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ODONTOGENIC DISEASE of The MAXILLARY SINUS - Dental Ebook & Lecture Notes PDF Download (Studynama - Com - India's Biggest Website For BDS Study Material Downloads)
ODONTOGENIC DISEASE of The MAXILLARY SINUS - Dental Ebook & Lecture Notes PDF Download (Studynama - Com - India's Biggest Website For BDS Study Material Downloads)
Maxillary sinus is the largest air containing space that occupy maxillary bone bilaterally.
It is 1st paranasal sinus to develop.
Its development begins in 3rd month of I.U life as mucosal invagination or pouching of ethmoid infundibula.
Penumatization; it is formation of air cavity in bone.
o Primary Penumatization (initial maxillary sinus development); in this invagination expands into the cartilaginous
nasal capsule.
o Secondary Penumatization; it occurs in 5th month of I.U life, in this, invagination of primary Penumatization expand
into developing maxillary bone.
o After birth, maxillary sinus expands by Penumatization into developing alveolar process and extend anteriorly and
inferiorly from base of skull.
o As the dentition develops, portion of alveolar process of maxillary which is vacated by eruption of teeth, become
pneumatized.
Expansion of maxillary sinus normally stops after eruption of permanent teeth.
o But sometime maxillary sinus pneumatizes further after removal of posterior tooth because of space created after
their loss.
Maxillary sinus is larger in edentulous patient than dentate patients.
Other names of Maxillary sinus; antrum, antrum of Highmore.
ANATOMY OF MAXILLARY SINUS
o It is four sided Pyramid Shaped
Base of Pyramid/medial wall; lateral wall of nose
Apex of pyramid; zygomatic process of maxilla
Roof of sinus; floor of orbit
Posterior wall; extends length of maxilla and dips into the maxillary tuberosity.
o This wall separated maxillary antrum from
infratemporal & pterygopalatine fossa.
Floor of sinus; lateral hard palate & base of alveolar process of
maxilla
Anterior Surface; facial surface of maxilla.
DIMENSIONS OF MAXILLARY SINUS
o Antero – posterior; 34 mm
o Height; 33 mm
o Width; 23 mm
o Volume; 15 – 20 ml
Opening of maxillary sinus (aka ostium) opens into middle
meatus of nasal cavity.
o This opening is present in inferior position at 2/3 rd
distance up on the base of sinus.
o So that’s why mucus is drained via the help of cilia
present in sinus against the gravity.
LINING OF MAXILLARY SINUS;
o Lined by respiratory epithelium, mucus secreting,
pseudostratified, ciliated, columnar epithelium.
o Beating of cilia moves the mucus produced by lining
and any foreign material contained into nasal cavity.
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Cilia beat at rate of 1000 strokes per minute & can move mucus up to distance of 6 mm per minute.
Radiolucent cavity
Well defined, dense, corticated radiopaque margins or walls
Epithelial lining not visible
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01) Mucosal hypertrophy 03) Neoplasia
02) Accumulation of fluid or blood
CAUSES OF DISRUPTION OF CORTICAL OUTLINE OF MAXILLARY SINUS
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MAXILLARY SINUSITIS
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these in the affected sinus.
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.
Important causes
o Prolonged antral infection (10 days)
o Trauma, including roots or teeth displaced into the antrum or the formation of an oro-antral communication
o Apical infection associated with an upper posterior tooth (rare).
Diagnosis
o History of repeated attacks of acute maxillary sinusitis
o Long standing nasal discharge
Humidification of inspired air to loosen & remove dried secretions from nasal passage & sinus ostium.
Decongestants
o Systemic Decongestants – pseudoephedrine
Tab. Actifed – DM (GSK) Syp. Combinol – DM
Tab. Actifed – P (GSK) Syp. DayCor (Abbott)
Syp. Arinac (Abbott) Tab. Fexet – D (Getz)
Tab. Arinac (Abbott) Tab. Fexo – D (Hilton)
Tab. Coldrex (Stand Pharma) Panadol CF
In this technique, the anterior wall of the sinus is accessed in the area of canine fossa through vestibular approach. The sinus is
opened, and abnormal tissue or foreign bodies are removed. The ostium - meatal area is evaluated & opened, or a new opening
for more dependent drainage into nose (termed antrostomy) may be created near the floor of sinus.
o Infection control
o Removal of contaminated or devitalized graft material.
o Antibiotic therapy
o Caldwell – Luc sinus opening.
Antral Pseudocyst
o Result of accumulation of serum (not sinus mucus) under sinus mucosa.
o Caused by inflammation of sinus.
o no clinical consequences.
o No Tx. required.
Sinus Mucocele
o Cystic lesion under sinus epithelium
o Causes;
Surgery on sinus – in this condition Mucocele are known as, “surgical ciliated cysts or Postoperative maxillary
cysts.
Retention Cysts
o Result from blockage of ducts
These all lesions on radiograph appear as; round, faint radio-opacity within sinus.
OROANTRAL COMMUNICATION/FISTULA
it is an epithelized, pathological unnatural communication b/w oral cavity & maxillary sinus.
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PREDISPOSING FACTORS OF OROANTRAL
COMMUNICATIONS
REMEMBER 5 “E”
Escape of fluids
o From mouth to the nose on the side of extraction.
o This happens when the patient rinses or gargles the mouth following extraction of a tooth.
Epistaxis (Unilateral)
o It is due to blood in the sinus escaping through ostium into the nostril.
Escape of air
o From mouth into the nose, on sucking, inhaling or drawing on a cigarette, or puffing the cheeks (Inability to blow
cheeks. Passage of air into mouth on sucking).
Enhanced column of air
o Causes alteration in vocal resonance and subsequently change in the voice.
Excruciating pain
o In and around the region of the affected sinus, as the local anesthesia begins to wear off.
REMEMBER 5 “P”
01) Pain
a. Previously a dominant feature, is now negligible, as the fistula is established, it allows free escape of fluids.
02) Persistent, purulent or mucopurulent, foul, unilateral nasal discharge from the affected nostril
a. especially when head is lowered down.
03) Postnasal drip
a. The trickling of the nasal discharge from the posterior nares, down the pharynx.
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b. The continuous swallowing of the foul mucopurulent discharge may lead to unpleasant taste.
c. This is accompanied by nocturnal cough, hoarseness, ear ache.
04) Possible sequelae of general systemic toxemic condition
a. Fever, malaise, morning anorexia, frontal and parietal headaches and in extreme cases anosmia.
05) Popping out of an antral polyp:
a. The persistent infection in the antrum may lead to establishment of chronic long standing Oroantral fistula, which
may be occluded by an antral polyp.
b. This can be seen as a bluish red lump extruding through the fistula.
DIAGNOSIS
SINUS PRECAUTIONS
Avoid blowing the nose.
Avoid sneezing violently.
o Open the mouth while sneezing.
Avoid sucking on straws.
Avoid smoking.
o If cannot, advice patient to take smalls puffs, not deep drags to avoid pressure.
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SURGICAL MANAGEMENT OF OROANTRAL FISTULA
Before closing the Oroantral fistula, it is imperative to eliminate any acute of chronic infection
within sinus by irrigation of fistula & antibiotics.
There are 3 methods of surgical closing the Oroantral fistula with the help of Flap Procedure.
o The
thickness and keratinized nature of palatal tissue more closely
resemble the crestal ridge tissue than the thinner, less keratinized tissue in the buccal vestibule.
Disadvantage
o Large area of expose bone that results from elevation of flap.
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Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.
10
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.