Maxillary Sinusitis Of Dental Origin Research Articles

Management of complications of odontogenic maxillary sinusitis

Odontogenic maxillary sinusitis is damage to the mucosa of the maxillary sinus caused by the spread of inflammation from periapical dental processes in the immediate proximity or prominent in the maxillary sinus. Another ethiology can be trauma or dental tumors with or without infection. Failure to identify the etiological dental factor usually causes severe complications. An early history and a thorough clinical examination, together with a radiological evaluation, are key factors in establishing a correct final diagnosis. The multidisciplinary approach between dentists, ophthalmologists, otorhinolaryngologists, neurologists and other specialists is necessary to avoid further complications, which sometimes put the patient’s life at risk. A medical management and an early diagnosis corresponding to the dental pathology, remain critical in the treatment of maxillary sinusitis of dental origin and the prevention of severe complications.

Chronické rinosinusitidy odontogenní etiologie

Chronic rhinosinusitis is a common disease of the nose and paranasal sinuses. We note diseases of dental origin occurring with an increasing regularity. This cause tends to be overlooked. Treatment is longer and more complicated compared to rhinogenic sinusitis due to the higher prevalence of anaerobic bacteria. The treatment can be divided into two main steps. The first is to remove the cause of the odontogenic infection itself, followed by the remediation of secondary nasal cavities using functional endoscopic surgery (FESS). In order to treat this disease properly, inter-disciplinary cooperation between an otorhinolaryngologist and a dentist or oral surgeon is necessary. Conclusions of this paper is to highlight the idea of treating these two seemingly separate issues and procedures into one functional unit that will be most effective and least burdensome for the patient. From my point of view, it seems ideal to address this issue comprehensively. This shortens the treatment time and eliminates the need for the patient to move between different departments. Keywords: apical periodontitis – odontogenic sinusitis – oroantral fi stula – maxillary sinusitis of dental origin – endoscopic sinus surgery – root canal infection

Pathophysiology and clinical presentation of odontogenic maxillary sinusitis

This study aims to consolidate the emerging data regarding the pathophysiology and clinical features of odontogenic maxillary sinusitis (ODMS). A search of existing English literature was performed on Pubmed, and Scopus databases using the following keywords: “odontogenic sinusitis” and “maxillary sinusitis of dental origin”. A total of 56 articles were included in this study. Endodontic and periodontal infections are one of the most frequently mentioned causes of ODMS in the literature. However, newer studies suggest iatrogenic causes as the leading cause. Microbiological studies reveal that the most common anaerobic isolates are Peptostreptococcus spp, Fusobacterium spp, pigmented Prevotella, and Porphyromonas spp. Histological findings of the maxillary sinus mucosa demonstrate numerous papillary-like folds in the surface of the epithelium with an increased expression of TJ protein claudin-4, round cell infiltration, fibrosis, cystic degeneration, and mucosal hyperplasia. The most common symptoms are: unilateral purulent rhinorrhoea and foul smell/ taste. Patients may also have post nasal drip, nasal congestion, cheek pain, purulent discharge in the oral cavity and dental pain. Our study comprehensively reviews the pathophysiology and clinical features of ODMS to provide a more holistic understanding of this condition, facilitating the early diagnosis and management of ODMS patients.

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.

Clinical Manifestations and Symptoms of Maxillary Sinusitis of Odontogenic Origin Demonstrated by Cone Beam Computed Tomography

Objectives: To compare the symptomatology of patients with maxillary sinusitis of dental origin (MSDO) with sinusitis due to upper respiratory tract infection (URTI) with a special focus on time to ...

Combined endoscopic and intra-oral approach for chronic maxillary sinusitis of dental origin-a prospective clinical study.

The traditional Caldwell-Luc approach for maxillary diseases has been criticized for its shortcomings such as removal of a large amount of bone, numbness of the teeth, flap dehiscence, and recurrent sinusitis. On account of its minimal invasiveness and physiological approach, functional endoscopic sinus surgery (FESS) has come to replace the Caldwell-Luc approach for the treatment of chronic rhinosinusitis. Chronic maxillary sinusitis of dental origin (CMSDO) is a less common variant on the chronic rhinosinusitis spectrum whose treatment involves simultaneous management of both the diseased maxillary sinus and the dental source of infection. Thus, this study was undertaken to assess the efficacy of FESS when combined with an intra-oral approach for the treatment of CMSDO. Eighteen patients with CMSDO in the age group of 18-50years were treated with a combined endoscopic and intra-oral approach (buccal advancement flap with/without buccal fat pad) in this study. The patients were followed up for a total duration of 18months. The primary outcome measurements were the SNOT-22 Quality of Life questionnaire and the Lund and Mackay CT Scan Scoring Criteria. The Friedman test was used to assess improvement in the above variables and the level of significance was set at 0.05. There was a statistically significant reduction (p < 0.05) in both the above parameters at all post-operative intervals. Two patients presented with epistaxis (immediate post-operative phase) and synechiae (second week follow-up interval). Both complications were successfully resolved. Two patients showed recurrence at the 6th-month interval for which they underwent revision surgery successfully. Overall, results were maintained even at the 18th month follow-up interval. The endoscopic approach appears to be a reliable, minimally invasive technique associated with less morbidity and stable long-term results. Thus, a multi-disciplinary approach between maxillofacial surgeons and otolaryngologists is essential in the treatment of CMSDO.

Facial abscess revealing maxillary sinusitis of dental origin

Maxillary sinusitis is exceptionally externalized. We report an unusual case of maxillary sinusitis externalized through the average meatus by following the intersinusonasal bulkhead toward the anterior angle of the maxilla and the nasogenian sulcus. The study involved a patient aged 17 years, with no previous medical history, presenting with facial swelling associated with right nasal obstruction occurred two days before. Clinical examination revealed febrile patient with abscess in the right nasogenian sulcus (A), with total filling of the right nasal fossa by a renitent submucosal bulge. Contrast-enhanced CT scan of the facial bones showed right maxillary sinusitis enlarging the average meatus (B) with collections in the intersinusonasal bulkhead and in the nasogenian sulcus. Furthermore, it showed intrasinusal migration of the 17th tooth root (C). The diagnosis of maxillary sinusitis of dental origin exteriorized to the face was made. Under general anesthesia, drainage of the different purulent collections through an incision in the nasal vestibule, middle meatotomy for drainage of the maxillary sinus and extraction of the 17th tooth were performed. Patient's evolution was favorable with regression of fever and of inflammatory signs.

Arthrite septique temporomandibulaire avec résorption condylienne secondaire

Septic arthritis are serious infections rarely observed for the temporomandibular joint. They are mainly hematogenous or transmitted by contiguity. Our patient presents the case of an infection of the temporomandibular joint by maxillary sinusitis of dental origin further complicated by cerebral abscess and empyema. Initial treatment consisted of an endonasal and intraoral drainage, intravenous empirical antibiotic therapy, a close clinicoradiological monitoring, and rehabilitation following a long-term active physiotherapy. Furthermore, the patient reported the onset of a dental articulation disorder with a left side premature contact and right lateral open bite, corresponding to a significant left condylar resorption. This infectious disease is very rare for temporomandibular location; however, its general and functional outcome is determined by the precocity of the treatment. It is important to know the diagnosis and the associated symptoms even if they are not very specifically described. It is essential to consider the diagnosis when facing atypical pain of the temporomandibular joint associated with trismus.

Cerebral Aspergillosis on autopsy; masquerading clinically as Brain tumor in a young female

Cerebral aspergillosis is a rare pathology with fatal outcome. It is mostly a post-mortem diagnosis because the initial symptoms are mostly nonspecific and the existing diagnostic modalities are not sensitive to ensure early and definite diagnosis. The clinical manifestations and disease severity are dictated by the immunologic state of the patient. Cerebral aspergillosis can mimic tuberculous meningitis, pyogenic abscess, or brain tumor. Maxillary sinusitis of dental origin or the lungs are the most common sites of primary aspergillus infection. Infection reaches the brain directly from the nasal sinuses via vascular channels or is blood borne from the lungs and gastrointestinal tract. Dissemination of aspergillus is relatively common, with the central nervous system (CNS) being one of the most frequent sites of Invasive aspergillosis (IA) after the lungs. Aspergillosis should be considered in cases manifesting with acute onset of focal neurologic deficits resulting from a suspected vascular or space occupying lesion especially in immunocompromised hosts. Only a high index of suspicion, an aggressive approach to diagnosis, and rapid vigorous therapy can alter the clinical course in this group of patients.

Rhinosinusitis in oral medicine and dentistry.

Rhinosinusitis is a very common condition which is normally readily recognizable. Given the intimate anatomic relationship between the antrum and the posterior maxillary teeth, maxillary sinusitis can present as odontalgia. Distinguishing between odontogenic orofacial pain and pain associated with maxillary sinusitis is important to prevent unnecessary dental intervention and to direct patients to medical colleagues. Conversely, odontogenic infection can spread to involve the antrum, termed odontogenic sinusitis, or maxillary sinusitis of dental origin. Odontogenic sinusitis accounts for about 10-40% of all cases of sinusitis, and usually requires combined dental and medical treatment. Maxillary sinusitis can also be a complication of exodontia, resulting from tuberosity fractures, displaced teeth or root fragments and the creation of oroantral communications and fistulae. Dental implants and endodontic materials can also impinge on the maxillary sinus, and are rare causes of sinusitis. Often it is stated that rhinosinusitis may contribute to a halitosis complaint, and widely used diagnostic protocols for rhinosinusitis sometimes list halitosis as a minor criterion. However, gold standards in halitotosis research such as organoleptic assessment or gas chromatography have not been used to validate a correlation between objective (genuine) halitosis and sinusitis. The pathophysiology of this mechanism is unclear, and the relative importance of this alongside other causes of extraoral halitosis is debated.

Clinical and radiologic findings in a case series of maxillary sinusitis of dental origin

Maxillary sinusitis of dental origin (MSDO) has been described for decades, but tends to be overlooked as a possible cause of chronic sinusitis by both clinicians and radiologists. The incidence of MSDO in published series is reported to be from 10% to 40% in bacterial sinusitis. We present this series to highlight clinical and radiologic indicators of MSDO. Databases from the authors' otolaryngology and endodontic practices were reviewed to identify patients who had been seen mutually. Sixty-seven (67) patients were identified. Both authors then reviewed the clinical records and associated computed tomography (CT) scans and determined that 31 patients had MSDO and 2 of had bilateral MSDO, for a total of 33 cases. The clinical and radiologic features related to these cases were then tabulated. The clinical characteristics of the 33 cases of MSDO were as follows: sinus pain (88%), postnasal drainage (64%), congestion (45%), maxillary toothache (39%), and foul drainage (15%). Radiographic CT findings of MSDO showed periapical abscess in 18 cases (55%), periodontal abscess in 3 cases (9%), and no obvious dental pathology in 12 cases (36%). The extent of associated sinusitis was variable from mucoperiosteal thickening to florid unilateral sinusitis involving multiple sinuses. Eighteen maxillary sinuses (55%) were found to have either patent maxillary infundibula or prior surgical antrostomy. Twenty-four patients (77%) had unilateral maxillary sinus disease. MSDO should be considered highly likely when radiographic evidence of dental pathology is associated with maxillary sinus disease. Regardless of negative CT evidence of dental pathology, MSDO should be suspected when unilateral maxillary sinus disease is seen, particularly when associated with a patent infundibulum. When MSDO is suspected, a clinical endodontic examination should be performed to rule out or treat an odontogenic etiology.

Sinusites maxillaires d’origine dentaire : traitement chirurgical

The frequency of maxillary sinusitis of dental origin (MSDO) is under estimated. The medical and surgical treatment has improved thanks to endoscopic guidance. We report our experience and strategy in the treatment of MSDO.Twenty-two patients presenting with MSDO were treated between 1998 and 2008. The results were evaluated on clinical, functional, sinusal, and odontologic signs.MSDO accounted for 16% of surgically managed sinusitis. CT was performed in 95% of cases. The etiologies were apical leakage in seven patients, migration of a tooth or root during extraction, or presence of ectopic tooth in the sinus in nine patients, a cyst in three patients, and oroantral communication in three patients. Surgery was performed after antibiotic and NSAID treatment. The first surgical step was the treatment of the odontogenic source. The second step was sinus drainage by endoscopic treatment in 64%, Caldwell-Luc in 23%, and drainage by oroantral communication enlarged then closed in the same operative time in 13%. The follow up ranged from 3 months to 10 years. Early postoperative superinfection was observed in two patients. Two patients presented with recurrent sinusitis. The postoperative sequels were hyposmia in three patients, dental pulpotomy, and trigeminal neuralgia in five patients treated by Caldwell-Luc surgery.Nasal endoscopy has improved the surgical management of MSDO. It makes curettage and exclusion of sinus cavities obsolete. It is reliable and has a low rate of complications. The best treatment remains prevention.

Endoscopic Medial Maxillectomy for Infected Dental Implants

Objective: Chronic maxillary sinusitis of dental origin (CMSDO) is a known complication of osseointegrated dental implants. Treatment of CMSDO currently involves antibiotics, steroids, and nasal irrigation. When medical management has failed, standard of care is removal of the dental implant. We propose performing endoscopic medical maxillectomy (EMM) as an alternative therapy. Method: Single center retrospective chart review on five patients with recalcitrant maxillary sinusitis secondary to dental implants into the maxillary sinus that were subsequently treated with EMM. Review included preoperative symptoms and SNOT-20 scores, medical treatment, computed tomography findings, intraoperative findings, postoperative medical management, postoperative symptoms, and SNOT-20 scores. Results: All 5 patients underwent endoscopic medial maxillectomy, postoperative culture-directed antimicrobial therapy, oral steroids, and nasal irrigation. The patients were followed postoperatively from a period of 3 months to 2 years. All 5 patients demonstrated complete resolution of symptoms of chronic sinusitis and did not require removal of the osseointegrated dental implants. Conclusion: Endoscopic medial maxillectomy provides a safe treatment option for CMSDO due to osseointegrated dental implants that have failed maximal medical therapy. Based on our series, we propose EMM as a viable alternative for those patients who have traditionally required implant removal as definitive therapy.

Bacteriological findings and antimicrobial resistance in odontogenic and non-odontogenic chronic maxillary sinusitis

The main objectives of this study were to estimate the frequency of chronic maxillary sinusitis of dental origin, and to evaluate the microbiology of odontogenic and non-odontogenic chronic maxillary sinusitis. Aspirates from 59 patients with chronic maxillary sinusitis (47 non-odontogenic, 12 odontogenic), collected during a 3-year period, were microbiologically processed for aerobic and anaerobic bacteria. Moreover, antimicrobial susceptibility was evaluated in the isolated bacteria. In this study, 20 % of chronic maxillary sinusitis cases were associated with a dental origin, and sinus lift procedures were the main aetiological factor. Our microbiological findings showed that all specimens from chronic maxillary sinusitis were polymicrobial. Sixty aerobes and 75 anaerobes were recovered from the 47 cases of non-odontogenic sinusitis (2.9 bacteria per specimen); 15 aerobes and 25 anaerobes were isolated from the 12 patients with odontogenic sinusitis (3.3 bacteria per specimen). The predominant aerobes were Staphylococcus aureus (27) and Streptococcus pneumoniae (16), while the more frequent anaerobes were Peptostreptococcus species (31) and Prevotella species (30). Haemophilus influenzae and Moraxella catarrhalis were absent in sinusitis associated with a dental origin. Overall, 22 % of Staphylococcus aureus isolates were oxacillin-resistant, and 75 % of Streptococcus pneumoniae isolates were penicillin-resistant and/or erythromycin-resistant; 21 % of anaerobic Gram-positive bacteria were penicillin-resistant, and 44 % of anaerobic Gram-negative bacteria were β-lactamase-positive. Vancomycin and quinopristin-dalfopristin had the highest in vitro activity against Staphylococcus aureus and Streptococcus species, respectively; amoxicillin-clavulanate and cefotaxime showed the highest in vitro activity against aerobic Gram-negative bacteria; and moxifloxacin, metronidazole and clindamycin were the most active against anaerobic bacteria.

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.

Endoscopic Surgical Treatment of Chronic Maxillary Sinusitis of Dental Origin

Chronic maxillary sinusitis of dental origin (CMSDO) is a common disease that requires treatment of the sinusitis as well as of the odontogenic source. We present our surgical experience performing contemporary treatment of the odontogenic source and endoscopic sinus surgery (ESS) in patients with CMSDO. Seventeen patients with CMSDO underwent contemporary treatment of the odontogenic source and ESS. Five patients presented chronic oroantral fistula (OAF); 5 patients presented odontogenic cysts occupying the maxillary sinus; 2 patients had inflammatory cysts of the molars; 2 patients had maxillary sinus infection secondary to peri-implantitis; 3 patients had foreign bodies pushed through the root canal into the sinus. The first surgical step was the treatment of the odontogenic source. The second step was ESS with opening and calibration of the maxillary natural ostium. Foreign bodies were extracted from the sinuses through the endonasal approach. No major complications after ESS were observed. The average time for ESS was +/-25 minutes. Good distant results without symptoms and complete closure of the fistula were obtained in all patients. When significant sinus disease is found, an endoscopic approach to drainage in all of the involved sinuses can promote predictably successful closure of OAF. The endoscopic approach to chronic maxillary sinusitis of dental origin is a reliable method associated with less morbidity and lower incidence of complications.

Chronic maxillary sinusitis of dental origin: is external surgical approach mandatory?

The study evaluated a minimally invasive endoscopic shaver-assisted technique for treatment of chronic maxillary sinusitis of dental origin. A retrospective multicenter chart review was performed at two clinics of all patients who had a diagnosis of chronic maxillary sinusitis of dental origin and were treated using the technique. The patients were divided into two main groups: patients with and without chronic oral antral fistula. Data from the patients were collected and analyzed. Seventy patients aged 16 to 62 years had surgery using the endoscopic technique. Thirty-nine patients presented with oral antral fistula of different locations, the most common being third molar fistula (26 cases). Foreign bodies were found in 21 sinuses, among them teeth roots (in 11), dental fillings (in 7), and packs (in 3). Fungal ball was found in six sinuses. The surgical technique included retrograde resection of the uncinate process, enlargement of the natural maxillary ostium posteriorly, and removal of the polyps and foreign bodies from the sinus through the middle meatal antrostomy window. Approach through the oral antral fistula facilitated additional access to the alveolar recess. Removal of polyps from the alveolar recess was performed using the microdebrider, which was introduced through the fistula under endoscopic control through the nasoantral window. The fistula was closed in two layers. Good results were obtained in all but four patients in terms up to 3 years. No complications occurred. Overall recovery rate after primary surgery was 94.7%. Endoscopic approach to chronic maxillary sinusitis of dental origin is a new, reliable method associated with less morbidity and lower incidence of complications.

片側上顎洞炎の検出菌の特徴と薬剤選択

Unilateral sinusitis includes maxillary sinusitis of dental origin, fungal maxillary sinusitis, and acute sinusitis. Microorganisms of 50 cases of unilateral maxillary sinusitis were studied. Eighty-six strains and 24 kinds of bacteria were detected. They included mainly Streptococcus pneumoniae(15.1%), Haemophilus influenzae(12.8%), Peptostreptococcus(10.5%), and Bacteroides (14%). Of the total 86 strains isolated, 41(47.7%)were aerobic and 45(52.3%) were anaerobic.Anaerobic microorganisms play a more important role in unilateral maxillary sinusitis than in bilateral sinusitis. This should be considered when selecting antibiotics for the treatment of unilateral maxillary sinusitis

Clinical studies on odontogenic rhinitis and odontogenic sinusitis with an emphasis placed on so-called maxillary sinusitis of dental origin (author's transl)

Clinical studies on odontogenic rhinitis and odontogenic sinusitis with an emphasis placed on so-called maxillary sinusitis of dental origin (author's transl)