Maxillary Sinus Flashcards
When does formation occur?
During 3rd and 4th foetal months
Maxillary and ethmoid sinus large at birth
Sphenoid and frontal expand within first few years of life
Paranasal sinus functions
Resonate the voice
Reduce weight of skull
Reserve chambers for warming air
Maxillary sinus size
15ml in average adult
37h x 27w x 35l
Maxillary sinus opening
Opens at middle meatus
Epithelium of sinus
Pseudostratified ciliated columnar epithelium
OAC/OAF Diagnosis
Radiographic position of roots in relation to antrum
Bone at trifurcation of roots
Bubbling of blood
Direct vision
Good light and suction - echo
Blunt probe
OAC Management
Inform patient
If small (<2mm)
encourage clot
suture margins
A/B
Do not create negative pressure
If large:
Close with buccal advancement flap
Chronic OAF complaints:
Fluid discharge from nose
Problem with speech
Problem with wind instruments
Problem with smoking/straw
Bad taste/odour
Sinusitis like pain
Types of flaps for OAF closure
Buccal advancement flap (BAF)
Buccal fat pad with BAF
Palatal flap
Bone graft
Collagen membrane
Rotated tongue flap
Maxillary tuberosity fracture aetiology
single standing molar
unknown unerupted molar
extracting in wrong order
not enough alveolar support
pathological gemination
Diagnosis of fractured tuberosity
Noise
More than 1 tooth movement
tear in soft tissue/ palate
Movement noted visually/ with supporting fingers
Fractured tuberosity management
Reduce and stabilise with:
Ortho buccal arch wire and composite
Arch bar
Splints
Dissect out and close wound primarily
Splinted Fractured tuberosity Post Op
Remove or treat pulp
Ensure out of occlusion
Consider A/B
POIG
Remove tooth surgically 4-8 weeks later
Root/ Tooth in antrum management
Confirm with OPT, PA, Occlusal or CBCT
Refer for retrieval if difficult to ENT/ Maxfax
Root in antrum retrieval
Through XLA socket:
Open fenestration
suction
Small curettes
Irrigation or ribbon gauze
Close OAC
Caldwell-Luc approach:
Buccal/ labial window cut in bone
ENT:
Endoscopic retrieval
Aetiology of sinusitis:
Usually viral caused:
Inflammation and oedema
Obstruction of ostia
Trapping of debris within sinus cavity
Sinusitis signs:
Facial pain
pressure
ear pain
nasal
obstruction
hyposmia
Sinusitis Indicators:
Discomfort on palpation of infraorbital region
Diffuse pain in maxillary teeth
Equal sensitivity from multiple teeth in same region
Pain that worsens with postural movements
Sinusitis Tx aims:
Treat presenting symptoms
Reduce tissue oedema
Reverse obstruction of the ostia
Sinusitis treatment
Ephedrine nasal drops 0.5%
One drop in each nostril x3 daily for max 7 days
Steam/ menthol inhalation
Antibiotics for sinusitis?
Only for bacterial sinusitis
Amoxicillin 500mg x3/day for 7 days
Doxycycline 100mg x1/day for 7 days (200mg loading dose)
