Thursday, March 29, 2012

Antroliths and mucositis of paranasal sinuses

Antroliths and mucositis of paranasal sinuses

Antroliths and mucositis form within paranasal sinuses, but there is no apparent symptoms-sinus in both the disorders.



Antroliths are also referred to as antral caluli, antral stones and rhinoliths. Hard-calcified structures found in the maxillary antrum are called antroliths. The calcification of foreign bodies, fragments of bones and roots or mucus lead to antrolith formation. A foreign body acts as a nucleus on which magnesium, calcium phosphate and calcium carbonate mineral salts deposit, initiating the growth of antroliths. The rhinoliths also form around pus and red blood cells, the endogenous nucleus. The antrolith density and shape varies. The antrolith surface is rough and irregular. The rhinoliths color varies from brown to black. These structures without symptoms-sinus are rare. They are observed on the radiographs. The orthopantomographs and waters view display antroliths developing in the antral cavity. However, antroliths may create heaviness in the sinus region.
On rare occasions, antroliths may be related to facial pain, nasal discharge with blood and chronic or acute sinusitis.  Removal of antroliths is must because these structures cause pain and soreness in the sinus membrane, making the patient susceptible to sinusitis.  Caldwell-Luc surgery method is used to remove the antroliths. During this surgical approach, a window is made in the maxillary sinus’ anteriolateral wall to visualize the sinus. The method is also used to remove antrum lining in some chronic maxillary sinusitis cases.
Mucositis is thickened mucous membrane of the maxillary sinus. Thickness of a normal maxillary sinus is approximately one millimeter. However, thickness increases up to fifteen times due to inflammation caused by an allergen or infection. The membrane with over three-millimeter thickness is called mucositis. Inflammatory lesion of the teeth, including periapical or periodontal diseases thickens the membrane. This disorder is usually asymptomatic and is documented on a radiograph. The mucositis appear as a band on the radiograph. The band is more radiopaque than the sinus filled with air. 
Localized swelling or inflammation of the maxillary sinus membrane due to periapical inflammation is referred to as periapical mucositis.  The maxillary posterior teeth having apical periodontitis trigger the inflammation. To resolve the symptoms-sinus, treat the endodontic disorder. Periapical mucositis shall not be confused with mucocele or mucous retention cyst found in the sinus. Mucositis could be recurrent and chronic.
Chemoradiotherapy and / or radiotherapy during maxillofacial surgery may also cause mucositis. This condition can be treated with laser therapy. Mucosal irradiation before starting the therapy can even reduce the mucositis.

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