diseases and surgery of sinus maxillaris
TRANSCRIPT
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DISEASES AND SURGERY OF SINUS MAXILLARIS
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Diseases of sinus maxillaris
• Anatomical disorders • Oronasal fistules • Sinus apertus • Radix in sinus maxillaris • Cysts • Imflammations • Tumors • Injuries • Preprosthetic disorders
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Functions of paranasal sinuses
• Humidifying and warming inspired air
• Regulation of intranasal pressure
• Increasing surface area for olfaction
• Lightening the skull
• Resonance
• Absorbing shock
• Contribute to facial growth
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Anatomy of paranasal sinuses
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Bony structure
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Arterial supply
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Innervation
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Ethmoid roof
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Anatomical disorders
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Sinus Apertus (Open sinus)
The mucosa and the bony wall of the sinus is
injured
Sometimes the mucosa can be intact
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Causes
• Tooth extraction (upper molar and premolar)
• Operation
• Injury
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Diagnosis
• Inspection, physical examination
• Nose blowing test, Bucca blowing test
• Fluid can flow in to the nose during drinking
• Test with probe (carefully!)
• X-ray (OP, PA, CBCT)
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Nose-blowing test
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Examination with probe
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Therapy
• Spontaneous closure
• Immediate (6-24 hrs) surgical closure with flap
• Dealyed surgical closure in case of:
– Purulent sinusitis conservative therapy (spontaneous closure can occur)
– Fistula development (closure after the elimination of fistule, Luc-Caldwell operation, conservative therapy)
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Closure with buccal flap
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Closure with palatinal flap
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Pichler flap
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Pichler flap
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Pichler flap
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Pichler flap
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Pichler flap
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Pichler flap
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Imflammations
Acute and chronic Sinusitis Maxillaris Origin: Odontogene (1/3) Rhinogene (2/3) Acute or chronic apical process Parodontitis Radix or radicular or follicular cyst Parodontitis marginalis Sinus apertus-Exploration Implantation
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Acute Sinusitis
Forms:
Serotic
Purulent
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Symptomes
• Pain of face (fossa canina), can irradiate to the direction of upper teeth. Pain is increased in case of leaning forward and beating face
• Headache • Fever, subfebrility • Running nose (serotic, purulent uni- or
bilateral), • Edema of face or lower eyelid • Covered sinus on X-ray
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Differential diagnosis
• Acute Pulpitis
• Trigeminal Neuralgie
• Acute pulpitis, acute periodontitis
• TMJ disfunction
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Therapy of acute Sinusitis
• Antibiotic (local – systematic)
• Nose drop, inhalation
• Physiotherapy – Local warming
• Sinus maxillaris rinsig
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Chronic Sinusitis
Forms:
Purulent (uni- or bilateral)
Polipotic-serotic
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Symptomes of chronic Sinusitis
• Weak symptoms
• Foreign body feeling in the region of maxillary sinus
• Runing nose, inhibited nasal breathing
• Headache
• Pharyngeal mucus flow
• Acute exacerbation
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Therapy of chronic Sinusitis
• Conservative
• Surgical
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Therapy of chronic Sinusitis
Without elimination of cause recidive is very often
• Conservative
– Inhalation, local warm, nasal drops
– Sinus rinsing
– In case of Polypotic form local steroid (nasal spray)
• Surgical
– FESS operation (Functional Endoscopic Sinus Surgery Extirpation of polyps through hiatus semilunaris)
– Luc-Caldwell operation, oral surgery (dental origin)
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Foreign body in the maxillary sinus
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Radix in sinus maxillaris
• Instruments: Depurator, Luca-, Kerpel-
• Water rinsing
• Sinuscopy
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Cysts in the maxillary sinus
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Tumors in the maxillary sinus
• Benign: (Polyp, Cyst, Mucokele), Adenoma, osteoma, odontogene origin
• Malignant: Adenocarcinoma, Sarcoma, epithelial carcinoma (planocellular)
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Symptoms
• No symptoms for long time
• Swelling, asymmetry, occlusional problems
• Uncertain tooth pain
• Nose bleeding, smelly nasal flow, tear flow disorder
• Inhibited nasal breathing
• Ulceration on the mucosa of upper jaw
• Diagnosis: endoscopy, imaging methods, histology
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Injuries
• Open-, closed fractures
• Midface fractures
• Fracture of lower wall of orbita (Blow out)
• Bone imjury→mucosa injury→haemosinus
• Foreign bodies
• Iatrogen injuries
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Fracture of tuber maxillae -
complication of tooth extraction
Therapy:
- stop of extraction and aplication of splint
- complete the extraction with
1) the elimination of broken tuber or
2) reconstruction of the broken tuber
(osteosynthaesis)
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