Analysis of Treatment Outcome Associated with Pre-Operative Diagnostic Accuracy Changes and Dental Treatment Timing in Odontogenic Sinusitis Involving Unilateral Maxillary Sinus

Abstract

Background and Objectives Unilateral sinusitis is caused by various factors. Odontogenic sinusitis; especially, is different from non-odontogenic sinusitis in clinical features and prognosis. The purpose of this study is to evaluate the prognosis of odontogenic sinusitis in accordance with the changes in diagnostic accuracy over time and the timing of dental treatment. Subjects and Method 195 patients who underwent endoscopic sinus surgery for unilateral sinusitis within the interval from 2006 to 2017 were reviewed to analyze the etiologies and clinical characteristics. Preoperative CT was assessed to identify patients who had not been diagnosed with odontogenic sinusitis in the past. In the unilateral bacterial sinusitis, we identified changes in incidence, diagnostic accuracy, and outcome in the odontogenic sinusitis. We divided odontogenic sinusitis patients into three groups: preoperative and intraoperative dental treatment group, postoperative dental treatment group, and untreated group. Then we analyzed the difference in prognosis of these three groups. Results The total number of patients with odontogenic sinusitis was 86 (44%), which accounted for about 36% until 2011, but increased to about 48% after 2013. From 2006 to 2011, there were 15 cases of missed diagnosis of odontogenic sinusitis, but there was 1 case in 2012 and no cases since 2013. The treatment outcome of unilateral bacterial sinusitis was significantly increased from 84.1% before 2011 to 96% after 2012. The success rate was 97.1% in the case of accurate diagnosis of odontogenic sinusitis, but the success rate was 43.8% in case of missed diagnosis. In odontogenic sinusitis, the success rate was low when dental treatment was not performed. However, there was no difference in success rate among different dental treatment timings. Conclusion The incidence of odontogenic sinusitis has steadily increased over the last decade. The prognosis has been improved by appropriate treatment under accurate diagnosis through preoperative examination and radiological evaluation. There was no difference in the prognosis of odontogenic sinusitis according to the dental treatment time. Therefore, it is a good choice for tooth preservation to have an endoscopic sinus surgery first and then decide the dental treatment timing. Key words: Chronic rhinosinusitis ㆍ Odontogenic sinusitis ㆍ Treatment strategy