Paranasal Sinus Diseases Flashcards
Overview of the intrinsic diseases of the paranasal sinuses
- inflammatory disease
- neoplasms
- benign
- malignant
Overview of the Extrinsic diseases of the paranasal sinuses
- inflammatory diseases
- benign odontogenic cysts and neoplasms
- bone dysplasias
- dental structures displaced into the sinuses
Maxillary sinus
-Gestational development
- Clinically significant size achieved
- development completed
- Gestational development
- 2 months
- Clinically significant size achieved
- birth
- development completed
- 12 years
Ethmoid Sinus
-Gestational development
- Clinically significant size achieved
- development completed
- Gestational development
- 3 months
- Clinically significant size achieved
- birth
- development completed
- 12 years
Frontal Sinus
Gestational development
- Clinically significant size achieved
- development completed
- Gestational development
- 4 months
- Clinically significant size achieved
- 3 years
- development completed
18-20 years
Sphenoid Sinus
-Gestational development
- Clinically significant size achieved
- development completed
- Gestational development
- 3 months
- Clinically significant size achieved
- 8 years
- development completed
12-15 years
ostiomeatal complex (OMC) is composed of which 5 structures?
- mazillary ostium
- infundibulum
- ethmoid bulla
- uncinate process
- hiatus semilunars
ostiomeatal complex (OMC)
AKA ostiomeatal unit
a COMMON CHANNEL that links the frontal sinus, anterior ethmoid air cells and the maxillary sinus to the middle meatus, allowing airflow and mucociliary drainage
representing the integrity of the middle meatus
drainage pathway for max sinus
middle meatus through hiatus semilunairs
drainage pathway for sphenoid sinus
sphenoethmoidal recess
drainage pathway for frontal sinus
middle meatus via infundibulum
drainage pathway for anterior ethmoidal group
middle meatus via infundibulum
drainage pathway for middle ethmoidal group
middle meatus / bulla ethmoidalis
drainage pathway for posterior ethmoidal group
superior meatus
effect on appearance of max sinus if no teeth present in the alveolar bone above?
may look like the floor of the max sinus is dropping down / dropping below
due to resoprtion of bone and lack of teeth in the bone
mucositis definition?
appearance?
treatment?
LOCALIZED thickened sinus mucosa
- so it will stop on its own (no treatment usually)
radiographically - can appear more hazy and a thickened outline
- but 1-2 mm thickened lining is considered normal
definition of sinusitis?
disease process
GENERALIZED inflammatory condition of the sinus mucosa caused by an allergen, bacteria, or a virus
inflammation –> ciliary dysfunction –> retention of sinus secretion –> ostiomeatal complex
pansinusitis definiton
sinusitis affecting ALL the paranasal sinuses
if see this in young children - think of other things too because not normal
major affect of sinusitis and implication
you get dysfunction in the cilia – so retention of sinus secretion resulting in affecting the ostiomeatal complex
acute sinusitis
present for 4 weeks or less, causes pain, tenderness to pressure or swelling
chronic sinusitis
present for more than 12 consecutive weeks
where we can start to see changes in the bone
sub-acute sinusitis
4 weels up to 12 weeks
tx for sinusitis depends mostly on?
whether or not it is affecting the osteomeatal complex
- just soft tissue lining affected - not much to do
retention cyst define
BENIGN LESION usually discovered incidentally on a plain sinus radiograph or cross-sectional imaging of the head
do retention cyst cause symptoms?
implication?
Not usually
- so usually discovered incidentally clinically becuase they are slow gorwing
and usually require no treatment
retention cyst radiogrphic features
usual location?
mucosal and cortical integrity is preserved
it will appear more radio-opaque, DOME-SHAPED structures with a ROUNDED edge, located on the FLOOR OF MAX SINUS
retention cyst differential diagnosis
sinonasal polyp
paranasal sinus mucocoele
paranasal sinus mucocele
complete ossification of one or more paranasal sinuses by mucus, often associated with bony expansion due to obstruction of the nasal sinus drainage
paranasal sinus mucocele most common location
ethmoid and frontal sinus
paranasal sinus mucocele apppearance on plain film? on CT or MRI?
film– appears as opacified
CT or MRI –> have hyperattenuating or near water intensity signal
paranasal sinus mucocele displace surrounding structure? treatment?
yes
most of time are surgicially removed
osteomas found when?
HYPER-dense strucutres seen within the sinus
found in patients undergoing imaging of the sinuses, appearing in 3% of CT examinaitons of the paranasal sinuses
frequent in 20-50 year olds
osteoma radiographic appearance
HYPER-dense and WELL-CIRCUMSCRIBED mass
usually uniformly dense and mature ones will resemble ‘normal’ bone with marrow space sometimes visible
osteomas clinical presentation
asymptomatic snd incidental findings
osteomas found where
frontal - 80%
ethmoid air cells 15%
maxillary sinus 5%
sphenoid - rare (2%)
seen elswhere in the head and neck - particularly the mandible
osteomas assoicated with?
Gardernes syndrome and abouot 30% of patients have a history of rhinosinusitis
male predilection
antroliths
radio-opqaue foreign body or tissue debris (becomes like trapped) usually in the max sinus
do not need to treat and usualy incidental findings and asymptomatic
(unless cause too much irritation and inflammation)
maxillary antral carcinomas
describe
present when? why?
uncommon/ rare head and neck MALIGNANCY
present LATE despite growing large since they remain confined to maxillary sinus and produce no symptoms
maxillary antral carcinomas epidemiology
over 45 years old and hs a strong male predilection (5:1) and more common in Africa and Asia than Europe or North America
maxillary antral carcinomas clinical presentation
UNILATERAL stifdness and obstruction, blood tinged nasal discharge, proptosis, diplopia, pain resembling tooth ache, enlargement and ulceration
maxillary antral carcinomas types?
squamous cell carcinoma (80%) o adenoid cystic carcinoma (10%) - more lymph origin
maxillary antral carcinomas radiographic features
irregular radio-opacity within the sinus, can erode the sinus wall
loss of cortical outline in the maxillary sinus
maxillary antral carcinomas tx and prognoisis?
surgery followed by radiation therapy
- poor prognosis (due to seeing it late)
- 5 year survival of about 10%
two major things discussed in extrinsic diseases involving the paranasal sinuses
inflammatory lesions (like peri-apical abscess)
AND
dental structures displaced into the sinuses (like tooth / implant)
peri-apical lesion and sinus relation?
keep in mind if it has close proximity
it may or may not displace the outline of the sinus
T/F a peri-apical lesion can change the sinus floor?
TRUE
- it may or may not but it can displace it and may see a hazy mucosal outline into the sinus area
note the pdl and lamina dura of the associated tooth - as it can leach into the sinus
*note furcation involvment or not – can displace the sinus and it can be pushed
how to tell if it is a tooth or not that has been displaced into the sinus?
look for PDL or lamina dura surounding the fragment
