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Tonetti MS. Dental Pathophysiology of Odontogenic Sinusitis: Periodontitis. Otolaryngol Clin North Am 2024:S0030-6665(24)00117-8. [PMID: 39227245 DOI: 10.1016/j.otc.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Periodontitis is a highly prevalent oral microbial biofilm-driven chronic inflammatory disease. If unmanaged, periodontitis leads to progressive destruction of the ligamentous attachments of teeth to the alveolar bone and resorption of the alveolar bone. It eventually leads to tooth hypermobility and loss. Periodontitis commonly causes overlying maxillary sinus inflammation (mucositis), reflected on radiographic imaging as maxillary sinus mucosal thickening. While uncommon, advanced periodontitis (stage III/IV) or chronic perio-endo lesions can lead to purulent odontogenic sinusitis (ODS). This article describes periodontitis pathophysiology, diagnostic features, and its potential to cause ODS. Clinical practice guideline conform therapy is very successful in managing periodontitis and enabling long-term tooth retention. Localized tooth extration is reserved to end-stage disease.
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Affiliation(s)
- Maurizio S Tonetti
- Shanghai Perio-Implant Innovation Center, Institute for Integrated Oral-Craniofacial and Multisensory Research, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center of Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China; European Research Group on Periodontology, Genova, Italy.
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2
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Chiapasco M, Tommasato G. Management of Oral Surgery-Related Complications. Otolaryngol Clin North Am 2024:S0030-6665(24)00104-X. [PMID: 39214737 DOI: 10.1016/j.otc.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
This article reviews the optimal management of oroantral fistulas, implants protruding into the maxillary sinus, implants completely displaced into the sinus(es), and infected bone grafts used for sinus augmentation. For each scenario, multidisciplinary management strategies will be considered based on whether there is concurrent infectious odontogenic sinusitis. A multidisciplinary approach with oral surgeons and otolaryngologists is often mandatory to ensure optimal therapeutic outcomes.
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Affiliation(s)
- Matteo Chiapasco
- Department of Biomedical, Surgical, and Dental Sciences, Unit of Oral Surgery, University of Milano, Milano, Italy.
| | - Grazia Tommasato
- Department of Biomedical, Surgical, and Dental Sciences, Unit of Oral Surgery, University of Milano, Milano, Italy
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3
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Scaini R, Berzaghi A, Saibene AM, Taschieri S, Testori T. Dental Evaluation: Oral Surgery-Related Complications. Otolaryngol Clin North Am 2024:S0030-6665(24)00109-9. [PMID: 39214738 DOI: 10.1016/j.otc.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The article provides an in-depth review focused on diagnosing oral surgery-related complications that may cause odontogenic sinusitis (ODS). It emphasizes the importance of evaluating patients with prior oral surgical procedures to determine whether the prior procedure is an ongoing infectious source of the ODS. Specifically, diagnostic evaluations will be described for detecting oroantral communications and fistulas, dental implant dislocation or protrusion, and whether implants and graft placed in maxillary sinuses are infected. It highlights the role of different oral examination techniques, optimal imaging modalities, and the importance of otolaryngologic collaboration to evaluate for infectious ODS.
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Affiliation(s)
- Riccardo Scaini
- Implantology and Oral Rehabilitation Section, IRCCS Istituto Ortopedico Galeazzi, Università Degli Studi di Milano, IRCCS Galeazzi S. Ambrogio Hospital, Via Cristina Belgioioso 173, 20157 Milano, Italy.
| | - Andrea Berzaghi
- Department of Surgery, Medicine and Dentistry, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università Degli Studi di Milano, San Paolo Hospital via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Silvio Taschieri
- Biomedical, Surgical and Dental Sciences Department, IRCCS Ospedale Galeazzi, Università Degli Studi di Milano, IRCCS Galeazzi S. Ambrogio Hospital, Via Cristina Belgioioso 173, 20157 Milano, Italy
| | - Tiziano Testori
- Implantology and Oral Rehabilitation Section, IRCCS Istituto Ortopedico Galeazzi, Università Degli Studi di Milano, IRCCS Galeazzi S. Ambrogio Hospital, Via Cristina Belgioioso 173, 20157 Milano, Italy; Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA; Department of Oral Medicine, Infection and Immunity, Harvard University, School of Dental Medicine, Boston, MA, USA
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4
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Craig JR, Saibene AM, Adappa ND, Douglas JE, Eide JG, Felisati G, Kohanski MA, Kshirsagar RS, Kwiecien C, Lee D, Makary CA, Palmer JN, Ray A, Wilson C, Kuan EC. Maxillary Antrostomy Versus Complete Sinus Surgery for Odontogenic Sinusitis With Frontal Sinus Extension. Laryngoscope 2024. [PMID: 39189339 DOI: 10.1002/lary.31731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES Endoscopic sinus surgery (ESS) is often necessary when managing odontogenic sinusitis (ODS), but ESS extent for ODS with extramaxillary sinus involvement has been incompletely studied. This study compared outcomes after wide maxillary antrostomy (MA) alone versus complete ESS for ODS with frontal sinus involvement. METHODS A multicenter prospective cohort study was conducted on patients with uncomplicated ODS (no extrasinus spread) who underwent ESS when computed tomography demonstrated maxillary, anterior ethmoid (AE), and frontal sinus opacification. Multiple preoperative and postoperative variables were recorded, including 22-item sinonasal outcome tests (SNOT-22) and endoscopic findings. Ultimate SNOT-22 and endoscopic resolution, and time to SNOT-22 and endoscopic resolution were compared between patients who underwent MA alone versus "complete" ESS (maxillary, ethmoid, frontal; not sphenoid). RESULTS Of 70 patients, mean age was 59.2 years, and 55.7% were male. Thirty-five underwent MA alone, and 35 had complete ESS. At first postoperative visits (mean 9.3 days), AE sinus purulence was more likely resolved after complete ESS compared with MA (97.1% vs. 71.4%, p = 0.006). However, time to resolution of AE purulence was comparable by 6 weeks postoperatively (p = 0.158). There were no significant differences in times to foul smell resolution and achieving ≥9 point SNOT-22 reduction (p > 0.05). CONCLUSIONS For ODS with frontal sinus involvement, MA alone and complete ESS both resulted in rapid and long-term symptomatic resolution. While ultimate resolution of sinus purulence was equivalent between surgery groups, complete ESS did lead to faster resolution of frontoethmoidal purulence in a significant number of cases. LEVEL OF EVIDENCE 2 Laryngoscope, 2024.
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Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Alberto M Saibene
- Department of Otolaryngology-Head and Neck Surgery, University of Milan, Milan, Italy
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Jacob G Eide
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Giovanni Felisati
- Department of Otolaryngology-Head and Neck Surgery, University of Milan, Milan, Italy
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Rijul S Kshirsagar
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Redwood City Medical Center, Redwood City, California, U.S.A
| | - Catherine Kwiecien
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Daniel Lee
- Department of Otolaryngology-Head and Neck, University of Toronto, Toronto, Canada
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Amrita Ray
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Carl Wilson
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
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5
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Craig JR, Saibene AM, Felisati EG, Felisati G. Collaboration between otolaryngologists and oral surgeons in maxillary sinus elevation planning. Clin Implant Dent Relat Res 2024. [PMID: 39187918 DOI: 10.1111/cid.13385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/16/2024] [Accepted: 08/10/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The collaboration between otolaryngologists and dental providers is crucial for the planning and execution of maxillary sinus elevation (MSE) procedures, which are integral to successful dental implant placements. PURPOSE This article examines the essential role of otolaryngological assessments in identifying potential sinonasal risks that could impact the outcomes of MSE. MATERIALS AND METHODS A comprehensive narrative review of existing literature was conducted. DISCUSSION The review underscores the importance of thorough preoperative evaluations, including patient history, computed tomography (CT) or cone-beam CT (CBCT) scans, and nasal endoscopy, to mitigate sinonasal health risks. It details various clinical scenarios and patient assessments, emphasizing a systematic approach to diagnosing and managing sinonasal conditions proactively. The discussion reveals that while some sinus conditions may not significantly affect MSE success, conditions impacting mucociliary clearance and sinus drainage are critical risk factors requiring otolaryngological intervention. Additionally, the article introduces a grading system to assist clinicians in identifying patients who would benefit from otolaryngological evaluations prior to MSE. CONCLUSION This review highlights the value of interdisciplinary collaboration and standardized protocols in enhancing the predictability and safety of MSE procedures, ultimately improving patient outcomes.
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Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elena Giulia Felisati
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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6
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Alrmali AE, Wang HL. Dental Pathophysiology of Odontogenic Sinusitis: Oral Surgical Complications. Otolaryngol Clin North Am 2024:S0030-6665(24)00103-8. [PMID: 39155170 DOI: 10.1016/j.otc.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
The article explores the understudied pathophysiology of odontogenic sinusitis (ODS) development as a result of oral surgical complications such as oroantral communication (OAC) or fistula (OAF), maxillary sinus bone grafting, and dental implantation. A temporary OAC presents most often after dental extraction, especially with posterior maxillary teeth, though can happen with any oral surgical intervention. Maxillary sinus augmentation can also cause ODS, and while the pathophysiology is incompletely understood, it may be related to OAC/OAF formation or bone graft infection. Dental implants may also lead to ODS either via displacement into the sinus, partial protrusion into the sinus, or peri-implantitis.
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Affiliation(s)
- Abdusalam E Alrmali
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA; Department of Oral Pathology, Oral Medicine and Oral and Maxillofacial Surgery, University of Tripoli, School of Dentistry, Tripoli, Libya
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA.
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Kwiatkowska MA, Craig JR. Unilateral Sinus Disease: What Is, and Is Not Odontogenic Sinusitis? Otolaryngol Clin North Am 2024:S0030-6665(24)00090-2. [PMID: 39147657 DOI: 10.1016/j.otc.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
The differential diagnosis of unilateral sinus disease (USD) is broad, and while concerning etiologies like sinonasal neoplasia, invasive fungal sinusitis, and cerebrospinal fluid rhinorrhea should always be considered, most cases are due to noninvasive inflammatory or infectious conditions. To diagnose USD appropriately, clinicians must integrate the clinical history and examination, nasal endoscopy, computed tomography (CT), and possibly MRI. Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification on CT, with 45% to 75% of such cases being odontogenic in nature. This study provides USD diagnostic considerations and reinforces the diagnostic approach to ODS.
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Affiliation(s)
- Marta A Kwiatkowska
- Department of Otolaryngology and Oncological Laryngology, Military Institute of Medicine, National Research Institute, Warsaw, Poland. https://twitter.com/MartaKwiat_ska
| | - John R Craig
- Division Head of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health-Michigan State University College of Human Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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Boeddinghaus R, Ratcliffe M. Imaging of Odontogenic Sinusitis. Otolaryngol Clin North Am 2024:S0030-6665(24)00095-1. [PMID: 39089984 DOI: 10.1016/j.otc.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Odontogenic sinusitis (ODS) has been shown to be the most common cause of unilateral maxillary sinus opacification on computed tomography scans. Review of the maxillary alveolar ridge and maxillary tooth roots, and their relationships to the maxillary sinus floor is essential when interpreting paranasal sinus imaging. In recent years, ODS has received increased attention in the recent otolaryngologic and dental literature. This article will discuss technical considerations to optimize imaging of the paranasal sinuses and maxillary dentition, as well as both classic and nuanced radiologic findings of ODS.
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Affiliation(s)
- Rudolf Boeddinghaus
- Perth Radiological Clinic, 127 Hamersley Road, Subiaco, Western Australia 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, Western Australia 6009, Australia.
| | - Michael Ratcliffe
- Perth Radiological Clinic, 127 Hamersley Road, Subiaco, Western Australia 6008, Australia
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Yu AJ, Espinosa M, Adappa ND, Douglas JE. Complicated Odontogenic Sinusitis: Extrasinus Infectious Spread. Otolaryngol Clin North Am 2024:S0030-6665(24)00088-4. [PMID: 39048507 DOI: 10.1016/j.otc.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Odontogenic sinusitis (ODS) is a common cause of orbital, intracranial, and osseous infectious extrasinus complications. Dental infections can spread to the orbital or intracranial spaces though the sinuses via thrombophlebitis or direct extension, or from the dentition or oral cavity via vascular channels in the maxillary alveolar bone. ODS typically presents with unilateral involvement both clinically and radiographically. Any suspicion for extrasinus spread based on history and physical examination should be followed by appropriate imaging, formal dental evaluation, and, when appropriate, ophthalmology and neurosurgery consultations. This multidisciplinary approach ensures appropriate management of both the acute orbital and intracranial complications.
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Affiliation(s)
- Alison J Yu
- Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, 1537 Norfolk Street, Suite 5800, Los Angeles, CA 90033, USA
| | - Maria Espinosa
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, 1977 Butler Boulevard Suite E5.200, Houston, TX 77030, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, 5 Ravdin, Philadelphia, PA 19104, USA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, 5 Ravdin, Philadelphia, PA 19104, USA.
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10
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Safadi A, Saibene AM, Craig JR. Sinus Evaluation for Odontogenic Sinusitis. Otolaryngol Clin North Am 2024:S0030-6665(24)00087-2. [PMID: 39048505 DOI: 10.1016/j.otc.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
This article summarizes how to diagnose common and nuanced cases of odontogenic sinusitis (ODS) through a collaborative approach between otolaryngologists and dental specialists, with a heightened focus on the role of otolaryngologists in the diagnostic process. A critical part of the diagnostic framework is that otolaryngologists must confirm the infectious sinusitis but also suspect ODS to ensure he or she refers the patient to a dental specialist to confirm or refute ipsilateral infectious maxillary dental pathology. To confirm the purulent sinusitis of ODS, nasal endoscopy is most critical. Computed tomography imaging is an important part of the workup.
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Affiliation(s)
- Ahmad Safadi
- Otolaryngology-Head and Neck Surgery Unit, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Poriya M.P. The Lower Galilee 15208, Israel
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Via Antonio di Rudinì, 8, Milan 20142, Italy; Department of Health Sciences, Università Degli Studi di Milano, Via Antonio Di Rudinì 8, Milan, Italy.
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA. https://twitter.com/JohnCraigNose
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McKenna DE, Fernandes V, Reddy E. Odontogenic Sinusitis Presenting With Infraorbital Numbness and Progressive Maxillary Sinus Atelectasis. Cureus 2024; 16:e63891. [PMID: 39099902 PMCID: PMC11298068 DOI: 10.7759/cureus.63891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Odontogenic sinusitis is the most common cause of isolated maxillary sinusitis. Accurate diagnosis is important to ensure optimal treatment. We discuss the unique presentation of a 55-year-old man with odontogenic sinusitis and associated infraorbital nerve neuropathy. We document his later development of chronic maxillary atelectasis and discuss the possible underlying pathophysiology linking this with his infraorbital neuropathy.
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Affiliation(s)
- Dominic E McKenna
- Otolaryngology - Head and Neck Surgery, Southern Health and Social Care Trust, Craigavon, GBR
| | - Vinson Fernandes
- Otolaryngology - Head and Neck Surgery, Southern Health and Social Care Trust, Craigavon, GBR
| | - Ekambar Reddy
- Otolaryngology - Head and Neck Surgery, Southern Health and Social Care Trust, Craigavon, GBR
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12
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Oliveira-Santos N, Beersingh APHA, Felizardo HMA, Groppo FC, Gaêta-Araujo H. Association between maxillary sinus floor perforation by dental implants and mucosal thickening: A cone-beam computed tomography study. J Dent 2024; 144:104963. [PMID: 38522636 DOI: 10.1016/j.jdent.2024.104963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/22/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To investigate the association of perforation of the maxillary sinus floor by dental implants with mucosal thickening and to describe its characteristics in perforated cases. STUDY DESIGN One-hundred and twenty-nine maxillary sinuses of 93 patients presenting 202 dental implants in the maxillary posterior region were retrospectively assessed in cone-beam computed tomography scans and classified according to maxillary sinus perforation, bone graft, mucosal thickening, and mucosal appearance. Logistic regression determined the chance of mucosal thickening in perforated maxillary sinuses. The chi-square test compared categorical variables between maxillary sinus perforated or not by implants and maxillary sinus with or without mucosal thickening. The significance level assumed was 5 % (α = 0.05). RESULTS There was perforation of 60 maxillary sinuses floor (46.5 %) by 74 dental implants. The chance of mucosal thickening was higher when the implant tip was trespassing on the maxillary sinus floor (p < 0.001). There was a significant association between maxillary sinus mucosal thickening and perforation by a dental implant with the tip trespassing the maxillary sinus floor (p < 0.05). CONCLUSION Maxillary sinus mucosal thickening is associated with sinus floor perforation by dental implants and does not depend on the number of implants perforating it. CLINICAL RELEVANCE There is an association between dental implants' perforation of the maxillary sinus floor and the thickening of the maxillary sinus. In those cases, the appearance of the mucosa thickening may be irregular, local, or total opacification of the sinus cavity.
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Affiliation(s)
- Nicolly Oliveira-Santos
- Department of Oral Surgery and Stomatology, Division of Oral Diagnostic Sciences, School of Dental Medicine, University of Bern, Bern, Switzerland; Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil.
| | | | | | - Francisco Carlos Groppo
- Department of Biosciences, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Hugo Gaêta-Araujo
- Department of Stomatology, Public Health, and Forensic Dentistry, Division of Oral Radiology, School of Dentistry of Ribeirao Preto, University of Sao Paulo (USP), Ribeirao Preto, Sao Paulo, Brazil
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13
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Rosso C, Urbanelli A, Spoldi C, Felisati G, Pecorari G, Pipolo C, Nava N, Saibene AM. Pediatric Odontogenic Sinusitis: A Systematic Review. J Clin Med 2024; 13:2215. [PMID: 38673488 PMCID: PMC11050471 DOI: 10.3390/jcm13082215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Pediatric odontogenic sinusitis (PODS) is a rare condition with limited research on its clinical features, diagnostic criteria, and treatment options. The current guidelines on pediatric rhinosinusitis do not mention a possible dental origin of the disease. This systematic review aims to summarize and analyze the existing literature on PODS, focusing on epidemiology, etiology, diagnostic tools, complications, treatment options, and outcomes. Methods: A systematic review was conducted following PRISMA reporting guidelines. Electronic searches were performed in multiple databases using keywords related to PODS and therapeutic strategies. Original articles reporting data on treatment outcomes for PODS were included. Results: The review highlighted the scarcity of high-quality evidence on PODS. The literature mainly consists of case reports and low-grade evidence studies. Limited data on the epidemiology, etiology, diagnostic tools, complications, and treatment outcomes of PODS in children are available. Conclusions: Further research is needed to better understand the clinical features, diagnosis, and treatment of PODS in pediatric patients. High-quality studies are required to establish evidence-based guidelines for the management of this condition, especially given the apparently high rate of complications when compared to adult ODS.
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Affiliation(s)
- Cecilia Rosso
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy; (C.R.); (C.S.); (G.F.); (C.P.); (N.N.)
| | - Anastasia Urbanelli
- Otorhinolaryngology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (A.U.); (G.P.)
| | - Chiara Spoldi
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy; (C.R.); (C.S.); (G.F.); (C.P.); (N.N.)
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy; (C.R.); (C.S.); (G.F.); (C.P.); (N.N.)
| | - Giancarlo Pecorari
- Otorhinolaryngology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (A.U.); (G.P.)
| | - Carlotta Pipolo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy; (C.R.); (C.S.); (G.F.); (C.P.); (N.N.)
| | - Nicolò Nava
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy; (C.R.); (C.S.); (G.F.); (C.P.); (N.N.)
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy; (C.R.); (C.S.); (G.F.); (C.P.); (N.N.)
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14
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Saibene AM, Allevi F, Calvo-Henriquez C, Maniaci A, Mayo-Yáñez M, Paderno A, Vaira LA, Felisati G, Craig JR. Reliability of large language models in managing odontogenic sinusitis clinical scenarios: a preliminary multidisciplinary evaluation. Eur Arch Otorhinolaryngol 2024; 281:1835-1841. [PMID: 38189967 PMCID: PMC10943141 DOI: 10.1007/s00405-023-08372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE This study aimed to evaluate the utility of large language model (LLM) artificial intelligence tools, Chat Generative Pre-Trained Transformer (ChatGPT) versions 3.5 and 4, in managing complex otolaryngological clinical scenarios, specifically for the multidisciplinary management of odontogenic sinusitis (ODS). METHODS A prospective, structured multidisciplinary specialist evaluation was conducted using five ad hoc designed ODS-related clinical scenarios. LLM responses to these scenarios were critically reviewed by a multidisciplinary panel of eight specialist evaluators (2 ODS experts, 2 rhinologists, 2 general otolaryngologists, and 2 maxillofacial surgeons). Based on the level of disagreement from panel members, a Total Disagreement Score (TDS) was calculated for each LLM response, and TDS comparisons were made between ChatGPT3.5 and ChatGPT4, as well as between different evaluators. RESULTS While disagreement to some degree was demonstrated in 73/80 evaluator reviews of LLMs' responses, TDSs were significantly lower for ChatGPT4 compared to ChatGPT3.5. Highest TDSs were found in the case of complicated ODS with orbital abscess, presumably due to increased case complexity with dental, rhinologic, and orbital factors affecting diagnostic and therapeutic options. There were no statistically significant differences in TDSs between evaluators' specialties, though ODS experts and maxillofacial surgeons tended to assign higher TDSs. CONCLUSIONS LLMs like ChatGPT, especially newer versions, showed potential for complimenting evidence-based clinical decision-making, but substantial disagreement was still demonstrated between LLMs and clinical specialists across most case examples, suggesting they are not yet optimal in aiding clinical management decisions. Future studies will be important to analyze LLMs' performance as they evolve over time.
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Affiliation(s)
- Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy.
| | - Fabiana Allevi
- Maxillofacial Surgery Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Christian Calvo-Henriquez
- Service of Otolaryngology, Rhinology Unit, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Antonino Maniaci
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Miguel Mayo-Yáñez
- Otorhinolaryngology, Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
| | - Alberto Paderno
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA
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Kwon KW, Gwak JW, Chung YS. Retrospective comparison of first-line treatments for odontogenic sinusitis based on duration of symptoms. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:91-99. [PMID: 38420842 DOI: 10.14639/0392-100x-n2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/06/2023] [Indexed: 03/02/2024]
Abstract
Objectives To investigate the clinical efficacy of dental treatment and endoscopic sinus surgery (ESS), each primary/combined treatment modality, in patients with odontogenic sinusitis (ODS), according to its phase, acute or chronic. Materials and methods We retrospectively reviewed clinical data on 172 patients diagnosed with ODS. They were divided into two groups: acute (≤ 3 months; 90 patients) and chronic (> 3 months; 82 patients) ODS. The success rate and time to resolution of each primary/combined treatment modality were compared between the two groups. Results In both ODS groups, the success rate was highest with combined ESS and dental therapy, followed by ESS alone and dental therapy alone. ESS outperformed dental therapy (96.6% vs 65.5% for acute ODS, p = 0.011; 80.6% vs 56.5% for chronic ODS, p = 0.046) and led to quicker resolution of symptoms for acute ODS than dental therapy (0.9 vs 1.7 months, p = 0.012). In the comparison between ESS alone and combined therapy, no significant difference was observed for acute ODS, whereas combined therapy demonstrated a superior success rate for chronic ODS (100% vs 80.6%, p = 0.046). Conclusions In our study, the clinical utility of dental treatment and/or ESS depended on the morbidity period of ODS. For chronic ODS, combined ESS and dental treatment seems to be an effective first-line treatment.
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Affiliation(s)
- Kyung Won Kwon
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otolaryngology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jang Wook Gwak
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo-Sam Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Ringel B, Kons ZA, Holbrook EH, Gray ST. Trends of Odontogenic Sinusitis Incidence During the COVID-19 Pandemic. Laryngoscope 2024; 134:1597-1602. [PMID: 37772908 DOI: 10.1002/lary.31082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES The COVID-19 pandemic affected the epidemiology of several diseases. This study aims to compare the incidence of surgically treated odontogenic sinusitis (ODS) before and during the COVID-19 pandemic and identify unique features. METHODS A retrospective chart review of patients who underwent at least maxillary antrostomy at a tertiary referral center was performed. The patients were divided into two cohorts: "pre-COVID" (March 2018 to February 2020) and "COVID" (March 2020 to February 2022). Data on demographics, comorbidities, and treatment interventions were collected and analyzed. RESULTS Of the 734 patients who underwent maxillary antrostomy, 370 (50.4%) were operated on during the COVID period, with a mean age of 53.1 ± 15.7 years. ODS was found as the etiology of 22 (6%) and 45 (12.2%) of the pre-COVID and COVID cases, respectively (p = 0.006). Although no difference was found in the incidence of diabetes (p = 0.9) or obesity (p = 0.7) between groups, a trend toward higher incidence of immunosuppression was found in the pre-COVID patients (18.2% vs. 0%, p = 0.06). A higher incidence of sphenoid sinus involvement (31.8% vs. 8.9%, p < 0.05) was identified in the pre-COVID group; however, no differences in ethmoid (86.4% vs. 86.7%, p = 0.999) or frontal sinus involvement (54.5% vs. 37.8%, p = 0.3) were found between the groups. CONCLUSION There was an increase in the incidence of ODS during the first 2 years of the COVID-19 pandemic compared to the 2 years prior. Similar clinical characteristics were found in both groups. Future studies focusing on specific etiologies to explain ODS preponderance may help determine optimal treatment and prevention strategies. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1597-1602, 2024.
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Affiliation(s)
- Barak Ringel
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Zachary A Kons
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eric H Holbrook
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
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Kocum P, Šedý J, Traboulsi J, Jirák P. One-stage combined ENT and dental surgical treatment of odontogenic sinusitis: a prospective study. Eur Arch Otorhinolaryngol 2024; 281:1347-1356. [PMID: 37982839 PMCID: PMC10858141 DOI: 10.1007/s00405-023-08332-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE The study analyses outcomes of the surgical treatment of odontogenic sinusitis that concurrently address sinusitis and its dental source. METHODS A total of 364 adult patients were included, representing 13% of all patients we have operated on for any rhinosinusitis over the past 18 years. The diagnosis was based on both ENT and dental examinations including CT imaging. Patients were divided into three groups: (1) FESS with dental surgery without antrotomy, (2) FESS with intraoral antrotomy, and (3) intraoral surgery without FESS. The mean postoperative follow-up was 15 months. RESULTS First group involved 64%, second group 31%, and third group 6% of the cases. The one-stage combined ENT and dental approach was used in 94% of cases (group 1 and 2) with a success rate of 97%. Concerning FESS, maxillary sinus surgery with middle meatal antrostomy only was performed in 54% of patients. Oroantral communication flap closure was performed in 56% of patients (success rate 98%). Healing was achieved within 3 months. The majority (87%) of patients were operated on unilaterally for unilateral findings. Over the past 18 years, a 6% increase of implant-related odontogenic sinusitis was observed. CONCLUSION Odontogenic sinusitis is common, tending to be unilateral and chronic. Its dental source needs to be uncovered and treated and should not be underestimated. Close cooperation between ENT and dental specialists has a crucial role in achieving optimal outcomes. The one-stage combined surgical approach proves to be a reliable, safe, fast and effective treatment.
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Affiliation(s)
- Petr Kocum
- Department of ENT, Head and Neck Surgery, Na Homolce Hospital, Roentgenova 37/2, Prague 5, Czech Republic.
- Centre for Dental Surgery Podstata-Hudler, Ltd., Jinonická 1313/25, Prague 5, Czech Republic.
| | - Jiří Šedý
- 3DK Clinic, U Zdravotního Ústavu 2213/8, Prague 10, Czech Republic
- Faculty of Medicine, Institute of Dentistry and Oral Sciences, Palacký University, Palackého 12, Olomouc, Czech Republic
- Second Faculty of Medicine, Institute of Anatomy, Charles University, V Úvalu 84, Prague 5, Czech Republic
| | - Joseph Traboulsi
- Department of ENT, Head and Neck Surgery, Na Homolce Hospital, Roentgenova 37/2, Prague 5, Czech Republic
| | - Petr Jirák
- Department of ENT, Head and Neck Surgery, Na Homolce Hospital, Roentgenova 37/2, Prague 5, Czech Republic
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Lin J, Wang C, Wang X, Chen F, Zhang W, Sun H, Yan F, Pan Y, Zhu D, Yang Q, Ge S, Sun Y, Wang K, Zhang Y, Xian M, Zheng M, Mo A, Xu X, Wang H, Zhou X, Zhang L. Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment. Int J Oral Sci 2024; 16:11. [PMID: 38302479 PMCID: PMC10834456 DOI: 10.1038/s41368-024-00278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
ABSTARCT Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multi-disciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.
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Affiliation(s)
- Jiang Lin
- Department of Stomatology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Faming Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shanxi International Joint Research Center for Oral Diseases, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi' an, China
| | - Wei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
| | - Hongchen Sun
- Department of Oral &Maxillofacial Pathology, School and Hospital of Stomatology, Jilin University, Jilin, China
| | - Fuhua Yan
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yaping Pan
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qintai Yang
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaohua Ge
- Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Yao Sun
- Department of Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Kuiji Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Mu Xian
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Zheng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Anchun Mo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanguo Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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Wu J, Zheng M, Wang X, Wang S. Endo-Periodontal Lesions-An Overlooked Etiology of Odontogenic Sinusitis. J Clin Med 2023; 12:6888. [PMID: 37959353 PMCID: PMC10648035 DOI: 10.3390/jcm12216888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study was to analyze the oral etiology of patients with odontogenic sinusitis (ODS) and to compare the differences in demographic data, clinical symptoms, extent of sinus involvement, bone penetration of the maxillary sinus floor (MSF) between different etiologies. A retrospective investigation was conducted on 103 patients with ODS recruited from Beijing TongRen Hospital. All enrolled patients underwent sinus CT, nasal endoscopy, and oral examination. A comparison of the patients' clinical symptoms, the extent of involvement of the sinuses, and bone resorption of the MSF according to odontogenic etiologies was conducted. Follow-up was based on symptoms and clinical examination. The most common odontogenic etiologies were endo-periodontal lesions (EPLs, 49.5%), apical periodontitis (AP, 32.0%), and periodontitis (PE, 8.7%). There were statistically significant differences in age (p = 0.002), sex (p = 0.036), inflammation involving the ethmoid sinus (p = 0.037), and bone penetration of the MSF (p < 0.001) between the AP, EPL, and PE groups. There were no significant differences in sinusitis symptoms (p > 0.005) among patients with different odontogenic etiologies. In conclusion, EPL is a neglected oral etiology with a destructive effect on the bone of the MSF, which deserves more attention in diagnosis and treatment.
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Affiliation(s)
- Jianyou Wu
- Beijing Stomatological Hospital, Capital Medical University, Tian Tan Xi Li 4#, Beijing 100050, China;
- Beijing Laboratory of Oral Health, Capital Medical University, Tian Tan Xi Li 4#, Beijing 100050, China
- Department of Stomatology, Beijing TongRen Hospital, Capital Medical University, Dongjiaominxiang, Beijing 100730, China
| | - Ming Zheng
- Department of Otolaryngology–Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Dongjiaominxiang, Beijing 100730, China;
| | - Xiangdong Wang
- Department of Otolaryngology–Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Dongjiaominxiang, Beijing 100730, China;
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otorhinolaryngology, Dongjiaominxiang, Beijing 100730, China
| | - Songlin Wang
- Beijing Laboratory of Oral Health, Capital Medical University, Tian Tan Xi Li 4#, Beijing 100050, China
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Canevari FR, Giorli A, Monti G, Biagini C, Bagnasco D, Cavaliere C, Pipolo C, De Corso E, Gelardi M, Gramellini G, Ioppi A, La Mantia I, Malvezzi L, Bignami M, Dehgani-Mobaraki P, Seccia V, Maggiore G, Macchi A. Diagnostic therapeutic assistance pathway (PDTA) of type 2 chronic rhinosinusitis. FRONTIERS IN ALLERGY 2023; 4:1237131. [PMID: 37841050 PMCID: PMC10570804 DOI: 10.3389/falgy.2023.1237131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a complex and heterogeneous disorder whose etiopathogenetic picture is not yet completely known and is classically divided into CRS with (CRSwNP) and without nasal polyps (CRSsNP). But today the distinction is made with type 2 and nontype 2 variants. A rational and defined pathway for the diagnosis of chronic rhinosinusitis is an indispensable means to be able to arrive at a correct identification of the patient. This typing is essential to be able to arrive at the correct course of treatment, which turns out to be different for different types of patients. For this reason, the realization of a diagnostic therapeutic pathway represents a fundamental way for the otolaryngologist specialist but not only, since today diagnostics has a multidisciplinary framework. In the present work, precise indications have been developed to arrive at a correct diagnosis. The various diagnostic pathways and processes to arrive at a correct therapeutic framing have been highlighted. Therapy ranging from medical therapy to surgical therapy without neglecting the new biological therapies. It does not represent a guideline but a diagnostic method that can be adapted to all the various territorial realities.
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Affiliation(s)
- Frank Rikki Canevari
- Unit of Otorhinolaryngology – Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Alessia Giorli
- Otolaryngology Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giulia Monti
- ENT Department, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Cesare Biagini
- Otolaryngology Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Matteo Gelardi
- Department of Otolaryngology, University Hospital of Foggia, Foggia, Italy
| | - Giulia Gramellini
- ENT Deptartement, Asst Grande Ospedale Metropolitano Niguarda, Ear, Nose and Throat Unit of Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology – Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, “S. Chiara” Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Luca Malvezzi
- Otorhinolaryngology, Head and Neck Surgery Unit, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Department of Surgery, ASST Lariana, University of Insubria, Como, Italy
| | | | - Veronica Seccia
- Otolaryngology Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine,Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | | | - Alberto Macchi
- ENT Department, ASST Sette Laghi, University of Insubria, Varese, Italy
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Tsuchiya E, Takeda M, Mori E, Takakura I, Mitsuyoshi R, Otori N, Hayashi K. Evaluating tooth extraction as a stand-alone treatment for odontogenic sinusitis. Acta Otolaryngol 2023:1-4. [PMID: 37326445 DOI: 10.1080/00016489.2023.2223697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND There are multiple treatment methods for odontogenic sinusitis (OS); however, the optimal treatment remains unclear. AIMS/OBJECTIVE To determine the cure rate of OS after tooth extraction and the factors contributing to the cure. MATERIAL AND METHODS We prospectively identified 37 patients diagnosed with OS with an indication for causative tooth extraction. Before and three months after tooth extraction, the patients were assessed using sinus computed tomography and classified as either cured or uncured based on the absence or presence of soft tissue shadow in the maxillary sinus. The prognostic factors were analysed by comparing the two groups. RESULTS There were ten patients for whom all data could be obtained. The mean age of the patients at the time of tooth extraction was 53.8 ± 12.9 years (range, 34-75 years). In seven patients, the soft tissue shadow in the maxillary sinus disappeared; these patients were classified as cured. Uncured patients were significantly younger than cured patients (59.9 vs. 39.7 years). CONCLUSIONS AND SIGNIFICANCE Tooth extraction effectively treated OS in 70% of patients. However, even after tooth extraction, OS may not improve, particularly in younger patients.
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Affiliation(s)
- Emi Tsuchiya
- Department of Dentistry, The Jikei University School of Medicine, Tokyo, Japan
| | - Momoko Takeda
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
- Takeda ENT Clinic, Fujimi, Japan
| | - Eri Mori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ikuko Takakura
- Department of Dentistry, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryoto Mitsuyoshi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiko Hayashi
- Department of Dentistry, The Jikei University School of Medicine, Tokyo, Japan
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Sabatino L, Lopez MA, Di Giovanni S, Pierri M, Iafrati F, De Benedetto L, Moffa A, Casale M. Odontogenic Sinusitis with Oroantral Communication and Fistula Management: Role of Regenerative Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050937. [PMID: 37241169 DOI: 10.3390/medicina59050937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis.
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Affiliation(s)
- Lorenzo Sabatino
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Michele Antonio Lopez
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Specialised Odontostomatology Department of Head and Neck and Sensory Organs, Division of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Simone Di Giovanni
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Michelangelo Pierri
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Francesco Iafrati
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Luigi De Benedetto
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Antonio Moffa
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Manuele Casale
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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23
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Yassin-Kassab A, Peterson EL, Craig JR. Total times to treatment completion and clinical outcomes in odontogenic sinusitis. Am J Otolaryngol 2023; 44:103921. [PMID: 37187016 DOI: 10.1016/j.amjoto.2023.103921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/30/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Multidisciplinary collaboration is essential for effective odontogenic sinusitis (ODS) management. One point of debate has been the optimal timing of primary dental treatment and endoscopic sinus surgery (ESS), but differences in time to completion of these treatment pathways have not been studied. METHODS A retrospective cohort study was conducted on ODS patients from 2015 to 2022. Demographic and clinical variables were recorded, and various durations of time were analyzed from rhinologic consultation through treatment completion. Resolution of sinusitis symptoms and purulence on endoscopy was also recorded. RESULTS Eighty-nine ODS patients were analyzed (47.2 % male, median 59 years-old). Of the 89 ODS patients, 56 had treatable dental pathology, and 33 had no treatable dental pathology. Median time to treatment completion for all patients was 103 days. Of 56 ODS patients with treatable dental pathology, 33 had primary dental treatment, and 27 (81 %) required secondary ESS. In patients who underwent primary dental treatment followed by ESS, median time from initial evaluation to treatment completion was 236.0 days. If ESS was pursued primarily followed by dental treatment, median time from initial evaluation to treatment completion was 112.0 days, which was significantly shorter than if dental treatment was pursued primarily (p = 0.002). Overall symptomatic and endoscopic resolution was 97.8 %. CONCLUSIONS After dental and sinus surgical treatment, ODS patients experienced 97.8 % resolution of symptoms and purulence on endoscopy. In patients with ODS due to treatable dental pathology, primary ESS followed by dental treatment resulted in a shorter overall treatment duration than primary dental treatment followed by ESS.
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Affiliation(s)
- Abdulkader Yassin-Kassab
- University of Pittsburgh School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Pittsburg, PA, United States of America
| | - Edward L Peterson
- Henry Ford Health, Department of Public Health Sciences, Detroit, MI, United States of America
| | - John R Craig
- Henry Ford Health, Department of Otolaryngology-Head and Neck Surgery, Detroit, MI, United States of America.
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24
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Sabatino L, Pierri M, Iafrati F, Di Giovanni S, Moffa A, De Benedetto L, Passarelli PC, Casale M. Odontogenic Sinusitis from Classical Complications and Its Treatment: Our Experience. Antibiotics (Basel) 2023; 12:antibiotics12020390. [PMID: 36830300 PMCID: PMC9952703 DOI: 10.3390/antibiotics12020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Odontogenic sinusitis (ODS) refers to the maxillary sinus infection, which is secondary to either adjacent infectious dental pathologies or procedures. The aim of this retrospective study is to report the experiences of the department of integrated therapies in otolaryngology (Campus Bio-Medico Foundation, Rome, Italy) in classifying and treating patients that are affected by odontogenic sinusitis derived from "classic complications". A total of 68 patients responding to the criteria and to the definition as a classical odontogenic complication were included. The surgical therapy consisted of a combined oral and nasal simultaneous approach for 28 patients (43%), a combined non-simultaneous approach for 4 patients (6%), a nasal only approach for 14 patients (21%), and an oral only approach for 20 patients (30%). All the patients presented a complete resolution of the symptoms. The choice of performing a nasal, oral, or combined approach is based on the presence of anatomical elements that facilitate sinusitis and reinfection occurrence, such as deviated nasal septum, concha bullosa, or obstructed osteo-meatal complex. The correct use of validated classification, the pre-operative CT scan, a multidisciplinary approach, and an appropriate presurgical examination are the necessary elements to obtain a good success rate.
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Affiliation(s)
- Lorenzo Sabatino
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Correspondence:
| | - Michelangelo Pierri
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Francesco Iafrati
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Simone Di Giovanni
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Antonio Moffa
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, 00128 Rome, Italy
| | - Luigi De Benedetto
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Pier Carmine Passarelli
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, 00128 Rome, Italy
| | - Manuele Casale
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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25
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Park MJ, Park HI, Ahn KM, Kim JH, Chung YS, Jang YJ, Yu MS. Features of Odontogenic Sinusitis Associated With Dental Implants. Laryngoscope 2023; 133:237-243. [PMID: 35179239 DOI: 10.1002/lary.30069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS). STUDY DESIGN Case-control study. METHODS This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS. RESULTS The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively). CONCLUSION Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS. LEVEL OF EVIDENCE 4 Laryngoscope, 133:237-243, 2023.
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Inha University School of Medicine, Incheon, South Korea
| | - Han Ick Park
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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26
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Chung SY, Halderman AA. Tips and tricks for management of the dysfunctional maxillary sinus. Curr Opin Otolaryngol Head Neck Surg 2023; 31:24-32. [PMID: 36484283 DOI: 10.1097/moo.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To review the various factors associated with the most common cause of maxillary sinus dysfunction; recalcitrant chronic maxillary sinusitis (RCMS). In addition, available medical and surgical management options are discussed along with various tips and tricks for optimal management. RECENT FINDINGS Defects in mucociliary clearance, immunodeficiency, anatomic factors, and infectious etiologies have been implicated in dysfunction of the maxillary sinus leading to RCMS. Medical management including oral antibiotics or topical drugs have shown varying degrees of success. Endoscopic modified medial maxillectomy (EMMM) has been shown to significantly improve symptoms in patients with RCMS. SUMMARY A dysfunctional maxillary sinus presents a clinical challenge. A thorough evaluation of any potential contributing factors must be done in addition to an assessment of the adequacy of prior surgical treatment of the maxillary sinus. Beyond the middle meatal antrostomy, EMMM can be used to effectively address RCMS. In cases that fail EMMM, removal of the condemned mucosa to encourage auto-obliteration of the sinus can be considered.
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Affiliation(s)
- Sei Y Chung
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern, Dallas, Texas, USA
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27
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The Influence of Endodontic Lesions on The Clinical Evolution of Odontogenic Sinusitis-A Cohort Study. J Clin Med 2023; 12:jcm12031103. [PMID: 36769751 PMCID: PMC9918245 DOI: 10.3390/jcm12031103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/01/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
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.
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28
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Prelacrimal Window Approach in the Management of Odontogenic Maxillary Sinusitis from Dental Foreign Body. Case Rep Dent 2022; 2022:1730656. [PMID: 36133402 PMCID: PMC9484961 DOI: 10.1155/2022/1730656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/20/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
The floor of the maxillary sinus is partly formed by the alveolar process of the maxilla, and this anatomical relationship forms an interface for collaboration between rhinologists, maxillofacial and dental surgeons, and dentists. Odontogenic maxillary sinusitis (ODMS) occurs secondary to infectious processes of the maxillary molar and premolar teeth or following complications from dental procedures. Extruded dental foreign bodies within the sinus can cause chronic mucosal irritation leading to mucociliary dysfunction and sinogenic symptoms. Anteriorly placed foreign bodies are difficult to access via the conventional endoscopic maxillary antrostomy. Endoscopic approaches to access the anterior maxillary sinus involve extended resection of the medial maxillary wall, potentially with the removal of the inferior turbinate and nasolacrimal duct mobilisation. The prelacrimal window approach (PLWA) is a favourable modification that provides excellent visualisation of the maxillary sinus with minimal tissue resection and displacement. We describe the case of an extruded distobuccal 27 tooth root into the anterior maxillary sinus, presenting with acute sinusitis. The patient was successfully managed via a PLWA. This case represents the importance of recognition of ODMS with early referral to otorhinolaryngologists.
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Douglas JE, Patel T, Rullan-Oliver B, Ungerer H, Hinh L, Peterson EL, Kohanski MA, Kennedy DW, Palmer JN, Adappa ND, Craig JR. Odontogenic Sinusitis is a Common Cause of Operative Extra-Sinus Infectious Complications. Am J Rhinol Allergy 2022; 36:808-815. [PMID: 35876310 DOI: 10.1177/19458924221114941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Orbital, intracranial, and osseous extra-sinus complications can arise from bacterial or fungal sinusitis. Odontogenic sinusitis (ODS) can cause extra-sinus complications, but its prevalence remains poorly characterized. OBJECTIVE To determine the frequency of ODS as a cause of operative extra-sinus infectious complications and describe clinical features of all complicated sinusitis cases. METHODS A multi-institutional retrospective review was performed on all operative sinusitis-related extra-sinus complications from 2011 to 2020. ODS was diagnosed by sinus computed tomography (CT) and dental evaluations when available. Demographics, complication types, sinusitis etiologies, and various clinical features were analyzed. RESULTS Forty-five patients were included (mean age 55.5 years, 56% male). Of the extra-sinus complications, 40% were orbital only, 22% intracranial only, 13% osseous only, and 25% involved combined complications. The 2 most common causes of extra-sinus complications were ODS (40%) and mucopyocele (27%). When invasive fungal etiologies were excluded, and only unilateral maxillary opacification on CT was considered, nearly 60% of extra-sinus complications were due to ODS. Unilateral maxillary sinus opacification on CT was present in 100% of complicated ODS compared to 44% of nonodontogenic cases, and oral anaerobes were only identified in ODS cases. No complicated ODS patients underwent dental interventions during hospitalization. CONCLUSION ODS was the most common cause of operative extra-sinus infectious complications. Clinicians should consider ODS high on the differential diagnosis of all patients presenting with complicated sinusitis, especially when sinusitis is unilateral and invasive fungal infection is not suspected.
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Affiliation(s)
- Jennifer E Douglas
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Tapan Patel
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Bianca Rullan-Oliver
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Heather Ungerer
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Lisa Hinh
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Edward L Peterson
- Department of Public Health Sciences, 2971Henry Ford Health, Detroit, Michigan
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - David W Kennedy
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - James N Palmer
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head & Neck Surgery, 6569University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - John R Craig
- Department of Otolaryngology-Head & Neck Surgery, 2971Henry Ford Health, Detroit, Michigan
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Allevi F, Fadda GL, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Treatment of Sinusitis Following Dental Implantation: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2022; 36:539-549. [PMID: 35244478 DOI: 10.1177/19458924221084484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Implantological procedures aimed at rehabilitating upper jaw edentulous patients (dental implant placement and/or maxillary sinus grafting) can sporadically result in sinusitis. In these patients, endoscopic sinus surgery is the most commonly employed treatment, but clinical scenarios and comprehensive management strategies are extremely heterogeneous across studies. OBJECTIVE We sought to systematically define treatment strategies and related success rates for sinusitis following dental implantation, detailing different current treatment choices and concepts. METHODS Adopting a PRISMA-compliant review framework, systematic searches were performed in multiple databases using criteria designed to include all studies published until November 2020 focusing on the treatment of human sinusitis following dental implantation. We selected all original studies, excluding case reports, specifying treatment modalities with objective treatment success definitions. Following duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates, which were pooled in a random-effects meta-analysis. RESULTS Among 581 unique citations, eight studies (181 patients) were selected. Seven studies were retrospective case series. All studies relied on endoscopic sinus surgery, often coupled with intraoral accesses, and assessed therapeutic success endoscopically. The pooled treatment success rate was 94.7% (95% confidence interval, 91.5%-98%). Failures were treated in seven of 15 cases with further antibiotic therapies and in another seven cases with surgical revision. A single patient was lost to follow-up. CONCLUSIONS Endoscopic sinus surgery appears to be the most frequent treatment of choice for sinusitis following dental implantation, with excellent success rates. The protean clinical picture drawn from the selected studies calls for the standardization of diagnostics and definitions in this field to enable direct comparisons between the results of different studies. The role of postoperative antibiotic therapies, which have been employed unevenly across studies, should also be prospectively investigated.
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Affiliation(s)
- Fabiana Allevi
- Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
| | - Gian Luca Fadda
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Cecilia Rosso
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Federica Martino
- Unit of Otorhinolaryngology, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Cavallo
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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31
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Okifo O, Ray A, Gudis DA. The Microbiology of Acute Exacerbations in Chronic Rhinosinusitis - A Systematic Review. Front Cell Infect Microbiol 2022; 12:858196. [PMID: 35402317 PMCID: PMC8988222 DOI: 10.3389/fcimb.2022.858196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acute exacerbations (AE) in chronic rhinosinusitis (CRS) are a common and important clinical issue. However, relatively little is known regarding the underlying microbiology that drives exacerbations or how it relates to the microbiome of CRS. The purpose of this study is to examine the literature to characterize the microbiome associated with acute exacerbations in a chronic rhinosinusitis setting. Understanding this disease process may facilitate targeted antibiotic therapy, reduced antibiotic resistance, and offer more effective disease control and treatment efficacy. Objective To characterize the microbiome associated with acute exacerbations of chronic rhinosinusitis (AECRS). Methods We conducted a systematic review of the literature on Medline, Embase, and Web of Science databases from January 1990-June 2021 to identify studies related to AE in CRS. Exclusion criteria include non-English, non-human studies, and case reports. Studies without culture or PCR data were also excluded. Results Fourteen studies were identified which provided detailed data regarding sinus microbiome in AECRS patients. In these patients, a total of 1252 individual isolates were identified. While common acute pathogens were identified in high frequencies in the sinonasal cultures (Staphylococcus pneumonia, Haemophilus influenza), the predominant bacteria were Staphylococcus aureus (including methicillin-sensitive Staphylococcus aureus) and Pseudomonas aeruginosa. Patient characteristics that may represent higher risk phenotypes were not consistently collected in the studies. Discussion of antimicrobial sensitivities and/or resistance were included in 7/14 studies. Conclusions This systematic review identifies the predominant microbiology species that may contribute to AECRS. Further studies are needed to understand the pathogenic role of bacteria and viruses in AECRS and to identify associated comorbidities and patient phenotypes that may predispose to AE. The optimal treatment regimen for AECRS remains unclear.
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Affiliation(s)
- Oghenefejiro Okifo
- Department of Otolaryngology – Head & Neck Surgery, Henry Ford Health System, Detroit, MI, United States
| | - Amrita Ray
- Department of Otolaryngology – Head & Neck Surgery, Henry Ford Health System, Detroit, MI, United States
- *Correspondence: Amrita Ray,
| | - David A. Gudis
- Department of Otolaryngology Head and Neck Surgery, Columbia University, New York City, NY, United States
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32
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Craig JR. Odontogenic sinusitis: A state‐of‐the‐art review. World J Otorhinolaryngol Head Neck Surg 2022; 8:8-15. [PMID: 35619928 PMCID: PMC9126162 DOI: 10.1002/wjo2.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/01/2021] [Indexed: 01/07/2023] Open
Abstract
Odontogenic sinusitis (ODS) is more common than historically reported, and is underrepresented in the sinusitis literature. ODS is distinct from rhinosinusitis in that it is infectious sinusitis from an infectious dental source or a complication from dental procedures, and most commonly presents unilaterally. ODS clinical features, microbiology, and diagnostic and treatment paradigms are also distinct from rhinosinusitis. ODS evaluation and management should generally be conducted by both otolaryngologists and dental providers, and clinicians must be able to suspect and confirm the condition. ODS suspicion is driven by certain clinical features like unilateral maxillary sinus opacification on computed tomography, overt maxillary dental pathology on computed tomography, unilateral middle meatal purulence on nasal endoscopy, foul smell, and odontogenic bacteria in sinus cultures. Otolaryngologists should confirm the sinusitis through nasal endoscopy by assessing for middle meatal purulence, edema, or polyps. Dental providers should confirm dental pathology through appropriate examinations and imaging. Once ODS is confirmed, a multidisciplinary shared decision‐making process should ensue to discuss risks and benefits of the timing and different types of dental and sinus surgical interventions. Oral antibiotics are generally ineffective at resolving ODS, especially when there is treatable dental pathology. When both the dental pathology and sinusitis are addressed, resolution can be expected in 90%–100% of cases. For treatable dental pathology, while primary dental treatment may resolve the sinusitis, a significant percentage of patients still require endoscopic sinus surgery. For patients with significant sinusitis symptom burdens, primary endoscopic sinus surgery is an option to resolve symptoms faster, followed by appropriate dental management. More well‐designed studies are necessary across all areas of ODS. Odontogenic sinusitis (ODS) is one of the most common cause of unilateral maxillary sinus disease, but has been underrepresented in previous sinusitis literature. Clinicians must be able to suspect ODS based on certain clinical features like unilateral middle meatal purulence on nasal endoscopy, subjective foul smell, and sinus computed tomography demonstrating maxillary sinus opacification with or without overt adjacent dental pathology. Diagnosing ODS requires confirmation of infectious sinusitis by otolaryngologists ideally with nasal endoscopy, and confirmation of adjacent maxillary dental pathology by dental specialists. Management centers on multidisciplinary collaboration and shared‐decision making between otolaryngologists, dental specialists, and patients.
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Affiliation(s)
- John R. Craig
- Department of Otolaryngology‐Head and Neck Surgery Henry Ford Health System Detroit Michigan USA
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Bell G, Howard L, Lamont T. Clinical and radiographic assessment and restoration of maxillary sinus function in relation to oro-antral fistula closure: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:432-441. [PMID: 35490135 DOI: 10.1016/j.oooo.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study was to determine current practice in assessment of maxillary sinus health during oro-antral fistula closure. METHOD A systematic review using specific MeSH headings between 1990 and September 2021 on Medline, Ovid, and PubMed was performed. The inclusion criterion was closure of oro-antral fistula in adult patients. Exclusion criteria were oro-antral fistula arising in children; or from trauma, malignancy, or developmental abnormality; or any osteonecrotic lesion of bone. Risk of bias for individual papers was not assessed. Oxford Centre for Evidence Based Medicine levels of evidence were recorded. RESULTS 4309 papers were identified, and 119 were eligible for review. Nineteen were from otolaryngology (16%), 25 from combined ear, nose, and throat (ENT) and oral/oral and maxillofacial (OS/OMF) surgery (21%), and 75 from OS/OMF surgery (63%). Preoperative rhinoscopy and cross-sectional imaging were reported in 33 papers (28%), reflecting the role of ENT with or without OS/OMFS. Sixty-eight did not record any formal assessment of maxillary sinus health (57%), of which 60 were from OS/OMF surgery (50%). Use of computed tomography was reported in 58 papers (49%), and use of cone beam computed tomography was reported in 8 papers (7%) but did not correlate with assessment of sinus health. DISCUSSION Most surgery for oro-antral fistual closure was undertaken without objective assessment of maxillary sinus health, pre- or postoperatively. The involvement of ENT was associated with formal assessment of maxillary sinus health.
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Affiliation(s)
- Garmon Bell
- Associate Specialist, Oral & Maxillofacial Surgery, Dumfries & Galloway Royal Infirmary, Dumfries, Scotland.
| | - Laura Howard
- Senior House Officer, Dublin University Dental Hospital, Lincoln Place, Dublin, Ireland
| | - Thomas Lamont
- Senior Lecturer in Restorative Dentistry, Dundee Dental Hospital, Dundee, Scotland
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Kwiatkowska MA, Szczygielski K, Chloupek A, Szczupak P, Jurkiewicz D. Clinical characteristics of odontogenic sinusitis with periapical lesions. Am J Otolaryngol 2022; 43:103338. [PMID: 34968816 DOI: 10.1016/j.amjoto.2021.103338] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/11/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Although the symptoms and radiographic signs may mimic rhinogenic sinusitis, odontogenic sinusitis (OS) with periapical lesions (PALs) is fundamentally an endodontic infection. It is considered to be one of the main causes of OS, especially when presented unilaterally. Despite this routine dental examination is not performed and periapical infection frequently remains undiagnosed by otolaryngologists and radiologists. MATERIAL AND METHODS This prospective observational study covered a group of 61 patients with symptomatic OS with PAL. Assessment of quality of life was done using the 22-item Sino-Nasal Outcome Test-22 (SNOT-22) and Oral Health-Impact Profile-14 (OHIP-14). Temporal and etiological relationship between the dental cause and sinonasal complication was established among the otolaryngologist and dental specialist based on the clinical symptoms, nasal endoscopy described according to the modified Lund-MacKay scale, computed tomography (CT) scans measured and scored in compliance with Lund- Kennedy, Zinreich and Estrela scales. RESULTS Out of 61 patients, 28 (46%) were women and 33 (54%) men. Group median age 49.1 years, ranged from 22.8 to 78.9 years. Total OHIP-14 score was 12.7 ± 11.3, with the highest value obtained in domains describing physical pain (mean 2.9 ± 2.4, median 3) in which the highest score was obtained in item 3 - painful aching in mouth and/or teeth - scored ≥2 by 52.5% of participants. Concerning dental symptoms 11.5% of patients were asymptomatic. Total SNOT-22 score was 40.7 ± 21.1, with the highest value in domains describing nasal symptoms. 23% of patients reported mild, 44.3% moderate and 32.7% severe symptoms. In the endoscopic evaluation 86.8% of cases presented discharge, 73.8% mucosal edema. In 11.5% of cases the polypoid tissues was observed in nasal cavities. The first molar tooth was the most frequently affected with an incidence of 42.6%, followed by the second molar (27.9%). In 33 (48.5%) of cases the inflammatory process caused the discontinuity of the sinus floor, which in 51.5% coexisted with total maxillary sinus opacification. 10 teeth (14.7%) had the periapical lesions with a diameter exceeding 8 mm. In case of the multi-rooted teeth, PALs were usually encountered at more than one root (57.4%). Maxillary and ethmoid sinus were affected in 54% of cases and additional frontal sinus involvement in 32.8%. In 69.6% patients, ostiomeatal complex was obstructed. CONCLUSIONS Persistent sinonasal symptoms such as rhinorrhea, post-nasal drip and nose congestion along with dental pain may suggest endodontic nature of OS, especially after previous root-canal treatment. The bigger the PAL is in diameter and the closer to the maxillary sinus, the greater effect on its mucosal involvement and obstruction of ostiomeatal complex is observed. PALs around molar or premolar tooth apexes with coexistence of unilateral sinus opacifications should be noticed and mentioned by radiologists and evaluated by dental specialists in order to refer the patient to further treatment.
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Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020667. [PMID: 35055488 PMCID: PMC8775885 DOI: 10.3390/ijerph19020667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/04/2023]
Abstract
Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.
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Shi-hao DU, YANG C, CHEN S, Sheng-nan GUO, Shan-ze WANG, Wei GUO, Shuo DU, Ji-ping ZHAO. Key questions and outcomes for the Clinical Practice Guideline on Acupuncture and Moxibustion for Allergic Rhinitis. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2022. [DOI: 10.1016/j.wjam.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Combined Endoscopic and Intraoral Approach or Intraoral Alone in Surgical Management of Odontogenic Sinusitis. SURGERIES 2021. [DOI: 10.3390/surgeries2040040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Craig JR, Tataryn RW, Sibley HC, Mason WD, Deuel JA, Loyd GE, Nerenz DR, Goyal P. Expected Costs of Primary Dental Treatments and Endoscopic Sinus Surgery for Odontogenic Sinusitis. Laryngoscope 2021; 132:1346-1355. [PMID: 34418111 DOI: 10.1002/lary.29825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/08/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Treatment of odontogenic sinusitis (ODS) due to apical periodontitis (AP) is highly successful when both dental treatment and endoscopic sinus surgery (ESS) are performed. Variation exists in the literature with regard to types and timing of dental treatments and ESS when managing ODS. This study modeled expected costs of different primary dental and sinus surgical treatment pathways for ODS due to AP. STUDY DESIGN Decision-tree economic model. METHODS Decision-tree models were created based on cost and treatment success probabilities. Using Medicare and consumer online databases, cost data were obtained for the following dental and sinus surgical treatments across the United States: root canal therapy (RCTx), revision RCTx, apicoectomy, extraction, dental implant, bone graft, and ESS (maxillary, ± anterior ethmoid, ± frontal). A literature review was performed to determine probabilities of dental and sinus disease resolution after different dental treatments. Expected costs were determined for primary dental extraction, RCTx, and ESS pathways, and sensitivity analyses were performed. RESULTS Expected costs for the three different primary treatment pathways when dental care was in-network and all diseased sinuses opened during ESS were as follows: dental extraction ($4,753.83), RCTx ($4,677.34), and ESS ($7,319.85). CONCLUSIONS ODS due to AP can be successfully treated with primary dental treatments, but ESS is still frequently required. Expected costs of primary dental extraction and RCTx were roughly equal. Primary ESS had a higher expected cost, but may still be preferred in patients with prominent sinonasal symptoms. Patients' insurance coverage may also impact decision-making. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Roderick W Tataryn
- Tataryn Endodontics, Spokane, Washington, U.S.A.,Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, California, U.S.A
| | - Haley C Sibley
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | | | - Joshua A Deuel
- Department of Oral Maxillofacial Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Gary E Loyd
- Department of Anesthesiology, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - David R Nerenz
- Henry Ford Health System, Department of Neurosurgery, Center for Health Policy and Health Services Research, Detroit, Michigan, U.S.A
| | - Parul Goyal
- Syracuse Otolaryngology, Syracuse, New York, U.S.A
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