Maxillary sinuses

Question 1

When are the maxillary sinuses formed?

Answer 1

during the 3rd and 4th foetal months

Question 2

functions of the paranasal sinuses

Answer 2

resonant to the voice
reserve chambers for gaming inspired air
reduces the weight of the skull

Question 3

What is the maxillary sinus?

Answer 3

pyramid-shaped cavity within the body of each maxilla
usually the largest of the sinuses

Question 4

maxillary sinus average dimensions

Answer 4

15ml volumetric space in average adult
37mm high
27mm wide
35mm antero-posteriorly

Question 5

maxillary sinus opening (ostium) anatomical features

Answer 5

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

Question 6

Maxillary teeth relation to maxillary antrum

Answer 6

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

Question 7

maxillary sinus epithelium

Answer 7

epithelium of the sinuses is pseudo stratified ciliated columnar epithelium

Question 8

function of the cilia in the epithelium of the maxillary sinus

Answer 8

mobilises trapped particulate matter and foreign material with sinus
- moves material towards the Ostia for elimination into the nasal cavity

Question 9

possible issues with maxillary sinus

Answer 9

OAC
- acute
OAF - oro-antral fistula
- chronic
root in antrum
sinusitis
benign lesions
malignant lesions

Question 10

OAC/OAF diagnosis

Answer 10

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

Question 11

OAC acute management

Answer 11

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

Question 12

OAC - post op instructions

Answer 12

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

Question 13

chronic OAF - common patient complaints

Answer 13

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

Question 14

OAF management

Answer 14

excision of sinus tract
raise buccal advancement flap
antral washout - not always done

Question 15

flap design options for OAF

Answer 15

buccal advancement flap
buccal fat pad with buccal advancement flap
palatal flap
bone graft

Question 16

maxillary tuberosity fracture aetiology

Answer 16

single standing molar
unknown unerupted molar or wisdom tooth
pathological germination
extracting in wrong order
inadequate alveolar support

Question 17

maxillary tuberosity fractures commonly involve what other problem?

Answer 17

maxillary sinus involvement

Question 18

fractured tuberosity diagnosis

Answer 18

noise
movement noted visually or with supporting fingers
more than one tooth movement
tear in soft tissue of palate

Question 19

tuberosity fracture management

Answer 19

reduce and stabilise
- orthodontic buccal arch wire with composite
- arch bar
- lab made splits
dissect our and cut wound primarily

Question 20

fractured tuberosity - things to make sure to do if you splint the tooth

Answer 20

remove or treat pulp
ensure tooth is out of occlusion
consider antibiotics
post-op instructions
remove tooth surgically 4-8 weeks later

Question 21

root or tooth in maxillary sinus - management

Answer 21

confirm radiographically
- OPT
- occlusal
- or periapical
- or CBCT
decision on retrieval
- if in doubt or retrieval difficult - refer

Question 22

root or tooth in maxillary sinus - ways to retrieve

Answer 22

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

Question 23

sinusitis aetiology

Answer 23

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

Question 24

Sinusitis signs and symptoms

Answer 24

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

Question 25

sinusitis - dental causes to rule out

Answer 25

periapical abscess
periodontal infection
deep caries recent extraction socket
TMD
neuralgia or atypical facial pain

Question 26

sinusitis indicators

Answer 26

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

Question 27

sinusitis treatment

Answer 27

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

Question 28

sinusitis treatment aims

Answer 28

treat preening symptoms
reduce tissue oedema
reverse ostia obstruction

Question 29

Antibiotics for sinusitis

Answer 29

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)

Question 30

non-bacterial sinusitis causes

Answer 30

fungal infection
trauma
- sinus wall fractures
- orbital floor fractures
- RCT
- tooth extractions
- dental implants
- deep periodontal treatment
- nasal packing