OD19 Flashcards
What is the difference between an OAC and a OAF?
OAC – creates a hole between mouth and maxillary sinus
OAF – epithelialized tract leading up to the sinus
OAC untreated becomes OAF – needs to be surgically removed
How long does it take a OAC to turn into a OAF?
7-10 days
What is the function of the maxillary sinus?
Respiration – HUMIDIFIES AIR – prevents inflammation of respiratory tract
Speech
Lightening of the skull – skull would be too heavy otherwise
How would you diagnose a OAC and what shouldn’t you do if you suspect one?
Only by observation – try find BASE OF POCKET Bubbling of saliva No bone in base of socket Suspicion Radiograph
Later on:
Reflux of fluid, smoke etc into nose
Reflux of fluid into mouth
Discharge & bad taste
Sinusitis
DONT:
Force nasal expiration
NOT by probing
How would you manage an OAC non-surgically?
• Inform patient (duty of candour)
• Instructions -
No Nose blowing 2/52- Takes 2 weeks to epithelialize over
Sneeze with mouth open – decreases pressure within sinuses
OHI – regular toothbrushing usually enough
• Nasal decongestants Ephedrine 0.5%
1-2 drops a few times
daily
• Steam inhalations
• Antibiotics INDICATED
Broad spectrum
Bacteria will result in OAF
Amoxicillin 1st line
Doxycycline 2nd line (SDCEP guidelines)
• Review – check under good visual illumination to see if OAC still present
Can be managed with a soft splint for 2/52.
May struggle to take impression- place gauze in communication.
How would you manage an OAC surgically?
• Buccal advancement flap +/- fat pad – 1ST LINE
3 sided flap – broader base to flap as blood supply compromised
If theres a good chance of OAC, raise this flap to start with as it is easier rather than having to modify 2 sided flap
Cut underneath periosteum – becomes stretchy and can stretch it right over
Acts as air/ water seal
Can sometimes use buccal fat pad – NORMALLY just do single layer flap however buccal fat pad can be utilised sometimes
Failure – not removing fistula/ not getting closure onto healthy tissue
• Palatal advancement flap – 2ND LINE
Take care for greater palatine artery
Mucosa on palate is more keratinised – MORE ROBUST
Leaves area of exposed bone – leave to heal via secondary intention
• Tongue flap - 3RD LINE (RARE)
Involves initially attaching tongue flap to palate, allowing it to heal then detaching the tongue
Indicated in cleft palate / persistent fistula
What are the three types of odontogenic cysts?
- Radicular (LAMINA DURA OF DEAD TOOTH)
- Dentigerous (ECTOPIC TOOTH)
- Keratinocyst (MULTILOCULAR RADIOLUCENCY)
Most common cancerous tumour in the mouth?
Squamous cell carcinoma (SCC)
What happens in fibrous dysplasia?
Overgrowth of bone
What is Paget’s disease?
A chronic skeletal disease. Affects remodelling. New bone is placed out of balance and is normally weak and brittle.
Name a potential dental/ oro-facial problem caused by Paget’s disease.
Denture retention- maxilla growing.
Compression of nerves as they come out the skull.
What advice should you give to facial trauma patients?
Do not blow nose.
What are the methods of removing displaced teeth from a sinus?
Through socket
Caldwell-Luc – raise flap/ remove bone around sinus and try find the tooth in the sinus
-> Better to do under GA
What is one method to make more space for maxillary implants?
Sinus lift.
Symptoms of maxillary sinusitis?
Pain (on bending forwards)
Can be unilateral or bilateral
Discharge – post-nasal drip
