MAXILLARY SINUS TREATMENT PLAN MDSCONQUER

having us back here with part 4 in which I'm going to discuss about the treatment plan of both acute as well as chronic maxillary sinusitis so coming to the treatment of acute phase of maxillary sinusitis is you need to go ahead with broad-spectrum antibiotics which are going to cover both arabic as for less than aerobic bacteria so nasal drops are used antihistamines are given regularly dr. levo citizen is a choice steam inhalation okay and anti-inflammatory given I mean most of the things are well known by coming to the chronic phase so whenever you have a chronic phase okay you need to find out the etiology so underlining cause should be treated first so if the underlining cause is a the dental infection or foreign body or a pollen you can see nasal polyps sometimes X turning into this sinusitis or sinus phases or it may be due to the nasal infection that is being transmitted to this they should be identified and they should be treated first etiology should be treated first so you can do an tur wash similar to your gastric Nevis with an antiseptic solution or you can perform nasal and throw to me I have already discussed which is done in the inferior meters or you can go ahead with a card will look operation to remove these polyps as well as the foreign bodies which are inside so apart from this you can go with an anti-inflammatory and antibiotics and the important thing to be added is the advanced treatment that is Fe SS that is functional endodontic sinus surgery okay maybe Ames or or the latest based if you see the recent knee to zero to zero I think they have chances that they can ask questions related to this recent advanced techniques that is Fe okay so the next important aspect is about the auto antral communication says already discussed it is a communication between the antrum and the oral capped and it is called as Ora and Rufus Tila whenever the epithelium is formed between this two spaces okay so fistula how do you know the definition of fistula which is a communication between the two cavities so these two cavities are the one is Antrim and the second one is oral cavity so whenever there is an epithelium lining form then it is called as fistula so theologists can be while extracting the posterior T especially first and second first and second molars or whenever while removing the broken root piece of these teeth from the sockets or periapical lesions of the upper posterior teeth or mid facial trauma or osteomyelitis of maxilla or sometimes the malignancies that are involved in the maxilla or magnetism scientists can lead to this communication and there are few tests which helps in confirmation of these communication one is probe can be used to detect and confirm the communication you can use a bubble test or you can use a nose blowing test okay so so these are the important things that you have to make a note about the confirmation and the sequel of this aura anthem communication is due to the sinus formation and it's spread formation of fistula then the patient will complaints of voice incompetency food particles entering into the sinus past discharge pleural discharge halitosis lots of things will be further radiographically you can see okay this is a maxillary first molar area okay and there is some foreign body in the maxillary sinusitis the confirmation of form in the maxillary sinusitis so the treatment is oriental communication is benefit education is less than 0.5 millimeters just suture the marginal gingiva on either sides of the socket and protect the area by giving a partial denture and these are the different flaps that are used one is buccal advancement flap most commonly asked question the other names a shell is that is parallel flap buccal pad of fat combination of both that is from the buccal side as well as from the parallel side you can use tongue flap or in the case some cases you can use a foreign material like gold foil or acrylic block to protect this communication so the general principles that are follower followed of general things make sure that a flap should have adequate blood supply to prevent the flap necrosis always try to give insertion of the sound bone and whenever the wound is there make sure that the wound should not be sutured under tension and the flap design should be adequately visible and accessible the next comes is already discussed these are the flaps that are used a combination of both buckle as well as the palatal so these are the diagrams okay this is a buckle flap which is reflected from the buckle side okay so one is sliding flap and one is advancement flap both these are the buckle flaps the next comes is the parallel flap where you wear a parallel flap is taken and extended okay this is a parallel flap the next course is rotational advancement parallel flap where the flap is taken and it is rotated and I'd want to this space the next one is submucosal connect to tissue flap and hinge flap okay so these are the parallel flaps and the last verse is the combination of both means both the buckle as well as the paradigm see this both the buckle is a combination of both the flaps out of which by pedestal flap means this is a communication area where you're going to give an in session okay and you're going to drag this and you're going to suture this so where you're going to leave an uncovered area uncovered area for the granulation tissue formation so this is a biped assault flap so apart from this the limited size of the local flaps makes it difficult to close the larger fishless so if it is smaller one you can compare it so therefore distance flap has been used flaps taken from so the flaps taken from foreheads tongue temporalis buccal fat extremities can be used as a distance flaps so I hope you remember one is buccal flat one is parrot and flap different buccal flaps different parallel flaps combination of both and finally the distant flap the next one is even if you are not able to take a distant flap then you need to go for a foreign metal that is a low plastic crafts that can be a gold foil titanium foil or it can be a poly methyl methyl acrylate that is an acrylic plug or you can use a Collison or hydroxyapatite block or the fibrin do any of these can be used and make a note I hope you remember this antral packing lock once the surgery is done you're going to pack the complete space with the antrum and vile packing that you have to use this whitehead varnish ok the composition of whitehead varnish and this whitehead varnish is a commonly asked question and given in 2017 it okay so this was repeated so give some importance to this area ok next comes is the post-operative instructions most of the instructions will be same as your extraction that is advice not to blow the nose as it creates the pressure and at the site of the closure of the communication advice not to open mouth bite because stretching of the sutures norine Singh gargling no smoking avoid sneezing limited mouth opening advice nasal drops sutures should be removed after seven days auntie most of things are well known ok there's nothing new to be either to your notices and sometimes the root tips or the roots may enters into the sinus because I have shown you I will be aware you can see a foreign body in the maxillary sinus similarly roots can enter so you have to confirm it on clinical on that particular case by observing the root tips and radiographically by taking an IRB for the confirmation and the roots in the sockets are removed by various methods ok different methods can be tried out of which the last and the important one is card will look okay so you can try different one like socket apexes is widened twice the size of the root FX and you can you can try to pull it off or irrigating with lots of saline and pushing into the socket so that so so that the flush out can remove the one or a thin long rubber gaze is pushed into the sinus through the socket and removed in a single jerk by which it can get locked or it can be removed or by using a high vacuum session or they can be different approaches okay but mainly we need to focus more on the operation so I'm going to discuss this in the next part so indications it is a technique that is used to remove remove the teeth or root or any foreign body in the sinus nothing new everything is known in the case of trauma the mid facial fractures when the roof of the sinus is fractured and the floor of the orbit is rocked okay it is the best way of correcting so this is a specific condition where you how to make it and you know that it is used to remove the sinus wall or the nasal polyps in the case of your chronic sinusitis already discuss nothing new and it can be used in the removal of the cysts in the sinus removal of polyps in the sinus known and management of hematoma of the sinus mainly occurring from the nose bleeding small Magnus is so most of the things are already known all these are known the only thing that you have to focus on this okay how the procedure either you can go for la or general anesthesia the lip is elevated vertical incision digital to that of the lateral as well as the distal to that of the first molar are made okay make sure you give a ginger clearing session or a horizontal insertion made few mm above the attached gingiva in the given job okay so the next all is make sure you prevent the damage to the tough inferior or not okay make a note about this this is an important right next on the facial wall of the sinus with the help of a bar and a hand this make a opening of 0.5 centimeter in mostly it is at the can I in força aérea then the opening is done antiseptic solution isn't it everything whatever that is there opening process operator is then the sinus is irrigated with antiseptic solution flap is placed back and switch it over the book okay so I was talking about FES that is functional endoscopic sinus surgery so this is this is a diagram based question they can give so here he is trying to operate the ethmoid sinus okay so through the nose with an endoscopic surgery that is Fe SS so Fe SS is also called as intranasal endoscopic Technic okay that allows the establishment of adequate sinus dryness and it helps in clearing all the blocks and removing the things okay so this is an important area where they can ask a new advanced based questions for now I'm done with maxillary sinus few parts I think this is more than sufficient both from the anatomy histology applied aspects as well as the clinical features with the treatment plan and with some latest advances so this is dr. shreek on signing off from team MDS conferred