Nasal blow attempt
The nasal blow attempt is a diagnostic method in dentistry to rule out the opening of the maxillary sinus as a possible complication of the extraction after a tooth extraction in the maxillary posterior area. It is also a diagnostic method for testing nasal patency , especially in small children .
Anatomical basics
During the extraction of a tooth, a connection from the oral cavity via the tooth socket and the pierced thin lamella of the maxillary sinus floor to the maxillary sinus can arise, an oral-antral connection (MAV). Physiologically, there is a connection to the throat area via the exit of the maxillary sinus to the middle nasal passage . Depending on the pressure conditions, air and secretion can flow through this connected system.
execution
When trying to blow the nose, pressure builds up in the nasal cavity by snorting into the nose with the nose closed. The accompanying "crack in the ears" is a sign of the increased pressure in the nose and throat ( Valsalva experiment ). The soft palate seals the oral cavity at the root of the tongue so that no pressure builds up in the oral cavity. The mouth must remain open for the nasal blow attempt. If the maxillary sinus has an open connection to the oral cavity because of the opened floor of the maxillary sinus during the extraction, air flows under high pressure from the nose into the maxillary sinus and from there via the mouth-antrum connection to be diagnosed (MAV, mouth-maxillary sinus opening ) in the mouth. This is associated with a loud noise (hissing, whistling, gurgling) from the alveolus . In this case, the attempt to blow the nose is positive, which, as a therapeutic consequence, requires plastic covering with tight closure of the wound in order to close the connection that has formed. If the nasal blow attempt is positive, the blood in the alveolus can form visible bubbles in the alveolus due to the airflow from the alveolus.
Wrong results
Occasionally there is a false positive result if the hissing has another cause, for example because the soft palate on the floor of the mouth does not close tightly due to the numbing of the palate during the tooth extraction and flutters. Cysts, polyps or tumors can also block the MAV so that no air flows out of the alveolus (false negative result).
Reverse nasal blow attempt
A supplement to the nasal blowing experiment is the reverse nasal blowing experiment . The attempt is made to generate a flow of air from the oral cavity into the nasal cavity in order to diagnose whether the maxillary sinus is open to the mouth. To do this, the patient inflates his cheeks ("like a trumpeter"). The nose is not held shut in the reverse attempt to blow the nose . The soft palate is automatically pressed against the back wall of the pharynx so that the paranasal sinus is closed. There is normal pressure in the nasal cavity. The pressure in the oral cavity is increased by the puffed cheeks and / or by the air pressure generated by the lungs. The reverse attempt to blow the nose is positive if the air can escape from the mouth via the maxillary sinus into the nose, which can be heard through a clear hissing hiss of the air flowing out of the nose. Because of the opened maxillary sinus, it may not be possible to build up pressure in the mouth and the cheeks cannot be inflated at all. If the maxillary sinus opening is very small, the pressure drop is very slow. If the lip is also numbed after a tooth extraction, the patient cannot close the lips properly, which can cause the air to hiss through the cleft lip. To prevent this, the patient's lips are held shut. The reverse nasal blow attempt as an additional diagnostic feature is justified by the fact that the defect in the floor of the maxillary sinus during a regular nasal blow attempt can be closed by a type of valve flap that only allows air to pass through the reverse nasal blow attempt.
The nasal blow attempt is preferable to probing, since the thin, remaining mucous membrane on the floor of the maxillary sinus may be pierced during probing and this creates an oral-antral connection.
medicine
The nasal blow experiment is a diagnostic procedure in children and ear, nose and throat medicine for testing nasal patency, especially in small children. If nasal breathing is obstructed on one side, unequal fogging of a cold metal mirror held under the nose can be determined when trying to blow the nose.
literature
- Norbert Schwenzer, Michael Ehrenfeld, oral and maxillofacial medicine. Series of textbooks for training and further education: Dental, oral and maxillofacial medicine, 5 vols., Vol. 3, Dental surgery: Textbook for training and further education, Thieme Verlag, Stuttgart; 3rd edition, (May 17, 2000), ISBN 3-13-116963-X
Web links
Individual evidence
- ↑ a b c J. Th. Lambrecht, The opening of the maxillary sinus Switzerland Monthly Schr Zahnmed, Vol 108: 12, p. 1201 (1998)
- ^ Roche Lexicon of Medicine, Nose Blowing Experiment , 2003, Elsevier Health Sciences, ISBN 3-437-15156-8 , p. 1294.
