Chronic Purulent Sinusitis Research Articles

Effectiveness of probiotic therapy in chronic purulent maxillary sinusitis in patients with type 1 diabetes mellitus

Effectiveness of probiotic therapy in chronic purulent maxillary sinusitis in patients with type 1 diabetes mellitus

The efficacy of the extended endoscopic frontal sinus drill-out in cases of repeatedly operated polypous-purulent pansinusitis accompanied by a whistle in the front wall of the frontal sinus

Treatment of patients with severe chronic and recurrent forms of frontal sinusitis, often caused by scarring as a result of repeated interventions in the frontal sinuses, is a difficult task. In such cases, for adequate drainage of the frontal sinus and ensuring stable patency of the nasolabial anastomosis, an endoscopic extended frontotomy can be the choice operation, the possibility of which certainly depends on the experience of the surgeon, anatomical features of the structure of the frontal sinus and the nature of the pathological process. The article shows the effectiveness of surgical treatment of chronic purulent frontal sinusitis that developed after 5 interventions on the paranasal sinuses with external and combined access, accompanied by the development of a fistulous passage of the anterior wall of the frontal sinus. For wide drainage of the frontal sinus and stable preservation of patency of the nasolabial fistula, the patient underwent extended endoscopic frontotomy (Draf III operation according to the international classification).

Якісний і кількісний склад мікробіоти вмісту порожнини товстої кишки у пацієнтів із цукровим діабетом 1-го типу, хворих на хронічний гнійний гайморит

Проведено дослідження якісного та кількісного складу мікробіоти вмісту порожнини товстої кишки у 50 хворих на цукровий діабет (ЦД) 1-го типу та 47 хворих на хронічний гнійний гайморит із ЦД віком від 18 до 44 років. Отримані дані свідчать про те, що у пацієнтів із хронічним гайморитом, хворих на ЦД 1-го типу, домінантними мікроорганізмами є анаеробні бактероїди та аеробні кишкові палички. За популяційним рівнем, коефіцієнтом кількісного домінування та коефіцієнтом значущості встановлено суттєвий дефіцит найважливіших за представництвом у складі товстокишкового біоценозу людини та мультифункціональною роллю у підтримці мікроекологічного гомеостазу автохтонних облігатних анаеробних бактерій роду Bifidobacterium на 41,3 % та Lactobacillus на 51,3 %. На фоні вираженого дефіциту облігатних, фізіологічно корисних у біоценозі товстої кишки біфідо- та лактобактерій зростає популяційний рівень бактероїдів на 18,8 %, пептококів — на 64,9 %, клостридій — на 88,0 %, кишкових паличок — на 28,7 %, протеїв — на 57,0 %, стафілококів — на 71,1 %, дріжджоподібних грибів роду Candida — на 92,0 %. Бактерії, що контамінують порожнину товстої кишки пацієнтів із хронічним гайморитом, хворих на ЦД 1-го типу, — патогенні (E.coli Hly+ та ентеропатогенні штами) та умовно-патогенні ентеробактерії (Enterobacter, Citrobacter, Proteus) досягають високого популяційного рівня, в основному за рахунок ЦД 1-го типу, що сприяє порушенню провідних функцій мікрофлори товстої кишки.Одержані результати є основою для вивчення клінічного перебігу та оптимізації лікування запальних захворювань лор-органів, зокрема хронічних гнійних та гнійно-поліпозних синуїтів, у пацієнтів на ЦД 1-го типу з використання біфідо- і лактовмісних пробіотиків.

Species composition and population level of the microbiota of the contents of the maxillary sinuses and oropharynx in patients with chronic purulent maxillary sinusitis with type 1 diabetes mellitus

Aim – to study the species composition and population level of the microbiota of the contents of the maxillary sinuses and oropharynx in patients with chronic purulent maxillary sinusitis (CPMS), which arose on the background of type 1 diabetes mellitus (DM).Material and methods. A microbiological examination of 97 samples of the contents of the maxillary sinus cavity was performed. The main group consisted of 50 patients with CPMS with type 1 diabetes aged 20-67 years (10 patients aged 20-31 years, 14 patients aged 31-45 years and 26 aged 45-67 years). Among patients of the main group, endocrinologists found in 39 patients the course of type 1 diabetes of moderate severity, in 11 - severe course. The control group consisted of 47 people of the same age, who during the last 6 months did not suffer from any diseases and considered themselves practically healthy.Results. The leading pathogens in CPMS in patients with type 1 (DM) are S. pneumoniae (34% of patients), H. influenzae (24%), M. catarrhalis (24%), S. aureus (10.0%), S. pyogenes (6.0%), E. coli Hly + (2.0%). It is established that the purulent-inflammatory process in the maxillary sinuses in patients with type 1 diabetes develops against the background of the formed dysbiosis of the oropharynx: 1st degree in 6.0%, 2nd degree - in 28% of patients and 3rd degree - in 66% of patients, which is characterized by a pronounced deficiency of indigenous obligate anaerobic and aerobic bacteria and contamination of the habitat with pathogenic and opportunistic pathogens and other microorganisms.Conclusions. The leading causative agents of chronic purulent maxillary sinusitis in patients with type 1 diabetes mellitus at the present stage are: S.pneumoniae (32.0%), H.influenzae (26.0%), M.catarrhalis (24.0%), S. pyogenes (10.0%), S. aureus (6.0%) and E. coli Hly + (2.0%). Patients with chronic purulent maxillary sinusitis, which developed on the background of type 1 diabetes mellitus, are eliminated from the habitat of bifidobacteria, lactococci and S. mutans, which are important for their multifunctional role in the microbiocenosis; the number of physiologically useful lactobacilli is significantly reduced by 2 orders of magnitude, salivary streptococci by 92.91%, S.viridans by 25.17%, S.sanguis by 86.17%, S.mitis by 45.33%, M.luteus-25.35%. Against this background, the number of opportunistic pathogens increases significantly by 84.59%, fusobacteria by 69.33%, pyogenic streptococcus - by 50.5%, hemophilic bacteria - by 55.71%, moraxella - by 74.01%, yeast-like fungi of the genus Candida - by 25.63%. Bacteria that contaminate the oropharynx and the contents of the cavities of the maxillary sinuses reach a high population level (from 4.33 ± 0.14 to 5.69 ± 0.09 lg KUO \ ml). In chronic purulent sinusitis in patients with type 1 diabetes mellitus in the contents of the oropharyngeal cavity are associations of autochthonous obligate and facultative opportunistic and allochthonous microorganisms, consisting of 3 types of microorganisms in 3 (6%) patients, out of 4 in 41 ( 82%) and out of 5 in 6 (12%) patients. Chronic purulent process in the maxillary sinus in patients with type 1 diabetes mellitus develops against the background of the formed dysbacteriosis / dysbiosis of the oropharynx I degree in 6.0%, II degree - in 28.0% of patients and III degree - in 66.0% of patients with chronic purulent maxillary sinusitis, characterized by elimination or severe deficiency of autochthonous obligate anaerobic and aerobic bacteria (bacteria of the genus Bifidobacterium, Lactobacillus, Streptococcus (S.salivarius, S.sanguis, S.mitis, S.mutans, L.lactis, M.luteus) biotope contamination by pathogenic and conditionally pathogenic S.pneumoniae, S.pyogenes, H.influenzae, M.catarrhalis, E.coli, E.coli Hly+, Enterobacter freundii., Klebsiella oxytoca, S.aureus and others.

The role of microorganism association in the development of chronic purulent maxillary sinusitis in patients with type 1 diabetes mellitus

Aim – to study the species composition and population level of the microbiota of the content of the maxillary sinuses and the role of associations of microorganisms in the development and course of chronic purulent maxillary sinusitis (CPMS) in patients with type 1 diabetes.Material and methods. A microbiological examination of 97 samples of the contents of the cavity of the maxillary sinuses was carried out. The main group consisted of 50 patients with CPMS with type 1 diabetes at the age of 20-67 years (10 patients at the age of 20-31 years, 14 patients - 31-45 years old and 26 - at the age of 45-67 years). Among the patients of the main group, endocrinologists established the course of type 1 diabetes mellitus of moderate severity in 39 patients, and a severe course in 11 patients. The control group consisted of 47 CPMS patients of the same age without type 1 diabetes mellitus (DM).Results. Bacteriological and mycological methods in the content of maxillary sinuses of patients with maxillary sinusitis associated with type 1 diabetes mellitus (DM) 175 strains of different kinds of microorganisms were isolated and identified, belonging to 24 various taxonomic groups which form different by their qualitative content microbial associations in the biotope which consist of three different kinds in 58% of patients, consist of four kinds – in 34,0% and five various taxa – in 8,0% of patients. Chronic purulent maxillary sinusitis in patients with type 1 DM disrupts microbial associations. In patients with CPMS with type 1 DM in comparison with the control group, the number of associations consist of three kinds increases by 2,7 times, but the number of associations composed of 4 types of microorganisms decreases by 11.76%. The number of associations consisting of 5 types in patients is reduced by 3.5 times. The above may indicate the influence of not only the etiological agent but also a certain association of microorganisms on the severity of the course of CPMS associated with type 1 diabetes. All leading pathogens persist in the biotope in association. Associates, depending on their role in normobiocenosis, can inhibit the pathogenetic activity of the leading pathogen or, conversely, activate its pathogenetic role, which must be taken into account when choosing a therapeutic tactics.Conclusions. Chronic purulent maxillary sinusitis in patients with type 1 diabetes disrupts microbial associations. In the content of the cavity of the maxillary sinuses of patients with chronic purulent maxillary sinusitis, combined with type 1 diabetes mellitus, 175 strains of various types of microorganisms belonging to 24 different taxonomic groups were isolated and identified, which in the biotope form microbial associations of different qualitative composition, consisting of 3 different species in 58% of patients, out of 4 species in 34.0% and from five different taxa - in 8.0% of patients. Among the most numerous associations, consisting of 3 types of pathogenic and opportunistic autochthonous facultative microorganisms, associations of the following representatives are more common: M. catarrhalis, S. aureus and Bacteroides spp.; Prevotella spp., S. viridans and S. salivarius; M. catarrhalis, Prevotella spp. and S. epidermitidis; H. influenzae, Prevotella spp. and S. epidermitidis. Associations consisting of 4 species were found in 34% of patients and consist of S. pneumoniae, M. catarrhalis, S. pyogenes, Fusobacterium spp; S. pneumoniae, E. coli, S. aureus and Candida spp.; S. pneumoniae, E. coli Hly +, S. viridans and Candida spp. In patients with chronic purulent maxillary sinusitis, combined with type 1 diabetes mellitus with a severe course, there were associations consisting of S. pneumoniae, M. catarrhalis, Candida spp. and S. epidermitidis; S. pneumoniae, M. catarrhalis, S. pyogenes, S. epidermitidis; Bacteroides spp., H. influenzae, S. pyogenes, Enterobacter freundii spp.; Bacteroides spp., H. influenzae, S. pyogenes, Candida spp. In patients with chronic purulent maxillary sinusitis, against the background of a severe course of type 1 diabetes mellitus, associations of microorganisms, consisting of 5 types, were found. Their composition was different, but in all the pathogen S. pneumoniae was isolated and identified at a high population level, opportunistic obligate anaerobic bacteria of the genus Bacteroides and Prevotella, Fusobacterium, streptococci, and Staphylococcus aureus. All leading pathogens persist in the biotope in association, which must be taken into account when choosing therapeutic tactics.

Management of patient after surgical interventions in nasal cavity and paranasal sinuses

Relevance: It was noted that after conducting еndonasal surgical interventions in the nasal cavity and paranasal sinuses, prolonged functional disorders were observed, accompanied by reactive edema, leading to sinus congestion, crusting and respiratory failure. Purpose: the aim of the study was to increase the effectiveness of treatment of patients with chronic rhinosinusitis by improving the technique of early postoperative rehabilitation. Materials and methods: the results were obtained from a comprehensive examination and treatment of 110 patients with chronic purulent and polypous sinusitis, aged 21 to 60 years, who were divided into two similar groups. Patients of the first group and second group received basic postoperative therapy, including systemic antibiotics. In addition, patients of the first group (main) instilled Sinuforte 1 time per day in both halves of the nose. Sinuforte began to be administered from the second day after surgery or the day after removal of tampons. Patients of the second group (control) washing the nose with saline 4-5 times a day and instilled Pinosol oil in the nose. Patients were evaluated for ten days after surgery. The subjective state of patients (complaints) was assessed, the clinical endoscopic picture, olfactometry were evaluated, rhinocytograms were performed. Results: a good clinical result was obtained, comparable or greater than the effect of treating patients without the inclusion of Sinuforte in complex therapy. In this case, the drug is administered once a day, while washing the nose and regular cleaning of the nasal cavity by a doctor is not required.

Re-operations in relapsing frontitis after Belogolovov frontal sinus opening

The authors studied the causes of development of recurrent chronic purulent frontal sinusitis after Belogolovov frontal sinus opening in 26 patients at the period of 2010–2016. The article discusses the specific features of formation of frontal ostium using demineralized bone grafts and polytetrafluoroethylene, describing the disadvantages of each of the materials. It was decided to return to the previously suggested original method of formation of frontal ostium using a combined drain tube consisting of a rigid tubular fragment and a homotissue component (femoral artery), which is the natural fluid conductor in the human body.

Ectopic tooth involving the orbital floor and infraorbital nerve

Aim Ectopic eruption of a tooth within the dental arch is often noticed in clinical practice and is well documented in the literature, while ectopic eruption outside the dental arch (as in the maxillary sinus) is rare. Due to its rarity and lack of consensus over management, its incidence needs to be further defined. Surgical approach, with cyst enucleation, has been considered the treatment of choice. In the present study, a case of an ectopic maxillary third molar with chronic purulent maxillary sinusitis is presented. The aim of this report is to describe the extraction of an ectopic third molar carried out through a nasal endoscopic procedure.

Signs of endogenic intoxication in patients with chronic purulent maxillary sinusitis with type 1 diabetes mellitus

98 patients aged from 19 to 42 were under our observation who were treated at the ENT Department of the Regional Clinical Hospital. The diagnosis of chronic purulent maxillary sinusitis with type 1 diabetes mellitus in exacerbation stage was made in 78 patients (the main group), exacerbation of chronic purulent maxillary sinusitis without comorbid pathology was found in 20 patients (the control group). All the patients underwent standard otorhinolaryngeal examination, general analyses of the blood and urine, blood test for spectrophotometric detection of average mass molecules (AMM). Reactive response was detected by the signs of intoxication. The diagnosis was verified by endocrinologists on the basis of comprehensive clinical anamnesis and laboratoryinstrumental examinations. The course of the disease in all the patients was found to develop against the ground of an increased content of glycated hemoglobin AlcHb (10±0,92) in the blood. To evaluate adaptive and general reactive potential of patients with chronic purulent maxillary sinusitis with type 1 diabetes mellitus integral immune- hematologic coefficients. To detect the level of AMM we used the definition of average molecular peptides by N.I. Gabrielian screening method (1985). 1 ml of the venous blood serum was treated with 0,5 ml 10 % trichloracetic acid solution, then centrifuged during 30 minutes at the rate of 3000 rpm. Supernatant was dissolved in distilled water in the ration 1:10 and with the wave length of 254 nm on the spectrophotometer the content of AMM is detected in standard units. The obtained digital results of clinical and immunological studies were calculated by means of variation statistics methods. The results of the study were processed by means of the software product Statistica for Windows 5.0 (StatSoft, USA). Endogenic intoxication develops in patients with chronic purulent maxillary sinusitis complicated by type 1 diabetes mellitus which is connected with disorders of the immune system and decrease of general body resistance that is evidenced by the dynamics of changes of integral immunоhematological coefficients and average mass molecules. In patients with chronic purulent maxillary sinusitis and type 1 diabetes mellitus the level of AMM was (0,53±0,04 standard units) and was reliably higher as compared with the control (р<0,001). In case of chronic purulent maxillary sinusitis with type 1 diabetes mellitus reduced non-specific immune resistance occurs at the expense of microphage part against the ground of deficiency of non-specific immune protection.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПАЦИЕНТОВ С ХРОНИЧЕСКИМ ГНОЙНЫМ ВЕРХНЕЧЕЛЮСТНЫМ СИНУСИТОМ: СРАВНЕНИЕ ТРАДИЦИОННЫХ И МАЛОИНВАЗИВНЫХ МЕТОДОВ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ

Purpose: to compare the results of the traditional and minimally invasive methods of surgi-cal treatment performed for chronic purulent maxillary sinusitis. Materials and methods. We examined 100 patients with chronic suppurative maxillary sinusitis (one-sided process), 56 women and 44 men, aged 18 to 76 years (the average age is 40 years). All patients were divided into 3 groups. The main group was treated with balloon sinusoplasty. Two comparison groups were endoscopic and microsurgery through the anterior wall of the maxillary sinus. Main criteria for the effectiveness of surgical treatment of patients with chronic purulent the maxillary sinusitis was an endoscopic picture of the nasal cavity, evaluation of CT scan of paranasal sinuses, and a study of the transport function of ciliated epithelium. Results: Good and satisfactory results prevail in the main group of patients. Conclusion: balloon sinusoplasty can be recommended as one of the methods of choice in the treatment of patients with chronic purulent maxillary sinusitis.

TAXONOMIC CONTENT AND POPULATION MICROBIOTA LEVEL OF THE MAXILLARY SINUS CONTENT IN PATIENTS WITH CHRONIC PURULENT SINUSITIS WITH TYPE 1 DIABETES MELLITUS DEPENDING ON THE AGE OF PATIENTS

Microbiological examination of 97 samples of the maxillary sinus content was performed. The main group included 50 patients with chronic purulent maxillary sinusitis (CPMS) with type I diabetes mellitus (DM) aged from 15 to 54: 10 individuals aged from 15 to 20; 14 patients aged from 21 to 35, and 26 patients aged from 36 to 55.The range of changes of the content and population level of microbiota of the maxillary sinus content with CPMS depends on the age of patients afflicted with type I diabetes mellitus. The degree of microbiotic disorders intensifies, a dominating role of pathogenic and opportunistic microorganisms in biotope microbiocenosis increases with age (from 15 to 55).In patients with CPMS and type I DM, aged from 15 to 20, the deficiency of autochtonous obligate bacteria is formed and their role in biotope microbiocenosis decreases considerably – bacteria of the genus Bifidobacterium, Lactobaccilus, S.saliarius, S.sanguis, S.mitis and L.lactis. Against this ground a population level and domination of pathogenic and opportunistic bacteria increase such as S.pneumoniae, S.pyogenes, H.influenzae, M.catarrhalis, enterobacteria and the yeast-like fungi of the genus Candida.The amount and prevailing of pathogenic and opportunistic bacteria of the genus Bacteroides, Prevotella, Fusobacterium, S.pneumoniae, S.pyogenes, S.viridans, H.influenzae, M.catarrhalis, E.coli and the yeast-like fungi of the genus Candida increase with age (21-35). At the same time, all the patients do not have persistence of vital and multifunctional bacteria by their role in micro-ecologic system of the maxillary sinuses such as Bifidobacterium, Lactobaccilus, S.saliarius, S.sanguis, S.mitis and L.lactis. In addition, in patients aged from 21 to 35 suffering from this comorbid pathology contamination of biotope by pathogenic enterotoxicogenic Escherichia occurs. The deepest disorders of a population level and dominating role in microbiocenosis are found in patients with CPMS and type I DM in the age category from 36 to 55, where autochtonous obligate bacteria of the genus Bifidobacterium, Lactobaccilus, Streptococcus (S.saliarius, S.sanguis, S.mutans, S.mitis), L.lactis are absolutely absent. The following causative agents of inflammatory processes in the sinuses become dominating: S.pneumoniae, S.viridans, M.catarrhalis, S.pyogenes, E.coli Hly +. The amount of opportunistic bacteria of the genus Bacteroides, Lactobaccilus, Fusobacterium, Staphylococcus, E.coli and yeast-like fungi of the genus Candida increase.Therefore, taxonomic content and population level of microbiota of the maxillary sinus content in patients with CPMS combined with type I DM depend on the age of patients – a pronounced deficiency of autochtonous obligate vital for the human body is formed with age; and the amount of pathogenic, opportunistic bacteria and yeast-like fungi of the genus Candida increases. Decrease of the amount of autochtonous obligate bacteria and increase of pathogenic and opportunistic microorganisms is intensified with age in patients with CPMS combined with type I DM.

A methicillin-resistant Staphylococcus aureus (MRSA) Sequence Type 8, spa type t11469 causing infection and colonizing horses in Italy.

A Methicillin-resistantStaphylococcus aureus(MRSA) was isolated in Italy from a pathological sample of a mare presenting chronic purulent sinusitis and that had undergone frontal-sinus surgery three months before. Humans, horses, dogs and environmental samples were subsequently collected at the mare's stable and at the Veterinary Hospital, where the mare was operated/hospitalized, and screened for the presence of MRSA that was detected from other horses and from the environment at both sites. All the MRSA isolates belonged to clonal complex (CC)8, ST8-t11469-SCCmec-IVa, and showed similar phenotypic and genetic multidrug resistance patterns and macrorestriction-pulsed-field gel electrophoresis profiles. The only MRSA detected from humans was a CC1, ST1-t127-SCCmec-IVa. This paper represents the first report of a clinical MRSA infection in a horse in Italy. This study also supports the opinion that improper use of antibiotics and hospitalization/surgery can represent risk factors for MRSA colonization/infection in horses, and that the environment is among important sources for exposure.

Efficaсy of antiseptic solution in complex treatment of children with exacerbation of chronic purulent maxillary sinusitis associated with diabetes mellitus type 1

Chronic purulent sinusitises are common disease in children observed in all age groups, starting from the first months of the child’s life. The paper presents data on the use of 0.02% solution of antiseptic Decamethoxin in treatment of patients with exacerbation of chronic purulent maxillary sinusitis. 30 patients have been examined. Bacteriological examination of all patients of the main group reveals complete eradication after completion of Decamethoxin solution therapy.

Quantitative composition and microbiome population level of maxillary sinuses in case of type 1 diabetes combined with chronic purulent sinusitis

Quantitative composition and microbiome population level of maxillary sinuses in case of type 1 diabetes combined with chronic purulent sinusitis

Preoperative Chronic or Acute Purulent Sinusitis Is Not Associated with the Development of Post Operative Meningitis in Endonasal Skull Base Surgery

Preoperative Chronic or Acute Purulent Sinusitis Is Not Associated with the Development of Post Operative Meningitis in Endonasal Skull Base Surgery

Maxillary Sinusitis Caused by Dental Implants Extending into the Maxillary Sinus and the Nasal Cavities

This report describes the case of a patient who underwent osseointegrated dental implant placement. The implants were misplaced inside the nasal fossae and in the right maxillary sinus, causing chronic purulent sinusitis. CT scan without contrast showed signs of right maxillary sinusitis and confirmed the misplacement of four dental implants that surfaced into the nasal cavities. The imaging also revealed the presence of another implant that emerged inside the maxillary sinus. The patient underwent functional endoscopic sinus surgery with complete symptom remission at the long-term follow-up. We propose that sinusitis caused by protrusion of implants and by sinus floor lift procedures could share common physiopathological patterns and predisposing factors.

Dentigerous Cyst with Ectopic Third Molar Tooth in Maxillary Sinus causing Chronic Rhinosinusitis

ABSTRACT Ectopic eruption of teeth into a region other than the oral cavity is rare although there have been reports of teeth in the nasal septum, mandibular condyle, coronoid process, palate, chin and maxillary sinus. Eruption of ectopic teeth in maxillary sinus usually is found incidentally on routine radiological investigations. We present a case of an ectopic maxillary third molar tooth with dentigerous cyst that caused chronic purulent sinusitis in left maxillary sinus. How to cite this article Jain NK, Vashistha S, Jain M. Dentigerous Cyst with Ectopic Third Molar Tooth in Maxillary Sinus causing Chronic Rhinosinusitis. Clin Rhinol An Int J 2013;6(2):106-107.

Ectopic premolar tooth in the maxillary sinus: A case report and review of literature

Ectopic eruption of teeth in non-dental sites is a rare phenomenon and such cases have been reported to occur in the nasal cavity, chin, maxillary sinus, mandible, palate, and orbital cavity. Ectopic tooth eruptions in maxillary sinus are usually asymptomatic or may present with recurrent sinusitis. Majority are found incidentally during routine clinical or radiological investigation. We present a case of an ectopic upper second premolar tooth that caused chronic purulent sinusitis in relation to the right maxillary sinus. The tooth was attached to the posterior wall of the sinus without an associated dentigerous cyst. The case was innovatively managed by endoscopic approach through sublabial route.

Histological changes of Maxillary Sinus Wall at Chronic Purulent Sinusitis

Chronic purulent sinusitis, including the odontogenic origin, are accompanied by the substantial alteration of affected mucous membrane by the type of papillary hyperplasia and remodulation of adjoining bone tissue with forming of the osteosclerosis and osteoporosis.

12 minute consultation: Evidence based management of a patient with facial pain

There is a common misconception that facial pain and headache are mainly caused by sinusitis. The findings of nasal endoscopy, computer tomography (CT) and the results of observational studies reveal that this is not the case. Moreover, when sinus surgery is performed in patients where headache/facial pain has been a feature, it has been found that these symptoms persist after sinus surgery, particularly where there had been no nasal symptoms or endoscopic signs of paranasal sinusitis. This review was based on a literature search performed on 30 November 2011. The MEDLINE, EMBASE and Cochrane databases were searched using the subject heading of facial pain, that is, rhinosinusitis, migraine, cluster headaches, midsegment facial pain, trigeminal neuralgia, paroxysmal hemicrania, hemicrania continua and drug-dependent headache. The search was limited to English language articles. Relevant references from selected articles were reviewed after reading the abstract. A review of the literature shows that headaches are rarely caused by sinusitis. Similarly, only a small proportion of patients with facial pain have sinusitis, and these patients have either acute sinusitis or an acute exacerbation of chronic purulent sinusitis. Importantly, most patients with chronic rhinosinusitis rarely have facial pain unless they develop an acute infection or suffer barotrauma. CT scans should not routinely be performed for facial pain because of the prevalence of incidental changes in asymptomatic patients. Surgery is very rarely indicated in the treatment for chronic facial pain. A structured history of the pain and its associated symptoms, nasendoscopy and relevant targeted investigations should lead to a correct diagnosis and the appropriate treatment.