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lesions of the maxillary sinus - Coggle Diagram
lesions of the maxillary sinus
maxillary sinusitis
medical & surgical tx rationale
what is it?
inflammation
of the mucosa lining the maxillary sinus
caused by
virus
bacteria
fungus
after allergic rxn
causing
hyperplasia
&
hypertrophy
of the sinus mucosa
which
blocks the ostium
types
acute vs chronic, have diff s/s
acute sinusitis
untreated or multiple bouts can lead to
chronic sinusitis
lasts 12 weeks or longer
s/s
facial pressure or discomfort
stuffy or congested nose
thick nasal drainage
reduced or absent sense of smell or taste
there is thickening of sinus lining
symptoms
headache
nasal obstruction
purulent nasla discharge aka post nasal drip
malaise
fever
pain
character
dull, heavy, throbbing
location
over cheek & max teeth
duration
typically lasts 10 days, althought symptoms may continue up to 3-4 weeks
signs
swelling of cheek (in children)
common causes
viral infx
bacterial infx, usually by aerobes such as
Staph aureus
Strep pneumoniae
Haemophilis influenza
E coli
by
source
(this is impt to distinguish for tx!!!)
odontogenic sinusitis
accounts for 10-12% of max sinusitis cases
cld be from periapical or periodontal infection
more likley from anaerobic bacteria eg.
Bacteriodes, Enterobacteria, Peptococuss, Peptostretococuss, Porphyromonas, Prevotella, Eubacterium
tx
same as for non-odontogenic
but also add
metronidazole
removal of cause of infection
removal of cause of infx
for chronic sinusitis,
antral washout
non-odontogenic sinusitis
tx
ABs
eg. Amoxycillin, Amoxiclav, Azithromycin
nasal decongestant
analgesic for pain and fever
applied anatomy
paranasal sinuses
maxillary sinus
drainage
blood ss
nerve ss
dx imaging
periapical films and occlusal
DPT
posterior-anterior skull
occipito-mental skulll (Waters view)
CT scan
MRI
investigation of maxillary sinus disease
clinical
redness of mucosa in upper sulcus or on face
swelling in face; redness on skin
nasal discharge
pain on
palpation of lateral surface of maxilla
percussion of maxillary teeth
transillumination
nasal endoscopy
root pushed into sinus
this is a
complication
of exodontia
can also have fracrured tuberosity that causes OAP, esp w exo of 8s
causes an
oro-antral perforation
(unnatural communication between oral cavity and maxillary antrum)
mx
some differences depending on size go recap matt chen tutorial
if large,
establish blood clot in socket
place sutures across, gauze pack for an hour
instructions to pt: no nose-blowing and sucking w straw, no cigarettes
prescribe
ABs
nasla congestant
when failure to close, remains patent, and gets epithelialised, forms
oro-antral fistula
mx
surgical closure via
buccal advancement procedure
palatal rotation flap
neoplasms of the maxillary sinus
generally rare, only <10% of H&N tumours
diff types
SCC (60-90%)
adenoid cystic CA
mucoepidermoid CA
melanoma (rarerarerare)
tx
maxillectomy
usually remove teeth as well, and sometimes even the orbit