Odontogenic Maxillary Sinusitis: Therapeutic Management of Cases with Oroantral Fistulae

Yasutaka Yun,Hiroshi Iwai,Shunsuke Sawada,Kensuke Suzuki,Tomofumi Sakagami,Akira Kanda,Yuka Kojima,Tomoe Nakatani,Masao Yagi,Risaki Kawachi,Hideyuki Murata,Mikiya Asako

doi:10.3390/sinusitis5010006

Yasutaka Yun, Hiroshi Iwai + Show 10 more

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https://doi.org/10.3390/sinusitis5010006

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Abstract

Odontogenic maxillary sinusitis (OMS) is a disease in which inflammation from the teeth extend into the maxillary sinus, causing symptoms of unilateral sinusitis. OMS can recur, with some being resistant to antibiotics. In intractable cases, exodontia and endoscopic sinus surgery (ESS) are necessary treatments. Here we report our analysis on the indications for surgical intervention in cases diagnosed with and treated as OMS. We retrospectively examined 186 patients who were diagnosed with sinusitis on a computed tomography (CT) scan. For cases diagnosed with OMS, the site of the causative tooth and the presence or absence of oroantral fistula to the maxillary sinus was examined. In addition, we analyzed the therapeutic efficacy of the initial treatment of antibiotics, and what the indications were for ESS. Among the patients examined, OMS was diagnosed in 44 cases (23.6%). In 14 out of 20 cases that underwent a post-medical treatment CT scan, OMS found to be treatment-resistant. Of these 14 cases, 12 (88%) had oroantral fistulae to the maxillary sinus. In all cases where exodontia, fistula closure surgery, and endoscopic sinus surgery (ESS) were performed, the fistula disappeared and the shadow of inflammation in the paranasal sinus improved. In OMS with oroantral fistula, ESS, exodontia, and fistula closure should be recommended over medication such as macrolide therapy.

Highlights

Odontogenic maxillary sinusitis (OMS) is a disease in which inflammation of the teeth extend into the maxillary sinus, causing symptoms of unilateral sinusitis [1,2]
Refractory cases should be treated with dental procedures, such as exodontia, or surgical treatment, such as endoscopic sinus surgery (ESS) to open the sinuses, there is a lack of consensus on the indications for surgical treatment [6,9]
We retrospectively reviewed the sinus computed tomography (CT) findings of 186 patients who were seen at our clinic from April 2015 to March 2016 (12 months) and diagnosed with sinusitis, including OMS

Summary

Introduction

Odontogenic maxillary sinusitis (OMS) is a disease in which inflammation of the teeth extend into the maxillary sinus, causing symptoms of unilateral sinusitis (e.g., nasal discharge, facial pain, foul odor, cacosmia, etc.) [1,2]. Referred to as apical root lesion, is caused by inflammation spreading to the apex of tooth. This is further classified into pyogenic periodontitis (Figure 1A), in which inflammation expands through the root canal, and marginal periodontitis (Figure 1B), in which inflammation expands through the periapical space [5]. Bone resorption in the alveolar bone of the maxillary sinus due to inflammation may lead to traffic in the maxillary sinus, resulting in oroantral fistula (Figure 1C,D). These fistulae are defined as an unnatural communication between the oral cavity and maxillary sinus with epithelialization in the fistula tract [7]. Refractory cases should be treated with dental procedures, such as exodontia, or surgical treatment, such as endoscopic sinus surgery (ESS) to open the sinuses, there is a lack of consensus on the indications for surgical treatment [6,9]

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