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MaxSinus lecture 1

MaxSinus lecture 1 - King Saud University King Dental...

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Unformatted text preview: King Saud University King Dental College Oral and Maxillofacial Surgery 311 MDS Maxillary Sinus in Health and Maxillary Disease Disease Anatomical facts and location: Anatomical √ The largest para-nasal sinuses. sinuses. √ Situated in the maxilla. Situated √ Has pyramidal shape. Has √ Lateral nasal bone forms its base. its √ Apex headed towards the zygomatic bone. zygomatic √ Canine fossa, orbital floor and hard palate form the pyramidal walls. √ Communicates with nasal cavity through maxillary ostium, in the posterior end of hitus simlunaris of middle meatus. meatus. Anatomical morphology: Anatomical √ Size varies from one person to another. person √ Asymmetry existed in the same individual. the √ Small in children and grows up with aging. grows √ Average height is about 3.5 cm, depth 3.2 cm and width 2.5 cm. cm. √ Capacity of about 15 cc. cc. Anatomical morphology: Anatomical √ Divided into several compartments by bony septa (underwood’s septa). (underwood’s √ Lined with pseduo-stratified columnar ciliary epithelium (schneiderian membrane). (schneiderian Relation with other structures: Relation √ Alveolar bone and dentition. Alveolar √ Nasal cavity and nasopharynex. nasopharynex. √ Orbital cavity and its contents. contents. √ Hard palate and oral cavity proper. proper. √ Pterygomaxillary fissure and its contents. its √ Neurovascular structures including infraorbital and superior alveolar nerve. superior Development: Development: √ Develops from invagination of the mucous membrane of middle meatus of the nasal cavity at about the 3rd month of intrauterine cavity life. life. √ Fully development reaches with the age of 16 years. 16 √ Loss of permanent teeth and alveolar bone may make the sinus to appear huge in size. may Blood supply: Blood Blood supply from facial, maxillary, Blood infraorbital, greater and lesser palatine arteries and lateral and posterior nasal branches of sphenopalatine artery. branches Venous drainage to the anterior facial vein, Venous sphenopalatine vein and pterygopaltine plexus. plexus. Nerve supply: Nerve √ Infraorbital nerve. Infraorbital √ Posterior, middle and anterior superior alveolar nerves. alveolar √ Greater and lesser palatine nerves. palatine Lymphatic drain: Lymphatic The lymphatic drain of the sinus is through The the nose or the submandibular lymph nodes. the Physiology: Physiology: Unknown but the following functions have Unknown been proposed: been √ Speech and voice resonance. Speech √ Reduce weight of skull. Reduce √ Warmth inspired air. Warmth √ Filtration of inspired air. Filtration √ Immunologic barrier ( body defense). Immunologic Pathology: Pathology: Congenital anomalies. Inflammatory diseases. Cysts and odontogenic Cysts infection. infection. Bone metaplasia and benign Bone tumors. tumors. Neoplasia. Trauma. Congenital anomalies: Congenital √ Cleft palate. Cleft √ Facial fistula and cleft. Facial √ Cystic formation. Cystic √ Atresia. Atresia. Inflammatory diseases: Inflammatory √ Bacterial infection. Bacterial √ Bacterial infection secondary to viral infection. infection. √ Fungal infection. Fungal Sinusitis Sinusitis Acute sinusitis: Suppurative or non suppurative inflammation Suppurative of the mucosal lining of the sinus. It involves one or both sinuses. involves Causes: Causes: √ Secondary to hay fever and allergic rhinitis. Secondary √ Secondary to acute rhinitis (common cold) and URT infection. and √ Bacterial infection due to: dental sepsis, swimming and diving, trauma and foreign body dislodgment. body Sings and symptoms: Sings and √ √ √ √ √ √ √ √ Headache. Headache. Pain and tenderness. Pain Nasal obstruction. Nasal Nasal discharge. Nasal Toxic manifestations. Toxic Heavy filling with bending. Heavy Nasal congestion. Nasal X-ray and transillumination findings. X-ray Treatment: Treatment √ Rest and fluid and mouth hygiene. Rest √ Antibiotics (C&S); pneumococci and streptococci are the most causative organisms. organisms. √ Analgesics and antihistamines. Analgesics √ Local treatment (decongestant and steam inhalation). inhalation). Sinusitis Sinusitis Chronic sinusitis: Chronic It is a chronic type of infection affected the It mucosal lining of one or both sinuses, resulted in mucopus or pus collection. A polypoidal type of inflammation can lead to formation of multiple or single mucosal polyps. Causes: Causes: √ As a consequence of non resolved acute sinusitis. sinusitis. √ Dental abscesses. Dental √ Virulent organism with low resistance. Virulent √ Foreign body dislodgement or trauma. Foreign Signs and symptoms: Signs √ √ √ √ √ √ √ Headache. Headache. Nasal obstruction Nasal Nasal discharge. Nasal Fatigue. Fatigue. Hyposmia/ cacosmia. Hyposmia/ Transllumination findings. Transllumination Proof puncture. Proof Treatment: Treatment √ Antibiotics. Antibiotics. √ Systemic decongestants. Systemic √ Sinus wash-out. Sinus Mycotic infection: Mycotic Aspergillosis: Opportunistic infection caused by maxillary sinus flora fungi environment in susceptible individual, leads to obliteration of the sinus space and erosion of its bony components. space Complications of sinusitis: Complications Orbital abscess and orbital cellulites. Intracranial abscesses. Meningitis. Cavernous sinus thrombosis. Spread of infection to neighboring sinuses, Spread structures and organs. structures Osteomyelitis. Gastrointestinal disturbances. Cysts and odontogenic tumors: Cysts Odontogenic cysts: √ radicular cysts. radicular √ residual cysts. residual √ dentigerous cysts. dentigerous √ premordial cysts. premordial Non-odontogenic Non-odontogenic cysts. cysts. Mucocele and Mucocele retention cysts. retention Odontogenic Odontogenic tumors: tumors: √ ameloblastoma. ameloblastoma. √ Myxoma. Myxoma. Bone metaplasia and benign tumors: Bone √ Fibrous dysplasia. Fibrous √ Ossifying fibroma. Ossifying √ Transitional papilloma. Transitional √ Osteoma. Osteoma. √ Giant cell lesions. Giant Neoplasia: Neoplasia √ Squamous cell carcinoma. Squamous √ Adenocarcinoma. Adenocarcinoma. √ Sarcoma (osteosarcoma). Sarcoma √ Ewing’s sarcoma. Ewing’s Trauma: Trauma √ √ √ √ √ √ Tuberosity fracture. Tuberosity Dentoalveolar fracture. Dentoalveolar LeFort’s fractures. LeFort’s Zygomatic complex fracture. Zygomatic Pure and impure orbital floor fractures. Pure Establishment of oro-antral fistula. Establishment Clinical examination: Clinical Inspection √ Assess asymmetry. Assess √ Color of overlaying skin. Color Clinical examination: Clinical Palpation √ Tenderness. √ Swelling and expansion. Swelling √ Depression. Depression Clinical examination: Clinical Examination of nasal passage √ Nasal patency. Nasal √ Pus discharge. Pus √ Nasal polyps. Nasal √ Erythema, redness, change in the color of nasal mucosa. nasal Clinical examination: Clinical Transillumination Clinical examination: Clinical Diagnostic sinus lavage √ sinus rinsing through the canine fosaa. the √ Nasal antrostomy. Nasal Radiographical examination: Radiographical Routine radiographical examination √ Orthopantomogram (OPG) (OPG) √ Occipitomental (water’s view), with lateral tilt. view), Radiographical examination: Radiographical Special investigation and radiographical examination Sinuscopy Sinogram CT scan MRI Microbiology and histological examination: Microbiology Culture and sensitivity and biopsy. ...
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