Maxillary sinusitis of dental origin

Abstract

On the basis of microscopic examination of sixteen specimens obtained at autopsy it appears that the roentgenographic picture is not always reliable enough to prove or disprove the dental origin of an involvement of the mucous membrane of the maxillary sinus. There is no difficulty in reconciling the changes of the antral mucosa with a periapical lesion that has perforated the bony floor of the maxillary sinus. However, the findings of my studies seem to indicate that the mucosa of the maxillary sinus is often affected by periapical lesions which are separated from the floor of the antrum by a bony wall of even great thickness. It is the network of blood vessels and lymphatics extending from the periodontal membrane into the antral mucosa that forms the path for the spread of the infection through the bone marrow. Perivascular infiltration with lymphocytes and plasma cells proceeds from the apical focus through the bone marrow, which is transformed into fibrous tissue containing thrombosed vessels, into the maxillary sinus, causing an inflammatory reaction of its mucous membrane. However, these alterations of the membrane which may derive also from a so-called profound “pyorrhea” and even from a chronic pulpitis are more or less limited to the part of the mucous membrane near the dental focus. The changes of the mucous membrane show all gradations of a chronic inflammation involving its periosteal layer, the mucous membrane proper, and the pseudostratified ciliated epithelium. The transformation of the antral mucosa into a dense fibrous tissue seemingly represents a process of repair. The present study does not allow the adoption of any conclusions as to the extension of these more or less localized lesions of dental origin but broadens remarkably our point of view on the relationship between teeth and inflammatory diseases of the mucous membrane of the maxillary sinus. From a clinical point of view it would be important to ascertain whether or not these more or less local lesions of dental origin of the mucous membrane of the maxillary sinus provoke clinical symptoms and whether or not they disappear with the removal of the tooth from which they originate. A solution of this problem can only be achieved by the cooperation of dentists and rhinologists. Despite the fact that I am a firm believer in the possibility of a successful conservative treatment of infected teeth, and appreciate the advantages of root resections following properly treated pulp canals, I consider extraction of teeth such as described in this paper the only treatment of choice.