Maxillary Sinus in Disease and Trauma

Question 1

where is the maxillary sinus the largest

Answer 1

para- nasal sinuses

Question 2

where is the maxillary sinus located

Answer 2

maxilla

Question 3

what is the shape of the maxilla

Answer 3

pyramidal

Question 4

what forms the base of the maxillary sinus

Answer 4

the lateral nose bone

Question 5

what are the physiological functions of the maxillary sinus

Answer 5

• speech and voice resonance
• reduces weight of skull
• warms the inspired air
• filtration of inspired air
• immunologic barrier (body defense)

Question 6

is everyones maxillary sinus the same size

Answer 6

no

Question 7

is everyones symmetry of the maxillary sinus the same

Answer 7

no

Question 8

describe the size of the max sinus with age

Answer 8

small in children and increases in size with aging

Question 9

what is the average height, depth, width and capcity of the max sinus

Answer 9

• height: 3.5cm
• depth: 3.2cm
• width: 2.5cm
• capacity: 15cc

Question 10

the max sinus is divided into several compartments by bony septa AKA:

Answer 10

Underwood’s septa

Question 11

where does the max sinus open

Answer 11

at postero-inferior end of semi lunar hiatus lying in the middle meatus

Question 12

what is the membranous lining of the max sinus cavity

Answer 12

the schneiderain membrane

Question 13

microscopically what is the bilaminar membrane of the max sinus made of

Answer 13

mucous secreting pseudostratified ciliated columnar epithelial cells on the internal side and periosteum on the osseous side

Question 14

lining of the max sinus contains osteoclasts which contribute to:

Answer 14

pneumatisation

Question 15

what happens in acute sinusitus

Answer 15

cilia can become paralyzed and sinuses are congested with mucus

Question 16

what happens in chronic sinusitis

Answer 16

may damage cilia; the mucosal lining becomes thick and scarred

Question 17

what is the gold standard for the view of the max sinus

Answer 17

Water’s view

Question 18

what are the maxillary sinus disorders

Answer 18

• congenital anomalies
• inflammatory diseases
• odontogenic infection
• cysts
• neoplasia
• bone metaplasia and benign tumors
• trauma

Question 19

what are the inflammatory diseases of max sinus

Answer 19

• bacterial infection
• bacterial infection secondary to viral infection
• fungal infection

Question 20

about ____ of inflammatory epidoses are eextensions of dental infections

Answer 20

10%

Question 21

what are the classifications of maxillary sinusitis and how long for each

Answer 21

• acute: less than 2 weeks
• subacute: 2 weeks- 3 months
• chronic sinusitis: greater than 3 months

Question 22

what happens in acute maxillary sinusitus

Answer 22

there is suppurative or non suppurative inflammation of the mucosal lining of the maxillary sinus
- involves one or both sinuses

Question 23

what are the causes of acute maxillary sinusitis

Answer 23

• secondary to hay fever and allergic rhinitis
• secondary to acute rhinitis (common cold) and URI

Question 24

what are the signs and symptoms of acute maxillary sinusitis

Answer 24

• headache
• pain and tenderness
• nasal obstruction
• nasal discharge
• toxic manifestations
• heavy filling with bending
• nasal congestion

Question 25

what is the clinical exam for acute maxillary sinusits

Answer 25

- 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)

Question 26

what is the treatment for acute maxillary sinusitis

Answer 26

- rest and fluid and OH - antibiotics - augmentin after C and S is done - analgesics and NSAIDs (acetominophen and IBU) - antihistamines - local treatmetns

Question 27

what are the most causative organisms in acute maxillary sinusitis

Answer 27

pneumococci and streptococci

Question 28

what are the local treatments for acute maxillary sinusitis

Answer 28

- nasal decongestant: afrin 2-3 nasal puffs 2 times a day for 3-4 days - steam inhalation

Question 29

what is chronic sinusitis

Answer 29

- a chronic type of infection that affects the mucosal lining of one or both sinuses, resulting in mucous or pus collection

Question 30

what are mucosal polyps in the sinus

Answer 30

a polypoidal type of inflammation can lead to formation of multiple or single mucosal polyps inside the sinus

Question 31

what are the causes of chronic maxillary sinusitis

Answer 31

- as a consequence of non resolved acute maxillary sinusitis - dental abscesses - virulent organism with low resistance - foreign body dislodgement or trauma

Question 32

what are the signs and symptoms of chronic maxillary sinusitis

Answer 32

- headache - nasal obstruction - nasal discharge - fatigue - hyposmia/anosmia

Question 33

what is the surgical treatment for chronic maxillary sinusitis

Answer 33

sinus wash out

Question 34

what is the treatment for chronic maxillary sinusitis

Answer 34

same as acute maxillary sinusitis

Question 35

what are the complications of maxillary sinusitis

Answer 35

- orbital abscess and orbital cellulitis - intracranial abscesses/meningitis - cavernous sinus thrombosis - spread of infection to neighboring sinuses, structures and organs - osteomyelitis

Question 36

what is a mycotic infection of the maxillary sinus and what organism causes it

Answer 36

-aspergillosis - an opportunistic infection caused by maxillary sinus flora in a susceptible individual - low immunity

Question 37

what does a mycotic infection lead to and what is the tx

Answer 37

- obliteration of the sinus space and erosion of its bony components - surgical removal of the associated lesion from the sinus

Question 38

what are the odontogenic cysts of the maxillary sinus

Answer 38

- radicular cysts - residual cysts - dentigerous cysts - primordial cysts

Question 39

what are the non odontogenic cysts of the maxillary sinus

Answer 39

- mucous retention cyst - mucocele

Question 40

what are the odontogenic tumors of the maxillary sinus

Answer 40

- ameloblastoma - myxoma

Question 41

what are the neoplasias of the maxillary sinus

Answer 41

- squamous cell carcinoma - adenocarcinoma - sarcoa (osteosarcoma) - Ewing's sarcoma

Question 42

what are the bone metaplasia and benign tumors of the maxillary sinus

Answer 42

- fibrous dysplasia - ossifying fibroma - transitional papilloma - osteoma - giant cell lesions

Question 43

what are the types of trauma to the maxillary sinus

Answer 43

- Le fort I fracture - zygomatic complex fracture - orbital floor fractures - oro antral communications, tuberosity fracture during tooth extraction process

Question 44

describe the Le Fort I fracture and what is involved

Answer 44

- horizontal fracture though the maxilla above the level of the nasal floor and alveolar process - piriform rims - anterior maxilla - zygomatic buttresses - pterygoid plates