Maxillary sinuses Flashcards
When are the maxillary sinuses formed?
during the 3rd and 4th foetal months
functions of the paranasal sinuses
resonant to the voice
reserve chambers for warming inspired air
reduces the weight of the skull
What is the maxillary sinus?
pyramid-shaped cavity within the body of each maxilla
usually the largest of the sinuses
maxillary sinus average dimensions
15ml volumetric space in average adult
37mm high
27mm wide
35mm antero-posteriorly
maxillary sinus opening (ostium) anatomical features
opens at the middle meatus
opening approx 4mm diameter
located superiorly on medial wall of sinus
lined with mucosa
can become narrow or blocked during episodes of inflammation or disease
Maxillary teeth relation to maxillary antrum
alveolar canals that transport posterior superior alveolar vessels and nerves to maxillary posterior teeth are generally found on posterior wall of sinus cavity
roots of maxillary molars and sometimes premolars project onto the floor of the maxillary sinus
- roots may perforate the bone so that only the mucosal lining of the sinus covers them
maxillary sinus epithelium
epithelium of the sinuses is pseudo stratified ciliated columnar epithelium
function of the cilia in the epithelium of the maxillary sinus
mobilises trapped particulate matter and foreign material with sinus
- moves material towards the Ostia for elimination into the nasal cavity
possible issues with maxillary sinus
OAC
- acute
OAF - oro-antral fistula
- chronic
root in antrum
sinusitis
benign lesions
malignant lesions
OAC/OAF diagnosis
size of tooth
radiographic position of roots in relation to antrum
bone at trifurcation of roots
bubbling of blood
nose holding test
- careful as can create an OAC
direct vision
good light and suction
blunt probe
OAC acute management
inform patient
if small or sinus lining intact
- encourage clot
- suture margins
- antibiotic
- post op instructions
if large or lining torn
- close with buccal advancement flap
OAC - post op instructions
avoid blowing nose or sneezing with pinched nostrils as both actions can increase sinus pressure and cause wound breakdown
also avoid
- smoking
- sucking through straws
- blowing up balloons or air mattresses
- playing a wind or brass musical instrument
- snorkeling or scuba diving
also advisable to keep a soft diet and avoid any sharp/hard foods that may interfere with healing wound
chronic OAF - common patient complaints
problems with fluid consumption
- fluids going into nose
problems with speech or singing
- nasally quality
problems playing brass/wind instruments
problems smoking
problems using a straw
bad taste/pus discharge
- post-nasal drip
pain/sinusitis type symptoms
OAF management
excision of sinus tract
raise buccal advancement flap
antral washout - not always done
flap design options for OAF
buccal advancement flap
buccal fat pad with buccal advancement flap
palatal flap
bone graft
maxillary tuberosity fracture aetiology
single standing molar
unknown unerupted molar or wisdom tooth
pathological germination
extracting in wrong order
inadequate alveolar support
maxillary tuberosity fractures commonly involve what other problem?
maxillary sinus involvement
fractured tuberosity diagnosis
noise
movement noted visually or with supporting fingers
more than one tooth movement
tear in soft tissue of palate
tuberosity fracture management
reduce and stabilise
- orthodontic buccal arch wire with composite
- arch bar
- lab made splits
dissect our and cut wound primarily
fractured tuberosity - things to make sure to do if you splint the tooth
remove or treat pulp
ensure tooth is out of occlusion
consider antibiotics
post-op instructions
remove tooth surgically 4-8 weeks later
root or tooth in maxillary sinus - management
confirm radiographically
- OPT
- occlusal
- or periapical
- or CBCT
decision on retrieval
- if in doubt or retrieval difficult - refer
root or tooth in maxillary sinus - ways to retrieve
through extraction socket
- open fenestration with care
- suction
- small curettes
- irrigation or ribbon gauze
- close as for OAC
Calwell-Luc approach
- buccal/labial sulcus
- buccal window cut in bone
ENT
- endoscopic retrieval
sinusitis aetiology
most precipitated by effects of a viral infection
- inflammation and oedema
- obstruction of ostia
- trapping of debris within sinus cavity
mucocillary clearance patterns may be altered by
- allergens
- inflammation
- anatomical abnormalitie s
when sinus can no longer evacuate its contents efficiently
- build up of pressure
- opportunistic situato for bacterial overgrowth of normal flora
Sinusitis signs and symptoms
facial pain
pressure
congestion
nasal obstruction
paransal drianage
hyposomia
- reduced ability to smell or detect odors
fever
headache
dental pain
halitosis
fatigue
cough
ear pain
anaesthesia/parasthesia over cheek
sinusitis - dental causes to rule out
periapical abscess
periodontal infection
deep caries recent extraction socket
TMD
neuralgia or atypical facial pain
sinusitis indicators
discomfort on palpation of infraorbital region
diffuse pain in maxillary teeth
equal sensitivity from percussion of multiple teeth in same region
pain that worsens with head or facial movements
sinusitis treatment
decongestants
- reduce mucosal oedema
- ephedrine nasal drops 0.5%
- one drop each nostril up to 3 times daily
- maximum 7 days
humidified air
- steam/menthol inhalations
sinusitis treatment aims
treat preening symptoms
reduce tissue oedema
reverse ostia obstruction
Antibiotics for sinusitis
should only be used if symptomatic treatment is ineffective or symptoms worsen and signs and symptoms point to bacterial sinusitis
antibiotics
- amoxicillin 500mg, 3x a day for 7 days
or
- doxycycline 100mg, 1x a day for 7 days (200mg loading dose)
non-bacterial sinusitis causes
fungal infection
trauma
- sinus wall fractures
- orbital floor fractures
- RCT
- tooth extractions
- dental implants
- deep periodontal treatment
- nasal packing
