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xD3 Oral Surgery Ex1 > Maxillary Sinus Disease (Deeb) > Flashcards

Maxillary Sinus Disease (Deeb) Flashcards

1
Q

How does the maxillary sinus develop?

A

Arises as an out pouching of the nasal mucosa

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2
Q

Does the size of the maxillary sinus increase or decrease in adolescence?

A

Increased

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3
Q

When the sinus expands during adulthood, which direction does it go?

A

The floor expands into the alveolus

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4
Q

What is the anterior wall of the maxillary sinus?

A

The anterior surface of the maxilla

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5
Q

What is the superior wall of the maxillary sinus?

A

The floor of the orbit

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6
Q

What is the posteriolateral wall of the maxillary sinus?

A

The maxillary tuberosity and the infra temporal fossa

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7
Q

What makes up the floor of the sinus?

A

The confluence of the posterolateral (maxillary tuberosity and the infra temporal fossa) and anterior (anterior surface of the maxilla) walls

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8
Q

Where does the maxillary sinus drain?

A

The osmium in the medial wall at the superior midpoint OR posteriorly

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9
Q

Where does the maxillary sinus empty INTO?

A

The ethmoid infundibulum

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10
Q

Where is the ethmoid infundibulum located?

A

Under the middle turbinate in the posterior middle meatus

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11
Q

What is the hallmark of a sinus infection?

A

Purulence

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12
Q

What type of epithelium lines the sinus?

A

Respiratory epithelium (pseudocolumnar squamous epithelium with numerous goblet cells and cilia)

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13
Q

What are the cilia of the sinus mucousa programmed to do?

A

Move toward the natural ostium

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14
Q

Where is most of the normal airflow in the maxillary sinus?

A

Around the middle turbinate

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15
Q

What happens when an obstruction occurs in the maxillary sinus?

A

You get a cycle of flow

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16
Q

What is the fifth-most common medical diagnosis for which antibiotics are prescribed?

A

Sinusitis

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17
Q

What percent of completely asymptomatic adults have abnormalities on the sinus CT?

A

Up to 40 percent

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18
Q

What percent of adults with minor colds have abnormalities on sinus CT?

A

Over 80 percent

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19
Q

What is the criteria for acute sinusitis?

A

Symptoms for 1-4 weeks (symptoms for less than 1 week are almost always viral)

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20
Q

What is the criteria for chronic sinusitis?

A

Symptoms for more then 12 weeks

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21
Q

What are MAJOR factors for sinusitis?

A
  1. Facial pain / pressure
  2. Facial congestion / fullness
  3. Nasal drainage / discharge
  4. Postnasal drip
  5. Nasal obstruction / blockage
  6. Hyposmia / anosmia
    7 Fever (acute only)
  7. Purulence on endoscopy (automatic)
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22
Q

What are MINOR factors for sinusitis?

A
  1. Headahce
  2. Maxillary dental pain
  3. Cough
  4. Halitosis
  5. Fatigue
  6. Ear pain, pressure, or fulness
  7. Fever
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23
Q

What are the requirements to reach a diagnosis of sinusitis?

A

“Strong history for sinusitis with…”
2 major factors
1 major factor and 2 minor factors
Purulence at midde meatus or in sinus cavity

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24
Q

Is swelling common in sinusitis?

A

No. That is usually indicative of a dental etiology

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25
Q

What is usually present upon palpation when a patient has sinusitis?

A

Tenderness over the sinus cavities.

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26
Q

What is the most valuable sinus imaging technique for a sinusitis diagnosis?

A

CT Coronal Sections without contrast

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27
Q

What does cloudiness in the sinuses on the CT image indicate?

A

Fluid in that portion of the sinus

28
Q

What is the tallest point in the lower 48 states?

A

Mt Whitney

29
Q

What are 4 causes of inflammation at the osteomeatal complex (OMC) causing obstruction in sinusitis?

A
  1. Infections
  2. Immunologic
  3. Allergic
  4. Anatomical
30
Q

Is routine endodontic treatment an issue with sinusitis (i guess this means in causing it)?

A

No. it is rarely an issue.

31
Q

Will perforation of the sinus during endodontic treatment create an additional risk?

A

No, it creates no additional risk

32
Q

What type of endodontic filling material may lead to chronic inflammatory response in sinus lining?

A

Sargenti type filling material

33
Q

What effect does periodontal disease have on the sinus mucosa?

A

May thicken in the area of disease but will reduce with periodontal therapy

34
Q

What are the most common acute sinusitis pathogens?

A
  1. Haemophilus influenzae
  2. Streptococcus pneumoniae
  3. Moraxella (Branhamella) catarrhalis (rare in adults, 20% in children)
35
Q

Chronic pathogens include the same as the acute pathogens as well as what?

A

Multiple anaerobes (although their contribution is unclear)

36
Q

What will a paranasal sinus CT or cone beam show around the affected tooth in odontogenic sinusitis?

A

Mucosal thickening

37
Q

What percent of sinusitis have dental causes?

38
Q

What treatment is indicated with odontogenic sinusitis?

A

Endodontic therapy or extraction

39
Q

What are some viral causes of sinusitis?

A

Rhinovirus, influenze virus, RSV in children

40
Q

What are two causes of fungal sinusitis?

A
  1. Allergic (immunocompetent)

2. Invasive (immunocompromised)

41
Q

What are some genetic disease that contribute to sinusitis?

A

Cystic fibrosis, congenital immunologic, metabolic, ciliary function deficits

42
Q

What are some allergy-related sinusitis etiologies?

A

Environmental, Asthma/ASA/nasal polyp triad

43
Q

What type of anatomic variation would predispose a patient to sinusitis?

A

Variation in osteomeatal complex anatomy

44
Q

What are the 4 portions of the sinusitis cycle?

A
  1. Stasis
  2. Infection
  3. Inflammation
  4. Impaired mucociliary clearance
45
Q

What is the typical medical therapy for sinusitis?

A

Antibiotics 10-14 day course (cover typical organisms for acute disease; culture-guided for chronic disease)

46
Q

What is the medical therapy for chronic sinusitis?

A
  1. Decongestants
  2. Mucolytics (guaifenesin)
  3. Topical steroids
  4. Saline lavage
  5. Oral steroids (less commonly given)
  6. Antifungals (for AFS or invasive fungal infection)
47
Q

What is a historical debridement surgery for sinusitis?

A

Caldwell-Luc Operation

  1. Antrostomy in anterior wall (canine fossa)
  2. Inferior meatus antrostomy for drainage
  3. Gauze packing
48
Q

What are the principles of contemporary therapy for sinusitis?

A
  1. Break the cycle
  2. Preserve native tissue
  3. Restore natural function
49
Q

What is FESS?

A

Functional endoscopic sinus surgery

50
Q

What is the goal of FESS?

A

Restore natural drainage path of sinuses

51
Q

What are three main components of FESS?

A
  1. Diseased tissue is removed
  2. Natural osmium is enlarged
  3. Maxillary sinus mucosa is preserved
52
Q

What are three other sinus pathologies common in the maxillary sinus?

A
  1. Mucous retention cyst
  2. Mucocele
  3. Neoplastic disease
53
Q

What percent of the population has mucous retention cysts in their maxillary sinus?

A

Up to 8% (which Dr Deeb says is “very common”)

54
Q

What treatment is necessary for a mucous retention cyst?

A

No treatment necessary

55
Q

What is a dome-shape opacity usually on the floor of the sinus?

A

Mucous retention cyst

56
Q

What is an expansile cystic lesion almost always in the ethmoid, frontal or sphenoid sinuses?

57
Q

May serious complications result from a mucocele?

58
Q

May a mucocele require surgical exploration?

59
Q

What are some other “nasal” pathology?

A
  1. Nasopharyngeal carcinoma

2. Nosebleeds

60
Q

Are nasopharyngeal carcinomas associated with the usual SCC risks?

61
Q

Are nasopharyngeal carcinomas common in young adults?

62
Q

What must be disproven for a cervical mass (adenopathy) in a young adult without other explanation?

A

Nasopharyngeal carcinoma

63
Q

Which nosebleeds are more common and easier to control: anterior or posterior?

64
Q

What nosebleeds are less common and harder to manage: anterior or posterior?

65
Q

Do nasopharyngeal carcinomas have relatively poor outcomes?

xD3 Oral Surgery Ex1 (4 decks)

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