The Maxillary Sinuses Flashcards
Which sinuses are present in the viscerocranium?
Frontal sinus
Sphenoid sinus
Ethmoid cells
Maxillary sinus
What are the functions of the paranasal sinuses?
Resonance to the voice
Reserve chambers for warming air
Reduce weight of the skull
How much volumetric space is there within the maxillary sinus?
15ml in the average adult.
Where is the opening of the maxillary sinus located?
The ostia is located on the Middle meatus (hiatus semilunaris)
Located on superiorly on the medial wall of the sinus
Describe the epithelium of the maxillary sinus?
The epithelium of the sinuses is pseudostratified ciliated columnar epithelium
The cilia
They mobilize trapped particulate matter and foreign material within the sinus, then move this material toward the ostia for elimination into the nasal cavity
What complications can arise within the maxillary sinus?
Oro-Antral Communication (OAC) - Acute
Oro-Antral Fistula (OAF) - Chronic
Root in the antrum
Sinusitis
Benign Lesions
Malignant Lesions
Foreign body within antrum
How would you identify an oro-antral communication/fistula?
Size of tooth
Radiographic position of roots in relation to antrum
Bone at trifurcation of roots
Bubbling of blood
Nose holding test (careful as can create an OAC)
Direct vision
Good light and suction - echo
Blunt probe (take care not to create an OAC)
What steps should be taken after you have identified an acute oro-antral communication?
Inform patient
If small or sinus lining intact:
Encourage clot
Suture margins
Antibiotic (area of debate)
Post-op instructions
Minimising pressure formation within the sinuses and mouth
Small OACs <2mm usually heal with normal blood clot formation and routine mucosal healing
If large or lining torn:
Close with buccal advancement flap
What are the steps in performing a buccal advancement flap to close an oro-antral communication?
Design flap with wide base
Raise flap
Trim buccal bone if required
Incise the periosteum
Bring the flap across tension free
What symptoms might a patient with a chronic OAF complain of?
Problems with fluid consumption (fluids from nose)
Problems with speech or singing (nasal quality)
Problems playing brass/wind instruments
Problems smoking cigarettes or using a straw
Bad taste/odour/halitosis/pus discharge (post-nasal drip)
Pain/sinusitis type symptoms
What surgical options are there for closing an oro-antral communication/fistula?
Buccal Advancement Flap
Buccal Fat Pad with Buccal Advancement Flap
Palatal Flap
Bone Graft/Collagen Membrane
Rotated Tongue Flap (Historical)
When is the maxillary tuberosity more likely to fracture?
Single standing molar
Unknown unerupted molar or wisdom tooth
Pathological gemination/concrescence
Extracting in wrong order
Inadequate alveolar support
How would you identify a tuberosity fracture?
Noise
Movement noted both visually or with supporting fingers
More than one tooth movement
Tear in soft tissue of palate
What steps would you take to close a maxillary tuberosity fracture?
Reduce and stabilise
Orthodontic buccal arch wire with composite
Arch bar
Splints (lab-made)
Dissect out and close wound primarily
