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Presence of anaerobic bacteria and symptoms supports diagnosis of odontogenic sinusitis. Am J Otolaryngol 2022; 43:103544. [DOI: 10.1016/j.amjoto.2022.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/24/2022] [Indexed: 11/23/2022]
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2
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Odontogenic Maxillary Sinusitis: The Interface and Collaboration between Rhinologists and Dentists. JOURNAL OF OTORHINOLARYNGOLOGY, HEARING AND BALANCE MEDICINE 2021. [DOI: 10.3390/ohbm2040008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Odontogenic maxillary sinusitis (OMS) is an inflammatory condition affecting the paranasal sinuses and is commonly encountered by both Otorhinolaryngologists and Dentists. However, there is an ongoing debate regarding the best sequence of management. Clinicians are faced with the dilemma of first addressing either the affected tooth or the affected sinus. This paper provides a review of the current literature on the aetiology, presentation, and management of OMS, as well as our experience in managing this condition. Overall, the causative pathology of the patient’s OMS, their symptoms, and the risk of surgery should drive decision making with regards to sequence of management.
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Clinical features in maxillary sinus fungus ball in patients with malignant hematological disease. Eur Arch Otorhinolaryngol 2021; 279:1919-1927. [PMID: 34216265 DOI: 10.1007/s00405-021-06973-5] [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: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies on fungus balls have primarily focused on immunocompetent patients, and only a few studies have described the clinical characteristics of fungus balls in malignant hematological disease (MHD) patients. Therefore, we compared the clinical features of maxillary sinus fungus ball (MSFB) between immunosuppressive patients with MHD and immunocompetent patients. METHODS Twenty patients with MHD and 40 randomly selected immunocompetent patients were enrolled and divided into MHD and non-MHD groups. All patients were diagnosed with MSFB and their clinical features were retrospectively analyzed. RESULTS Patients in the MHD group had non-specific clinical symptoms and endoscopic manifestations of MSFB, similar to those in the non-MHD group. On computed tomography (CT), the MHD group showed higher Lund-Mackay scores, lesser single sinus opacifications, more multiple sinus opacifications on the affected side, and more bilateral opacifications compared to the non-MHD group. The MHD group had a lower frequency of central hyper-density and heterogeneous opacifications than the non-MHD group. There were no significant differences between the two groups in terms of the fungal-infected side, lateral sinus wall ratio, sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and nasal septum deviation. CONCLUSION The clinical symptoms and endoscopic manifestations of MSFB in patients with MHD were similar to those of immunocompetent patients. However, more atypical signs and wider mucosal inflammation were found on CT scans of MSFB patients with MHD. These results indicate that caution should be executed when excluding the possibility of fungus balls in immunosuppressive patients.
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Craig JR, Tataryn RW, Cha BY, Bhargava P, Pokorny A, Gray ST, Mattos JL, Poetker DM. Diagnosing odontogenic sinusitis of endodontic origin: A multidisciplinary literature review. Am J Otolaryngol 2021; 42:102925. [PMID: 33486208 DOI: 10.1016/j.amjoto.2021.102925] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming sinusitis, and dental specialists confirming endodontic sources. The purpose of this study was to conduct a multidisciplinary literature review to highlight clinical and microbiological features of ODS, and the most optimal diagnostic modalities to confirm endodontic disease. METHODS An extensive review of both medical and dental literature was performed by rhinologists, endodontists, and an infectious disease specialist. Frequencies of various clinical and microbiological features from ODS studies were collected, and averages were calculated. Different endodontic testing and imaging modalities were also evaluated on their abilities to confirm endodontic disease. RESULTS ODS patients most often present with unilateral sinonasal symptoms for over 3 months, purulence on nasal endoscopy, and overt dental pathology on computed tomography (CT). Subjective foul smell, and maxillary sinus cultures demonstrating anaerobes and α-streptococci (viridans group) may be more specific to ODS. For endodontic evaluations, cold pulp testing and cone-beam CT imaging are most optimal for confirming pulpal and periapical disease. CONCLUSION Diagnosing ODS requires collaboration between otolaryngologists and dental specialists. Clinicians should suspect ODS when patients present with unilateral sinonasal symptoms, especially foul smell. Patients will generally have purulent drainage on nasal endoscopy, and both sinus opacification and overt dental pathology on CT. However, some patients will have subtle or absent dental pathology on CT. For suspected endodontic disease, endodontists should be consulted for at least cold pulp testing, and ideally cone-beam CT.
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Craig JR, Poetker DM, Aksoy U, Allevi F, Biglioli F, Cha BY, Chiapasco M, Lechien JR, Safadi A, Simuntis R, Tataryn R, Testori T, Troeltzsch M, Vaitkus S, Yokoi H, Felisati G, Saibene AM. Diagnosing odontogenic sinusitis: An international multidisciplinary consensus statement. Int Forum Allergy Rhinol 2021; 11:1235-1248. [PMID: 33583151 DOI: 10.1002/alr.22777] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Odontogenic sinusitis (ODS) is distinct from non-odontogenic rhinosinusitis, and often requires multidisciplinary collaboration between otolaryngologists and dental providers to make the diagnosis. The purpose of this study was to develop international multidisciplinary consensus on diagnosing ODS. METHODS A modified Delphi method was used to assess for expert consensus on diagnosing bacterial ODS. A multidisciplinary panel of 17 authors with ODS expertise from 8 countries (8 otolaryngologists, 9 dental specialists) was assembled. Each author completed 2 of 3 surveys (2 specialty-specific, and 1 for all authors). Thirty-seven clinical statements were created, focusing on 4 important diagnostic components: suspecting ODS; confirming sinusitis in ODS; confirming different dental pathologies causing ODS; and multidisciplinary collaborative aspects of diagnosing ODS. Target audiences were all otolaryngologists and dental providers. RESULTS Of the 37 clinical statements, 36 reached consensus or strong consensus, and 1 reached no consensus. Strong consensus was reached that certain clinical and microbiologic features should arouse suspicion for ODS, and that multidisciplinary collaboration between otolaryngologists and dental providers is generally required to diagnose ODS. To diagnose ODS, otolaryngologists should confirm sinusitis mainly based on nasal endoscopic findings of middle meatal purulence, edema, or polyps, and dental providers should confirm dental pathology based on clinical examination and dental imaging. CONCLUSION Based on multidisciplinary international consensus, diagnosing ODS generally requires otolaryngologists to confirm sinusitis, and dental providers to confirm maxillary odontogenic pathology. Importantly, both dental providers and otolaryngologists should suspect ODS based on certain clinical features, and refer patients to appropriate providers for disease confirmation.
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Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI
| | - David M Poetker
- Department of Otolaryngology- Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, WI.,Division of Surgery, Zablocki VAMC, Milwaukee, WI
| | - Umut Aksoy
- Division of Surgery, Zablocki VAMC, Milwaukee, WI.,Department of Endodontics, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Fabiana Allevi
- Department of Health Sciences, San Paolo and Carlo Hospital, Maxillofacial Surgery, University of Milan, Milan, Italy
| | - Federico Biglioli
- Division of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, CT
| | - Bruce Y Cha
- Division of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, CT
| | - Matteo Chiapasco
- Department of Biomedical, Surgical, and Dental Sciences, San Paolo and Carlo Hospital, Oral Surgery Unit, University of Milan, Milan, Italy
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Saint-Aubin, France
| | - Ahmad Safadi
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Regimantas Simuntis
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Roderick Tataryn
- Tataryn Endodontics, Spokane, WA.,Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA
| | - Tiziano Testori
- Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Saulius Vaitkus
- Department of Otolaryngology-Head and Neck Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hidenori Yokoi
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University, Tokyo, Japan
| | - Giovanni Felisati
- Department of Health Sciences, San Paolo and Carlo Hospital, Otolaryngology Unit, University of Milan, Milan, Italy
| | - Alberto M Saibene
- Department of Health Sciences, San Paolo and Carlo Hospital, Otolaryngology Unit, University of Milan, Milan, Italy
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Allevi F, Fadda GL, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Diagnostic Criteria for Odontogenic Sinusitis: A Systematic Review. Am J Rhinol Allergy 2020; 35:713-721. [PMID: 33236664 DOI: 10.1177/1945892420976766] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Odontogenic sinusitis affects a significant proportion of patients with paranasal sinus infections. Nevertheless, no shared diagnostic criteria for this condition have yet been implemented and published studies differ in their definition of the disease. OBJECTIVE The present systematic review of the literature was undertaken to characterize and analyze the different diagnostic criteria currently employed for odontogenic sinusitis. METHODS Systematic searches for studies published between 2009 and 2019 were performed in Medline, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Search criteria were designed to identify all studies focusing, even partially, on odontogenic sinusitis. Human original studies except single case reports published in the English, French, German, Spanish, or Italian language were included. We removed duplicate abstracts and conducted full-text reads, data extraction, and quality assessment procedures (using the Oxford Centre for Evidence-based Medicine levels of evidence and National Heart Lung and Blood Institute Study Quality Assessment Tools). We reviewed articles for diagnostic criteria, both in terms of definition and etiology identification. RESULTS Among 1,000 unique citations, 63 studies were deemed eligible. Most articles (n = 45) were retrospective case series; a single randomized clinical trial was available. Only 49 studies reported diagnostic criteria, yet relied marginally on published guidelines (n = 10 articles) for identifying sinusitis, often choosing instead to develop their own clinical (n = 15 articles), endoscopic (n = 12 articles), and/or radiologic (n = 30 articles) criteria. For odontogenic focus identification, 14 papers required a multidisciplinary evaluation, 11 papers required a time relationship between dental procedures and sinusitis, 24 papers required oroscopy and/or dental evaluation, and 53 papers required computed tomography. CONCLUSIONS Current diagnostic criteria for odontogenic sinusitis are extremely heterogeneous. Establishing shared diagnostic criteria aimed at defining both sinusitis and related odontogenic foci would spur collaboration between investigators and support more comprehensive outcomes evaluations together with a better understanding of treatment options.
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Affiliation(s)
- Fabiana Allevi
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy
| | - Gian Luca Fadda
- Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Cecilia Rosso
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Federica Martino
- Unit of Otorhinolaryngology, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Alberto Maria Saibene
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
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Patrick A, Saeed K, Kumar N. Multiple myeloma and pulmonary aspergillosis: dental treatment prior to chemotherapy and management of post extraction complications. BMJ Case Rep 2020; 13:13/4/e235038. [DOI: 10.1136/bcr-2020-235038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This case study discusses the dental management of a patient with a history of multiple myeloma and pulmonary aspergillosis, whom was referred to a hospital-based dental service for urgent dental review. The patient had received a dental assessment in primary care prior to commencement of chemotherapy and had four teeth extracted without complications. However, following the commencement of chemotherapy, he presented with a significant infection associated with two of his wisdom teeth resulting in extraction. Despite atraumatic extraction, the upper right wisdom tooth socket developed an oroantral fistula. A multidisciplinary team approach was required to enable effective patient management in this complex patient regarding myeloma, aspergillosis and the medications used including bisphosphonates and chemotherapy. It highlights the higher risk of oral complications that can arise in myelosuppressed patients and emphasises the need to identify potential sources of dental infection prior to the commencement of chemotherapy.
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Analysis of Treatment Outcome Associated with Pre-Operative Diagnostic Accuracy Changes and Dental Treatment Timing in Odontogenic Sinusitis Involving Unilateral Maxillary Sinus. ACTA ACUST UNITED AC 2019. [DOI: 10.3342/kjorl-hns.2018.00703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cha H, Song Y, Bae YJ, Won TB, Kim JW, Cho SW, Rhee CS. Clinical Characteristics Other Than Intralesional Hyperdensity May Increase the Preoperative Diagnostic Accuracy of Maxillary Sinus Fungal Ball. Clin Exp Otorhinolaryngol 2019; 13:157-163. [PMID: 31674170 PMCID: PMC7248610 DOI: 10.21053/ceo.2019.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives This study aimed to evaluate the clinical characteristics of maxillary sinus fungus ball (MFB) to increase the preoperative diagnostic accuracy. Methods A retrospective review of 247 patients who underwent endoscopic sinus surgery for unilateral maxillary sinusitis from January 2015 to December 2017 at a single institution was performed. Patients with pathologically proven MFB were compared to those with unilateral chronic maxillary sinusitis (CMS). Patient demographics and computed tomography (CT) findings were evaluated. The CT features were categorized as intralesional hyperdensity (calcification), the irregular lobulated protruding lesion (fuzzy appearance), maxillary sinus full haziness without mass effect, maxillary sinus full haziness with mass effect, and others. A regression tree analysis was performed. Results In total, 247 patients were analyzed; among them, 179 (72.5%) had MFB and 68 (27.5%) had CMS. MFB showed predominance in older individuals. Among the radiological features, intralesional hyperdensity was most commonly associated with MFB. The presence of a fuzzy appearance or full opacity with mass effect was also associated with MFB. The highest area under the curve was noted with the regression tree analysis based on the model, which included the presence of intralesional hyperdensity, demographic data (age), and presence of fuzzy appearance or maxillary sinus full haziness with mass effect in case of absence of intralesional hyperdensity (0.904). Conclusion A simple algorithm to optimize the preoperative diagnosis of MFB was developed. Physicians should be aware of such findings in the management of patients presenting with unilateral CMS.
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Affiliation(s)
- Hyunkyung Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjae Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Impact of odontogenic chronic rhinosinusitis on general health-related quality of life. Eur Arch Otorhinolaryngol 2018; 275:1477-1482. [DOI: 10.1007/s00405-018-4977-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 12/16/2022]
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Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment. Curr Opin Otolaryngol Head Neck Surg 2018; 26:27-33. [DOI: 10.1097/moo.0000000000000430] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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