Disorders Of Maxillary Sinus Question And Answers
Question 1. Write short note on clinical features, radiographic features, and management of chronic maxillary sinusitis.
Answer. Inflammation of mucosa of paranasal sinuses is referred to as sinusitis. When maxillary sinus is involved, it is called as maxillary sinusitis, and when there is inflammation of mucosa of maxillary sinus from long term, it is called as chronic maxillary sinusitis.
Chronic Maxillary Sinusitis Clinical Features
- It develops as a result of neglected and overlooked dental focus of infection. The lining becomes thick and irregular.
- General symptoms of chronic sinusitis include sense of tiredness, low-grade fever and feeling of being unwell.
- Stuffy sensation over affected side of faces.
- Nasal obstruction, nasal discharge and headache are related symptoms.
Chronic Maxillary Sinusitis Radiographic Features
- Chronic sinusitis may result its persistent opacification of sinus and sclerosis or thickening of surrounding bone.
- Sometime, if infected teeth is involved, then inflammatory changes leads to resorption of antral floor and remodeling to produce appearance described as an antral halo.
Chronic Maxillary Sinusitis Management
Removal of cause of dental infection: Treatment is directed to drain periapical abscess from root canal or by extracting teeth.
- Antibiotic, i.e. doxycycline hydrochloride 100 mg daily
- Analgesic and anti-inflammatory drugs, i.e. ibuprofen and nimesulide.
Nasal decongestant: Xylometazoline 0.1% is used. Steam inhalation should be done.
- If antibiotics and nasal drops fail to resolve the condition, then pus is removed from antrum by antral lavage.
- If all above procedures as failed to cure sinusitis, then anterostomy is done.
Read And Learn More: Oral Medicine Question And Answers
Question 2. Write short note on maxillary sinusitis.
Answer. Involvement of mucosa of maxillary sinus is known as maxillary sinusitis.
Maxillary Sinusitis Types
- Acute: It is associated with severe pain in the sinus region.
- Subacute: This is the middle stage between acute and chronic sinusitis
- Chronic: This occurs due to neglected and overlooked dental focus of infection. Lining become thick and irregular.
Maxillary Sinusitis Etiology
Maxillary Sinusitis Dental Causes
- Periapical infection: This can follow dental infection mainly from maxillary molar and the premolar as floor of sinus is nearby to them which got infected due to direct extension of apical abscess.
- Oroantral fistula: This occurs due to the accidental opening of floor of maxillary sinus at the time of extraction.
- Periodontitis: Spread of infection is from deep pocket of marginal periodontitis.
- Trauma: Injury to the facial bones mainly nasal bone and malar bone.
- Dental material in antrum: As endodontic filling material penetrates the maxillary sinus, it can lead to maxillary sinusitis.
- Implants: Mainly in molar region, if bone is thin implant can penetrate nose or the sinus.
Maxillary Sinusitis Non-dental Causes
- Due to mechanical obstruction of ostium: Common cold, allergic rhinitis and other conditions such as deviated nasal septum, nasal polyp and prolonged nasotracheal intubation leads to maxillary sinusitis.
- Direct bacterial contamination.
- Immune deficiency states such as leukemia, lymphoma and AIDS.
- Influenza: It occurs when bacteria invade as secondary microorganism.
- Diseases of maxillary sinus: Tumor of maxillary sinus or benign mucosal cyst of antrum can lead to maxillary sinusitis.
Maxillary Sinusitis Clinical Features
Acute Maxillary Sinusitis
- There is presence of severe pain which is constant and localized. Pain can be felt in area of eyeball, cheek and the frontal region. Exacerbation of pain is present while stooping or lowering the head. Pain gets increased on biting over affected side. Referred pain is present in teeth, orbit, head and ear.
- Due to postnasal drip there is irritation, nasal stuffiness and the nasal discharge.
- Generalized toxemia: There is presence of fever with chills, dizziness, malaise and nausea.
- In the anterior nares, the nasal mucosa get reddened and inflamed, there can be presence of pus.
- On palpation there is tenderness to pressure or swelling in the involved sinus.
- Intra-orally, there can be the presence of mucobuccal swelling, reddening and pain near the sinus region.
Sub-acute
- Symptoms such as pain and generalized toxemia are absent.
- Discharge is purulent and is associated with nasal voice and the stuffiness.
- Sore throat is present.
- There is hindrance in the sleep due to cough which irritates the patient.
Chronic
- General symptoms of chronic sinusitis are tiredness, lowgrade fever and feeling of being unwell. There is presence of stuffy sensation over affected side of faces.
- Nasal obstruction, nasal discharge and headache are some of the related symptoms.
Maxillary Sinusitis Radiographic Features
- Radiographically the sinus appears to be radiopaque. Water’s view is characteristic.
- Four of the patterns are commonly appreciated i.e.
- Localized thickening: It is present at base of sinus
- Generalized thickening: There is generalized thickening of mucoperiosteum around wall of sinus.
- Complete filling except ostium: There is complete filling of the sinus except in region of ostium on medial wall.
- Complete filling: Presence of complete filling of sinus of wall
- In cases with allergy, mucosa is more lobulated to contrast in state of infection where it is straight and parallel to the wall of sinus.
- In chronic sinusitis, sinus is opaque and there is sclerosis or thickening of surrounding bone.
- If infected teeth are present, inflammatory changes can lead to resorption of antral floor and become remodeled to produce antral halo appearance.
Maxillary Sinusitis Management
- First of all drain the periapical abscess from root canal or remove the tooth so that pus can drain out.
- Give doxycycline hydrochloride 100 mg/day. Penicillin is also the drug of choice. Amoxicillin and cotrimoxazole can be given.
- Ibuprofen or nimesulide can be given as analgesic and anti-inflammatory drug.
- 0.5% Ephedrine nasal drops are commonly used. 0.1% xylometazolin is an alternative but it can cause rebound effect.
- Steam inhalation should be given.
- In antibiotics and the nasal drops do not provide relief, pus should be removed from antrum. This is done under local anesthesia by inserting hollow trochar and cannula inside the antrum via nasal wall beneath inferior turbinate.
- If all the above mentioned procedures fail then middle meatal antrostomy can be done.
- Transnasal endoscopic surgery can also be carried out.
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