Chronic Odontogenic Sinusitis Research Articles

Використання деяких нестероїдних протизапальних анальгетиків після проведення хірургічного лікування утрудненого прорізування запізнілих зубів та хронічних одонтогенних гайморитів

Purpose: The aim of the study is to compare the effectiveness of using NSAIDs with the active ingredient – ketorolac tromethamine and nimesulide to eliminate postoperative pain in maxillofacial surgery Methods: Examination was carried out on 198 patients. All experimental patients were divided into 4 groups. The first group included 54 patients with difficult eruption of wisdom teeth, who underwent excision of the hood of soft tissues located above an incompletely erupted wisdom tooth. The second group included 49 patients who underwent atypical removal of a decayed wisdom tooth. The third group included 57 patients with atypical removal of dystopian and ratinized teeth. The fourth group included 38 patients who underwent gentle sinus surgery with local plasty of the oro-antral connection in chronic odontogenic sinusitis. Results: The results of the examination of patients after surgical interventions in the maxillofacial region indicate that the drugs nimesulide and «Ketanov» are highly effective and safe drugs, which we recommend using to eliminate pain and treat inflammatory symptoms. Conclusions: The drug nimesulide is effective after surgical interventions on soft tissues. The drug «Ketanov» has a more pronounced and long-lasting analgesic and anti-inflammatory effect, we recommend its use in extensive operations in the maxillofacial area, which include interventions on soft and bone tissues at the same time. Key words: analgesia, inflammation, difficult wisdom tooth eruption, atypical tooth extraction, retention, dystopia, odontogenic sinusitis, nimesulide, Ketanov.

The Influence of Endodontic Lesions on The Clinical Evolution of Odontogenic Sinusitis-A Cohort Study.

Endodontic disease with formation of periapical lesions (PALs) is one of the most common causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between otolaryngologists and dentists, but the best sequence of management is still unknown. The aim of the present study is to clarify how radiological characteristics of teeth with PALs and previous root-canal treatment (RCT) influence the clinical evolution of the disease and to define the predictive value of its radiological and endoscopic features in determining the need for further surgical intervention. A total of 68 symptomatic patients with ODS with PALs were included in the study. The evaluation was performed by an otolaryngologist and a dentist based on a medical interview, nasal endoscopy, cold pulp testing and tomography images. Patients were prospectively followed for at least 12 months, during which nasal steroids, saline irrigations and RCT were administered. The criteria of disease improvement were: decrease of symptoms, healed sinonasal mucosa in endoscopy and radiological resolution of periapical radiolucency and sinus inflammation. Results showed that 9 (13%) patients improved after conservative treatment and 59 (87%) required further surgical intervention. Patients who improved after medical treatment and RCT were younger (p = 0.043) and had a greater distance from the top of the periapical lesion to the maxillary sinus' floor (p = 0.003). When expansion of PALs and bone destruction toward the maxillary sinus was observed on radiological imaging (p = 0.041), and when more than one tooth root was affected (p = 0.004), patients were more likely to require surgical intervention. In conclusion, the more roots that are affected and the closer the top of the PAL is to the maxillary sinus' floor, the greater the possibility of medical treatment and RCT failure. When the bone destruction extends into the maxillary sinus, patients eventually require both tooth extraction and FESS in order to resolve ODS completely.

OPTIMIZATION OF SURGICAL INTERVENTION METHODS IN THE TREATMENT OF ODONTOGENIC CYSTS OF THE UPPER JAW

Abstract: The therapy of odontogenic cysts of the upper and lower jaws, both conservative and operative, is of a complex nature – the frequency of this disease, according to the data, does not decrease. A number of researchers believe that the risk of inflammatory complications in odontogenic cysts is very high. The result of the injection of an odontogenic cyst of the upper jaw can be the occurrence of acute osteomyelitis with the development of a fistula and the outflow of purulent discharge into the maxillary sinus, which can later lead to the development of chronic odontogenic sinusitis. Studies of pus and granulations and analysis of the results obtained in most cases indicate a mixed microflora (staphylococcus, streptococcus, proteus, etc.). Also, when analyzing the literature, it was noted that the surgical treatment of odontogenic cysts localized on the upper jaw, as well as the use of osteoplastic materials for filling bone defects is very ambiguous and contradictory. The authors justify this fact by the fact that there is a high risk of relapses, in particular, after cystectomy, the probability of relapse is at least 17.8%. The usual scenario for conducting such nosologies is radical excision of odontogenic cysts of the jaws, after which a long time is needed to restore the bone defect, as well as adequate subsequent prosthetics. Based on these data, modern authors develop low-traumatic, sparing methods of surgical treatment of odontogenic cysts, especially of the upper jaw, including using endoscopic techniques. Based on the above, an urgent task for dental surgeons is to optimize the methods of surgical treatment of odontogenic cysts of the upper jaw, in particular with a decrease in the volume of the operating field.

Combined Endoscopic and Intraoral Approach or Intraoral Alone in Surgical Management of Odontogenic Sinusitis

The physiological behavior of paranasal sinuses depends on the potency of the ostiomeatal complex and on normal mucociliary function. The interruption of this delicate equilibrium can lead to pathological conditions such as sinusitis. Anywhere between 10% and over 25% of cases of maxillary sinusitis have an odontogenic origin, such as: dental infection; alveolar dental trauma; or iatrogenic causes, such as extractions, endodontic therapies, maxillary osteotomies or placement of endosseous implants. The resolution of sinus pathology is related to the resolution of odontogenic pathology. Aim: to evaluate the therapeutic efficacy of a combined oral and endoscopic approach in the treatment of chronic odontogenic sinusitis vs. oral dental management through a case control study. Materials and Methods: all patients showing signs and symptoms of odontogenic sinusitis with obliteration (appreciable radiopacity in CT) of unilateral maxillary sinus between January 2018 and September 2019 at Padua University Hospital were enrolled in this retrospective study. The exclusion criteria were: maxillary sinusitis without odontogenic origin, or resolution with a systemic antibiotic therapy; and presence of anatomical abnormalities that promote the onset of rhinosinusitis. The patients were divided into two groups: one group was treated with a combined surgical approach under general anesthesia (Functional Endoscopic Sinus Surgery-FESS and simultaneous closure of oroantral communication with Bichat’s fat pad advancement); while the other group was treated only with an intraoral approach under local anesthesia and conscious sedation (closure of oroantral communication with Bichat’s fat pad advancement). The variable “success of the surgical procedure” in the two groups was compared by a Student test (with p < 0.05). Results: among the patients enrolled, 10 patients (aged between 42 and 70) made up the case group and the other 10 patients (aged between 51 and 74) constituted the control group. There was no statistically significant difference in success between the two groups (p < 0.025). Conclusions: according to this case study, an exclusive annotation invasive intraoral approach seemed to be comparable to the transoral endoscopic combined method. However, during diagnosis it is necessary and fundamental to distinguish between odontogenic and rhinogenic sinusitis in order for the resolution of odontogenic sinusitis to be achieved.

Effect of local immunotherapy on the indexes of mucosal immunity in patients with surgical dental pathology

Currently, inflammatory processes and injuries of maxillofacial region, occupy leading positions in the overall structure of surgical morbidity. Restoration of dentition integrity is based on intraosseous dental implants, being a widespread method of treatment in dentistry. The aim of the present work was to perform a comprehensive analysis of cytokine contents (IL- 1β, IL-1ra, IL-2, IL-8, IL-10, TNFα, IFNγ) in maxillary sinus discharges and mixed oral fluid in the patients with surgical dental pathology (chronic odontogenic maxillary sinusitis, complicated by mandibular fracture, as well as during simultaneous dental implantation) and to assess the effect of locally applied immunotherapy on the parameters studied. As a part of the two-stage study, 218 people were comprehensively examined, divided into groups depending on the type of disorder and methods of treatment. The patients with chronic odontogenic sinusitis (J 32.0, n = 44) were treated with topical immunotherapy with Cycloferon (meglumine acridonacetate), patients with a mandibular fracture (S 02.6, n = 70) and with a dental implant (K 08.1, n = 70) received Betaleucine (recombinant IL-1β). At the first stage of the study, examination of all the patients with surgical dental pathology showed immunological predictors of low-efficient acute inflammatory response associated with imbalance of the pro- and anti-inflammatory cytokine system. These predictors were primarily found in the patients with chronic odontogenic sinusitis, i.e., a decrease in IL-1β at high IL-1ra values in the maxillary sinus secretions. In the patients with complicated mandibular fractures, there was a pronounced dynamic decrease in IL-1β with consistently low values of TNFα in mixed saliva. There were distinct dynamic features of IL-1β, IL-8, and IL-1ra levels in oral fluid of the subjects undergoing implantological procedures. The second stage of the study, associated with the local use of Cycloferon and Betaleucine, and analysis of the data revealed different effects of the drugs on the studied parameters, presuming an integral effect of topical immunotherapy, i.e., some leveling of the previously detected imbalance of the cytokine system, due to normalization of their concentrations. Hence, the results obtained may indicate that the patients with surgical dental diseases treated with local immunotherapy had a higher adaptive potential of the local mucosal immunity.

Assessment of odontogenic changes in computed tomography of patients with chronic sinusitis

IntroductionChronic sinusitis can be caused by both laryngological and dental factors. The number of odontogenic sinusitis (OS) in last decades is increasing and seems to be underrated. A unique developmental and microbiological factors causing OS require a different therapeutic approach.Material and methodsThis study evaluated tomography examinations of 500 patients with a clinical diagnosis of chronic sinusitis. The patients were referred by laryngologists, neurologists, and maxillofacial surgeons. The scans were reanalyzed in view of the presence of odontogenic and laryngological pathologiesResultsAmong the 500 patients, 19,6% showed no inflammatory changes in the mucosa of the paranasal sinuses. All patient groups had numerous teeth missing, ranging from 27.3% to 33.2%. Most common odontogenic pathologies were periapical changes (28,8%) and the presence of teeth after improper endodontic treatment (24,2%). In the group in question dental implants (0,4%) and maxillary sinus augmentation (2,8%) were a marginal etiological factor.ConclusionsComputed tomography allows a thorough assessment of odontogenic changes. Obstruction of osteomeatal complex does not have direct influence on OS development. 43,2 % of the patients with chronic sinusitis have OS. It can be diagnosed in 50,8% of isolated right, 39,0% of isolated left and 57,8% of bilateral maxillary sinusitis patients. The results of this study can be used by dentists, maxillofacial surgeons and otolaryngologists to improve the standard of diagnosis and treatment in case of chronic odontogenic sinusitis.

Одонтогенный синусит – мультидисциплинарная проблема

Chronic focal infection is pathologically closely associated with internal pathology and is a serious factor in its aggravation. Systemic inflammatory reactions are associated with metabolic changes, such as oxidative stress, impaired regulatory participation of macro- and microelements with an imbalance in their distribution in biological media. The resulting homeostatic imbalances cannot be ignored by the attraction of chronic foci of infection, such as odontogenic sinusitis. The aim of the study was to substantiate complex approaches to the supervision of patients with chronic odontogenic sinusitis against the background of comorbid multiple chronic focal infection (MCFI). Materials and methods. In patients with chronic odontogenic sinusitis against the background of multiple chronic foci of infection, the activity of systemic inflammatory factors was studied. Levels and ratio of pro- and anti-inflammatory cytokines – interleukins 2, 6, 10, TNF alpha, C-reactive protein in comparison with the oxidation activity of lipids, proteins, low molecular weight thiols, assessment of Zn, Cu, Fe parameters in biological media and hepcidin in blood. In patients with chronic odontogenic sinusitis against the background of MCFI, an increase in the level of pro-inflammatory (TNF alpha, interleukin 6) was found with an imbalance in the distribution of Zn, Cu, Fe with a deficiency of these elements in the intracellular media. Expressed correlations of these changes with the activity of lipid peroxidation and free radical oxidation of thiol compounds were revealed. The data obtained serve as a rationale for the use of antioxidant and mineral replacement therapy in the complex treatment of patients with MCFI.

The frequency of the development of a maxillary odontogenic sinusitis acording to various sings and standarts

According to statistics, among sinusitis of various etiologies, the frequency of odontogenic maxillary sinusitis averages from 26 to 40%. This disease affects mainly people of working age and occupies a signiticant place in the practice of a dental surgeon. Aim of the study was to analyze the frequency of occurrence of odontogenic sinusitis in the practice of a dentist- surgeon, tactics and principles of treating patients in an inpatient setting. Materials andmethods. The article presents the results of a retrospective epidemiological analysis of the incidence according to the case reports (70 case reports of inpatients) and records of surgical intervention of the Department of Maxillofacial Surgery in the Ivanovo Regional Clinical Hospital from 2016 to 2019. Results . In total, during the study period, 21 patients addressed chronic odontogenic sinusitis in the exacerbation stage and out of exacerbation, among them 12 (57%) men and 9 (43%) women. This pathology mainly affects men aged 40 to 50 years. The highest percentage of occurrence as a causative tooth was 1 molar - 76 ± 0.25%, 2 premolar, 2 and 3 molars, respectively in 5 ± 0.23%, 9 ± 0.20%and 10 ± 0.26% of cases (p < 0.001). The quantitative indicator of the period of hospitalization of patients in the hospital averaged 9.4 bed days. A total of 22 patients referred to chronic perforated sinusitis, among them 10 (45%) men and 12 (55%) women. Pathology is prevalent mainly among women 5060 years old. When analyzing causal teeth in the development of chronic perforated sinusitis, the highest percentage of occurrence as a causative tooth of 1 molar was also recorded - 67 ± 0.21%, the hospitalization period in the hospital is on average 9.95 bed days. All patients underwent radical maxillary sinusotomy on the right/left, plastic tistula. About 27 maxillary cysts related to the maxillary sinus, 27patients, among them 16 men and 11 women, came. Moreover, 22 (81%) patients had a root cyst, 4(15%) had a follicular from the third molar, and 1 (4%) had a malformation. The examined patients had Hxed teeth whose roots stand in the cavity of the cyst. Cysts occur in patients at almost any age, more often men suffer, the hospitalization period in the hospital averages 8.8 bed days. Conclusions . Women aged 50 to 60 years are more likely to suffer from chronic perforated sinusitis, and men from 30 to 60 years old are most prone to the formation of cysts that have grown into the maxillary sinus. In most cases, for all 3 nosological forms of the disease, the tirst molar was the causative tooth. When the maxillary sinus was involved in the inflammatory process, a radical sinusotomy was predominantly performed, significantly reducing the frequency of relapses.

Chronic maxillary sinusitis of dental origin and oroantral fistula: The results of combined surgical approach in an Italian university hospital.

Unilateral chronic maxillary sinusitis is a possible complication of odontogenic disease or dental treatment and is mainly due to the development of an oroantral fistula (OAF). The management of chronic maxillary sinusitis of dental origin (CMSDO) requires a combined treatment via endoscopic sinus surgery (ESS) and intraoral surgical treatment of the odontogenic source. The aim of this study is to present the results of our university hospital unit in the treatment and follow-up of a case series of 34 patients treated with a combined surgical approach for CMSDO due to OAF. All patients were treated with ESS combined with an intraoral approach. No intraoperative or immediate postoperative complications were observed; nasal synechia was found in 3 patients (8.82%). The overall success rate after the primary intervention was 94.12%; recurrence was observed in 2 cases (5.88%), both were suffering from diabetes mellitus and were tobacco smokers. Our results confirm that simultaneous surgery with a combination of an intraoral and endoscopic approach can be considered the best strategy for the long-term restoration of normal sinonasal homeostasis in selected patients with chronic odontogenic sinusitis and OAF, guaranteeing an effective treatment with minimal complications in the short and long term.

Сравнительная оценка показателя микрокристаллизации ротовой жидкости при проведении различных комплексов послеоперационного лечения у пациентов с хроническим одонтогенным синуситом верхнечелюстной пазухи

Сравнительная оценка показателя микрокристаллизации ротовой жидкости при проведении различных комплексов послеоперационного лечения у пациентов с хроническим одонтогенным синуситом верхнечелюстной пазухи

Информативность интегральных индексов интоксикации у пациентов с хроническим одонтогенным синуситом верхнечелюстной пазухи

Информативность интегральных индексов интоксикации у пациентов с хроническим одонтогенным синуситом верхнечелюстной пазухи

ПРОГНОСТИЧЕСКАЯ ЭФФЕКТИВНОСТЬ ИНДЕКСОВ ИНТОКСИКАЦИИ ПРИ ОСТРОМ И ХРОНИЧЕСКОМ ОДОНТОГЕННОМ СИНУСИТЕ ВЕРХНЕЧЕЛЮСТНОЙ ПАЗУХИ

ПРОГНОСТИЧЕСКАЯ ЭФФЕКТИВНОСТЬ ИНДЕКСОВ ИНТОКСИКАЦИИ ПРИ ОСТРОМ И ХРОНИЧЕСКОМ ОДОНТОГЕННОМ СИНУСИТЕ ВЕРХНЕЧЕЛЮСТНОЙ ПАЗУХИ

Evaluation of the Prevalence of Maxillary Sinuses Abnormalities through Spiral Computed Tomography (CT).

Introduction Maxillary sinus disease is common and numerous disorders can affect this anatomical area. Abnormalities can be classified as: non-neoplastic, neoplastic benign, and neoplastic malignant. Objective Evaluate through CT the prevalence of diseases in maxillary sinuses, using the Radiology Department's database of a hospital in São Paulo city. Methods The sample consisted of 762 facial CT scans that we divided into three groups: Group A (12–19 years old); Group B (20–49 years old); Group C (above 50 years old); and male or female. We considered the following pathological processes: I - Mucoperiosteal Thickening; II - Chronic Sinusitis; III - Chronic Odontogenic Sinusitis; IV - Rhinosinusitis; V - Polypoid Lesions; VI - Bone Lesions; VII - Neoplasms; VIII - Antrolith; IX - Foreign Bodies; X - Oroantral Fistula. Results Our study found that 305 exams (40.02%) were normal and 457 exams (59.97%) were abnormal. We found the following disease frequencies: focal mucoperiosteal thickening (21.25%); polypoid lesions (10.76%); chronic sinusitis (7.48%); chronic odontogenic sinusitis (2.29%); neoplasms (2.03%); rhinosinusitis (1.77%); bone lesions, foreign bodies and oroantral fistula in 0.65%; 0.13% and 0.06% respectively. There was no significant difference between male and female, and Groups A, B, or C when relating the frequencies of abnormalities found. There was no significant difference between male and female and the age group for the side of the altered maxillary sinus. Conclusion We observed a high prevalence of sinus maxillary diseases. Mucoperiosteal thickening; acute, chronic, and odontogenic sinusitis; polypoid lesions and neoplasms have high prevalence in maxillary sinuses. Thus, facial CT exam was effective for the evaluation of diseases in maxillary sinuses.

Сравнительное сопоставление микрокристаллизации биологических сред у пациентов с хроническим одонтогенным синуситом верхнечелюстной пазухи

Сравнительное сопоставление микрокристаллизации биологических сред у пациентов с хроническим одонтогенным синуситом верхнечелюстной пазухи

Endoscopic assistance in the diagnosis and treatmentof odontogenic maxillary sinus disease

Endoscopic sinus surgery has become an increasingly popular treatment for most surgical cases of chronic sinusitis. However, in some cases, a modification of the classic Caldwell-Luc operation is unavoidable. The purpose of this paper is to present the outcome of 20 cases with pathology of the maxillary sinus which was approached endoscopically on diagnostic or interventional purpose. The primary indication for endoscopy for 11 cases was acute or chronic odontogenic sinusitis. For six cases, endoscopy was performed for removing a foreign body from the sinus cavity and for the remaining three cases, for diagnostic purpose only. A 4-mm rigid endoscope was used through the middle nasal meatus (eight cases) or via a puncture at the canine fossa (seven cases). A combined endoscopic approach was used in five cases. In three cases, endoscopy was combined with Caldwell-Luc technique. For the majority of the patients, the operation was performed under local anesthesia (16 cases). The mean follow-up period was 9.1 months. No major complications were observed. One patient died 18 months after an endoscopically assisted detection of malignancy. Results were depended on the surgical procedure pursued and the underlying sinus pathology. Laborious surgery and chronic sinusitis gave the less satisfactory results. Endoscopy of the maxillary sinus can be applied in a variety of indications. Alone or in combination with conventional surgery, it is a minimally invasive and highly diagnostic tool.

The Canine Fossa Puncture Technique in Chronic Odontogenic Maxillary Sinusitis

Endoscopic sinus surgery (ESS) including middle meatus antrostomy (MMA) has been advocated as the technique of choice in the treatment of maxillary chronic odontogenic sinusitis (COS). However, recently the endoscopic canine fossa puncture (CFP) has been proposed as an alternative surgical technique of accessing the entire antrum when pathology is limited only to the maxillary sinus. This study was designed to assess the outcomes of the CFP approach versus ESS (comprising MMA) in the management of COS. A prospective study was performed on patients with COS produced by odontogenic infections (periapical granulomas or small inflammatory cysts of the molars or bicuspids), oroantral fistula (OAF), large odontogenic cysts, and maxillary foreign bodies (dental fillings, teeth roots, and implants). Patients were randomly allocated into two groups: 56 patients underwent CFP and in 54 patients the maxillary sinus was approached through MMA. After a mean follow-up of 18.5 months, recurrence rates were compared between the two groups. During the follow-up period, OAF recurred in 10 patients: 4 in the MMA group (7.4%) and 6 in the CFP group (10.7%). The difference is not statistically significant (p = 0.39, Fisher exact test). In patients with COS a conservative approach with avoidance of endonasal surgery is suggested: in COS without a fistula, CFP at the time of dental treatment will be sufficient. In OAF cases, CFP yielded similar results with MMA. Nevertheless, additional study with a larger sample and a longer follow-up is required to validate these results.

Maxillary sinusitis of dental origin due to oroantral fistula, treated by endoscopic sinus surgery and primary fistula closure

To present the current treatment approach for oroantral fistula causing maxillary sinusitis. Case series. Four cases of oroantral fistula (diameters: 6, 9, 11 and 13 mm) due to chronic maxillary sinusitis were treated by excision of all diseased oroantral fistula tissue, followed by endoscopic creation of a large middle antrostomy and closure of the fistula using buccal flaps. A synthetic surgical glue and local alveolar bone were used. Patients were followed up for six months to three years; all were considered cured. Most surgeons use buccal or palatal flaps, combined with the Caldwell-Luc procedure, to treat chronic odontogenic sinusitis and to repair fistulae more than 5 mm in diameter. This study supports the hypothesis that an endoscopic technique could be successfully used in patients with oroantral fistula causing chronic maxillary sinusitis of dental origin, instead of the Caldwell-Luc procedure, at least in patients with a small to medium-sized oroantral fistula.

Functional endoscopic sinus surgery as an adjunctive treatment for closure of oroantral fistulae: a retrospective analysis

The objective of this study was to report results of functional endoscopic sinus surgery (FESS) for treatment of chronic maxillary sinusitis of dental origin in a series of patients with oroantral fistulae (OAF). Fourteen patients were treated by FESS and OAF closure by local flap. Data on severity of symptoms, diagnostic endoscopy, and coronal CT scan findings, as well as intraoperative course and complications, were recorded. The follow-up period lasted up to 2 years, comprising clinical examinations and control CT scans. All OAF healed uneventfully. All patients reported improvement in severity of sinusitis symptoms, which was confirmed through results of clinical examinations and control CT scans. No significant complications were recorded. No revision surgery was needed in any case. These results indicate that FESS, combined with OAF closure by buccal flap, might be an effective and safe option for treatment of selected cases of chronic odontogenic sinusitis with OAF.