Maxillary Sinus Diseases and Treatments (Part 1) PDF

MAXILLARY SINUS DISEASES and TREATMENTS Asst. Prof. Canseda Avağ SINUS PARANASALES MAXILLARY SINUS BORDERS BORDERS ANTERIOR---- Maxilla surface POSTERIOR---- maxillary tuberosity and Infratemporal fossa MEDIAL (INNER) SIDE---- Nasal cavity LATERAL SIDE: Zygomatic process of maxilla UPPER---- Orb...

MAXILLARY SINUS DISEASES and TREATMENTS Asst. Prof. Canseda Avağ SINUS PARANASALES MAXILLARY SINUS BORDERS BORDERS ANTERIOR---- Maxilla surface POSTERIOR---- maxillary tuberosity and Infratemporal fossa MEDIAL (INNER) SIDE---- Nasal cavity LATERAL SIDE: Zygomatic process of maxilla UPPER---- Orbital cavity floor BOTTOM---- Alveolar and palatine process of maxilla MAXILLARY SINUS ANATOMY ü The adult maxillary sinus averages 34 mm in the anteroposterior direction, 33-37 mm in height, and 23-25 mm in width. ü The volume of the sinus is approximately 12 to 20 mL. SINUS MUCOSA ü It is usually covered by mucus secreting pseudostratified columnar ciliary epithelium. The cilia and mucus are necessary for the drainage of the sinus because the sinus opening, or ostium, is not in a dependent (inferior) position but lies two-thirds the distance up the medial wall ANATOMICAL AND RADIOLOGICAL APPEARANCE MAXILLARY SINUS INFECTIONS ORIGIN COURSE Ø Nonodontogenic Infections Ø Acute maxillary sinusitis Ø Odontogenic Infections Ø Chronic maxillary sinusitis MAXILLARY SINUS INFECTIONS ORIGIN Nonodontogenic Infections of the Maxillary Sinus Ø Upper Respiratory Tract Infections Ø Allergic Rhinitis Odontogenic Infections of the Maxillary Sinus Ø Dental abscess and lesion Ø Usually unilateral. Ø Approximately 10% of maxillary sinusitis cases are of dental origin. Ø Pathophysiology, microbiology and treatment are different. Microbiology Nonodontogenic Infections of the Maxillary Sinus Aerobic, anaerobic, or mixed bacteria may cause infections of the maxillary sinuses. The organisms usually associated with maxillary sinusitis of nonodontogenic origin include those usually found within the nasal cavity. Streptococcus pneumoniae, Haemophilus influenzae, and moraxella catarrhalis Odontogenic Infections of the Maxillary Sinus Maxillary sinus infections of odontogenic origin are more likely to be caused by anaerobic bacteria, as is the usual odontogenic infection. Rarely does H. influenzae or S. aureus cause odontogenic sinusitis. The predominant organisms are aerobic and anaerobic streptococci and anaerobic Bacteroides, Enterobacteriaceae, Peptococcus, Peptostreptococcus, Porphyromonas, Prevotella, and Eubacterium. Treatment Nonodontogenic Infections of the Maxillary Sinus Ø Upper Respiratory Tract Infection treatment Ø Allergic Rhinitis low-dose steroid nasal sprays, antihistamines Odontogenic Infections of the Maxillary Sinus ROOT CANAL TREATMENT Ø DENTAL EXTRACTION and CURETTAGE Ø MAXILLARY SINUS INFECTIONS COURSE Acute maxillary sinusitis Ø may occur at any age. Ø The onset is usually described by the patient as a rapidly developing sense of pressure, pain, fullness, or all of these in the vicinity of the affected sinus. Ø The discomfort rapidly increases in intensity and may be accompanied by facial swelling and erythema, malaise, fever, and drainage of foul-smelling mucopurulent material into the nasal cavity and nasopharynx. Chronic maxillary sinusitis ü is usually a result of bacterial infections that are low-grade and recurrent, obstructive nasal disease or allergy. ü Chronic maxillary sinusitis is characterized by episodes of sinus disease that respond initially to treatment, only to return, or that remain symptomatic in spite of treatment. Cysts And Cyst-like Lesions Located and Developed in The Sinus cavity 1.Antral pseudocyst 2.Sinus mucocele 3.Retention cyst 4.Ciliated cyst 1. Antral Pseudocyst: v *It occurs as a result of serum accumulation between the periosteum and bone at the base of the maxillary sinus. v *Dome-shaped, faint radiopacity at the base of sinus. v *Not surrounded by epithelium. v *Does not cause clinical symptoms and require no treatment. 2. Sinus Mucocele: Ø *It occurs as a result of obstruction of the sinus ostium. Ø *Surrounded by epithelium. Ø *It is a true cyst. Ø *Radiopacification is seen in the sinus. Ø *They are the most expansive cysts of the paranasal sinuses. *May expand to orbit and cranial fossa. Ø *Requires surgical treatment. 3. Retention Cysts: vresult from blockage of ducts within the mucus-secreting glands of the sinus. vThese lesions are usually so small that they are not visible on radiographic images. vRequire no treatment •4. Ciliated Cysts: • * Just know it is name. MAXILLARY SINUS DISEASES and TREATMENTS Complications of Oral Surgery Involving the Maxillary Sinus The most common dental complications of oral surgical procedures that subsequently involve the maxillary sinus include the displacement of teeth, roots, or instrument fragments into the sinus or the creation of a communication between the oral cavity and the sinus during surgery of the posterior maxilla. Retrieval of a tooth, root fragment, or broken instrument can be accomplished in several ways. Complications of Oral Surgery Involving the Maxillary Sinus. – RISK FACTORSØ Maxillary molar with widely divergent roots that is adjacent to edentulous area Ø Sinus pneumatized into the alveolar process surrounding the tooth Ø Abnormally long roots, Ø Presence of periapical lesions in the adjacent part of the sinus floor Ø Perforation of the sinus membrane with injudicious use of instruments Avoiding A Potential Sinus Exposure ü Careful observation ü Evaluation of high-quality radiographs (In case of doubt, 3D tomography should be taken.) Check presence or absence of an excessively pneumatized sinus Check widely divergent or dilacerated roots Check cystic lesions in close relation to the sinus cavity Removal The Root In Sinus Cavity 1. Through The Socket 2. Caldwell-Luc Approach Ø In some cases, however, the sinus must be opened through the Caldwell-Luc approach and the object retrieved.