Early treatment of maxillary sinusitis consists of humidification of inspired air to loosen and aid in the removal of dried secretions from the nasal passage and the sinus ostium. Also required are antibiotics, systemic decongestants, And topically applied congestants to decrease mucosal edema and inflammation and to promote drainage of the sinus through \ts natural opening. On occasion, surgical drainage of the sinus is indicated. The cause of the sinusitis should be diagnosed, treated, and eliminated. Treatment ir directed at relief of pain, and narcotic analgesics are usually required. A nasal spray containing vasoconstrictors, such as 2% ephedrine or 0.25% phenylephrine, is prescribed, as are orally administered antihistamines, such as pseudoephedrine (Sudafed). Antibiotics, selected empirically as-described previously, . are rescribed for a period of 10 to 14 days. Purulent material is submitted for C&S testing, using both aerobic and anaerobic echniques.If the patient fails to respond to this initial treatment regimen within 72 hours, it is .necessary to reassess the treatment and the antibiotic. If the cause of the problem has not been identified and eliminated, this should be accomplished. The results of the C&S testing, using both aerobic and anaerobic techniques. removal of foreign-body free segments and debulking of overly extended grafts. These procedures are usually accomplished through a Caldwell-Luc lateral sinus wall surgical approach or,  arely, with nasal access endoscopic sinus surgery. Patients having sinus disease suspected to be caused by or, secondary to sinus lift procedures should be referred to an oral and maxillofacial surgeon’ for evaluation and treatment. Antibiotic therapy alone may temporarily improve the acute problem, but the ultimate treatment will require sinus exploration and debridement by a surgeon. Midface orthognathic surgical procedures, to include maxillary osteotomies are common operations performed by oral and maxillofacial surgeons to correct facial deformities and maxillomandibular jaw size discrepancies. Most of these procedures include osteotomies to mobilize the maxilla so that it can be rhoved and stabilized in a more advantageous position. The bone cuts needed to perform this operation are made through the lateral and , medial walls of the maxillary sinus and the lateral osseous nasal walls. Separation of the nasal septum from the ‘rnax- , illa at the nasal floor is also required. Once mobilized the ‘maxilla may be advanced, retruded, down grafted or impacted with bone removal at appropriate locations. Once repositioned, the maxilla is stabilized to more superior osseous structures by applying bone plates and screws of titanium, titanium alloy, or bioresorbable materials.In ,most instances midfacial osteotomies actually improve the patency and capacity of the nasal airway, even if the maxilla is yertlcally impacted because, of dilatation of the liminal valve in the anterior portion of the nasal passage. Often, maxillary osteotomies also include .perforrnance of partial inferior nasal’ turbinectomies to reduce the size of the inferior nasal turbinates that may be hypertrophied by recurrent allergic or infectious rhinitis. Usually these procedures improve and do not impede maxillary sinus dramage. However, during maxillary osteotomy procedures, initial significant disruption of the sinus membrane and displacement or disruption or both of the nasal mucosa takes place. The sinus cavities Initially fill with blood  uring

Panoramic radiograph showing mucous-retention phenomenon in right maxiliary sinus
Panoramic radiograph showing mucous-retention phenomenon in right maxiliary sinus

val or dome shaped. The base of its attachment may be oad or narrow. The cyst has a smooth, uniform outline. J!t mucosal cysts arise from the floor of the stnus. They v-ry in size from a few millimeters to occupying the i,ajority of the sinus cavity. Mucosal cysts are rarely symptomatic in the maxillary StIlUS and .generally require no treatment beyond obser- , “,tiO!’I. Radiographs taken several months after diagnosis ~-n”’Ilomy show resolution of the lesion. If, however, , me symptoms of sin IS disease cannot be attributed to. .her factors, thi>o;.:patients should be referred to a speslist for further treatment. Mucosal. cysts should be differentiated from other con- ;:itioris that produce a similar radiographic picture, These oncrdons include cysts of odontogenic origi~ antral olyps, and benign or malignant neoplasms. On rare ccasions secondary infection may produce a pyocele-a mptomatic lesion that may Invade.associated structures • ‘ith symptoms of -acute maxillary sinusitis. These atlents should also be referred to an oral-maxillofacial , ,Jrgeon for medical and surgical management. ‘

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