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BDS4 ORAL SURGERY > Maxillary Sinus (complications & clinical significance) > Flashcards

Maxillary Sinus (complications & clinical significance) Flashcards

1
Q

what are functions 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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2
Q

what sinuses are present in the skull?

A
  • frontal sinus
  • sphenoid sinus
  • ethmoid sinus
  • maxillary sinus
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3
Q

Describe the shape of the maxillary sinus (usually):

A

pyramid-shaped cavity

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4
Q

What is the average volumetric space of the maxillary sinus in adults?

A

15ml

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5
Q

What are the average dimensions of the maxillary sinus?

A
  • 37mm high
  • 27mm wide
  • 35mm antero-posteriorly
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6
Q

what is the ostium?

A

opening of the maxillary sinus (approx 4mm in diameter)

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7
Q

where do the alveolar canals typically lie in relation to the maxillary sinus?

A

posterior wall of sinus cavity

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8
Q

what epithelium is found within the maxillary sinus?

A

pseudostratified ciliated columnar epithelium

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9
Q

what are the functions of cilia in the maxillary sinuses?

A
  • mobilise trapped particulate matter and foreign material within the sinus
  • move the material towards the ostia for elimination into the nasal cavity
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10
Q

What possible issue can arise with the maxillary sinus that you may come into contact with in a dental setting?

A
  • oro-antral communication
  • oro-antral fistula
  • root in antrum
  • sinusitis
  • benign lesions
  • malignant lesions
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11
Q

How can an oro-antral communication be diagnosed?

A
  • radiographic assessment of tooth position in relation to sinus
  • bubbling of blood after XLA
  • direct vision
  • blunt probe
  • nose holding test
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12
Q

if a small OAC occurs, how is this managed?

A
  • inform patient
  • encourage clot
  • suture margins
  • antibiotics
  • specific post op instructions
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13
Q

What specific post-op instructions should be given to a patient with an OAC?

A

minimise pressure formation within the sinuses & mouth

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14
Q

If the OAC is large or the lining is torn, how is this managed?

A

buccal advancement flap

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15
Q

What are the steps of performing a buccal advancement flap for OAC?

A
  • raise flap
  • trimming of buccal bone occasionally required
  • incising the periosteum
  • check flap can be brought across defect tension free
  • suture
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16
Q

What might patients complain of who have chronic OAF?

A
  • problems with fluid consumption (fluid from nose)
  • problems with speech
  • problems playing brass/wind instruments
  • problems smoking cigarettes/using a straw
  • bad taste/odour/halitosis/pus discharge
  • pain/sinusitis type symptoms
17
Q

what flap design options are there for treatment of OAF?

A
  • buccal advancement flap
  • buccal fat pad with buccal advancement flap
  • palatal flap
  • bone graft
  • rotated tongue flap
18
Q

what can cause fracture of the maxillary tuberosity?

A
  • single standing molar
  • unknown unerupted molar or wisdom tooth
  • pathological gemination/concrescence
  • extracting in wrong order
  • inadequate alveolar support
19
Q

how can a fractured tuberosity be diagnosed?

A
  • noise
  • movement noted both visually or with supporting fingers
  • more than one tooth movement
  • tear in soft tissue of palate
20
Q

How is a fractured tuberosity managed?

A

Reduce & stabilise
- orthodontic buccal arch wire with composite
- arch bar
- splints

21
Q

If you splint a tooth in management of a fractured tuberosity, what must you also do?

A
  • remove or treat pulp
  • ensure it is out of occlusion
  • consider antibiotics/antiseptics
  • post-op instructions
  • remove tooth surgically 4-8 weeks later
22
Q

If there is a root in the maxillary sinus that needs to be retrieved, what approaches can be used?

A
  • through the extraction socket
  • caldwell luc approach (via buccal/labial sulcus)
  • ENT endoscopic retrieval
23
Q

Why does sinusitis usually occur?

A

Viral infection
- inflammation and oedema
- obstruction of ostia
- trapping of debris within sinus cavity

24
Q

What may alter mucociliary clearance patterns?

A
  • allergens
  • inflammation
  • anatomic abnormalities
25
Q

What occurs when the sinus can no longer evacuate its contents efficiently?

A
  • build up of pressure
  • opportune situation for bacterial overgrowth of normal flora
26
Q

what are some signs and symptoms of sinusitis?

A
  • facial pain
  • headache/pressure
  • congestion
  • dental pain
  • halitosis
  • nasal obstruction
  • fever
  • ear pain
  • cough
27
Q

What dental diagnoses may present similarly to sinusitis?

A
  • periapical abscess
  • periodontal infection
  • deep caries
  • recent extraction socket
  • TMD
  • neuralgia or atypical facial pain
28
Q

what are the indications of sinusitis on examination?

A
  • discomfort on palpation of infraorbital region
  • a diffuse pain in the maxillary teeth
  • equal sensitivity from percussion of multiple teeth in same region
  • pain that worsens with head or facial movements
29
Q

what initial treatment is available for patients with sinusitis?

A
  • decongestant ephedrine nasal drops 0.5%
  • humidified air (steam/menthol inhalation)
30
Q

What antibiotics can be prescribed for patients with worsening sinusitis?

A
  • Amoxicillin 500mg, TID, 7 days
  • Doxycycline 100mg, 1x day, 7 days
31
Q
A

BDS4 ORAL SURGERY (16 decks)

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