Surgical management of diseases of the maxillary antrum Flashcards
How does the maxillary antrum change with age?
- at birth a small space on lateral wall of nose
- 9 years - floor = floor of nose
- 23-25 years - fully developed
What are the borders of the maxillary antrum?
- superior = floor of orbit
- inferior = hard palate, roots of posterior teeth
- medial = lateral wall of nose
What lines the maxillary sinus?
ciliated columnar epithelium
What is sinusitis?
Inflammation of the lining epithelium of the sinuses
What’s the aetiology of sinusitis?
- extension of nasal infection
- blockage of middle meatus
- nasal allergies
- infection from roots
- infection from OAF
What’s the pathology of sinusitis?
– increased secretion from lining
– increase in ciliary activity which is initially effective and then cilia are destroyed
– thickening of mucous membrane
– fibrosis
What are the signs and symptoms of sinusitis?
Acute:
- acute pain in upper teeth
- beating sensation in cheek
- fullness below eyes
- nasal discharge
Chronic:
- incomplete resolution
- thickened or polypoid mucous membrane
- purulent nasal discharge
- recurrent sinusitis
- OAF
What investigations can be done for sinusitis?
- Radiographs to assess:
- fluid levels
- mucosal thickening
- radiopaque sinus - Transillumination
- Intranasal antrostomy
What’s the treatment for sinusitis?
bed rest
nasal decongestants
analgesics
antibiotics
What’s the treatment of an oro antral fistula? (OAF)
At time of extraction:
• Suture across socket - horizontal mattress or…
• Construct protective splint
• Close fistula:
1. buccal flap with bilateral relieving incisions
2. trim buccal plate
3. remove root
4. advance buccal flap
5. incise through periosteum at base of flap
6. antibiotics & nasal decongestants
7. no nose blowing
How do you treat a chronic/recurring OAF?
- Buccal flap repair
- Buccal pad of fat
- Palatal flap repair
- Intranasal antrostomy
- antibiotics, analgesics, decongestants, no nose blowing
What’s the common ‘complaining of’ for a patient with OAF?
bad taste in a quadrant,
spontaneous pain on/off,
eating/drinking NAD,
recent deafness in ear corresponding to the quadrant the bad taste is coming from
What is the frontal sinus?
- birth - absent
- age 5 begins to develop
- great variation in size and shape
- lined by columnar epithelium
What problems related to the frontal sinus?
- Sinusitis
- tap frontal bone - very sore
- accompanies acute ethmoiditis
- early stages - ‘vacuum frontal headache’
- pain above eyes - 10am to 4/5pm
- dull and boring in nature
- pull on trochlea due to inflammation - problems with vision
- oedema of brow and upper eyelid swelling
What complications can occur from the frontal sinus?
spread to cranium inner third of upper part of orbit
middle third of orbital roof - abscess
chronic infection - polyps
