Recognizing odontogenic sinusitis: A national survey of otolaryngology chief residents

Odontogenic Factors Associated with Maxillary Sinus Schneiderian Membrane Thickness and their Relationship to Chronic Sinonasal Symptoms: An Ambispective Cohort Study

Odontogenic sinusitis is a common maxillary sinus disease. It develops due to the violation of the Schneiderian membrane due to pathological, iatrogenic, or traumatic causes from dental and dentoalveolar structures. The aim of this cohort study was to investigate local and systemic factors associated with Schneiderian mucosal thickening (MT) in patients referred for evaluation of apical periodontitis (AP) and examine their relationship with chronic sinonasal symptoms. Cone-beam computed tomography (CBCT) scans of 197 patients referred for evaluation of endodontic diseases were reviewed. Mucosal thickening in relation to the affected tooth was measured in the coronal section in millimeters at the maximum area perpendicular to the bone. Based on this measurement, the sinus floor was categorized for MT as present (>1 mm) or absent (<1 mm). The sociodemographic and clinical characteristics of the study participants were assessed and compared according to the presence or absence of MT. Furthermore, the relationship between odontogenic sinusitis and chronic sinonasal symptoms was assessed using a chronic sinusitis survey. Male patients had a higher MT than female patients. The presence of periapical lesions and inadequate endodontic treatment were significantly associated with MT. The multivariate logistic regression model showed that the presence of AP increased the odds of MT by approximately 2.5 times (p = 0.028), and nasal obstruction was significantly higher in patients diagnosed with mucosal thickness at different times of their follow-up period (p = 0.018). MT was 2.5 times more likely in the presence of apical periodontitis, and nasal obstruction was the most significant factor associated with the presence of MT.

Visualization of clinically silent, odontogenic maxillary sinus mucositis originating from periapical inflammation using MRI: a feasibility study

OBJECTIVES

Maxillary sinus mucositis is frequently associated with odontogenic foci. Periapical inflammation of maxillary molars and premolars cannot be visualized directly using radiation-based imaging. The purpose of this study was to answer the following clinical question: among patients with periapical inflammatory processes in the maxilla, does the use of magnetic resonance imaging (MRI), as compared to conventional periapical (AP) and panoramic radiography (OPT), improve diagnostic accuracy?

METHODS

Forty-two subjects with generalized periodontitis were scanned on a 3 T MRI. Sixteen asymptomatic subjects with mucosal swelling of the maxillary sinus were enrolled in the study. Periapical edema was assessed using short tau inversion recovery (STIR) sequence. Apical osteolysis and mucosal swelling were assessed by MRI, AP, and OPT imaging using the periapical index score (PAI). Comparisons between groups were performed with chi-squared tests with Yates' correction. Significance was set at p < 0.05.

RESULTS

Periapical lesions of maxillary premolars and molars were identified in 16 subjects, 21 sinuses, and 58 teeth. Bone edema and PAI scores were significantly higher using MRI as compared to OPT and AP (p < 0.05). Using the STIR sequence, a significant association of PAI score > 1 and the presence of mucosal swelling in the maxillary sinus was detected (p = 0.03).

CONCLUSION

Periapical inflammation and maxillary mucositis could be visualized using STIR imaging. The use of MRI may help detect early, subtle inflammatory changes in the periapical tissues surrounding maxillary dentition. Early detection could guide diagnostic criteria, as well as treatment and prevention.

Healing of Unilateral Maxillary Sinusitis by Endodontic and Periodontal Treatment of Maxillary Teeth

Inflammatory conditions of dental origin may spread to the bone tissue, causing its destruction, and to anatomical structures located in the vicinity of the tooth affected with inflammation. Maxillary premolars and molars may develop inflammatory lesions of the Schneiderian membrane and lead to tooth-borne lesions in the maxillary sinuses. Unilateral inflammation of the maxillary sinuses should be diagnosed and treated. The aim of this study was to determine whether and after what time from the applied endodontic or nonsurgical periodontal treatment the inflammation in the maxillary sinus was diminished (assessed by the decrease in the Schneiderian membrane hypertrophy). A retrospective study was performed to analyze the records of endodontically, periodontally, or endodontically-periodontally treated patients with unilateral inflammation of the maxillary sinuses along with diagnostic Cone Beam Computed Tomography. The method for determination of the inflammation was measurements registered in millimeters in Carestream software. The analysis included the situation before treatment and 3 months, 6 months, and 12 months after completion of the treatment. Regardless of the origin of the maxillary sinus lesion, healing of inflammation of the sinus has been reported after the implementation of causative treatment of the maxillary tooth. Dental treatment reduces the need to implement conservative or surgical ENT treatment.

An unusual case of unilateral sinus disease may reveal the presence of a retained foreign body

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Unilateral sinus disease (USD) can be due to a wide range of conditions.

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This report presents the case of a patient with a foreign body retained in the left maxillary sinus.

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The patient underwent a functional endoscopic sinus surgery (FESS) with septoplasty.

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Besides being peculiar for the onset of clinical symptoms, this case highlights the importance of occupational safety measures to prevent foreign body aspiration.

Introduction

Differential diagnosis of unilateral sinus disease (USD) is important in clinical practice as it can be broad, and for which timely and effective treatment is important. With this report we would like to present a case of a patient with a foreign body retained in the left maxillary sinus for eight years.

Presentation of case

A 50-year-old gardener referred to have been injured on the job in 2010. Even though he was wearing his safety helmet with face shield and earmuffs, he had the sensation to have been hit by an object coming from the soil, while he was using his grass trimmer. However, the patient was asymptomatic with no complications. After eight years, the man started experiencing left nasal obstruction associated with purulent discharge and ipsilateral headache. A fetid odor coming from inside the nose and described as “the carcass of a dog” led him to seek medical attention. The patient underwent a functional endoscopic sinus surgery (FESS) with septoplasty and a foreign body, consisting of a metal nail, was retrieved.

Discussion

This case highlights a two key learning points. The first one concerns occupational safety measures; full-face shield helmets are the best option and should be employed in order to avoid the penetration of any possibly dangerous materials. Secondly, grass trimmers with more sophisticated designs are required in order to prevent injuries like this.

Conclusions

Besides being peculiar because of the onset of clinical symptoms, this case report highlights the importance of full-face shield helmets and certified machinery.