Mouth-antrum connection

As can be seen in the picture, the root tips of the upper molars are anatomically very close to the maxillary sinus

An mouth-antrum connection (MAV) ( Latin: antrum cavity; syn .: antrum perforation , also opening of the maxillary sinus ) is understood to be a (physiologically non-existent) iatrogenic connection between the oral cavity (Latin: cavum oris ) and the maxillary sinus ( lat. maxillary sinus ), for example, as part of a dental procedure .

causes

An iatrogenic opening of the maxillary sinus can occur unintentionally if the relatively thin layer of bone between the root tips of the molars (rear molars) and the maxillary sinus in the area of ​​the tooth sockets ( lat.alveolus ) is broken through, which occurs when a tooth is removed ( extraction ) Root tip resection , when placing a dental implant or during other oral surgery and dental interventions, for example the removal of an odontogenic cyst .

Such an opening cannot be ruled out even if the risk of MAV has been recognized beforehand by means of an X-ray. It is not to be classified as a medical malpractice. The molars are most frequently affected, especially teeth 16, 17, 26 and 27 , whose root tips often extend into the immediate vicinity of the maxillary sinus or even into it, as well as displaced wisdom teeth .

diagnosis

After every extraction of a tooth, but also after other interventions in which there is the possibility of opening the maxillary sinus, this must be ruled out immediately after the intervention. This is done by scanning the alveolus with a button probe or by trying to blow the nose .

consequences

Through the MAV, pathogens from the oral cavity or from the possibly inflamed tooth root can penetrate into the mostly physiologically sterile maxillary sinus and cause maxillary sinusitis (maxillary sinus inflammation ) or secondary diseases in other paranasal sinuses . An existing inflammation in the root area of ​​the causing tooth ( apical periodontitis ) increases the risk of such a complication. The composition of the oral bacterial flora differs from that of rhinogenic sinusitis. Fragments of the tooth can also enter the maxillary sinus and cause inflammation and other complications.

therapy

If an antrum perforation is diagnosed, the opening should be closed as soon as possible. A not inconsiderable proportion of the opened maxillary sinuses is infected after just 24 hours, 50% after 3 days and 80% after eight days. With immediate closure, the wound in the Schneiderian membrane (mucous membrane of the maxillary sinus), which is very regenerative, heals just as easily as the bone defect in the jawbone. This can slowly grow back through the formation of bone substance.

The perforation is closed by a plastic covering of the wound. The wound is tightly closed using a flap made from a created mucoperiosteal flap and a special suture technique . The patient should urgently avoid blowing his nose with high pressure during the first eight days after the plastic closure to prevent the wound from rupturing again and possible nasal secretions from entering the maxillary sinus. Sneezing should be done with your mouth open.

If the perforation was not recognized and / or an inflammation of the maxillary sinus has already occurred, the perforation must not be closed until the inflammation has healed so that any pus that may have developed can drain away , which can be assisted by an irrigation .

Therapeutic opening of the maxillary sinus

Iatrogenic opening of the maxillary sinus is done on purpose to treat a disease in the maxillary sinus (for example, chronic purulent inflammation, a tumor , cyst , granuloma, or polyp ). In such a case, after severing the oral mucosa, a small bone window is created in the area of ​​the canine fossa , through which a puncture can be made in order to insert an irrigation tube and / or an endoscope into the maxillary sinus. Furthermore, a sinus lift can be performed through such a window , a structure of the jawbone in order to create enough bone for the anchoring of a dental implant.

literature

• J. Thomas Lambrecht: The opening of the maxillary sinus . Lecture at the SSO Congress Davos 1998. In: SSO - Swiss Dental Society (Ed.): Swiss Monthly Journal for Dentistry . Vol. 108, No. 12/1998 , 1998 ( full text as PDF ).

Individual evidence

1. ↑ ^{a b c} Lambrecht 1998 (see literature)
2. ↑ ^{a b c d e f} opening of the maxillary sinus. (No longer available online.) North Rhine Association of Statutory Health Insurance Dentists, archived from the original on January 2, 2012 ; Retrieved July 15, 2012 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
3. ↑ Mouth-antrum connection. DocMedicus - health portal of the German Society for Nutrient Medicine and Prevention (DGNP) e. V., accessed on July 15, 2012 . 
4. ↑ Opening of the maxillary sinus in chronic sinusitis. Medeco GmbH, accessed on July 15, 2012 . 
5. ↑ ^{a b c} Maxillary sinus operations. BOA - Federal Association for Outpatient Surgery, accessed on July 15, 2012 . 
6. ↑ J. Lambrecht, I. Böhlck, P. Dierck: Is the maxillary sinus physiologically sterile? In: G. Watzek, M. Matejka: Diseases of the maxillary sinus. Springer Verlag, Vienna 1986, ISBN 3-7091-8834-2 .
7. ↑ Bernhard Drüke: Compromises and Limits in Dental Surgery . Spitta Verlag, 2003, ISBN 3-934211-65-8 , p. 46 ff .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !