Maxillary Sinus: The "hole" Problem

Front 1

Air contained spaces that occupy the mid-facial area bilaterally

Back 1

Maxillary sinus

Front 2

Bounderies of the maxillary sinus

Back 2

Medial boundery

- lateral wall of the fossa

Inferior boundery

- alveolar process

Superior boundery

- orbital floor

Anterior boundery

- canine fossa

Front 3

Only normally occuring communication between the nasal cavity and the maxillary sinus. This provide a means by which bacteria and debris become eliminated from the sinus

Back 3

Maxillary ostium (ostium maxillare)

Front 4

Function of maxilary sinus

Back 4

1. Warm air prior to inhalation

2. Resonance of the voice

3. Reduce the weight of the skull

4. Mucocillary clearance

Front 5

Maxillary sinus is line with

Back 5

Pseudostratified columnar cilliated epithelium

Front 6

Problems with the maxillary sinus may be caused by?

Back 6

1. Foreign body

2. Infection

3. Neoplasm

4. Accidental opening

Front 7

Infection affecting the maxillary sinus

Back 7

Nasal cavity

Oral cavity

Others

- fracture

- gunshot

- facial defects

Front 8

Sign and symtoms of acute sinusitis

Back 8

- purulent rhinorrhea

- pain, increase with palpation/percussion

- peri-orbital edema

- sensitive teeth or gums

- fever

- lymphadenopathy

Front 9

Treatment for acute sinusitis

Back 9

- steam inhalation/humifier

- antibiotics

- decongestants:

- pseudoephedrine

- phenypropanolamine

- phenyleprine

- antihistamine

- surgical drainage

Front 10

Option of drainage of sinus

Back 10

1. Cannulate ostia

2. Puncture anterior wall

3. Puncture nasal wall under the turbinate

Front 11

Sign and symptoms of chronic sinusitis

Back 11

- nasal discharge

- post-nasal drip

- nasal obstruction or congestion

- nasal discharge- post-nasal drip- nasal obstruction or congestion- pain, tenderness, and swelling around the eyes- reduced sense of smell

- nasal discharge- post-nasal drip- nasal obstruction or congestion- pain, tenderness, and swelling around the eyes- reduced sense of smell

- pain, tenderness, and swelling around the eyes

- reduced sense of smell

Front 12

What are the goals of treating chronic sinusitis?

Back 12

- keep your nasal passage draining

- eliminate underlying cause

- reduce sinus inflamation

- reduce the number of sinusitis flare up

Front 13

Extraction of teeth that are close to maxillary sinus may result to?

Back 13

- perforation of the floor of the sinus

- accidental dislodgement of or even the whole teeth

Front 14

Invasion od the maxillary sinus and establishment of a direct communication with the oral cavity is reffered to as an _______?

Back 14

Oro-antral fistula

Front 15

Maxillary sinus approximation: type 0

Back 15

Roots are not in contact with the sinus

Front 16

Maxillary sinus approximation: type I

Back 16

Roots are in contact with the sinus

Front 17

Maxillary sinus approximation: type II

Back 17

Roots encompases "enclosed" the sinus

Front 18

Maxillary sinus approximation: type III

Back 18

Roots are into sinus

Front 19

Factors influencing creation of oro-antral fistula

Back 19

- hypercementosis of the roots

- apical pathosis and attached granulomas

- density of the alveolar bone and thickness of sinus floor

Front 20

Oro-antral fistula may result when?

Back 20

> When maxillary posterior tooth has:

- widely divergent root

- long roots

- apical convergence

> instrument are used injudiciously

> forcing a root or tooth into the sinus upon removal

> implant surgery is not planned properly and aggressive placement is done

> removal of the large pathologic lesion within or invading the sinus cavity

Front 21

Consequences of oro-antral fistula

Back 21

- Entrance of contaminated air, water, food and bacteria

- difficulty in retaining complete denture

Front 22

How do we recognize an oro-antral fistula

Back 22

- thorough inspection of the area

- ask the patient to pinch his nose and blow gently

- rediographic confirmation

Front 23

Management of oro-antral fistula: (2mm diameter or less)

Back 23

Small

- apply pressure on the area till it ensure a blood clot in the socket

- advice patient to take sinus precautions

1. Avoid blowing the nose

2. Avoid violent sneezing

3. Avoid sucking on straw

4. Avoid smoking

Front 24

Management of oro-antral fistula: 2 - 6 mm communication

Back 24

Moderate

- ensure the maintenance of a blood clot by placing a figure-eight suture in the socket

- follow sinus precaution

- antibiotic for 7-10 days

- decongestants spray or drops

- confirm followups

Front 25

Management of oro-antral fistula: 7mm or more

Back 25

Large

- close the sinus communication with a flap procedure

- refer to an OMS if cannot be manage

Front 26

Surgical management of oro-antral fistula

Back 26

- elimination of disease and pathologic tissue

- flap should have a good blood supply

- flap tissue should lie its new position without tension

- good haemostasis must be achieved before discharging the patient

Front 27

Technique in oro-antral communication management

Back 27

- simple primary closure

- berger's buccal advancement flap

- palatal pedicale flap technique

- other rotational flap

Front 28

Fracture of maxillary tuberosity/predisposing factors

Back 28

- pneumatization in tuberosity area

- dilaceration and hypercementosis

- gemination or fussion

- supra-eruption of isolated molars

- existence of pathologic lesion

- pneumatization in tuberosity area- dilaceration and hypercementosis- gemination or fussion- supra-eruption of isolated molars- existence of pathologic lesion- decreases elasticity of the bone- supra-eruption of isolated molars- existence of pathologic lesion- decreases elasticity of the bon

Front 29

Disadvantage of buccal flap

Back 29

- unstable due to cheek movement

- possible harm to parotid papilla

- the flap is thin and may be poorly vascularized

- tendency to obliterate mucobuccal fold

Front 30

This flap provide a thick stable mucosa and is richly nourished by greater palatine nerve

Back 30

Palatal pedicle flap

Front 31

Transpositional flap used depends on the situation, variation of design and source of the flap may be considered.

Back 31

Alveolar transpositional flap

Front 32

Intraoral approach via lateral access to the maxillary sinus. Trapizoidal flap design is performed in order to expose the lateral wall of the maxillary sinus

Back 32

Caldwell-luc approach

Front 33

Post operstive instruction

Back 33

- pressure pack on area for 1-2 hours

- advice patient to avoid nose blowing, sucking, and smoking

- antibiotic theraphy for 7-10days

- nasal decongestant for 7-10days

Front 34

Success of operstion may not be guaranteed

Back 34

- presence of infection

- patient general physical condition

- inadequate tissue relief resultingbin suture tension

- failure to freshen wound edge

Front 35

Types of decongestants

Back 35

Psuedoephedrine

Phenylpropanolamine

Phenylephrine

Front 36

Ideal radiograph to use in viewing the sinus

Back 36

Water's view radiograph

Front 37

Treatment of acute sinusitis mainly for liquification of secretion

Back 37

Steam inhalation or humidifier

Front 38

Treatment used for pain relief or unresponsive infection of acute sinusitis

Back 38

Surgical drainage

Front 39

What are the 4 sinus precaution

Back 39

1. Avoid blowing the nose

2. Avoid violent sneezing

3. Avoid sucking on straw

4. Avoid smoking

Front 40

Disadvantage of berger's bucal flap advancement

Back 40

- unstable due to cheek movement

- possible harm to the parotid papilla

- flap is thin and may be poorly vasculated

- tendency to obliterate buccal fold