Maxillary Sinus

Question 1

What are the functions of the paranasal sinuses?

Answer 1

resonance to the voice
reserve chambers for warming inspired air
reduce the weight of the skull

Question 2

What cells line the sinuses?

Answer 2

pseudo stratified ciliated columnar epithelium

Question 3

How to diagnose a OAC?

Answer 3

bone at trifurcation of roots
bubbling blood
direct vision
good light and suction (echo)
nose blowing test (can create OAC)
blunt probe into socket (can create OAC)

Question 4

How to manage OAC?

Answer 4

Inform patient

If small (<2mm) or sinus lining is intact:
- encourage clot
- suture margins
- post-op instructions: avoid sucking with straw, avoid nose blowing, avoid smoking, avoid singing, avoid blowing balloons etc.

If large or lining torn:
- close with buccal advancement flap (3-sided flap: 2 relieving incisions + 1 horizontal crystal incision)

Question 5

How to diagnose OAF?

Answer 5

problems with:
- fluid consumption
- speech or singing
- playing brass/wind instruments
- smoking cigarettes or using straws
bad taste/odour/halitosis/pus discharge
pain/sinusitis-type symptoms

Question 6

How to manage OAF?

Answer 6

excise the sinus tract
close with buccal advancement flap

other flap designs:
- buccal fat pad with advancement flap
- palatal flap

Question 7

What causes maxillary tuberosity fracture?

Answer 7

single standing molar
inadequate alveolar support

Question 8

How to diagnose a fractured tuberosity?

Answer 8

noise
movement noted both visually or with supporting fingers
more than one tooth movement
tear in the soft tissue of the palate

Question 9

How to manage fractured tuberosity?

Answer 9

1. Reduce and stabilise (splint). RCT. Ensure tooth is out of occlusion. Remove tooth surgically after 4-8 weeks.
2. Dissect out and close wound primarily.

Question 10

How to manage (retrieve) a root/tooth in the maxillary sinus?

Answer 10

1. Through extraction socket
   - open fenestration with care
   - suction (efficient and narrow bore)
   - small curettes
   - irrigation or ribbon gauze
   - close as for OAC
2. Caldwell-luc approach
   - labial/buccal sulcus
   - buccal window cut in bone
3. ENT: endoscopic retrieval

Question 11

How to manage sinusitis?

Answer 11

Ephedrine nasal drops 0.5% one drop each nostril up to 3 times daily when required (maximum 7 days).

Steam/menthol inhalation.

ABs if bacterial cause.
Amoxicillin 500mg 3x daily for 7 days
or
Doxycycline 100mg 1x daily for 7 days