Maxillary Sinus Diseases

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Questions and Answers

What is the primary function of the maxillary sinus?

To warm inspired air and decrease the weight of the skull (correct)

To filter the air we breathe

To aid in the production of mucus

To humidify the air we breathe

What is the direction of the base of the maxillary sinus?

Anteriorly directed

Medially directed (correct)

Posteriorly directed

Laterally directed

What is the name of the nerve that runs through the roof of the maxillary sinus?

Greater palatine nerve

Anterior superior alveolar nerve

Middle superior alveolar nerve

Infra-orbital nerve (correct)

What is the location of the orifice of the maxillary sinus?

Upper part of the base of the sinus Signup and view all the answers

What is the shape of the maxillary sinus?

Pyramidal Signup and view all the answers

What is the distance of the floor of the maxillary sinus from the floor of the nasal cavity?

1 cm below Signup and view all the answers

What is the name of the sinus that occupies the body of the maxilla?

Maxillary air sinus Signup and view all the answers

What is the purpose of the objectives of this lecture?

To understand the diagnosis, assessment, and treatment planning of oro-antral communications and diseases of the maxillary sinuses Signup and view all the answers

At what age does the maxillary sinus attain its full size?

14-18 years of age Signup and view all the answers

Which of the following teeth is NOT related to the maxillary sinus?

Canine Signup and view all the answers

What is the primary location of the maxillary sinus?

Body of the maxilla Signup and view all the answers

Which of the following is a radiographic examination method used to diagnose maxillary sinus affection?

Panoramic x-ray Signup and view all the answers

What is the term used to describe the cavity or hollow space of the maxillary sinus?

Antrum Signup and view all the answers

Which of the following is a type of maxillary sinus affection?

Cysts Signup and view all the answers

What is the term used to describe the spread of infection from a dental abscess of related teeth into the maxillary sinus?

Dental origin Signup and view all the answers

What is the term used to describe the recent investigation method used to diagnose pathological conditions of the maxillary sinus?

Sinoscopy Signup and view all the answers

What is a common symptom of acute maxillary sinusitis that is exacerbated by bending the head downwards?

Pain referable to the specific sinus area Signup and view all the answers

What is a characteristic feature of an oro-antral fistula in acute maxillary sinusitis?

Foul or salty taste, yellowish green pus oozing intra-orally Signup and view all the answers

What is the primary goal of decongestants in the treatment of acute maxillary sinusitis?

To shrink the mucosa lining Signup and view all the answers

What is a characteristic feature of chronic maxillary sinusitis?

Foul odor and presence of oro-antral fistula or polypoidal reddish mass Signup and view all the answers

What is the primary goal of a Caldwell-Luc operation in chronic maxillary sinusitis?

To remove the thickened lining of the sinus Signup and view all the answers

What is a common cause of traumatic affection of the maxillary sinus?

Fracture of the middle third of the face Signup and view all the answers

What is a characteristic feature of hematoma of the maxillary sinus?

Spontaneous cessation of bleeding Signup and view all the answers

What is a possible complication of a hematoma of the maxillary sinus?

Continuous nasal bleeding Signup and view all the answers

What is the purpose of injecting radio-opaque material, such as Lipidol, in the diagnosis of a fistulous tract?

To determine the exact location and extension of the fistula Signup and view all the answers

What is the recommended treatment for a small perforation of 1-2 mm?

Placement of a haemostatic agent gelatin sponge Signup and view all the answers

What is a characteristic of palatal flaps?

They are more resistant to trauma and infection Signup and view all the answers

What is the purpose of using a palatal stent?

To support the flap against gravity Signup and view all the answers

What is a characteristic of regional and distant flaps?

They are abundant and highly vascular Signup and view all the answers

What is the term for the hard, calcified bodies with rough irregular surface found in the maxillary sinus?

Antral rhinoliths Signup and view all the answers

What is the advantage of using a Moczar flap?

It has lower post-operative pain and discomfort Signup and view all the answers

What is the recommended treatment for a large perforation of 5 mm or more?

Surgical closure Signup and view all the answers

What is the primary goal of marsupilization treatment for cystic lesions?

Decompression of the cystic content to decrease its overall size Signup and view all the answers

What is the term used to describe the complete removal of a cystic lesion?

Enucleation Signup and view all the answers

What is the primary characteristic of a benign tumor of the maxillary sinus?

Non-odontogenic origin Signup and view all the answers

What is the treatment option for malignant granuloma?

All of the above Signup and view all the answers

What is the primary goal of assessing clinical cases of oro-antral communication and fistula?

To determine the treatment plan Signup and view all the answers

What is the term used to describe the retrieval of a foreign body, tooth, root, or instrument from the antrum?

Management of oro-antral communication Signup and view all the answers

What is the primary characteristic of an oro-antral fistula?

A communication between the oral cavity and the maxillary sinus Signup and view all the answers

What is the primary goal of treatment for antral tumors?

To remove the tumor Signup and view all the answers

Study Notes

The Maxillary Sinus

Definition: Pyramidal-shaped air space occupying the body of the maxilla
Anatomy:
- Roof: forms the floor of the orbit
- Apex: directed laterally
- Floor: lies 1 cm below the floor of the nasal cavity
- Base: formed by the lateral wall of the nasal cavity
- Orifice: lies in the upper part of the base, opens into the middle meatus of the nose

Anterior superior alveolar nerve (in the anterior wall)
Infra-orbital nerve (in the roof)
Greater palatine nerve (behind the sinus)
Posterior superior alveolar nerve (in the posterior walls)
Middle superior alveolar nerve (in the lateral wall)

Function of the Maxillary Sinus

Warms inspired air and decreases the weight of the skull
Improves sound resonance

First molar, second molar, second premolar, third molar, and first premolar (in that order)

Diagnosis of Maxillary Sinus Affection

History: e.g., diffuse toothache with a history of common cold
Clinical examination: percussion, palpation, and trans-illumination
Radiographic examination:
- Intra-oral periapical and occlusal film
- Panoramic x-ray
- Water's view: occipito-mental produce for simultaneous comparison of both sinuses
Sinoscopy: a recent investigation method for diagnosing pathological conditions of the maxillary sinus

Maxillary Sinus Affections

Inflammatory (e.g., sinusitis)
Traumatic (e.g., fractures, hematomas)
Calcifications (e.g., antral rhinoliths)
Cysts (e.g., odontogenic, non-odontogenic)
Tumors (e.g., benign, malignant)

Oro-Antral Communications and Fistulae

Definition: Oro-antral communication is a passage between the oral cavity and the maxillary sinus, while an oro-antral fistula is a small opening between the two
Aetiology: dental origin, nasal origin, facial fracture, etc.
Assessment: radiographic examination, sinoscopy, etc.
Management: antibiotics, decongestants, analgesics, closure of oro-antral fistula, etc.

Acute Maxillary Sinusitis

Clinical features:
- Pain referable to the specific sinus area
- Interference with smell
- Dental pain or pain of teeth related to the sinus
- Foul unilateral nasal discharge or nasal obstruction
- Presence of oro-antral fistula
Treatment: antibiotics, decongestants, analgesics, removal of the cause, etc.

Chronic Maxillary Sinusitis

Clinical features:
- No pain
- Smell is often impaired
- Foul odor
- Presence of oro-antral fistula or polypoidal reddish mass
- Trans-illumination reveals opacity of the affected side
Treatment: removal of the dental cause, Caldwell-Luc operation, etc.

Traumatic Affections

Hematoma of the maxillary sinus
- Fracture of the middle third of the face
- Fracture of the tuberosity of the floor of the sinus during extraction
- May occur from nasal operations
Treatment: X-ray films, injection of radio-opaque material, gutta percha test, etc.

Closure of Oro-Antral Fistula

Small perforation (1-2 mm): blood clot will fill it and close automatically unless infected
Medium-sized perforation (2-5 mm): close it immediately by approximation of buccal and palatal tissues with tight sutures
Large perforation (5 mm or more): surgical closure is needed
Types of flaps:
- Local flaps (buccal, palatal)
- Regional flaps (tongue flaps)
- Distant flaps (temporalis flaps)

Calcifications

Antral rhinoliths
- Hard, calcified bodies with a rough, irregular surface
- Radiographic picture: rounded, lightly opaque shadow partially obliterating the sinus
Treatment: enucleation, marsupialization, or marsupialization followed by enucleation

Cysts

Odontogenic cysts (e.g., ameloblastoma, adenoma)
Non-odontogenic cysts (e.g., osteoma, fibro-osteoma)
Treatment: surgical excision, marsupialization, or marsupialization followed by enucleation

Tumors

Benign tumors (e.g., osteoma, fibro-osteoma, adenoma)
Malignant tumors (e.g., epidermoid carcinoma, adenocarcinoma, malignant lymphoma)
Treatment: surgical excision, irradiation, cytotoxic drugs, and corticosteroid therapy

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Description

This quiz is about the diagnosis, assessment, and treatment planning of oro-antral communications, fistulae, and diseases of the maxillary sinuses. Students will understand the definition, aetiology, and assessment of these conditions.