Maxillary Sinus (complications & clinical significance) Flashcards
what are functions of the paranasal sinuses?
- resonance to the voice
- reserve chambers for warming inspired air
- reduce the weight of the skull
what sinuses are present in the skull?
- frontal sinus
- sphenoid sinus
- ethmoid sinus
- maxillary sinus
Describe the shape of the maxillary sinus (usually):
pyramid-shaped cavity
What is the average volumetric space of the maxillary sinus in adults?
15ml
What are the average dimensions of the maxillary sinus?
- 37mm high
- 27mm wide
- 35mm antero-posteriorly
what is the ostium?
opening of the maxillary sinus (approx 4mm in diameter)
where do the alveolar canals typically lie in relation to the maxillary sinus?
posterior wall of sinus cavity
what epithelium is found within the maxillary sinus?
pseudostratified ciliated columnar epithelium
what are the functions of cilia in the maxillary sinuses?
- mobilise trapped particulate matter and foreign material within the sinus
- move the material towards the ostia for elimination into the nasal cavity
What possible issue can arise with the maxillary sinus that you may come into contact with in a dental setting?
- oro-antral communication
- oro-antral fistula
- root in antrum
- sinusitis
- benign lesions
- malignant lesions
How can an oro-antral communication be diagnosed?
- radiographic assessment of tooth position in relation to sinus
- bubbling of blood after XLA
- direct vision
- blunt probe
- nose holding test
if a small OAC occurs, how is this managed?
- inform patient
- encourage clot
- suture margins
- antibiotics
- specific post op instructions
What specific post-op instructions should be given to a patient with an OAC?
minimise pressure formation within the sinuses & mouth
If the OAC is large or the lining is torn, how is this managed?
buccal advancement flap
What are the steps of performing a buccal advancement flap for OAC?
- raise flap
- trimming of buccal bone occasionally required
- incising the periosteum
- check flap can be brought across defect tension free
- suture
What might patients complain of who have chronic OAF?
- 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
what flap design options are there for treatment of OAF?
- buccal advancement flap
- buccal fat pad with buccal advancement flap
- palatal flap
- bone graft
- rotated tongue flap
what can cause fracture of the maxillary tuberosity?
- single standing molar
- unknown unerupted molar or wisdom tooth
- pathological gemination/concrescence
- extracting in wrong order
- inadequate alveolar support
how can a fractured tuberosity be diagnosed?
- noise
- movement noted both visually or with supporting fingers
- more than one tooth movement
- tear in soft tissue of palate
How is a fractured tuberosity managed?
Reduce & stabilise
- orthodontic buccal arch wire with composite
- arch bar
- splints
If you splint a tooth in management of a fractured tuberosity, what must you also do?
- remove or treat pulp
- ensure it is out of occlusion
- consider antibiotics/antiseptics
- post-op instructions
- remove tooth surgically 4-8 weeks later
If there is a root in the maxillary sinus that needs to be retrieved, what approaches can be used?
- through the extraction socket
- caldwell luc approach (via buccal/labial sulcus)
- ENT endoscopic retrieval
Why does sinusitis usually occur?
Viral infection
- inflammation and oedema
- obstruction of ostia
- trapping of debris within sinus cavity
What may alter mucociliary clearance patterns?
- allergens
- inflammation
- anatomic abnormalities
What occurs when the sinus can no longer evacuate its contents efficiently?
- build up of pressure
- opportune situation for bacterial overgrowth of normal flora
what are some signs and symptoms of sinusitis?
- facial pain
- headache/pressure
- congestion
- dental pain
- halitosis
- nasal obstruction
- fever
- ear pain
- cough
What dental diagnoses may present similarly to sinusitis?
- periapical abscess
- periodontal infection
- deep caries
- recent extraction socket
- TMD
- neuralgia or atypical facial pain
what are the indications of sinusitis on examination?
- 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
what initial treatment is available for patients with sinusitis?
- decongestant ephedrine nasal drops 0.5%
- humidified air (steam/menthol inhalation)
What antibiotics can be prescribed for patients with worsening sinusitis?
- Amoxicillin 500mg, TID, 7 days
- Doxycycline 100mg, 1x day, 7 days
