OS-maxillary sinus

Question 1

Name the paranasal sinuses?

Answer 1

• Maxillary
• Ethmoidal
• Frontal
• Sphenoid sinus.

Question 2

What are the functions of the paranasal sinus?

Answer 2

• Resonance to the voice
• Reserve chambers for warming inspired air
• Reduce the weight of the skull.

Question 3

Where is the opening of the maxillary sinus?

Answer 3

It is located superiorly on the medial wall.
It opens into the middle meatus of the nose.

Question 4

What is the lining of the maxillary sinus?

Answer 4

Pseudostratified cilitated columnar epithelium.
(Cilia mobilise trapped matter and foreign objects towards the ostia for elimination.

Question 5

What anatomical features can be associated with the maxillary sinus?

Answer 5

The alveolar canal (containing the posterior superior alveolar vessels and nerves- for the posterior maxillary teeth)

Roots of maxillary molars and premolars. (could project into the floor or perforate the bone)

Question 6

List some clinical problems that can occur with the maxillary sinus?

Answer 6

OAC
OAF
Sinusitis
root in antrum
Benign lesions
Malginant lesions

Question 7

Compare an Oral Antral Communication and an Oral-Antral Fistula.

Answer 7

OAC- a communication created between the oral cavity and the sinus when extracting the tooth

OAF- this is chronic caused by the OAC not healing properly leaving a sinus tract.

Question 8

List some predictors of an OAC?

Answer 8

• Size of the tooth
• Big splayed roots
• Antrum wrapped around the roots
• Lone standing molars
• Fractured tuberosity.

Question 9

How do we manage an OAC?

Answer 9

Monitor- if it is small we want the blood to clot. Can place surgisel and suture.

Conservative- give the patient PEN V (OAC increases patient risk of sinusitis)

Use a buccal advancement flap

1. 2 reliving incisions
2. Raise full thickness of the flap
3. May need to trim bone away.
4. Incise periosteum (cut the surface under the flap)
5. Pull the flap across tension free
6. Suture.

Question 10

Give some complaints that could indicate an OAF?

Answer 10

Problems:
drinking- liquid going to nose.
Using a straw
Speech (nasal quality to voice)
Bad taste/odor/halitosis/ Pus discharge (post nasal drip)

Question 11

Compare the surgical treatment of an OAC and OAF?

Answer 11

OAF is treated the same way as an OAC except you need to remove the sinus tract before closing the flap.

Question 12

If a patient has chronic sinusitis aswell as their OAF how does this affect treatment?

Answer 12

You will need an antral washout aswell.

Question 13

How can we close the OAC/OAF if the buccal advancement flap fails?

Answer 13

Using a buccal advancement flap with a fatty buccal pad
You excise higher up then bring the fatty globular tissue down, then bring buccal flap (layered flap)

Question 14

What are the positives and negatives of a palatal flap?

Answer 14

Adv- thick flap
Disadv- leaves the palatal surface exposed which is painful.

Question 15

What is the Caldwell luc approach and what is it used for?

Answer 15

For retrieving a lost root in the sinus.
You make an incision in the sulcus and drill a hole into the maxillary sinus.

Question 16

What is sinusitis?

Answer 16

inflammation of a paranasal sinus.

Question 17

What are the main causes of sinusitis?

Answer 17

• viral infection
• trauma
• fungal infection
• benign or malignant lesions.

Question 18

How can a viral infection cause sinusitis?

Answer 18

Inflammation & oedema blocks the ostia, trapping debris in the sinus cavity.
this can damage the cilia (trapping more debris) and alter the cilia clearance.

Question 19

How can a fungal infection cause sinusitis?

Answer 19

increased mucous secretion & fungal growth can cause expansion of the bony walls.

Question 20

How can trauma cause sinusitis?

Answer 20

trauma violates the integrity of the bony cavity and sinus membrane.

Question 21

What are some indicators of sinusitis?

Answer 21

• Discomfort on palpatation of the infra-orbital region.
• A diffuse pain in the maxillary teeth
• Equal sensitivity from the percussion of multiple teeth in the same region .
• Pain that worsens with head or facial movements.

Question 22

How do we treat sinusitis?

Answer 22

Decongestants (0.5% Ephedrine nasal drops 3x daily)
Steam and menthol inhalations.

Question 23

When should antibiotics be considered for treatment of sinusitis?

Answer 23

If symptomatic treatment is not effective and patient is showing signs of bacterial sinusitis (lasting longer than 10 days/ fever/ worsening symptoms)

Question 24

What antibiotics should be used if neccessary for treatment of sinusitis?

Answer 24

Amoxicillin 500mg 3x daily for 7 days.
Doxycycline 100mg 1x day for 7 days (200mg loading dose)

Question 25

What is the risk with 0.5% ephedrine nasal spray

Answer 25

It can cause atrophy of the lining of the nose.

Question 26

How can bacteiral sinuistis occur?

Answer 26

Sinus is no longer able to clear it’s contents effectively, causing a buildup of pressure. This produces an area of stagnation in the sinus (stillness), allowing bacteria overgrowth of the normal flora. (bacterial opportunity)