DMF- Skeletal System Part 2 (Nasal Cavity up to paranasal sinus)

What is the growth center of the maxilla?

Nasal septum

What do growth centers determine?

Growth centers determine the growth of adjacent structure

What cranial nerve is CN I?

Olfactory nerve

Superoposterior portion of the nasal cavity contains

Olfactory receptors

Shortest cranial nerve?

Olfactory or CN I

exit of Olfactory Nerve

cribiform plate of ethmoid bone

Superior projection of the ethmoid bone

Crista galli

The nasal cavity is separated (left and right side) by what

Nasal septum

Divides left and right nose

Nasal septum

3 structures of nasal septum

VaPeS

Vomer

Perpendicular plate of ethmoid bone

Septal cartilage

What kind of cartilage is septal cartilage

Hyaline cartilage

Deficient in down's syndrome and achondroplastic dwarifsm

Nasal septum

Other term for down's syndrome

Trisomy 21

Type of dwarfism due to absence of cartilage formation

Achondroplastic dwarfism

Common malocclusion present in those with downs syndrome and achondroplastic dwarfism

Class III Maxillary deficiency

Class III maxillary deficiency is seen in patients with

Down's syndrome and achondroplastic dwarfism

Curled shelf of bone found in nasal cavity

Conchas/turbinates

Other term for conchas

Turbinates

Conchas have ___ that traps air pollutants

Mucous

3 types of Conchas

Superior nasal concha

Middle nasal concha

Inferior nasal concha

True or false: Superior, middle, and inferior nasal concha are parts of the ethmoid bone

FALSE, superior and middle nasal concha are part of the ethmoid bone BUT the inferior nasal concha is considered a separate bone

Nasal passageways located inferiorly to conchas

Meatus

3 types of Meatus

Superior Meatus

Middle Meatus

Inferior Meatus

Highest structure on most superior point in the human body

Vertex

Vertex is part of what bone

Parietal bone

Submentovertex location

Below the mentalis up to the vertex

Submentovertex radiograph is also known as

Jug handle view

In the "Jug handle view" radiograph, the "handle" appearance is what structure

Zygomatic arch

What radiograph do you use for fractures of the zygomatic arch?

Submentovertex radiograph

Zygomatic arch fractures present as ___ shaped deformitiy in the submentovertex radiograph

W-shaped deformity

Zygomatic arch fractures clinically present as

Dimple or depression

4 paired air filled spaces that surrounds the nasal cavity

Paranasal sinuses

Lining of paranasal sinuses

Respiratory epithelium

4 paranasal sinuses

FMES

- Frontal

- Maxillary

- Ethmoid

- Sphenoid

True or false: Name of the paranasal sinus corresponds with its bone

True

Funnel shaped structure

Infundibulum

Crescent shaped structure

Hiatus semilunaris

Maxillary sinus is also known as

Antrum of Highmore

Maxillary sinus has an opening called the

Ostium of Maxillary Sinus

Specialized membrane of maxillary sinus

Schneiderian membrane

Frontal sinus is found in what bone

Frontal bone

Frontal sinus drains in ____ towards _____ of ______

Infundibulum

Histus semilunaris

Middle meatus

Maxillary sinus drains in ____ towards _____ of ______

Infundibulum

Hiatus semilunaris

Missle meatus

Largest paranasal sinus

maxillary sinus

Maxillary sinus is found in

Maxillary bone

Other term for valsalva test

Valsalva maneuver

Test for oro-antral communication

Valsalva test

During valsalva test to confirm, what will you ask your patient to do?

Pinch nose and exhale gently

If a patient is positive for oro antral communication during valsalva test, you will see

Blood and bubbling in extraction socket

3 types of oro antral communication

1. Small (<2mm)

2. Medium (2mm to 6mm)

3. Large (>6mm)

Treatment for small type of oro-antral communication

No treatment

Why does small type of oroantral communication have no treatment

Because the blood clot will create a tight seal between the oral cavity and max sinus and will serve as a good seal

Treatment for medium type oroantral communication

Gel foam then Figure of 8 suture

(The suture will hold clot in place)

For medium type of oroantral communication before suturing, gel foam is placed to

Increase/improve clot formation

Treatment for large types of oro antral communication (2)

Refer to oral surgeon or

Oro-antral closure (by flaps)

2 types of oro antral closure/flaps

1. Palatal rotational advancement flap

2. Buccal advancement flap

Palatal rotational advancement flap and buccal advancement flap are forms of

Pedicle flap or pedicle graft

buccal advancement flap other term

Berger's flap

During palatal rotational advancement flap branches of what nerve will be included?

Greater palatine artery

Advantage of palatal rotational advancement flap

has good blood supply due to the greater palatine artery

Steps of palatal rotational flap (4)

1. Create incision

2. Raise the incised tissue and rotate it (covering the opening)

3. Suture

4. Wait for healing

Common cause of failure when doing/using flaps

Loss of blood supply

Palatal rotational flap usually heals by:

Secondary intention

What should you do before suturing (aside from placement of gel foam)

De-epithelialize (remove epithelium)

After extracting a max tooth that has sinus approximation, an opening will be formed between the oral cavity and maxillary sinus.

Oroantral communication

First thing you do if you think there is oroantral communication?

You have to confirm if there is really oroantral communication by doing valsalva test

During clinical practice (not following the books) if a there is oroantral communication, what will you usually do?

Pack with 1-2 gel foam, suture by figure of 8, then observe for 1-2 wks

Board Question: what is the purpose of placing a suture (figure of 8) during oroantral communication?

To hold the blood clot in place

After Oroantral Communication treatment and before dismissing the patient you will prescribe drugs to them. What will you prescribe (2)

1. Antibiotics

2. Decongestants

Common antibiotic that is prescribed after oroantral communication tx

Co-amoxiclav (augmentin)

Drug of choice for upper respiratory tract infection

Co-amoxiclav

Usual decongestant prescribed after oroantral communication treatment

Neozep

After oroantral communication treatment, aside from prescribing antibiotics and decongestants, you may sometimes prescribe

Anti-histamine

Procedure done to add bone between sinus and alveolar bone?

Sinus lift

Best 2D radiograph to asses maxillary sinus

Water's View

3 paranasal sinuses that can be seen in water's view radiograph?

MEF

Maxillary sinus

Ethmoid sinus

Frontal sinus

Best/Ideal radiograph to assess max sinus?

CBCT

Technique used to open max sinus through the canine fossa

Caldwell-luc technique

Paranasal sinus found in ethmoid bone

Ethmoidal sinus

3 types of ethmoidal sinus

AMP

Anterior E.S

Middle E.S

Posterior E.S

Paranasal sinus found in sphenoid bone?

Sphenoidal sinus

Only paranasal sinus that is absent on water's view radiograph

Sphenoidal sinus

Paranasal sinus cannot be seen in Water's View radiograph, since it can only be seen in (2)

1. CBCT

2. Lateral Cephalogram

The sphenoidal sinus drains into

sphenoethmoidal recess

The anterior ethmoidal sinus drains into ___ towards ___ of ___

Infundibulum

Hiatus semilunaris

Middle meatus

The middle ethmoidal sinus drains in ___ in ___

Ethmoidal bulla

Middle meatus

Posterior ethmoidal sinus drains in __

Superior meatus

3 paranasal sinuses that drains in infundibulum towards hiatus semilunaris if middle meatus

inFAMdibulum

1. Frontal

2. Anterior ethmoidal

3. Maxillary

2 sinuses that dont draun in middle meatus

1. Sphenoidal sinus

2. Posterior ethmoidal sinus

Location of lacrimal gland

Upper outer part of the eye

Location of canine fossa

Distal part of canine in the premolar area

Lacrimal gland produces

Tears

Tears that dont exit the lacrimal duct will accumulate in the

Lacrimal sac

Once the lacrimal sac is full it will go to the

Nasolacrimal duct

Direction of flow of excessive tears

From outer to inner canthus

Access during caldwell luc procedure

Canine fossa

Depression found distal of the canine in the premolar region

Canine fossa

During the caldwell luc procedure when you are not able to see the roots what do surgeons usually do?

After a window has been created, surgeons will fill the window with SALINE/NSS so that there will be buoyancy. The roots will float and when the root floats yung will vacuum the fluid and usually the root will be vacuumed as well

During caldwell luc procedure, you will usually clean the sinus with

Betadine

Caldwell-Luc steps (7)

1. Create a flap

2. Create a hole/window in the bone at the canine fossa.

3. Vacuum the schneiderian membrane

4. Once you have access to max sinus, you will use instruments to remove the root

5. Clean sinus with betadine

6. Place bone graft

7. Suture