Maxillary Sinus Pathologies - CLASSIFICATION

1.) Inflammatory conditions i.) Acute ii.) Chronic 2.) Cysts i.) Mucocele ii.) Cholesteatoma iii.) Odontogenic Keratocyst iv.) Radicular Cyst 3.) Benign tumours i.) Papilloma ii.) Juvenile Angiofibroma iii.) Ameloblastoma iv.) Odontogenic Myxoma v.) Pleomorphic Adenoma vi.) Ossifying Fibroma 4.) Malignant Tumours i.) Sq.Cell Carcinoma ii.) Adenoid Cystic Carcinoma iii.) Adenocarcinoma iv.) Sarcoma v.) Lymphoma 5.) Oroantral Fistula i.) Displaced roots or tips in the sinus ii.) Fracture of tuberosity iii.) Foreign body in sinus 6.) Rare Conditions i.) Aspergillosis ii.) Phycomycosis iii.) Wegeners granulomatosis iv.) Osteoblastic osteitis v.) Lytic Osteitis vi.) Fibrous Dysplasia

CALDWELL LUC PROCEDURE

Indications Chronic sinusitis Acute Sinusitis Mucocele Trans Antral approach Orbital Decompression Tumour surgery Foreign Body Removal Tooth/root Removal Pre-operative Evaluation CT, PNS view Pre-op Antibiotics General anaesthesia preferred Incision Made 5 mm gingivolabial sulcus Extending from the central incisor to the first molar

Exposure Periosteum is elevated from the maxilla Exposure extends from the pyriform aperture medially to the alveolar ridge Superiorly till the infraorbital nerve

Bone Cut Closure Through the Canine fossa Initially, a 5 mm square bone cut is made with an osteotome A ronguer is used to enlarge the cut.

Hemostasis Packs

Cautery , Bone wax Antibiotic packs Strip gauze pack brought out through the nose

Suture. Post-op Care Oral Rinses Analgesics Antibiotics Nasal Drops Complications Nerve injury Facial Swelling Fever Bleeding Infection Haematoma IO nerve, Superior alveolar

ORO ANTRAL FISTULA Definition Anatomy & Embryology Etiology Incidence Signs & Symptoms Diagnosis Management Options for Surgical Closure

Introduction Is relatively uncommon complication of maxillary teeth extraction Other possible causes include perforation into the sinus due to fracture of facial bones, periapical lesion, removal of larger tumours/cyst, cleft OAF occurs as a result of failure in healing of Oroantral communication (OAC)

Definition OAF is an epethelized, pathological,unnatural communication between the oral cavity and the maxillary Sinus

Definition of Fistula A fistula (Latin = a pipe or tube ) is an abnormal communication between the lumen or surface of one organ and the lumen or surface of another or between vessels.

Incidence Male predominance of 2:1 Peak age distribution in third & fourth decades

Incidence of OAF following OAC

Infection in the sinus Defect is larger than 5 mm in diameter Gingival tissues are not approximated Poor post-operative care Large surgical defect following a removal of a lesion

Pre-disposing factors for OAC Relationship of unerupted tooth to the maxillary sinus Abnormality in size and shape of tooth roots Hypercementosis/Bulbous Lone Long standing Maxillary molars Sclerosed bone Difficult Extraction Loss of periapical bone due to periapical granuloma/cyst Surgical procedures for large lesions Iatrogenic causes like incorrect use of elevators

Signs & Symptoms

Small Defects ( Pin hole defects) Minimal symptoms Only when there is URT infections Mucopurulent maxillary sinusitis present

Intermediate Defects

Source of recurrent infection and irritation Intermediate episodes of pain and tenderness Foul tasting discharge

Large Defects Free Drainge Acute Sinusitis

Diagnosis Clinical Bubbling in the socket, mostly blood Blood from the nostril Hollow sound when suction is used due to echo from the sinus XRay PNS Periapical Management Early treatment of OAC Treatment of Chronic Fistula Opacity of sinus memembrane lining

Early Treatment of OAC Socket Edge reduction Use of Supportive packs Use of protective plate

Treatment of OAF Cleansing the Sinus Surgical Closure

Local flaps Buccal Advancement flap

Modified Advancement flap Sliding Flap Palatal Flaps Straight advancement Rotational advancement Hinging and Island flaps Palatal Submucosal connective tissue flaps

Bridge flap Combined Local Flaps

Distant Flaps

Tongue Flaps Anteriorly based Posteriorly based Laterally based Temporalis Muscle Flap Buccal Fat pad f lap Osteoperiosteal flap Grafts

Autogenous Bone grafts Allografts Gold Foil

Tantulum foil Gold plate Fibrin Glue