Odontogenic disease of the maxillary sinus Flashcards
How does the maxillary sinus communicate with the nasal cavity?
-Middle nasal meatus
What shape is the sinus at birth?
-Tubular
What shape is the the sinus at childhood?
-Ovoid
What shape is the sinus in adults?
-Pyramidal
What is the posterior wall of the maxillary sinus pierced by?
-Posterior superior alveolar nerve and vessels
The anterior wall of the maxillary sinus is related to what?
-Infra-orbital plexus of nerves and vessels and origin of muscles of upper lip
What is the apex of the maxillary sinus?
-Zygomatic process of maxilla
What is the base of the maxillary sinus?
-Nasal surface of maxilla
What is the roof of the maxillary sinus?
-Orbital surface of maxilla
What is the floor of the maxillary sinus?
-Alveolar process of maxilla
What arterial supply do you see in the maxillary sinus?
- Facial artery
- Maxillary artery
- Infra-orbital artery
- Greater palatine artery
What venous drainage do you see with the maxillary sinus anteriorly?
-sphenopalatine vein
What venous drainage do you see posteriorly in the maxillary sinus?
-Pterygoid venous
The pterygoid plexus communicates with what by emissary veins?
-Cavernous sinus
What are the 3 layers that surround the space of the maxillary sinus?
- Epithelial layer
- Basal layer
- Sub-epithelial layer
THe cilia beat at a rate of what per minute and can move mucus a distance of how far per minute?
- 1000 strokes
- 6 mm
What are the functions of the sinuses?
Warming inspired air
- Humidify air
- Lightening of skull weight
- Resonance of voice
- Filters debris
- Accessory olfactory organ
- Protects skull from mechanical shock
- Production of bactericidal lysozyme
Where do you palpate the maxillary sinus?
- Lateral wall over prominence of cheek bone
- Between canine fossa and zygomatic buttress
How is transillumination done for maxillary sinuses?
-Placing a bright flash light against the mucosa on the palatal or facial surface of the sinus and observing the transmission of light through the sinus in the darkroom
What does endoscope allow?
-Direct visualization in inaccessible areas such as maxillary molar roots that are behind distobuccal root of maxillary 1st molars
What is maxillary sinusitis?
-When the inflammation develops in the sinus either due to infection or allergy
What is acute maxillary sinusitis?
-Less than 3 weekx
What is subacute maxillary sinusitis?
-3 weeks to 3 months
What is the etiology of maxillary sinusitis?
- Bacterial
- Viruses (more commone)
- Allergy
- Odontogenic infections
- Nasotracheal intubation
- Barotraumas (diving injuries)
What age can acute sinusitis occur?
-Any age
What does a patient complain of with acute sinusitis?
- Pain
- Pressure
- Heaviness at the affected side
What is the most common sign of acute sinusitis?
-Headache
What can exacerbate pain with acute sinusitis?
-Bending position
Where might you see dull pain with acute sinusitis?
-Molar and premolar region
What do you do to treat maxillary sinusitis?
- Humidification of air
- Decongestion
- Nasal spray
- Antibiotics
- Analgesic
What are nasal decongestants used in maxillary sinusitis?
- Ephedrine sulphate
- Phenylephrine
- Xylometazoline
What are antibiotics used for non-odontogenic infections?
- Bactrim (sulfur)
- Augmentin
- Azithromycin
- Cefdinir
What are antibiotics used for odontogenic infections?
- Amoxicillin
- Clindamycin
- Metronidazole
If a patient fails to respond to the initial Tx within how many hrs should you culture and do a sensitivity test?
-72hrs
What percent of the bacteria are beta lactamase producers?
-25%
What can help you differentiate between pulpal pain and sinusitis?
-In pulpal pain you can usually narrow it down to a single tooth where as in sinusitis you can not locate the pain
What are some dental implications of maxillary sinuses?
- Spread of infection for periapical/PDL space
- Over extension of dental material
- Results of periapical surgery
What can sinus lift procedures do?
-contribute to acute maxillary sinusitis
How can a sinus lift contribute to acute maxillary sinusitis?
- When the sinus is overfilled
- When the sinus membrane is severely lacerated or avulsed
Oro-antral fistulas are what?
-Invasion of the maxillary sinus and establishment of direct communication with the oral cavity
What is a fistula allows lined by?
-Stratified squamous epithelium
What does the stratified squamous epithelium in a fistula allow?
-Patency of the tract
What is a fistula?
-Biological tract that connects an anatomical cavity with the external surface or other anatomical cavity
What are the factors that influence the creation of an oro-antral fistula?
- Hypercementosis
- Density of alveolar bone and thickness of sinus
- Size of sinus
- Rough extraction
- Apical pathosis
- Attached granulomas
- Periodontal disease that may erode the sinus floor
- Presence of cyst or tumor
If you take out a tooth and have a hole in the sinus does that mean you have an oro-antral fistula?
-No you don’t because you don’t have a stratified squamous epithelial lining ( this takes a few weeks to form)
What are the signs and symptoms of a oro-antral fistula?
- Antral floor fracture
- Fracture of alveolar process or tuberosity
- Evidence of air stream passing from nostril
- Change in speech tone and resonance
- Bubbling of blood from the socket or nostril
What is the treatment for an oro-antral fistula?
- Buccal flap (more common)
- Palatal flap
- Combination of both
When you do a buccal flap treatment for an oro-antral fistula what do you want?
-Tension free primary closure
How often do you see an antral pseudocyst?
2-10%
How does an antral pseudocyst result?
-Result of accumulation of serum (not sinus mucus) under the sinus mucosa
What is a mucous retention cyst?
- Blockage of ducts within the mucus-secreting glands within the sinus
- Accumulated mucin becomes surrounded by epithelium
What can occur with a mucous mucocele?
–The lesions can become expansile and may expand or erode the walls of the sinus and must be differentiated through removal and biopsy (bony erosion)
What is the most common type of malignancy involving the maxillary sinus?
-Squamous cell carcinoma
What is the second most common tumor involving the maxillary sinus?
-Adenoid cystic carcinoma
