maxillary sinus in dentoalveolar sx Flashcards
Oro-antral Communication (O.A.C)
Invasion of the maxillary sinus and establishment of a direct communication with the
oral cavity is referred to as an “oro -antral communication”.
Prevention of Oroantral Communication
Pre-operative examination
Conduct thorough preoperative radiographic examination.
Factors influencing creation of oro-antral communication
* Teeth size/roots?
* root?
* Density of? thickness of?
* Relation of sinus to?
* Size of?
- 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
Factors influencing creation of oro-antral communication
* Rough? misguided?
* Apical?
* Periapical diseases which may?
* Presence of?
* Invasive?
- 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.
Prevention of Oroantral Communication –Intra operative Period
- 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
Policy of leaving root fragments
– Risk vs benefits?
– size?
– Root?
– Absence of?
– No?
– Risk vs benefits (Maxillary sinus)
– Fragment must be small (< 5 mm)
– 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 OAC is?
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.
Diagnosis of the oroantral communication
– To confirm the presence of a communication, the best technique is?
– 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.
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?
– 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.
Signs and symptoms of newly created oro-antral Communication
* Bubbling of blood from?
* Antral floor attached to?
* Fracture of the?
* Radiographic evidence of?
- 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.
Management of oro-antral communication Small Size - (2 mm in diameter or less)
* sx?
* Sinus precautions?
* Surgeon must not?
- 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
Management of oro-antral communication
Moderate Size O.A.C (2 to 6 mm)
* Ensure the maintenance of? suture?
over the tooth socket .
* rx?
- 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.
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?
- 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
buccal advancement flap
Disadvantage of the Buccal advancement flap?
Disadvantage of the Buccal advancement flap technique is loss of vestibular depth