maxillary sinus in dentoalveolar sx Flashcards

1
Q

Oro-antral Communication (O.A.C)

A

Invasion of the maxillary sinus and establishment of a direct communication with the
oral cavity is referred to as an “oro -antral communication”.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Prevention of Oroantral Communication

A

Pre-operative examination
Conduct thorough preoperative radiographic examination.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Factors influencing creation of oro-antral communication
* Teeth size/roots?
* root?
* Density of? thickness of?
* Relation of sinus to?
* Size of?

A
  • 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 the sinus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Factors influencing creation of oro-antral communication
* Rough? misguided?
* Apical?
* Periapical diseases which may?
* Presence of?
* Invasive?

A
  • Rough extraction and misguided manipulation.
  • Apical pathosis.
  • Periapical diseases which may erode sinus floor.
  • Presence of cysts and neoplasm.
  • Invasive surgery e.g. dental implants placement.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prevention of Oroantral Communication –Intra operative Period

A
  • Perform surgical extraction early, remove some bone around the tooth and if necessary section roots and remove them separately i.e if they are multi-rooted.
  • Avoid excess apical pressure during
    extractions of maxillary posterior teeth that are in close proximity to the sinus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Policy of leaving root fragments
– Risk vs benefits?
– size?
– Root?
– Absence of?
– No?

A

– Risk vs benefits (Maxillary sinus)
– Fragment must be small (< 5 mm)
– Root deeply embedded
– Absence of infection
– No radiolucency at root tip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

During dental extractions in the posterior maxillary region, it is important to determine if OAC is?

A

During dental extractions in the posterior maxillary region, it is important to determine if it is just
an O.A.C or if it is a O.A.C with displacement of the tooth into the socket.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnosis of the oroantral communication
– To confirm the presence of a communication, the best technique is?

A

– To confirm the presence of a communication, the best technique is to use the “Nose-blowing
test” (Valsalva Maneuver).
– The patient is asked to pinch their nostrils together to occlude the nose. The patient blows gently to see if air escapes into the oral cavity via the maxillary sinus opening.
– Presence of OAF appears as bubbling of blood in the extraction socket.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diagnosis of the oroantral communication
– If nose-blowing’ test is negative, don’t?
– Don’t attempt to ? the sinus to confirm diagnosis?
– Always check radiograph for?

A

– If nose-blowing’ test is negative, don’t explore the opening with suction tip and/or probes.
– Don’t attempt to irrigate the sinus to confirm diagnosis.
– Always check radiograph for the continuity of sinus floor and presence of tooth/root.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Signs and symptoms of newly created oro-antral Communication
* Bubbling of blood from?
* Antral floor attached to?
* Fracture of the?
* Radiographic evidence of?

A
  • 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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of oro-antral communication Small Size - (2 mm in diameter or less)
* sx?
* Sinus precautions?
* Surgeon must not?

A
  • Small (2 mm in diameter or less), no additional surgical treatment is necessary
  • Sinus precautions
    – avoid blowing the nose, violent sneezing, sucking on straws, and smoking
    – Patients who smoke and who cannot stop (even temporarily) should be advised to smoke in small puffs, not in deep drags, to avoid pressure changes.
  • Surgeon must not probe through the socket into the sinus with a periapical curette or a root tip pick
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of oro-antral communication
Moderate Size O.A.C (2 to 6 mm)
* Ensure the maintenance of? suture?
over the tooth socket .
* rx?

A
  • Ensure the maintenance of the blood clot in the area, a figure-of-eight suture should be placed over the tooth socket
  • Antibiotics, usually Augmentin, should be prescribed for 7 days.
  • A nasal decongestant spray should be prescribed to shrink the nasal mucosa to keep the ostium of the sinus patent.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of oro-antral communication
Large size O.A.C (7 mm or larger)
* Dentist should consider closing the sinus communication with?
* Usually requires that the patient be?
* Flap development and closure of a sinus opening are?
– most commonly used flap?

A
  • Dentist should consider closing the sinus communication 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.
    – most commonly used flap is a buccal flap
  • This technique mobilizes buccal soft tissue to cover the opening and provide for a primary closure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

buccal advancement flap

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Disadvantage of the Buccal advancement flap?

A

Disadvantage of the Buccal advancement flap technique is loss of vestibular depth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Palatal Rotation Flap

A
17
Q

Advantage of the Palatal rotation flap

A
  • Keratinized tissue is used to cover the O.A.C in relation to the alveolar ridge
  • There is no loss of vestibular depth on the buccal side
18
Q

Postoperative care/ Sinus Precautions

A
  • Antibiotics (Augmentin)
  • Pain Medication (Combination of Acetoaminophen, Ibuprofen)
  • Local treatment
  • Nasal Decongestant
  • e.g. Afrin Sinus decongestant,
  • 2 to 3 Nasal puffs 2 times daily for 3 to 4 days
  • Saline Nasal decongestant
  • Steam inhalation
19
Q

Management of Oroantral Communication with displacement of tooth/root into the sinus

A

Immediate vs Late
* Assess size of root
* Presence of infection
* Health of sinus

20
Q

Displacement of tooth or root into the maxillary sinus
* It is basically a mishap that results from?
* teeth most at risk of dislodgment?
* In association with?

A
  • It is basically a mishap that results from a neglected act by the operator while applying wrong force.
  • Occurs rarely but the maxillary 3rd molar and maxillary 2nd premolar are the most at risk of dislodgment.
  • In association with poor surgical technique.
21
Q

Displacement of tooth or root into the maxillary sinus Immediate Management
* Confirm the existence of oro-antral communication and the presence of tooth or root in sinus using?
* Locate the precise position of?

A
  • Confirm the existence of oro-antral communication and the presence of tooth or root in sinus using Periapical X-rays, panoramic X-rays and C.B.C.T Scan if necessary.
  • Locate the precise position of the foreign body within the sinus lining or in the sinus cavity.
22
Q

Immediate management of dislodged object in sinus
* Reflect?
* Reduce?
* Retrieve?
* If root or tooth dislodged into the sinus proper, consider?
* closure?

A
  • Reflect mucoperiosteal flap.
  • Reduce alveolar bone height.
  • Retrieve the tooth or the root by permitting their movement away from the sinus.
  • If root or tooth dislodged into the sinus proper, consider Caldwell-luc approach.
  • Undermine the flap and replace across the bony defect.
23
Q

Removal of Root-Tip from Sinus via
Caldwell-Luc Approach

A
24
Q

If the O.A.C is left untreated, The two sequelae of most concern are:

A
  • Formation of a chronic oroantral fistula.
  • Postoperative maxillary sinusitis
25
Q

What is a Fistula ?

A
  • Is a biological tract that connects an anatomical cavity with the external
    surfaces or another anatomical cavity (unlike sinus tract).
  • It is always lined with a stratified squamous epithelium and the patency of the tract is preserved until epithelial cells scraped off
26
Q

Oro-antral fistula
It might be a complication of:

A

Unrecognized (overlooked) fistula.
Untreated fistula.
Failure of spontaneous closure of OAC.
Failure of surgically repaired oro-antral fistula

27
Q

Signs and symptoms of Oro Antral Fistula Patient usually complains of:

A
  • Nasal regurgitation of liquid and reflux of food and drinks.
  • Altered nasal resonance,
  • Intermittent episode of pain and local tenderness.
  • Foul-tasting discharge.
  • Bad taste in the mouth and whistling sound while speaking.
28
Q

Primarily management of Chronic Oro Antral Fistula

A

It is aimed to eliminate any sinus infection:
* Excision of any mucosal polyp or purulent granulation to promote drainage.
* Regular irrigation with warm water or saline.
* Single course of antibiotics and nasal inhalation and decongestant.
* Acrylic base plate.

29
Q

Management of Chronic Oro Antral Fistula Important Surgical Principles
* Success?
* Flap should have?
* Flap tissue must be?
* Flap should lie in its new position without?
* Good hemostasis?

A
  • Success of operation is not always guaranteed.
  • Flap should have good blood supply.
  • Flap tissue must be handled gently.
  • Flap should lie in its new position without tension.
  • Good hemostasis must be achieved before discharging the patients.