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5. Surgical anatomy
• Base-Lateral wall of nose
• Apex – projects laterally into zygomatic
process of maxilla
• Roof – orbital floor
• Floor – alveolar process of maxilla which
supports premolars and molars
• Posterior wall – infra-temporal and pterygopalatine fossa
• Anterior wall – facial surface of maxilla
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7. Applied anatomy
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Relationship with root apices
Canine fossa / lateral wall of nose
Opening of maxillary sinus
Increased size with progression of ageincreased risk for OAC/OAF
Lining of sinus
Cracks/fractures of the bony walls
Periapical involvement
Pressure on nerves
Post-surgical paraesthesia of max. teeth
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Foreign bodies in the sinus
12. Maxillary sinusitis
• Etiology .
• Infection-periapical abscess
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common cold
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upper respiratory tract infections.
Trauma;# of antral floor or walls.
Oro antral communication and fistula.
Neoplasm's and infected cyst of odontogenic
origin
Foreign .body in the sinus I.e displaced tooth
or root.
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13. • Clinical features
• Throbbing pain aggravated by head
movement,bending down, coughing,sneezing
• Tenderness of the cheek,mild swelling of the
cheek.
• Uni lateral foul nasal dischage
• Posterior teeth tender on vertical percussion.
• Oro antral fistula signs and symptoms
• Examination of oro pharynx [middle meatus at the
sight of drainage]
• Generalized constitutionl symptoms fever, chills,
sweating, nausea, anorexia due to swallowed pus.
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14. Management
• Non surgical :
Antral regimen - bed rest ,plenty of fluids
maintenance of oral hygiene
Antibiotics
Anti inflammatory analgesics
nasal decongestants,
mucolytic agents
Tinc. Benzoin,camphor,Steam inhalation
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15. Surgical management
• Surgical drainage of pus and lavage of sinus
cavity
• Nasal antrostomy
• Caldwell-luc surgery
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16. Caldwell-luc surgery
George Caldwell in 1893 Henry luc in 1897
Indications :
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removal of root, tooth or foreign bodies
from sinus
•
treatment of acute sinusitis resistant to
medical theraphy
• Mangement of chronic sinusitis wit
hyperplastic lining
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17. • Enucleation of odontogenic cyst, mucocele
tumor
• repair of fractures of the antrum
• Control of active hemorrhage following
trauma
• Lifting the floor of orbit in blow out
fractures
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19. Caldwell – Luc – surgical procedure
• Can be performed under LA/Sedation/GA
• Semilunar incision in buccal vestibule (canine to
second premolar)
• Mucoperiosteal flap raised
• Opening (antro-stomy) is made in anterior wall of
Max. Sinus using chisel/gouges/drill & enlarged
sufficiently using rongeurs
• Antral lining is curetted and antrum debrided and
irrigated
• Iodoform ribbon gauze/nasal antrostomy if
required
• Closure done with 3-0 silk
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20. Post-op management
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Antibiotics, analgesics for 5 days
Pack removal on 5th day
Tincture benzoin inhalation TID
Otrivine nasal drops TID for not more than
3 or 4 days
• Patient not to blow the nose or sneeze
• Soft diet + no vigorous gargling
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