Diseases of Maxillary Sinus
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
www.indiandentalacademy.com
Contents • • • • • • • • •
Introduction Surgical anatomy Applied anatomy Classification Clinical examination Investigations Sinusitis Caldwell-Luc approach OAC and OAF www.indiandentalacademy.com
Introduction
www.indiandentalacademy.com
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 www.indiandentalacademy.com
www.indiandentalacademy.com
Applied anatomy • • • • • • • • • •
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 bodieswww.indiandentalacademy.com 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 www.indiandentalacademy.com
• Benign tumors – – – –
Ossifying fibroma Osteoma Odontogenic tumors Adenomas
• Malignant tumors – Squamous cell carcinoma – Osteosarcoma
• Invasive tumors – Salivary gland tumors/ Adenocarcinoma – Basal cell carcinoma www.indiandentalacademy.com
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 • Infection- muco-purulent discharge • Tumour- Sero-sanguinous discharge 5. Nasal speculum examination 6. Signs of oro-antral communication 7. Eye signs – proptosis, diplopia, epiphora (blocked Naso-lacrimal drainage) www.indiandentalacademy.com 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 www.indiandentalacademy.com
Maxillary sinusitis • Etiology . • Infection-periapical abscess • common cold • 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. www.indiandentalacademy.com
• 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. www.indiandentalacademy.com
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 www.indiandentalacademy.com
Surgical management • Surgical drainage of pus and lavage of sinus cavity • Nasal antrostomy • Caldwell-luc surgery www.indiandentalacademy.com
Caldwell-luc surgery George Caldwell in 1893 Henry luc in 1897 Indications : •
removal of root, tooth or foreign bodies from sinus
•
treatment of acute sinusitis resistant to medical theraphy
• Mangement of chronic sinusitis wit hyperplastic lining www.indiandentalacademy.com
• 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 www.indiandentalacademy.com
www.indiandentalacademy.com
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 www.indiandentalacademy.com
Post-op management • • • •
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 www.indiandentalacademy.com
Post-op complications • Infra-orbital/PSA nerve paraesthesia • Recurrent sinusitis • Persistent oedema of cheek • OAF • Damage to maxillary teeth • Persistent bleeding www.indiandentalacademy.com
www.indiandentalacademy.com Leader in continuing dental education
www.indiandentalacademy.com