Diseases of maxillary sinus /certified fixed orthodontic courses by Indian dental academy

Diseases of
Maxillary Sinus

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INDIAN DENTAL ACADEMY
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Contents
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Introduction
Surgical anatomy
Applied anatomy
Classification
Clinical examination
Investigations
Sinusitis
Caldwell-Luc approach
OAC and OAF

Introduction


Surgical anatomy
• Base-Lateral wall of nose
• Apex – projects laterally into zygomatic
process of maxilla
• Roof – orbital floor
• Floor – alveolar process of maxilla which
supports premolars and molars
• Posterior wall – infra-temporal and pterygopalatine fossa
• Anterior wall – facial surface of maxilla

Applied anatomy
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Relationship with root apices
Canine fossa / lateral wall of nose
Opening of maxillary sinus
Increased size with progression of ageincreased risk for OAC/OAF
Lining of sinus
Cracks/fractures of the bony walls
Periapical involvement
Pressure on nerves
Post-surgical paraesthesia of max. teeth
Foreign bodies in the sinus

Classification
• Infections
– Acute maxillary sinusitis
– Chronic maxillary sinusitis

• Cysts
– Antral lining cyst
– Odontogenic cyst

• Bone dysplasias
– Fibrous dysplasia
– Paget’s disease of bone

• Benign tumors
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Ossifying fibroma
Osteoma
Odontogenic tumors
Adenomas

• Malignant tumors
– Squamous cell carcinoma
– Osteosarcoma

• Invasive tumors
– Salivary gland tumors/ Adenocarcinoma
– Basal cell carcinoma

Clinical presentation
1. Facial pain aggravated by coughing,exercise or
bending forwards.
2. Tenderness of cheek bone, posterior max.,
tenderness of teeth on percussion
3. Swelling of the cheek bone (erythematous).
4. Nasal discharge,obstruction or epistaxis
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Infection- muco-purulent discharge
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Tumour- Sero-sanguinous discharge
5. Nasal speculum examination
6. Signs of oro-antral communication
7. Eye signs – proptosis, diplopia, epiphora
(blocked Naso-lacrimal drainage)
8. Paraesthesia over cheek

Investigations
• Trans-illumination test
• Imaging
– plain films
• intra-oral (IOPA Xray, Maxillary occlusal)
• Extra-oral (PNS,OPG)

– CT Scan
– MRI

• Biopsy
– Aspiration (antral puncture) – HP/C&S
– FESS

Maxillary sinusitis
• Etiology .
• Infection-periapical abscess
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common cold
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upper respiratory tract infections.
Trauma;# of antral floor or walls.
Oro antral communication and fistula.
Neoplasm's and infected cyst of odontogenic
origin
Foreign .body in the sinus I.e displaced tooth
or root.

• Clinical features
• Throbbing pain aggravated by head
movement,bending down, coughing,sneezing
• Tenderness of the cheek,mild swelling of the
cheek.
• Uni lateral foul nasal dischage
• Posterior teeth tender on vertical percussion.
• Oro antral fistula signs and symptoms
• Examination of oro pharynx [middle meatus at the
sight of drainage]
• Generalized constitutionl symptoms fever, chills,
sweating, nausea, anorexia due to swallowed pus.

Management
• Non surgical :
Antral regimen - bed rest ,plenty of fluids
maintenance of oral hygiene
Antibiotics
Anti inflammatory analgesics
nasal decongestants,
mucolytic agents
Tinc. Benzoin,camphor,Steam inhalation

Surgical management
• Surgical drainage of pus and lavage of sinus
cavity
• Nasal antrostomy
• Caldwell-luc surgery

Caldwell-luc surgery
George Caldwell in 1893 Henry luc in 1897
Indications :
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removal of root, tooth or foreign bodies
from sinus

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treatment of acute sinusitis resistant to
medical theraphy

• Mangement of chronic sinusitis wit
hyperplastic lining

• Enucleation of odontogenic cyst, mucocele
tumor
• repair of fractures of the antrum
• Control of active hemorrhage following
trauma
• Lifting the floor of orbit in blow out
fractures

Caldwell – Luc – surgical procedure
• Can be performed under LA/Sedation/GA
• Semilunar incision in buccal vestibule (canine to
second premolar)
• Mucoperiosteal flap raised
• Opening (antro-stomy) is made in anterior wall of
Max. Sinus using chisel/gouges/drill & enlarged
sufficiently using rongeurs
• Antral lining is curetted and antrum debrided and
irrigated
• Iodoform ribbon gauze/nasal antrostomy if
required
• Closure done with 3-0 silk

Post-op management
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Antibiotics, analgesics for 5 days
Pack removal on 5th day
Tincture benzoin inhalation TID
Otrivine nasal drops TID for not more than
3 or 4 days
• Patient not to blow the nose or sneeze
• Soft diet + no vigorous gargling

Post-op complications
• Infra-orbital/PSA nerve paraesthesia
• Recurrent sinusitis
• Persistent oedema of cheek
• OAF
• Damage to maxillary teeth
• Persistent bleeding

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Diseases of maxillary sinus /certified fixed orthodontic courses by Indian dental academy

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