Sinus Flashcards by anisah h

What percentage of people fail to develop frontal sinuses?

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Which four sinuses are present in the head and neck?

Maxillary
Frontal
Sphenoid
Ethmoid

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Which sinus the the first to develop?

Maxillary

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What pattern of growth does the maxillary sinus undergo?

It is present at birth and rapid growth during primary teeth
By age three it is half adult size and reached full size by 23

15ml volume for adults

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What percentage of maxillary sinuses have septa?

8.5%

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What percentage of maxillary sinus have hyperplasia

Less than 1%

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What percentage of maxillary sinus have aplasia?

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What percentage of maxillary sinus are hypo plastic?

7% unilateral

7. 2% bilateral

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What forms the posterior wall of maxillary Antrum?

Pterygopalatine fossa

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Where does the sphenoid sinus drain into?

The sphenoethmoidal recess

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Where does the posterior ethmoidal sinus drain into?

Superior meatus

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Where does the frontal maxillary and ant and middle ethmoidal sinus drain into?

The middle meatus

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Where does then asp lacrimal duct drain into?

The inferior meatus

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What is concha bullosa?

This is when the middle concha becomes pneumatised and blocks the ostium

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What techniques are available to image the maxillary Antrum?

Plain films : OM/IO films for floor of Antrum, DPT for medial and posterior and lateral walls

CT/CBCT/MRI

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When using plain films for the sinus what should you look for?

Opacity within the Antrum
Alteration in wall integrity or outline
Foreign bodies

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What are the three main groups of antral diseases?

Developments
Aquired
Other

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Which developmental diseases of the sinus are there?

Hyperplasia
Aplasia
Hypoplasia

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What aquired diseases of the Antrum are there?

Inflam and polyps
Trauma
Cysts
Neoplasms

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What other diseases can affect the sinus?

Paget’s disease
Thalassemia
Fibrous dysphasia
Osteopetrosis

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What Inflam changes do you see in the sinuses following infection?

Thickening of more than 3mm
Fluid level
Polyps
Empyema
Mucous retention cyst

Mainly seen with bacterial and fungal not viral!

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A patient aged less than 16 with pansinusitis. What would you be suspicious of?

Cystic fibrosis

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When would you perform imaging techniques in a patent with Inflam of the sinuses?

Chronic sinusitis for more than 3 months

Consider CT

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What would you see following inflammatory sinus disease on a radiograph?

Thickening of lining

Opacification

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What would you see radiologically in a patient with chronic sinusitis?

Persistent opacification and sclerosis of the surrounding bone (hyperostosis)

A fluid level present in the Antrum. What could this be?

Blood Pus Exudate

What are polyps of the sinus associated with? What features can they have radiographically?

Inflammation They may displace bone mimicking a tumour

What is an antral choanal polyp?

Polyp that arises from the maxillary Antrum and protrudes through the ostium into middle meatus Then extends into the nasal cavity to the chona (boundary between nasal cavity and nasopharynx)

What types of cysts can affect the sinus?

Benign retention cyst

What are the features of these cysts?

Affects all ages (mainly 20-30 males) Twice as common in females as males 1.4-13% incidence Usually asymptomatic

What are the radiological features of a benign retention cysts?

``` Well defined Smooth outline Domed Same density through lesion Remaining sinus normal ```

What is a differential diagnosis of a sinus retention cyst?

Odontogenic tumour: but need a halo | Antral polyp: usually multiple, and heterogenous, thickened mucosal lining

What is a a mucocele?

Explainding lesion Beings with a retention cyst which then blocks the ostium The pressure then increases and bone becomes thinned down which can destroy the sinus bone 90% occur in ethmoidal or frontal sinus

Which fungal infection can affect the sinus?

Aspergillosis

What percentage of cysts of the Antrum are extrinsic to the Antrum?

50% Radicular > den > kerato

What are the radiologic features of an odontogenic cyst within the sinus?

Halo effect Base of Antrum Domed opacity Expansion of alveolus and displaced teeth occ Large cysts may disrupt the antral lining

How can you differentiate between an odontogenic tumour and cysts own tin the Antrum?

The tumour may Resorb teeth and displace the teeth into the sinus It expands and destroys sinus lining

Which tumours can affect the antral lining?

Osteoma and carcinoma

What age group are generally affected by Osteoma?

Males more than females 10-50 yrs Maybe teeth or antrolith or mycolith

How common are antral carcinoma?

<1% of all malignancies SCC carcinoma accounts for 80-90% of paranas sinus malignancies

Antral carcinoma is more common in who and and what age?

Makes more than females | >60 yrs

What should you do when there is an unexained radiopacity within the sinus?

Biopsy

What are the radiological features of an antral carcinoma?

Invaded walls Non specific Opacification in Antrum Need CT/MRI

What are the borders of the maxillary Antrum?

Superior is orbit Inferior is palate Medial is lateral wall of nose

What is the lining of the maxillary Antrum?

Ciliated columnar

What are the causes of sinusitis?

``` Nasal infection Infection from teeth Infection from OAF Nasal allergy Blocked middle meatus ```

What is the pathology behind sinusitis?

Increased secretion from lining Increased cliliary activity Thickening of mucous membrane Fibrosis

What are the acute symptoms of sinusitis?

Pain in upper teeth Beating sensation behind cheek Fullness below eyes Nasal discharge

What are the symptoms of chronic sinusitis?

Incomplete resolution Purulent nasal discharge Recurrent sinusitis OAF

How can we manage sinusitis?

Antrostomy Decongestants and antibiotics

When does the frontal sinus begin to form and what is it lines by?

5 years Lined by columnar epithelium

What are the symptoms of frontal sinus itis?

Frontal bone pain Pain above eyes Pulls on trochlea due to inflam: visual disturbances Oedema of brow and upper eyelid

What are the complication of frontal sinusitis?

Can spread to cranium and eye | May lead to chronic problems eg polyp

Where are the ethnoidal air cells located?

Lateral wall of nose upper part

What are the margins of the sinus?

Lateral: orbit Inferior: maxillary sinus

What is the ethmoidal sinus lines by?

Columnar ciliated epithelium

What are symptoms of ethmoidal sinusitis?

``` Pain behind eyes Tender medial canthus Spreads to involve the orbit And suboeriosteal swelling Maybe complete eye lid closure ```

Where is the sphenoid sinus located?

Body of sphenoid bone

What are the borders of the sphenoid sinus?

Lateral: cavernous sinus Superior : pituitary Floor: nerve of pterygoid canal

What are the symptoms of sphenoid sinusitis?

Pain in middle of skull and temporal region spreading down neck