Odontogenic sinusitis –topographic anatomy, classification, etiology, pathogenesis. Basic principles of treatment Flashcards
Sinus walls
- Upper wall (facies orbitalis)
- Lower wall (facies alveolaris)
- Posterior wall (facies dorsalis)
- Front wall (facies anterior)
- Medial wall (facies nasalis)
- Lateral wall (facies lateralis)
-Upper wall (facies orbitalis) clinical significance
- Floor of orbit
- Infraorbital nerve passes
Membrane of the maxillary sinus
Schneiderian membrane→ covered
by pseudo - stratified columnar ciliated epithelium
Vascularisation of Maxillary sinus
- Posterior superior alveolar artery
- Greater palatine artery
- Infraorbital artery
- Posterior lateral nasal artery
Innervation of maxillary sinus
Posterior, middle and anterior superior alveolar nerves
Acute odontogenic maxillary- sinusitis
- Arises from bacterial infection
- Common from premolar and molar teeth
Cause of Acute odontogenic maxillary- sinusitis
- Periapical abscesses
- Periodontitis
- Peri-implantitis
- Odontogenic cysts
- Osteomyelitis
Chronic odontogenic maxillary- sinusitis
-Results from prolonged inflammation of antral mucosa
Acute odontogenic maxillary sinusitis clinical symtoms
- 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
Chronic odontogenic maxillary sinusitis clinical symtoms
- Persistent pus discharge
- Pain during chewing
- Mobile teeth
- Dull headache
Diagnosis of sinusitis
- Periapical and panoramic radiographs
- CT
Sinusitis differential diagnosis
- Carcinoma
- Aspergillosis
- Cystic disease
Treatment of Acute odontogenic maxillary sinusitis
Antibiotics→ Penicillin, clindamycin and metronidazile
- Elimination of source
- Pain relief and reduction in nasal edema→ Analgesics and antihistamines
- Drainage
Treatment of Chronic odontogenic maxillary sinusitis
Elimination of infection source)Extraction/Endo
- Antibiotics
- Surgery
Caldwell Luc Operation
Sinus mucosa removed from antral wall
-New opening made→ better drainage into nose
Endoscopic sinus surgery
- Performed through nostrils
- Restores drainage
- Obstructive materials removed
Abnormal communication between oral and antral cavities
Oral antral communication
Most common cause of oral antral communication
Extraction of maxillary posterior teeth
If Oral antral communication left open
Epithelial tissue forms in its track→ Fistula→ Needs surgical intervention
Clinical characteristics of Oral antral communication and fistula
- Unpleasant tasting discharge
- Reflex of fluids into nose from mouth
- If long lasting→ Filled with granulations and epithelium
Management of Oral antral communication and fistula
- Visual inspection
- Radiographs
- Antibiotics to avoid infection
