Maxillary Sinus in Dentoalveolar Surgery Flashcards
what is an oro antral communication
invasion of the maxillary sinus and establishment of a direct communication with the oral cavity
what is done in the pre operative exam in prevention of oro antral communication
conduct thorough preoperative radiographic exam
what are the factors influencing creating of oro antral communications
- teeth size and configuration of the roots
- hypercementosis and bulbous roots
- density of alveolar bone and thickness of sinus floor
- relation of sinus to the root of upper teeth
- size of sinus
- rough extraction and misguided manipulation
- apical pathosis
- periapical diseases which may erode sinus floor
- presence of cysts and neoplasm
- invasive surgery such as implant placement
how are oro antral communications prevented in the intra operative period
- perform surgical extraction early, remove some bone around the tooth and if necessary section roots and remove them separately if they are multi rooted
- avoid excess apical pressure during extractions of maxillary posterior teeth that are in close proximity to the sinus
how should root fragments and root tips be removed to prevent an oro antral communication
use root elevator as a wedge in wiggling motion without excessive pressure - displacement
what is the policy of leaving root fragments
- risks vs benefits (max sinus)
- fragment must be small ( less than 5mm)
- root deeply embedded
- absence of infection
- no radiolucency at root tip
during dental extractions in the posterior maxillary region it is important to determine if it is just an ________ or ______
OAC or OAC with displacement of the tooth into the socket
what is the best technique to confirm the presence of a communication
Nose blowing tests AKA valsalva maneuver
what is a positive valsalva
presence of OAF appears as bubbling of blood in the extraction socket
if nose blowing test is negative:
dont explore the opening with suction tip and/or probes
- dont attempt to irrigate the sinus to confirm diagnosis
always check the radiograph for _____ of sinus floor and presence of_______
continuity; tooth/root
what are the signs and symptoms of newly created oro-antral communication
- bubbling of blood from the socket or nostril
- antral floor attached to roots apices of extracted tooth or teeth
- fracture of the alveolar process or the tuberosity
- radiographic evidence of sinus involvement
what is a small OAC
2mm in diameter or less
what is the treatment for a small OAC and sinus precautions
- no additional treatment needed
- surgeon must not probe through the socket into the sinus with a periapical curette or root tip pick
- sinus precautions: avoid blowing nose, violent sneezing, sucking on straws and smoking, patients who smoke and cannot stop should be advised to smoke in small puffs, not in deep drags to avoid pressure changes
what is a moderate size OAC
2-6mm
what is the treatment for moderate size OAC
- ensure the maintenance of the blood clot in the area, a figure eight suture should be placed over the tooth socket
- antibiotics, usually augmentin should be prescribed for 7 days
- a nasal decongestnat spray should be prescribed to shrink the nasal mucosa to keep the ostium of the sinus patent
what is the size of a large OAC
7mm or larger
what is the tx for a large OAC
- consider closing the sinus with a flap procedure
- usually requires that the patient be referred to an oral and maxillofacial surgeon
- flap development and closure of a sinus opening are somewhat complex procedures that require skill and experience
what flap is used for the large OAC and why
buccal flap because this technique mobilizes buccal soft tissue to cover the opening and provide for a primary closure
what is a disadvantage of the buccal advancement flap technique
loss of vestibular depth
what is an advantage of the palatal rotation flap
keratinized tissue is used to cover the OAC in relation to the alveolar ridge
- there is no loss of vestibular depth on the buccal side
what is the general post operative care/sinus precautions
- antibiotics (augmentin)
- pain medication ( combo of acetominophen, ibuprofen)
- local treatment: nasal decongestant- afrin- 2-3 nasal puffs 2 times a day for 3-4 days
- saline nasal decongestant
- steam inhalation
what are the considerations in management of oroantral communication with displacement of tooth/root into the sinus
- assess size of root
- presence of infection
- health of sinus
what is the displacement of tooth or root into the maxillary sinus caused by
a mishap that results from a neglected act by the operator while applying the wrong force
- in association with poor surgical technique
