Maxillary Sinus in Disease and Trauma Flashcards
where is the maxillary sinus the largest
para- nasal sinuses
where is the maxillary sinus located
maxilla
what is the shape of the maxilla
pyramidal
what forms the base of the maxillary sinus
the lateral nose bone
what are the physiological functions of the maxillary sinus
- speech and voice resonance
- reduces weight of skull
- warms the inspired air
- filtration of inspired air
- immunologic barrier (body defense)
is everyones maxillary sinus the same size
no
is everyones symmetry of the maxillary sinus the same
no
describe the size of the max sinus with age
small in children and increases in size with aging
what is the average height, depth, width and capcity of the max sinus
- height: 3.5cm
- depth: 3.2cm
- width: 2.5cm
- capacity: 15cc
the max sinus is divided into several compartments by bony septa AKA:
Underwood’s septa
where does the max sinus open
at postero-inferior end of semi lunar hiatus lying in the middle meatus
what is the membranous lining of the max sinus cavity
the schneiderain membrane
microscopically what is the bilaminar membrane of the max sinus made of
mucous secreting pseudostratified ciliated columnar epithelial cells on the internal side and periosteum on the osseous side
lining of the max sinus contains osteoclasts which contribute to:
pneumatisation
what happens in acute sinusitus
cilia can become paralyzed and sinuses are congested with mucus
what happens in chronic sinusitis
may damage cilia; the mucosal lining becomes thick and scarred
what is the gold standard for the view of the max sinus
Water’s view
what are the maxillary sinus disorders
- congenital anomalies
- inflammatory diseases
- odontogenic infection
- cysts
- neoplasia
- bone metaplasia and benign tumors
- trauma
what are the inflammatory diseases of max sinus
- bacterial infection
- bacterial infection secondary to viral infection
- fungal infection
about ____ of inflammatory epidoses are eextensions of dental infections
10%
what are the classifications of maxillary sinusitis and how long for each
- acute: less than 2 weeks
- subacute: 2 weeks- 3 months
- chronic sinusitis: greater than 3 months
what happens in acute maxillary sinusitus
there is suppurative or non suppurative inflammation of the mucosal lining of the maxillary sinus
- involves one or both sinuses
what are the causes of acute maxillary sinusitis
- secondary to hay fever and allergic rhinitis
- secondary to acute rhinitis (common cold) and URI
what are the signs and symptoms of acute maxillary sinusitis
- headache
- pain and tenderness
- nasal obstruction
- nasal discharge
- toxic manifestations
- heavy filling with bending
- nasal congestion
what is the clinical exam for acute maxillary sinusits
- examine the nasal cavity: discharge- pus- blood- polyps
- palpate the anterior wall of the maxilla (intra and extra oral approach)
- rule out odontogenic cause (through clinical and radiographic exam)
what is the treatment for acute maxillary sinusitis
- rest and fluid and OH
- antibiotics - augmentin after C and S is done
- analgesics and NSAIDs (acetominophen and IBU)
- antihistamines
- local treatmetns
what are the most causative organisms in acute maxillary sinusitis
pneumococci and streptococci
what are the local treatments for acute maxillary sinusitis
- nasal decongestant: afrin 2-3 nasal puffs 2 times a day for 3-4 days
- steam inhalation
what is chronic sinusitis
- a chronic type of infection that affects the mucosal lining of one or both sinuses, resulting in mucous or pus collection
what are mucosal polyps in the sinus
a polypoidal type of inflammation can lead to formation of multiple or single mucosal polyps inside the sinus
what are the causes of chronic maxillary sinusitis
- as a consequence of non resolved acute maxillary sinusitis
- dental abscesses
- virulent organism with low resistance
- foreign body dislodgement or trauma
what are the signs and symptoms of chronic maxillary sinusitis
- headache
- nasal obstruction
- nasal discharge
- fatigue
- hyposmia/anosmia
what is the surgical treatment for chronic maxillary sinusitis
sinus wash out
what is the treatment for chronic maxillary sinusitis
same as acute maxillary sinusitis
what are the complications of maxillary sinusitis
- orbital abscess and orbital cellulitis
- intracranial abscesses/meningitis
- cavernous sinus thrombosis
- spread of infection to neighboring sinuses, structures and organs
- osteomyelitis
what is a mycotic infection of the maxillary sinus and what organism causes it
-aspergillosis
- an opportunistic infection caused by maxillary sinus flora in a susceptible individual - low immunity
what does a mycotic infection lead to and what is the tx
- obliteration of the sinus space and erosion of its bony components
- surgical removal of the associated lesion from the sinus
what are the odontogenic cysts of the maxillary sinus
- radicular cysts
- residual cysts
- dentigerous cysts
- primordial cysts
what are the non odontogenic cysts of the maxillary sinus
- mucous retention cyst
- mucocele
what are the odontogenic tumors of the maxillary sinus
- ameloblastoma
- myxoma
what are the neoplasias of the maxillary sinus
- squamous cell carcinoma
- adenocarcinoma
- sarcoa (osteosarcoma)
- Ewing’s sarcoma
what are the bone metaplasia and benign tumors of the maxillary sinus
- fibrous dysplasia
- ossifying fibroma
- transitional papilloma
- osteoma
- giant cell lesions
what are the types of trauma to the maxillary sinus
- Le fort I fracture
- zygomatic complex fracture
- orbital floor fractures
- oro antral communications, tuberosity fracture during tooth extraction process
describe the Le Fort I fracture and what is involved
- horizontal fracture though the maxilla above the level of the nasal floor and alveolar process
- piriform rims
- anterior maxilla
- zygomatic buttresses
- pterygoid plates
