Infections of the Maxillary Sinus

Abstract

SUMMARY Most sinus disease is the result of obstruction of the natural ostium, failure of the mucociliary transport system, or an overproduction or change in viscosity of sinus secretions with eventual contamination and bacterial colonization. Acute maxillary sinusitis demands urgent medical treatment. Surgical treatment should be avoided when possible because of the high incidence of complications. Chronic maxillary sinusitis is treated with medications, drainage and irrigation, and surgery to eliminate pathologic tissue and re-establish normal sinus function. Diagnostic procedures for sinus infections include a thorough medical history, a review of the signs and symptoms, radiographs, and sinus aspiration. Other illnesses that may contribute to the patient's susceptibility to sinusitis should be considered, particularly when the condition is chronic and recurrent. The most common organisms isolated from acute sinusitis are Haemophilus influenzae and Branhamella (Moraxella) catarrhalis, both of which can be beta-lactamase producers. This affects the choice of antibiotics for treatment of the disease. Chronic suppurative sinusitis is usually a mixed infection with a greater predominance of anaerobes than is found in acute sinusitis. The oral and maxillofacial surgeon should be alert to any of the potential complications of sinus infection, in particular in the older or physically debilitated patient. The need for consultation and joint treatment efforts with other specialists, including the otolaryngologist, neurosurgeon, allergist, and infectious disease physician, when complications are suspected is obvious. As is true with virtually every condition treated in the practice of oral and maxillofacial surgery, a knowledge of the disease process, timely diagnosis, and effective and aggressive medical and surgical treatment when indicated also will generally bring about a resolution of maxillary sinusitis. In this manner, complications are avoided, and the patient is returned to a healthy, physiologically stable condition.