Odontogenic sinusitis –topographic anatomy, classification, etiology, pathogenesis. Basic principles of treatment

Question 1

Sinus walls

Answer 1

• Upper wall (facies orbitalis)
• Lower wall (facies alveolaris)
• Posterior wall (facies dorsalis)
• Front wall (facies anterior)
• Medial wall (facies nasalis)
• Lateral wall (facies lateralis)

Question 2

-Upper wall (facies orbitalis) clinical significance

Answer 2

• Floor of orbit
• Infraorbital nerve passes

Question 3

Membrane of the maxillary sinus

Answer 3

Schneiderian membrane→ covered
by pseudo - stratified columnar ciliated epithelium

Question 4

Vascularisation of Maxillary sinus

Answer 4

• Posterior superior alveolar artery
• Greater palatine artery
• Infraorbital artery
• Posterior lateral nasal artery

Question 5

Innervation of maxillary sinus

Answer 5

Posterior, middle and anterior superior alveolar nerves

Question 6

Acute odontogenic maxillary- sinusitis

Answer 6

• Arises from bacterial infection
• Common from premolar and molar teeth

Question 7

Cause of Acute odontogenic maxillary- sinusitis

Answer 7

• Periapical abscesses
• Periodontitis
• Peri-implantitis
• Odontogenic cysts
• Osteomyelitis

Question 8

Chronic odontogenic maxillary- sinusitis

Answer 8

-Results from prolonged inflammation of antral mucosa

Question 9

Acute odontogenic maxillary sinusitis clinical symtoms

Answer 9

• Dull/intense pressure like pain
• Erythema and swelling of check and anterior maxilla
• Headache, malaise, fever, oral malodour
• Mucopurulent drainage in nasal cavity and nasopharynx

Question 10

Chronic odontogenic maxillary sinusitis clinical symtoms

Answer 10

• Persistent pus discharge
• Pain during chewing
• Mobile teeth
• Dull headache

Question 11

Diagnosis of sinusitis

Answer 11

• Periapical and panoramic radiographs
• CT

Question 12

Sinusitis differential diagnosis

Answer 12

• Carcinoma
• Aspergillosis
• Cystic disease

Question 13

Treatment of Acute odontogenic maxillary sinusitis

Answer 13

Antibiotics→ Penicillin, clindamycin and metronidazile

• Elimination of source
• Pain relief and reduction in nasal edema→ Analgesics and antihistamines
• Drainage

Question 14

Treatment of Chronic odontogenic maxillary sinusitis

Answer 14

Elimination of infection source)Extraction/Endo

• Antibiotics
• Surgery

Question 15

Caldwell Luc Operation

Answer 15

Sinus mucosa removed from antral wall

-New opening made→ better drainage into nose

Question 16

Endoscopic sinus surgery

Answer 16

• Performed through nostrils
• Restores drainage
• Obstructive materials removed

Question 17

Abnormal communication between oral and antral cavities

Answer 17

Oral antral communication

Question 18

Most common cause of oral antral communication

Answer 18

Extraction of maxillary posterior teeth

Question 19

If Oral antral communication left open

Answer 19

Epithelial tissue forms in its track→ Fistula→ Needs surgical intervention

Question 20

Clinical characteristics of Oral antral communication and fistula

Answer 20

• Unpleasant tasting discharge
• Reflex of fluids into nose from mouth
• If long lasting→ Filled with granulations and epithelium

Question 21

Management of Oral antral communication and fistula

Answer 21

• Visual inspection
• Radiographs
• Antibiotics to avoid infection