The Maxillary Sinus Flashcards
Name the sinuses
Frontal
Sphenoid
Ethmoid
Maxillary
What are the function of the paranasal sinuses?
Add resonance to the voice
Lighten the weight of the skull
Act as chambers for warming inspired air
Describe the shape and location of the maxillary sinuses, include measurements
Pyramid shaped cavity within the body of the maxilla
Around 15ml of space in an adult
37mm high
27mm wide
25mm antero-posterior
Where is the opening of the maxillary sinus? How large?
Located within the hiatus semilunaris (in the middle meatus)
Approx 4mm diameter opening
Superiorly on medial wall of sinus
Lined with mucosa and can become blocked or narrowed with inflammation or disease
What epithelium lines the maxillary sinuses? What function does this serve?
Pseudo-stratified ciliated columnar epithelium
- mobilise trapped particulate and foreign material within sinus
- move the material close to Ostia for elimination within nasal cavity
How diagnose an OAC / OAF?
Check radiographic position of rots in relation to antrum in pre op radiograph
Check to see if there is bone at the trifurcation of roots
Bubbling of blood in socket
Nose holding test (careful as can create OAC)
Direct vision
Light and suction
Blunt probe
How would one manage an acute OAC?
Inform the patient of what OAC is
If small or sinus lining intact
- encourage clot
- suture margins
- consider antibiotic
- post-op instructions (minimise pressure within sinuses and mouth)
Small OAC <2mm usually heal with normal clot formation and routine mucosal healing
If large or lining torn
- close with buccal advancement flap
What might patients complain of with a chronic OAF?
Issues consuming fluids
- issues with a straw too
Issue smoking their cigarettes
Issues playing brass or wind instrument
Bad taste, halitosis, pus discharge
Pain or sinusitis style symptoms
How would one diagnose a fractured maxillary tuberosity?
Noise of fracture
Movement noted visually and with supporting fingers
Mobility in more than one tooth
Tear in the soft tissue of the palate
How can one manage maxillary tuberosity fracture?
Reduce and stabilise
- orthodontic buccal arch wire with composite
- arch bar
- splints (lab made)
Dissect out and close wound primarily
If i splint a tooth for a maxillary tuberosity fracture, what must i ensure?
Remove or treat pulp
Ensure it is out of occlusion
Consider antibiotics
Give post op instructions
Remove tooth surgically 4-8 weeks later
How would one manage a root stuck in antrum / sinus
Locate radiographically
Decision on retrieval - if difficult then refer
OAF type approach
- open fenestration with care
- suction with a narrow bore
- irrigation
- close as for OAC
Common causes of sinusitis?
Often viral infection
- inflammation and oedema
- obstruction of ostia
- trapping of debris within sinus cavity - opportune for bacterial overgrowth of normal flora
Altered mucocilliary clearance patterns
- due to allergens
- inflammation
- anatomical abnormalities
Give some signs and symptoms of sinusitis
Facial pain and pressure
Congestion and cough
Nasal obstruction and paranasal drainage
Hyposmia
Fever
Headache
Dental pain
Halitosis
Ear ache
Fatigue
Anaesthesia or parasthesia over the cheek
What are the main indicators that a pt has sinusitis?
Discomfort on palpation of infraorbital region
Diffuse pain in maxillary teeth
Equal sensitivity from percussion of multiple maxillary teeth
Pain that worsens with head or facial movements
