left antreated will form an epithelial line tract (OROANTRAL FISTULA) which could lead to CHRONIC SINUSITIS.
62
Q

What would you see clinically after XLA when an OAC has NOT been formed?

A
  • Can see the base of socket.
  • Can see a healthy blood clot forming at the base.
63
Q

3 reasons why the maxillary sinus is important for dentists?

A
  1. Common peri-operative complications.
  2. Sinus pathology can cause symptoms like toothache.
  3. Sinus pathology can present in the mouth.
64
Q

Where does the maxillary antrum drain into? Why is this important?

A

Drains into the MIDDLE MEATUS.

  • Underneath the frontal drainage, thus infection in the frontal sinus can co-infect the ethmoidal and mxillary sinuses.
65
Q

What happens if OAC is left untreated (5)?

A

OAF forms:
- Persistent sinusitis.
- Unilateral nasal discharge.
- Intra-oral antral polyp.
- Cacogeusia.
- Facial pain.

66
Q

What innervates the maxillary sinus?

A

Second (maxillary) division of the trigeminal nerve

67
Q

How is a root lodged in the maxillary sinus usually removed?

A

Endoscopically by the ENT.

Module 6 - Oral Surgery (11 decks)

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