Maxillary Sinuses

Question 1

what are the 5 paranasal sinuses?

Answer 1

1. frontal sinus
2. ethmoid sinus
3. maxillary sinus
4. nasal cavity
5. sphenoid sinus

Question 2

how should a sinus typically present on a CT?

Answer 2

• black as it is full of air

Question 3

what is the transmission when something gets in the sinus?

Answer 3

pushed up to the ostium
drains into the middle meatus of the nose

Question 4

how can the canine eminence be used?

Answer 4

it corresponds to the anterior of the sinus

Question 5

what are the 4 functions of the maxillary sinus?

Answer 5

• vocal resonance - affects how u speak esp when ill because sinus is not getting aerated
• olfactory function - affects smell
• warms and humidifies air
• decreases the weight of the skull

Question 6

describe the blood flow to the sinus. 3 arteries

Answer 6

suppliers
- infra-orbital artery
- posterior superior alveolar artery
- sphenopalatine artery

Question 7

what is a pneumatised sinus?

Answer 7

when the sinus dips down between teeth and theres not much bone between

have to be careful to not perforate the floor of the sinus if ur gonna extracted

Question 8

what is it called when a non-epithelialised communication has been created between the oral cavity and max sinus? give the definition

Answer 8

oro-antral communication, OAC

Question 9

what is the Schneiderian Membrane and its relevance to sinus graft?

Answer 9

the outline of the sinus wall - the tooth, bone, schneiderian membrane and sinus

• want to lift the membrane and put graft material UNDER the membrane but not to breach it
• otherwise material free floats in the sinus and blocks the ostium

Question 10

what are septa and its relevance to the Schneider membrane?

Answer 10

projections of thin bone within the sinus

can cause issues as the membrane lies thinly over them and can tear

Question 11

which 3 areas of dentistry can have a direct impact regarding the maxillary antrum?

Answer 11

1. exodontia - don’t wanna create a hole
2. endodontics - don’t want to perforate through the apex into the sinus
3. implant placement - implant might disappear into the sinus

Question 12

what happens when an OAC is not managed?

Answer 12

it turns into a:
OAF - ora-antral fistula

• a pathological epithelial lined passage between the oral cavity and the max antrum

Question 13

what issues can arise from the maxillary sinus from exodontia?

Answer 13

• OAC
• OAF
• teeth can become displaced
• maxillary tuberosity can fracture

Question 14

what are 7 risk factors for an OAC?

Answer 14

• close in proximity to the sinus
• thin alveolar bone
• root morphology
• lone standing molars
• periapical pathology
• trauma/difficult extractions
• poor technique from the dentist

Question 15

what are the signs and symptoms of an OAC?

Answer 15

signs - clinically visible and resonant

symptoms
- congestion
- pain
- air escaping into the mouth
- bubbling into the nose
- discharge of infected material out the nose
- ‘sinus like’ symptoms

Question 16

what manoeuvre must you never tell ur patients to do and why?

Answer 16

Valsaver Manoeuvre

• forcing expiration against a closed glottis
• AKA blow till ears pop

will create an OAC

Question 17

what are the signs and symptoms of an OAF?

Answer 17

signs
- soft tissue around the socket
- prolapse of sinus lining
- discharge

symptoms
- bubbling into the nose
- air escaping into the mouth

Question 18

how is an OAC managed?

Answer 18

Question 19

what are the 4 surgical techniques of how an OAC can be closed?

Answer 19

• buccal advancement flap
• palatal advancement flap
• buccal fat pad
• P.R.F. membrane closure

Question 20

give 4 cons of a buccal advancement flap. 1 pro.

Answer 20

• technique sensitive
• thin tissue can perforate easy
• hard to get good closure
• can lose the sulcus depth height
• it heals well

Question 21

give 4 pros and a con of palatal advancement flap

Answer 21

• good blood supply from the palatine vessels
• more tissue w/ less tension and is thicker = more resistant to trauma
• can preserve sulcus depth

cons
- leaves exposed palatal bone = v sore

Question 22

describe the buccal fat pad.

Answer 22

very technique sensitive
used for larger defects

Question 23

3 pros and 2 cons of a PRF membrane closure

Answer 23

• optimum technique
• no local flap required
• good healing
• requires training and materials
• not available on NHS = £££

Question 24

if a root has broken off and displaced, where could it have gone, whoops.

Answer 24

• suction
• inhaled
• swallowed
• antrum
• mucoperiosteum
• still in the socket

Question 25

what are the options if the root has broken off?

Answer 25

- gentle suction - may leave it and refer the px - CT scan - remove it

Question 26

what is a Caldwell-Luc / Lateral Window?

Answer 26

cutting into the sinus to remove something

Question 27

if you have created an OAC, whilst the px is getting referred, you tell them about the Antral Regime. What is this?

Answer 27

- analgesics - no nose blowing - sneeze like a horse - no straws - pressure - decongestants - antibiotics

Question 28

what is a tuberosity fracture? what should you do if there is movement or significant bleeding?

Answer 28

when bone has come out with an extraction - may cause an OAC - if theres TOO much movement, STOP!!! - significant bleeding, replace tooth and tuberosity back into the socket - bite on gauze and call for advice

Question 29

what are the possible pathologies of the sinus.

Answer 29

- infection - can be: periapical pathology/periodontitis/peri-implantits/post-xla infection - non-odontogenic/odontogenic cyst - benign neoplasm - malignant neoplasm - mucous retention cyst

Question 30

what is chronic odontogenic sinusitis? can it spread?

Answer 30

- prolonged low grade inflammation in the antral mucosa YES IT CAN SPREAD - to the orbit = orbital cellulitis - meningitis - intracranial abscess - cavernous sinus thrombosis

Question 31

what are the red flag symptoms of neoplasia?

Answer 31

- nasal discharge - bleeding - unilateral nasal obstruction - mobile teeth - ocular symptoms - neurological signs - radiological features - loss of weight/appetite