Systemic and Odontogenic Etiologies in Chronic Rhinosinusitis

Imaging of the Sinonasal Cavities

This article describes the various abnormalities that affect the sinonasal cavities and discusses inflammations, tumors, and tumor-like conditions. Specific imaging evaluations that focus on the sinonasal cavities are described in more detail.

CBCT Evaluation of Periapical Pathologies in Maxillary Posterior Teeth and Their Relationship with Maxillary Sinus Mucosal Thickening

In modern dentistry, radiographic imaging is crucial for examining the connection between the maxillary sinus floor and the root apices of the maxillary posterior teeth, particularly when the periapical region is affected by pathology that could result in infectious, inflammatory, or traumatic changes in the maxillary sinus. This study aimed to investigate the prevalence of periapical pathologies in the maxillary posterior teeth and their relationship with maxillary sinus mucosal thickening by using cone-beam computed tomography scans. This retrospective study was conducted on 420 digitized CBCT images which were scanned in sagittal, axial, and coronal views. Out of 420 total images, 223 (53.1%) were of males and 197 (44.9%) were of females. The data were analyzed using SPSS version 28. A total of 2936 posterior maxillary teeth were tested for periapical pathology (PP), 1477 on the right side and 1459 on the left side. In terms of gender, there was no significant relationship between PP in maxillary posterior teeth on both sides and mucosal thickness of the maxillary sinus (p > 0.05). A significant relationship was found between PP in maxillary posterior teeth on both sides and maxillary sinus mucosal thickening (p < 0.05). This study concluded that the prevalence of periapical pathology in the maxillary posterior teeth was significantly associated with a rise in the incidence of maxillary sinus mucosal thickening. Moreover, the primary causative factor for the pathophysiology of the odontogenic maxillary sinus was the periapical pathology in both maxillary first molars.

Microbiota dysbiosis in odontogenic rhinosinusitis and its association with anaerobic bacteria

Odontogenic rhinosinusitis is a subtype of rhinosinusitis associated with dental infection or dental procedures and has special bacteriologic features. Previous research on the bacteriologic features of odontogenic rhinosinusitis has mainly used culture-dependent methods. The variation of microbiota between odontogenic and nonodontogenic rhinosinusitis as well as the interplay between the involved bacteria have not been explored. Therefore, we enrolled eight odontogenic rhinosinusitis cases and twenty nonodontogenic rhinosinusitis cases to analyze bacterial microbiota through 16S rRNA sequencing. Significant differences were revealed by the Shannon diversity index (Wilcoxon test p = 0.0003) and PERMANOVA test based on weighted UniFrac distance (Wilcoxon test p = 0.001) between odontogenic and nonodontogenic samples. Anaerobic bacteria such as Porphyromonas, Fusobacterium, and Prevotella were significantly dominant in the odontogenic rhinosinusitis group. Remarkably, a correlation between different bacteria was also revealed by Pearson's correlation. Staphylococcus was highly positively associated with Corynebacterium, whereas Fusobacterium was highly negatively correlated with Prophyromonas. According to our results, the microbiota in odontogenic rhinosinusitis, predominantly anaerobic bacteria, was significantly different from that in nonodontogenic rhinosinusitis, and the interplay between specific bacteria may a major cause of this subtype of rhinosinusitis.

Evaluation of the effect of periapical lesions and other odontogenic conditions on maxillary sinus mucosal thickness characteristics and mucosal appearance: A CBCT study

Background. This retrospective study aimed to investigate the effect of various dental and maxillary sinus variables on maxillary sinus mucosal thickness (MT). The variables included periodontal bone loss (PBL), periapical status, dental restorations of posterior maxillary teeth, and the distance from the root apices to the sinus mucosa.

Methods. Cone-beam computed tomography (CBCT) images of the maxillary sinuses (n = 600) in 300 patients were examined. The sinus MT and the distance of the roots from maxillary sinuses were measured. Apical lesions of the roots, PBL, and situations of adjacent teeth were recorded. The relationships between these conditions and MT and characterization of MT were evaluated. The Kruskal–Wallis H test was used to compare groups due to the non-normal distribution of the data. The relationship between categorical variables was analyzed using chi-squared test.

Results. There was a significant correlation between maxillary sinus MT and periapical lesions, PBL, and restorations (P < 0.05). MT increased as the apical lesions of premolar teeth enlarged (P < 0.05, P = 0.022). MT increased in cases of mild PBL of molar teeth (P = 0.041).

Conclusion. In this retrospective study, the MT significantly increased in patients with periapical lesions, inadequate endodontic treatment, increased PBL, and inadequate dental restorations.

Classification of sinonasal pathology associated with dental pathology or dental treatment

BACKGROUND

The pathologies of the posterior teeth in the first and second quadrant and their treatments can be associated with pathology of the maxillary sinus in up to 30% of the cases. Sinus lift surgery in order to place dental implants have increased their incidence. It is necessary, therefore, to address sinonasal pathology (SN) related to dental pathology (DP) or dental treatments (DT) from an interdisciplinary point of view by establishing collaborative working groups between Dentistry (DEN) and Otolaryngology (ENT), as well as by developing registries and establishing coordinated diagnosis and treatment protocols of sinonasal pathology. The aim of this study was to present a brand new and useful classification that relates dental pathology and dental treatments performed on antral teeth with sinonasal pathology to facilitate communication between dentists and otolaryngologists.

METHODS

A review of the literature was performed and a classification which related dental pathology and treatments to sinonasal pathology was developed.

RESULTS

Six categories are described in our system: absence of sinonasal or dental pathology (0); patients with dental pathology associated (1) or not (4) with sinonasal pathology; 2 and 5- patients with dental treatment not associated (2) or associated (5) with sinonasal pathology; and patients with sinonasal pathology without dental pathology (3). The classification has applications in diagnosis (association and possible causal relationship between the sinonasal and dental pathology) and in the treatment of these pathologies simultaneously or sequentially.

CONCLUSIONS

This classification integrates the presence or absence of dental pathology or dental treatment, and its association or not it with sinonasal pathology. Moreover, it facilitates the communication between dentists and otolaringologists and eases the registration of information and the planning of dental, implant and sinus lift treatments.

Dental Emergencies: A Practical Guide

Dental disease is a frequent finding on head and neck images, especially in the context of emergencies, and can be a challenge for radiologists who are inexperienced with findings of dental trauma or disease. Dental abnormalities can be subtle and therefore must be included in the systematic approach to these images. Although dedicated dental images are not acquired in most emergency cases, the teeth are included on many different images of the head and neck, and their initial evaluation seldom requires a specific protocol. The high prevalence of craniofacial trauma, sinus infection, and maxillomandibular procedures, among other conditions, frequently requires interpretation of dental images in daily emergency practice. The imaging findings can be categorized into infection, trauma, and complications of procedures, although sometimes these categories can overlap. Such categories can help the radiologist decide which imaging protocol and dynamic maneuvers should be used and are also useful when reading images and proposing differential diagnoses. Familiarity with the imaging findings of dental emergencies improves the radiologist's diagnostic confidence and role in guiding patient care, avoiding progression to life-threatening conditions, and reducing aesthetic problems, dental loss, and related conditions. Information about the imaging protocols is provided, the relevant anatomy of the teeth and related structures is reviewed, and the key imaging findings of dental emergencies are presented.^©RSNA, 2019.

The incidence of anaerobic bacteria in adult patients with chronic sinusitis: A prospective, single-centre microbiological study

INTRODUCTION

Chronic sinusitis caused by anaerobes is a particular concern clinically, because many of the complications are associated with infections caused by these organisms. The aim of this study was to evaluate the incidence of anaerobic bacteria in chronic sinusitis in adults as a part of a prospective microbiological study.

MATERIALS AND METHODS

Over a one-year period, aspirations of maxillary sinus secretions and/or ethmoid cavities were derived in n = 79 adult patients with chronic sinusitis by endoscopy in a tertiary-care teaching hospital in Hungary. The qualitative and quantitative compositions of the total cultivable aerobic and anaerobic bacterial and fungal flora cultured on the samples were compared. Correct anaerobic species level identifications were carried out according to standard methods.

RESULTS

Bacteria were recovered for all of the 79 aspirates and the numbers of the significant cultured isolates (with colony forming units ≥103) were between 1 and 10. A total of 206 isolates, 106 anaerobic and 100 aerobic or facultative-anaerobic strains were isolated. The most common aerobic bacteria were Streptococcus pneumoniae (n = 40), Haemophilus influenzae (n = 29), Moraxella catarrhalis (n = 6), Staphylococcus aureus (n = 7) and Streptococcus pyogenes (n = 6). The anaerobic bacteria included black-pigmented Prevotella spp. and Porphyromonas spp. (n = 27), Actinomyces spp. (n = 13), Gram-positive anaerobic cocci (n = 16), Fusobacterium spp. (n = 19) and Cutibacterium acnes (n = 8).

CONCLUSIONS

This study illustrates the microbial dynamics in which anaerobic and aerobic bacteria prevail and highlights the importance of obtaining cultures from patients with chronic sinusitis for guidance in selection of proper antimicrobial therapy.

Assessment of relationship between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography

Background/purpose

Maxillary posterior teeth have close anatomical proximity to the maxillary sinus floor. The aim of this retrospective study was to evaluate the associations between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography (CBCT).

Materials and methods

CBCT images were collected from 235 Taiwanese patients. The sinus mucosal thickening >2 mm is considered a pathologic sinus membrane. Demographic data such as sex, age, the thickness of sinus membrane, and the adjacent teeth health were recorded, graded, and analyzed.

Results

A total prevalence of maxillary sinus membrane thickening of 36.6% (86/235) was found in this study. The sinus membrane thickening was significantly associated with periodontal bone loss (p < 0.001) and periapical lesions (p < 0.001), respectively. A multivariate logistic regression model demonstrated that males had a significantly higher risk of sinus membrane thickening than females (OR: 2.08, 95% CI = 1.21–3.56). The patients in the age group ≥60 years showed a 4.35-fold increased risk of sinus membrane thickening compared with the patients in the age group ≤35 years (95% CI: 1.94–9.77). Severe periodontal bone loss was significantly associated with mucosal thickening with an OR of 4.78 as compared with normal to mild group (95% CI: 1.69–13.58). The patients having teeth with apical lesions had a 5.04 time OR for sinus membrane thickening than those having teeth without apical lesions (95% C.I.: 2.37–10.69).

Conclusion

The prevalence of maxillary sinus membrane thickening was more frequently occurred in male and older people. Periodontal bone loss and periapical lesions were significantly associated with maxillary sinus membrane thickening.

Treatment Paradigm for Nasal Airway Obstruction

Nasal airway obstruction (NAO) is a common otolaryngic complaint with many potential causes, frequently structural or inflammatory in nature. Patients typically have multiple coexisting factors leading to symptoms. Good patient outcomes require careful preoperative evaluation, including nasal endoscopy, to accurately identify sources of obstruction and tailor intervention appropriately. Common structural causes of NAO include inferior turbinate hypertrophy, nasal septal deviation, and narrowing or collapse of the internal or external nasal valves. The internal nasal valve has the narrowest cross-sectional area within the nasal airway and is thus most sensitive to changes in dimension due to anatomic variation or surgical intervention.

Odontogenic sinusitis: A review of the current literature

Objectives

To present current literature on the topic of odontogenic sinusitis.

Data Source

PubMed literature search for odontogenic sinusitis.

Results

Odontogenic sinusitis is an inflammatory condition of the paranasal sinuses that is the result of dental pathology, most often resulting from prior dentoalveolar procedures, infections of maxillary dentition, or maxillary dental trauma. Infections are often polymicrobial with an anaerobe-predominant microbiome requiring special considerations for antimicrobial therapy. Medical management and treatment of the underlying dental pathology remains a critical initial step in the treatment of odontogenic sinusitis, however recent literature suggests that a significant portion of patients may require endoscopic sinus surgery for successful disease resolution.

Conclusions

This review describes the essential epidemiological and etiological factors, relevant clinical findings and diagnostic modalities, microbiologic and antimicrobial considerations, as well as the medical and surgical treatment approaches commonly utilized for the management of odontogenic sinusitis.

Level of Evidence

NA.

How to Assess, Control, and Manage Uncontrolled CRS/Nasal Polyp Patients

PURPOSE OF REVIEW

Chronic rhinosinusitis (CRS) is a multidimensional inflammatory disorder of the nose and paranasal sinuses. We reviewed the recent literature to identify improved methods to assess, control, and manage these difficult to control patients.

RECENT FINDINGS

The role of endotyping in CRS has offered a better understanding of the underlying pathophysiology and allows for more targeted treatment. The understanding of systemic disorders and their role in CRS and the importance of topical treatment reaching the sinuses has also allowed for better control of these patients. We have provided some of the commonly identified causes for uncontrolled CRS and a sensible approach to assessing these patients. We have also focused on common areas of pitfalls in the surgery and choice of patients and the role for ongoing systemic treatment. The future of managing this difficult condition includes endotyping using inflammatory markers and individualizing the treatment to the patient by using specific monoclonal antibodies.

Detection of Dental Pathologies in Routine Paranasal CT Scans: A Retrospective Study

INTRODUCTION

Multidetector Computed Tomography (MDCT) is a widespread method for evaluating paranasal sinuses and nasal cavity in daily practice. The maxillary teeth are in field of view in a paranasal sinus CT scan and it is possible to detect dental pathologies with CT.

AIM

To determine the incidence of maxillary teeth pathologies in routine paranasal sinus CT scans.

MATERIALS AND METHODS

A retrospective study was conducted. Consecutive 395 paranasal sinus CT scans were evaluated. All CT images were obtained with a 64 detector-CT. Patients with previous facial trauma, operation, invasive tumors and repeated exams were excluded. Detected findings were classified as "tooth loss, dental restorations or procedures and dental pathologies (carious lesions, dental developmental anomalies, periapical lesions and periodontal diseases). The proportion of findings was reported as simple percentiles.

RESULTS

Three hundred and eighty-four CT scans were included in the study. Dental restorations or procedures were determined in 129 (33.5%) patients. A total of 34 (8.8%) patients had normal teeth count and morphology. A total of 264 (64.3%) patients had at least one tooth loss. A total of 195 (51%) patients had at least one or more dental pathology. Number of dental carious lesions, dental developmental anomalies, periapical lesions and periodontal disease were 104 (27.0%), 78 (14.3%), 46 (11.9%), 44 (11.4%), respectively.

CONCLUSION

Dental pathologies were encountered in more than half of the patients. Detecting dental pathologies may prevent tooth loss and improve oral health. The radiologist should keep in mind dental pathologies while evaluating paranasal sinus CT in daily practice.