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BDS4 Oral Surgery > Maxillary sinus: complications and clinical significance > Flashcards

Maxillary sinus: complications and clinical significance Flashcards

1
Q

what main sinuses are there in the face

A
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2
Q

what sinuses are larger at birth

A

maxillary and ethmoid
(spenoid and frontal undergo expansion during first few years)

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3
Q

funcations of the paranasal sinuses

A
  • resonance to the voice
  • reserve chambers for warming inspired air
  • reduce the weight of the skull
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4
Q

anatomy of the maxillary sinus

A
  • usually, largest of the sinuses
  • pyramid-shaped cavity within the body of each maxilla
  • around 15ml space in average adult
  • 37mmx27mmx35mm
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5
Q

what is the opening of the maxillary sinus called and where is it

A

middle meatus (4mm in diameter)

superiorly on medial wall of sinus

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6
Q

what is the relationship of the maxillary antrum to the upper teeth

A
  • the alveolar canals that transport the posterior superior alveolar vessels and nerves to the maxillary posterior teeth are generally found on the posterior wall of the sinus cavity
  • roots of max molars and sometimes premolars may project into the floor of the max sinus
  • roots may perforate the bone so that only the mucosal lining of the sinus covers them
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7
Q

what epithelium makes up max sinus

A

psuedostratified ciliated columnar epithelium

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8
Q

what role do the cilia play in the max antrum

A
  • mobilise trapped particulate matter and foreign material within sinus
  • move this material toward the ostia for elimination into the nasal cavity
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9
Q

clinical significance of the max sinus

A
  • Oro-antral communication (OAC)
  • oro-antral fistula (OAF)
  • root in the antrum
  • sinusitis
  • benign lesions
  • malignant lesions
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10
Q

diagnosis of OAC/OAF

A
  • size of tooth
  • radiographic position of roots in relation to antrum
  • bone at trifurcation of roots
  • bubbling of blood
  • nose holding test (careful as can create OAC)
  • direct vision
  • good light and suction (echo)
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11
Q

difference between OAC and OAF

A
  • OAC - just happened
  • OAF - chronic problem, epithelium lined tract formed
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12
Q

what does an at risk radiograph in pre-op assessment look like for OAC

A
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13
Q

what is this

A

OAC

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14
Q

what is this

A

OAF

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15
Q

OAC management - acute

A
  • inform patient

if small:
- encorage clot
- suture margins
- antibiotic?
- post-op instructions in particular, minimise pressure formation within sinuses and mouth
- avoid = sucking through straw, inflating balloons, blowing nose, smoking if possible, singing

if large:
- close with buccal advancement flap

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16
Q

describe buccal advancement flap

A
  • 3-sided (2 relieving, 1 crestal)
  • raise full thickness
  • sometimes need to trim alveolar bone
  • incise the periostium to avoid pulling under tension
  • suture
17
Q

CO for patients with chronic OAF

A
  • problems with fluid consumption (fluids from nose)
  • problems with speech/ singing (nasal quality)
  • problems with brass/wind instruments
  • problems smoking cigarettes/using straws
  • bad taste/odour/ halitosis/pus discharge
  • pain/sinusitis type symptoms
18
Q

surgical management of OAF

A
  • excision of sinus tract prior to performing buccal advancement flap
  • sometimes need antral washout as can be infected
19
Q

flap design options

A
  • buccal advancement flap (most common)
  • buccal fat pad with buccal advancement flap
  • palatal flap
  • bone graft/collagen membrane
20
Q

aetiology of fracture of max tuberosity

A
  • single standing molar
  • unknown unerupted molar/wisdom tooth
  • pathological gemination/concrescence
  • extracting in wrong order
  • inadequate alveolar support
21
Q

diagnosis of fractured tuberosity

A
  • noise
  • movement noted visually/with supporting fingers
  • more than 1 tooth movement
  • tear in soft tissue of palate
22
Q

management of fractured tuberosity

A
  • reduce and stabilise (splints or ortho buccal arch wire with composite)
  • dissect out tooth and close wound primarily
23
Q

if you splint the tooth due to fractured tuberosity what do you need to remember to do

A
  • remove or treat pulp
  • ensure it is out of occlusion
  • consider antibiotic and antiseptics
  • post-op instructions
  • remove the tooth surgically 4-8 weeks later
24
Q

how would you confirm there is a root or tooth in the max sinus

A
  • OPT, occlusal or periapical (+/- CBCT)
25
Q

if a root was here, would you need to remove?

A

Not always
- won’t cause sinusitis
- won’t move
- haven’t torn lining

26
Q

what methods are there for retrieving a root in the max sinus

A
  1. OAF type approach/through the extraction socket
  2. Caldwell-Luc approach (buccal window cut in bone)
  3. ENT (endoscopic removal)
27
Q

what is the aetiology of sinusitis

A
  • most precipitated by effects of a viral infection
  • mucocillary clearance patterns altered
  • build up of pressure
  • opportune situation for bacteiral overgrowth of normal flora
28
Q

signs and symptoms of sinusitis

A
  • facial pain
  • pressure
  • congestion
  • nasal obstruction
  • paranasal drainage
  • hyposmia
  • fever
  • headache
  • dental pain
  • halitosis
  • fatigue
  • cough
  • ear pain
  • anaesthesia/paraesthesia over cheek
29
Q

what is important to rule out when you suspect sinisitis

A

dental cause:
- PA abscess
- periodontal infection
- deep caries
- recent extraction socket
- TMD
- neuralgia or atypical facial pain/chronic midfacial pain

benign sinus lesions
- polyps, papillomas, antral pseudocysts, mucoceles and mucous retention cysts
- odontogenic cysts/odontogenic tumours expanding into the maxillary sinus

malignant lesions
- primary tumours
- local spread from adjacent sites

30
Q

indicators of sinisitis

A
  • discomfort on palpation of infraorbital region
  • diffuse pain in max teeth (all TTP)
  • equal sensitivity from percussion of multiple teeth in the same region
  • pain that worsens with head or facial movements
31
Q

tx aims for sinisitis

A
  • treat presenting symptoms
  • reduce tissue oedema
  • reverse obstruction of the ostia
32
Q

tx of sinisitis

A
  • decongestants reduce mucosal oedema (ephedrine nasal drops 0.5% one drop each nostril up to 3x daily when required - use for max 7 days)
  • humidified air also helpful (steam/menthol inhalation)
33
Q

would you use antibiotics for sinisitis?

A

ONLY if:
- symptomatic tx not effective/symptoms worsen
- signs and symptoms suggest bacterial sinusitis

34
Q

if you were to prescribe antibiotics for sinisitis what would you prescribe

A
  • amoxicillin 500mg, 3x daily for 7 days (first line)
  • doxycycline 100mg, 1x daily for 7 days (200mg loading dose)
35
Q

fungal infections are rare to cause sinisisits but what would happen if it did

A
  • would be non-resolving
  • expansion of bony walls by increased mucus secretion and fungal growth
36
Q

what trauma can result in sinisitis

A
  • sinus wall fractures
  • orbital floor fractures
  • RCT
  • extractions
  • dental implants/sinus lifts
  • deep periodontal tx
  • nasal packing
  • nasogastric tubes
  • mechanical (nasal) intubation

BDS4 Oral Surgery (10 decks)

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