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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 Otorhinolaryngol Ital 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhao X, Li Z, Liu J. The Necessity of Subsequent Dental Treatment for Odontogenic Sinusitis After Endoscopic Sinus Surgery. Ear Nose Throat J 2023:1455613231196105. [PMID: 37681249 DOI: 10.1177/01455613231196105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To investigate the necessity of subsequent dental treatment for patients with odontogenic sinusitis (OS) after endoscopic sinus surgery (ESS). METHODS OS patients who received ESS from January 2018 to May 2022 were eligible. Demographic data, medical history, Lund-Mackay (LM) computed tomography (CT) score, Lund-Kennedy (LK) endoscopic score, and OS-specific CT score were recorded and analyzed. All patients were followed up for 6 months after surgery. RESULTS A total of 48 patients (30 males and 18 females) were enrolled. A total of 35 cases (72.9%) were caused by dental diseases (periapical periodontitis), and 13 cases (27.1%) were caused by iatrogenic factors (including tooth extraction or implantation). The overall treatment success rate was 97.9%, and the success rates in the dental disease OS group (97.1%) and the iatrogenic OS group (100%) were not significantly different (X2 = 0.329, P = .729). None of the patients in the dental disease group received treatment of the causative teeth within 6 months after the operation, except for one patient who received tooth extraction treatment 6 months after the operation. CONCLUSION Without considering the impact of dental disease on patients' oral health, OS can be completely alleviated by ESS alone, even if no dental treatment is carried out after surgery.
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Affiliation(s)
- Xiaochang Zhao
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zufei Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jinfeng Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Rangics A, Répássy GD, Gyulai-Gaál S, Dobó-Nagy C, Tamás L, Simonffy L. Management of Odontogenic Sinusitis: Results with Single-Step FESS and Dentoalveolar Surgery. J Pers Med 2023; 13:1291. [PMID: 37763059 PMCID: PMC10532572 DOI: 10.3390/jpm13091291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Odontogenic sinusitis (OS) is a well-known and important border of specialties in otorhinolaryngology and dentoalveolar surgery. Odontogenic sinusitis can develop due to iatrogenic harm or odontogenic infection. The gold standard diagnostic method is clinical and radiological-CBCT (cone beam computed tomography)-examination. The treatment of this condition requires collaboration between ENT and dentoalveolar surgery specialists and can be non-surgical or surgical based on staging. This paper aims to share the results of our clinical study whereby complex therapy was administered by a dentoalveolar surgeon and an otorhinolaryngologist in cooperation. PATIENTS AND METHODS We conducted a retrospective study comprising 111 OS patients who underwent complex therapy between 2016 and 2023 at Semmelweis University, Budapest, Hungary. All patients were treated with concurrent FESS (functional endoscopic sinus surgery) and dentoalveolar surgery. Follow-up was based on symptoms, clinical examination and CBCT imaging. RESULTS Of the 111 patients, 107 were successfully treated with concurrent FESS and dentoalveolar surgery, and only 4 had further symptoms following the complex therapy and needed retreatment. CONCLUSIONS The complex, single-session therapy involving FESS and oral surgery is an effective treatment method, which is less invasive and associated with fewer complications compared to previous interventions, such as the Luc-Caldwell procedure.
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Affiliation(s)
- Anna Rangics
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1085 Budapest, Hungary; (A.R.); (S.G.-G.); (C.D.-N.); (L.S.)
| | - Gábor Dénes Répássy
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Szabolcs Gyulai-Gaál
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1085 Budapest, Hungary; (A.R.); (S.G.-G.); (C.D.-N.); (L.S.)
| | - Csaba Dobó-Nagy
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1085 Budapest, Hungary; (A.R.); (S.G.-G.); (C.D.-N.); (L.S.)
| | - László Tamás
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
- Department of Voice Speech and Swallowing Therapy, Faculty of Health Sciences, Semmelweis University, 1085 Budapest, Hungary
| | - László Simonffy
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1085 Budapest, Hungary; (A.R.); (S.G.-G.); (C.D.-N.); (L.S.)
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Alghofaily M, Alsufyani N, Althumairy RI, AlSuhaibani A, Alfawzan F, AlSadhan L. Odontogenic Factors Associated with Maxillary Sinus Schneiderian Membrane Thickness and their Relationship to Chronic Sinonasal Symptoms: An Ambispective Cohort Study. Diagnostics (Basel) 2023; 13:2710. [PMID: 37627969 PMCID: PMC10453369 DOI: 10.3390/diagnostics13162710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
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.
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Affiliation(s)
- Maha Alghofaily
- Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia
| | - Noura Alsufyani
- Oral & Maxillofacial Radiology, Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia
- School of Dentistry, Department of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Riyadh I. Althumairy
- Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia
| | - Amal AlSuhaibani
- College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia; (A.A.); (F.A.); (L.A.)
| | - Fatimah Alfawzan
- College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia; (A.A.); (F.A.); (L.A.)
| | - Lama AlSadhan
- College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia; (A.A.); (F.A.); (L.A.)
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Watanabe S, Shibata Y, Ishikawa E. Brain Abscess Due to Dental Sinusitis: A Case Report on Incomplete Infection Defense Associated With a Post-Fusion Linear Skull Fracture. Cureus 2023; 15:e43941. [PMID: 37746460 PMCID: PMC10513899 DOI: 10.7759/cureus.43941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Brain abscess is a pyogenic disease secondary to a bacterial, tuberculous, or fungal infection of the brain; thus, early detection and treatment are of crucial importance. Herein, we present a case of a brain abscess arising from dental sinusitis due to an incomplete infection defense mechanism linked to a post-fusion linear skull fracture. The patient initially presented with a persistent headache, which was diagnosed as frontal sinusitis. Consequently, antibiotic treatment was started. However, due to a refractory response to antibiotics, MRI was performed, which revealed a brain abscess in the frontal lobe adjacent to the right frontal sinus measuring 40 mm in diameter. This abscess was surgically drained and cultured. Initially, the patient was treated with three antibiotics, which were eventually de-escalated. The cultures revealed nasal commensal bacteria, suggesting a direct spillover from sinusitis leading to a brain abscess. A tooth with root inflammation, which had been left untreated and resulted in bone melting of the maxillary sinus wall, was extracted. After more than eight weeks of antimicrobial therapy, improvement in the clinical and imaging findings was noted, and the patient was discharged. Brain abscesses may develop from sinusitis even after linear fractures have healed due to a continued incomplete infection defense mechanism. Moreover, root and sinus infections should undergo evaluation, including the upper dental crown using coronal computed tomography, and treatment should be initiated promptly.
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Affiliation(s)
- Shinya Watanabe
- Department of Neurosurgery, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, Mito, JPN
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Yasushi Shibata
- Department of Neurology, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, Mito, JPN
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
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Nair AK, Jose M, Sreela LS, Prasad TS, Mathew P. Prevalence and pattern of proximity of maxillary posterior teeth to maxillary sinus with mucosal thickening: A cone beam computed tomography based retrospective study. Ann Afr Med 2023; 22:327-332. [PMID: 37417021 PMCID: PMC10445722 DOI: 10.4103/aam.aam_74_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 01/28/2023] [Accepted: 02/07/2023] [Indexed: 07/08/2023] Open
Abstract
Context Odontogenic sinusitis is a prevalent but frequently unrecognized condition, and periapical pathologies of maxillary posterior teeth are accused as one of the main causative factors. Aim This study aimed to evaluate the relationship between the periapical status of maxillary posterior teeth and its proximity to the maxillary sinus floor in the occurrence of incidental sinus pathologies using cone-beam computed tomography (CBCT). Methodology CBCT scans of 118 patients of age range 18-77 years were evaluated retrospectively to determine the relationship of maxillary posterior teeth to sinus floor in which vertical relationship was assessed using modified Kwak's classification and periapical status using CBCT periapical index. Statistical analysis was performed using SPSS statistics software. Results Of all 227 sinuses examined, 56.8% showed pathological changes, with mucosal thickening being the most common. More than 50% (50.2%) of sinuses were associated with periapical lesions of at least one maxillary posterior tooth based on evidence of pathological mucosal thickening. The presence of pathologic mucosal thickening was also significantly related (P < 0.05) to the presence of periapical pathologies. There was a significant association between tooth position and pathological sinus mucosal thickening, especially with second molars, first molars, and second premolars, respectively (P < 0.05). Second molar involvement was the most significant (P < 0.05). Conclusion The present study established a positive association between periapical disease status of maxillary posteriors and maxillary sinus mucosal thickening. Maxillary second premolar and first and second molars pathologies can significantly affect the maxillary sinus compared to other maxillary posterior tooth. CBCT proved to be an efficient imaging modality in detecting these changes.
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Affiliation(s)
- Admaja K. Nair
- Department of Oral Medicine and Radiology, Government Dental College, Kottayam, Kerala, India
| | - Merrin Jose
- Department of Oral Medicine and Radiology, Government Dental College, Kottayam, Kerala, India
| | - L. S. Sreela
- Department of Oral Medicine and Radiology, Government Dental College, Kottayam, Kerala, India
| | - Twinkle S. Prasad
- Department of Oral Medicine and Radiology, Government Dental College, Kottayam, Kerala, India
| | - Philips Mathew
- Department of Oral Medicine and Radiology, Government Dental College, Kottayam, Kerala, India
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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) 2023; 59:medicina59050937. [PMID: 37241169 DOI: 10.3390/medicina59050937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Preda MA, Muşat O, Sarafoleanu CC, Popescu IS, Muşat A, Pîrvulescu R, Barac R, Tătaru CP, Muşat GC. Oculo-orbital complications of odontogenic sinusitis. Rom J Ophthalmol 2023; 67:175-179. [PMID: 37522025 PMCID: PMC10385719 DOI: 10.22336/rjo.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction: Odontogenic sinusitis is a well-known, but under-studied bacterial infection of the maxillary sinus that can extend to other sinuses, the orbit, or even the endocranium. Material and methods: We performed an observational retrospective study on the patients with odontogenic sinusitis treated in our hospital over a five-year period. We included patients over 18 years old diagnosed with odontogenic sinusitis and ocular complications and we excluded patients with ocular complications nonrelated to dental-originated sinusitis or patients with odontogenic sinusitis without orbital-ocular complications. Results: We examined the charts of 46 patients. From the total number of patients with oculo-orbital complications generated by odontogenic sinusitis, only 7 were women. The mean age was 33,7 with a standard deviation of 15,7 years. The oculo-orbital complications were assessed according to the Chandler classification. The most frequent orbital complication was preseptal cellulitis followed by orbital cellulitis. All the patients were treated with antibiotic covering both anaerobic and aerobic bacteria and 40 of the patients in our study received surgical treatment. The outcomes were favorable for all the patients in our study with clinical resolution. Conclusion: The oculo-orbital complications of odontogenic sinusitis are severe because they can result in vision loss or other ocular sequelae. The bacteriological features of this sinusitis explain the special characteristics of this infection and can facilitate the extent of the infection to the orbit. Prompt intervention with antibiotics covering anaerobic and aerobic bacteria and surgery addressed to the affected sinus/ sinuses, the dental disease and the orbital pathology ensures a big success rate in the therapy of these complications.
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Affiliation(s)
- Mihai Alexandru Preda
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Sfanta Maria” Clinical Hospital, Bucharest, Romania
| | - Ovidiu Muşat
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Dr. Carol Davila” Central Military Emergency Hospital, Bucharest, Romania
| | - Caius Codruţ Sarafoleanu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Sfanta Maria” Clinical Hospital, Bucharest, Romania
| | | | - Andreea Muşat
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Pîrvulescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- University Emergency Hospital, Bucharest, Romania
| | - Ramona Barac
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Emergency Eye Hospital, Bucharest, Romania
| | - Călin Petru Tătaru
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Emergency Eye Hospital, Bucharest, Romania
| | - Gabriela Cornelia Muşat
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Sfanta Maria” Clinical Hospital, Bucharest, Romania
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Kwiatkowska MA, Szczygielski K, Brociek-Piłczyńska A, Chloupek A, Jurkiewicz D. The Influence of Endodontic Lesions on The Clinical Evolution of Odontogenic Sinusitis-A Cohort Study. J Clin Med 2023; 12. [PMID: 36769751 DOI: 10.3390/jcm12031103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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13
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Chen WC, Hwang LA, Lin WC, Wu CN, Su WC, Fang KC, Luo SD. Curved Planar Reformation: A Useful Method for Screening Dental Pathologies in Chronic Rhinosinusitis via Paranasal Sinus Computed Tomography. Tomography 2022; 8:2330-8. [PMID: 36136890 DOI: 10.3390/tomography8050194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Curved planar reformation (CPR) is a multiplanar reformatting technique of computed tomography (CT) commonly used during dental cone-beam CT (CBCT) to generate panorex-like images for dental evaluation. Here, we evaluated the utility of an additional CPR sequence in detecting dental pathologies in patients with chronic rhinosinusitis (CRS). (2) Methods: CRS patients who underwent paranasal sinus CT were enrolled retrospectively. The CT images featured three orthogonal sequences and a reconstructed CPR sequence. Additional dental CBCT was performed in patients with pathologies with a strongly suspected odontogenic origin. Dental pathologies detected by CT, CPR, and CBCT were analyzed. (3) Results: A total of 82 CRS patients (37 females and 45 males; mean age 47.3 ± 13.7 years) were included, of whom 23 underwent dental CBCT. In total, 1058 maxillary teeth were evaluated. Compared with paranasal sinus CT, CPR identified greater frequencies of dental pathologies, particularly caries (p < 0.001), periapical lesions (p < 0.001), and fistulae (p = 0.014). CBCT identified greater frequencies of periodontal dental pathologies (p = 0.046) and premolar caries (p = 0.002) compared with CPR. CBCT and CPR detected molar dental pathologies at similar frequencies. (4) Conclusions: CPR could increase the diagnostic rate of odontogenic pathologies compared with standard CT orthogonal views, especially when the sinusitis is caused by caries, periapical lesions, or fistulae. The addition of a CPR sequence allows for simple screening of dental pathologies in CRS patients without a need for additional radiation.
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Martu C, Martu MA, Maftei GA, Diaconu-Popa DA, Radulescu L. Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities-A Narrative Review of Recent Data. Diagnostics (Basel) 2022; 12:1600. [PMID: 35885504 PMCID: PMC9319441 DOI: 10.3390/diagnostics12071600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 12/17/2022] Open
Abstract
The maxillary sinus is a structure at the border of specialties: otorhinolaryngology and maxillofacial surgery. Due to this fact, regarding etiology, it can be affected by both the rhinogenic and odontogenic path and can impose diagnostic difficulties. The etiopathogenic mechanisms that can affect the Schneiderian membrane are mainly inflammatory, iatrogenic, traumatic, and tumorous in nature. From a microbiological point of view, the bacteriology is polymorphic, including both aerobic and anaerobic species in acute OS, the predominating species in acute OS being aerobic, and in chronic anaerobic germs. The role of fungi in the determination of this pathology and in the production of the biofilm that leads to resistance to antibiotic treatment is also discussed. The present paper aims to present the etiopathogenesis, bacteriology, clinical manifestations, as well as treatment of odontogenic sinusitis (OS) from an updated perspective through reviewing the literature. If unilateral maxillary sinusitis is usually due to odontogenic causes, this does not clinically exclude the possibility of strictly rhinogenic causes in the occurrence of sinusitis. This underlines the important role of complex oral and rhinological clinical examination as well as the role of preclinical examinations in specifying the certainty diagnosis. Simple radiography, orthopantomography, CT, and CBCT are compared in terms of diagnostic accuracy. The treatment of OS is complex, involving medication, dental, and surgical measures. The value of endoscopic surgery is emphasized, comparing its advantages over the classic Caldwell-Luc technique.
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Affiliation(s)
- Cristian Martu
- ENT Clinic Department, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania; (C.M.); (L.R.)
| | - Maria-Alexandra Martu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - George-Alexandru Maftei
- Department of Dento-Alveolar Surgery and Oral Pathology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Diana Antonela Diaconu-Popa
- Department of Oral Implantology, Removable Dentures and Technology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania;
| | - Luminita Radulescu
- ENT Clinic Department, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania; (C.M.); (L.R.)
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Shin JM, Kim SJ, Lee HM, Park IH. Changing Trends in the Clinical Characteristics and Treatment Strategies for Odontogenic Sinusitis Over the Past 10 Years. Ear Nose Throat J 2022:1455613221080918. [PMID: 35199606 DOI: 10.1177/01455613221080918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The incidence of odontogenic sinusitis has been gradually increasing due to the recent increases in invasive dental procedures. This study aimed to describe the clinical features of present patients with odontogenic sinusitis compared to the past, confirm the importance of endoscopic sinus surgery (ESS), and analyze the predictive factors for ESS. METHODS This retrospective review included all patients diagnosed with odontogenic sinusitis between January 2010 and December 2011 and between January 2019 and December 2020. The patients were classified into 2 groups (past and present) depending on the time of the first visit. The clinical characteristics and treatment modalities were compared between the two groups. In addition, among patients in the present group, we analyzed variables to identify factors contributing to the risk of undergoing ESS. RESULTS This study included 56 patients (23 in the past group and 33 in the present group). Compared to the past group, the present group had an older mean age (P = .001) and significantly increased iatrogenic etiologies (52.1% vs 90.9%; P = .002). The proportion of patients treated with ESS also increased in the present group compared to that in the past group (39.1% vs 66.7%; P = .041). In the present group, 11 patients (33.3%) were cured with conservative treatment, while 22 patients (66.7%) underwent additional ESS. Multivariate analysis revealed that the Lund-Mackay score was the only significant predictor of ESS (odds ratio [OR]: 14.901, P = .035). CONCLUSION The incidence of odontogenic sinusitis with iatrogenic etiologies has increased compared to the past. In addition, two-thirds of the patients in the present study underwent ESS, a significantly higher proportion than in the past. Therefore, ESS is one of the most important treatment modalities for odontogenic sinusitis, especially iatrogenic, in recent years. A severe Lund-Mackay score was associated with a significantly increased risk of ESS.
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Affiliation(s)
- Jae-Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, 58934Korea University College of Medicine, Seoul, Republic of Korea
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul, Republic of Korea
- Medical Device Usability Test Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Su-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, 58934Korea University College of Medicine, Seoul, Republic of Korea
| | - Heung-Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, 58934Korea University College of Medicine, Seoul, Republic of Korea
| | - Il-Ho Park
- Department of Otorhinolaryngology-Head and Neck Surgery, 58934Korea University College of Medicine, Seoul, Republic of Korea
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul, Republic of Korea
- Medical Device Usability Test Center, Korea University Guro Hospital, Seoul, Republic of Korea
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17
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Rey-Martínez MH, Ruiz-Sáenz PL, Martínez-Rodríguez N, Barona-Dorado C, Meniz-García C, Cortés-Bretón Brinkmann J, Suárez-Quintanilla JA, Martínez-González JM. Analysis of the Radiological Changes of the Sinus Membrane Using Cone Beam Computed Tomography and Its Relationship with Dental Treatments. A Retrospective Study. Biology (Basel) 2022; 11:biology11020165. [PMID: 35205032 PMCID: PMC8869354 DOI: 10.3390/biology11020165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
Simple Summary Changes in the sinus membrane, in the form of thickening or opacification, usually pose problems of differential diagnosis between rhinological and odontogenic causes, given the similarity in their clinical behaviour. The interrelation between tooth roots and the possibility of maxillary sinus involvement seems to be a key determinant. Moreover, the role played by iatrogenic factors, especially surgical interventions, such as dental extractions, or impacted teeth, as well as implant treatments, must be considered. The contribution of new imaging procedures, such as conventional computed tomography or cone beam computed tomography, has triggered an increase in the identification of dental aetiology as a cause of the unilateral opacification of the anterior paranasal sinuses with the predominant involvement of the maxillary sinus. Abstract The aim of this study was to identify the most relevant dental factors and iatrogenic causes in the development of pathological changes to the sinus membrane and to analyse their possible influence on the development of odontogenic sinusitis. A descriptive, observational study was designed, with 276 patients who had been evaluated via cone beam computed tomography, analysing possible sinus thickening factors, such as apical infections, endodontic treatments, periodontitis, radicular cysts and impacted teeth, as well as iatrogenic factors caused by implant treatments or the development of oroantral communications produced during tooth extraction manoeuvres. Among the dental factors, periodontitis (47.1%), apical pathology (23.5%) and endodontic treatments (23.1%) were the predominant causes of sinus membrane thickening that most frequently produced an occupancy between 2 and 10 mm. Regarding the implant treatments, the placement of implants through the floor of the maxillary sinus was the main cause (9.8%), followed by sinus elevation techniques (6.2%). Dental extraction was the first cause of oroantral communication (5.0%), being the procedure that caused the greatest thickening of the sinus membrane. This study highlights the importance of dental treatments and iatrogenic factors in sinus pathology, and the need for diagnostic interrelations between the different specialists who address this pathology.
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Affiliation(s)
| | - Pedro Luis Ruiz-Sáenz
- Department of Odontology, Central Hospital of the Red Cross of Madrid, 28003 Madrid, Spain;
| | - Natalia Martínez-Rodríguez
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
| | - Cristina Barona-Dorado
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
| | - Cristina Meniz-García
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
- Correspondence: ; Tel.: +34-609-016-107
| | - Jorge Cortés-Bretón Brinkmann
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
| | - Juan Antonio Suárez-Quintanilla
- Department of Morphological Sciences, School of Medicine, University Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - José María Martínez-González
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (N.M.-R.); (C.B.-D.); (J.C.-B.B.); (J.M.M.-G.)
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Dumitrescu A, Martu MA, Nemtoi A, Sirghe A, Chelaru L, Tatarciuc D, Dumitrescu AM, Haba D. Association between Cone-Beam Computed Tomography and Histological and Immunohistochemical Features in Periapical Lesions Correlated with Thickened Maxillary Sinus Mucosa. ACTA ACUST UNITED AC 2021; 57:medicina57080840. [PMID: 34441046 PMCID: PMC8401138 DOI: 10.3390/medicina57080840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Odontogenic sinusitis is a frequently underestimated pathology with fewer symptoms in patients with periapical lesions, periodontal disease, or iatrogenic foreign bodies in the maxillary sinus. The aim of our study was to determine the correlation between maxillary sinusitis and periapical lesions using cone-beam computed tomography (CBCT) imaging and histological and immunohistochemical investigations. Materials and Methods: A total of 1450 initial patients diagnosed with maxillary sinusitis in the Ear-Nose-Throat (ENT) Department, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania, were treated with anti-inflammatory drugs. Of these, 629 still had unresolved symptomatology and were later referred to the Dental Medicine departments for further investigations. Only 50 subjects with periapical lesions in the premolar/molar maxillary area were included in the present study. All the periapical lesions were observed on CBCT and classified using the Periapical Status Index (PSI) and the mean maxillary sinus mucosa thicknesses (MSMT). The enrolled patients underwent surgical procedures with the excision of periapical lesions. The excised samples were submitted to the histological and immunohistochemical investigations. Results: The 50 patients presented periapical lesions of their maxillary teeth in 328 dental units. There was a higher prevalence of periapical lesions in men than in women (chi-square test). We observed a significant difference between the mean MSMT of individuals with periapical lesions compared to those without (p < 0.01). Mean MSMT was 1.23 mm for teeth without periapical lesions and 3.95 mm for teeth with periapical lesions. The histopathological study identified 50% cases with periapical granulomas, 10% cases with periapical granulomas with cystic potential, and 40% cases as periapical cysts. Immunohistochemical stainings showed that CD4+ helper and CD8+ cytotoxic T lymphocytes, along with CD20+ B lymphocytes and CD68+ macrophages, were diffusely distributed in all periapical cysts and in some periapical granulomas, but CD79α+ plasma cells characterized especially periapical granulomas. Conclusions: The current study observed a significant correlation between CBCT maxillary mucosa thickness and type of periapical lesion. Chronic inflammatory lympho-histiocytic infiltrate predominates in periapical lesions, supporting the idea that lesion progression is determined by a humoral-type (CD20+ and CD79α+ B lymphocytes) but also by a cellular-type (CD4+ and CD8+ T lymphocyte population) immune mechanism.
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Affiliation(s)
- Alexandra Dumitrescu
- Department of Oral and Maxillofacial Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.D.); (A.S.); (D.H.)
| | - Maria-Alexandra Martu
- Department of Periodontology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Correspondence: ; Tel.: +40-742-189-178
| | - Alexandru Nemtoi
- Department of Health and Human Development, “Stefan cel Mare” University of Suceava, 13 Universitatii Str., 720225 Suceava, Romania;
| | - Ana Sirghe
- Department of Oral and Maxillofacial Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.D.); (A.S.); (D.H.)
| | - Liliana Chelaru
- Department of Morpho-Functional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (L.C.); (A.-M.D.)
| | - Diana Tatarciuc
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania;
| | - Ana-Maria Dumitrescu
- Department of Morpho-Functional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (L.C.); (A.-M.D.)
| | - Danisia Haba
- Department of Oral and Maxillofacial Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.D.); (A.S.); (D.H.)
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Abstract
OBJECTIVE Odontogenic sinusitis (ODS) can cause infectious orbital, intracranial, and osseous complications. Diagnosis and management of complicated ODS have not been discussed in recent sinusitis guidelines. The purpose of this systematic review was to describe epidemiological and clinical features, as well as management strategies of complicated ODS. DATA SOURCES PubMed, EMBASE, and Cochrane Library. REVIEW METHODS A systematic review was performed to describe various features of complicated ODS. All complicated ODS studies were included in qualitative analysis, but studies were only included in quantitative analysis if they reported specific patient-level data. RESULTS Of 1126 studies identified, 75 studies with 110 complicated ODS cases were included in qualitative analysis, and 47 studies with 62 orbital and intracranial complications were included in quantitative analyses. About 70% of complicated ODS cases were orbital complications. Only 23% of complicated ODS studies were published in otolaryngology journals. Regarding ODS-related orbital and intracranial complications, about 80% occurred in adults, and 75% were male. Complicated ODS occurred most commonly from apical periodontitis of maxillary molars. There were no relationships between sinusitis extent and orbital or intracranial complications. High rates of anaerobic and α-hemolytic streptococcal bacteria were identified in complicated ODS. Management generally included systemic antibiotics covering aerobic and anaerobic bacteria, and surgical interventions were generally performed to address both the complications (orbital and/or intracranial) and possible infectious sources (dentition and sinuses). CONCLUSION ODS should be considered in all patients with infectious extrasinus complications. Multidisciplinary management between otolaryngologists, dental specialists, ophthalmologists, and neurosurgeons should be considered to optimize outcomes.
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Affiliation(s)
- John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Atif J Cheema
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Raven T Dunn
- Wayne State School of Medicine, Detroit, Michigan, USA
| | - Swapna Vemuri
- Department of Ophthalmology, Henry Ford Health System, Detroit, Michigan, USA
| | - Edward L Peterson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
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20
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Gâta A, Toader C, Valean D, Trombitaș VE, Albu S. Role of Endoscopic Sinus Surgery and Dental Treatment in the Management of Odontogenic Sinusitis Due to Endodontic Disease and Oroantral Fistula. J Clin Med 2021; 10:jcm10122712. [PMID: 34205358 PMCID: PMC8234404 DOI: 10.3390/jcm10122712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Odontogenic sinusitis (ODS) is frequently encountered in ENT practice; however, there are no guidelines regarding its management. This study aims to analyse the results of endoscopic sinus surgery versus dental treatment in ODS. Additionally, we aim to demonstrate the benefit of associating endoscopic sinus surgery (ESS) to surgical closure of chronic oroantral fistulas (OAF) by comparing mean time to healing in patients who opted or not for concurrent ESS. Methods: Records of patients with ODS were reviewed. Group one consisted of patients with ODS caused by periapical pathology undergoing either endoscopic sinus surgery (ESS) or dental treatment. Resolution of ODS was considered treatment success and was compared between the two treatment strategies. Group two included patients with ODS and associated chronic oroantral communication. Time to healing was compared between patients undergoing OAF closure alone versus patients receiving associated ESS, using the Log-Rank test to correlate Kaplan–Meier curves. Results: 25 patients from a total of 45 in group one underwent dental treatment alone, and 20 opted for exclusive ESS treatment. The failure rate was 40% for patients treated with ESS compared to 4% (one patient) for dental treatment. ODS resolved in all patients in the second group, but the mean time to healing was half (10 days) when ESS was complementary to OAF closure. Conclusion: The present study represents the first estimator of the role ESS plays in OAF treatment. Nonetheless, it provides proof of the importance of first addressing dental problems in odontogenic sinusitis.
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Affiliation(s)
- Anda Gâta
- Department of Otorhinolaryngology, University of Medicine and Pharmacy ‘Iuliu Hațieganu’, 400349 Cluj Napoca, Romania; (V.E.T.); (S.A.)
- Correspondence: ; Tel.: +40-746-210-022
| | - Corneliu Toader
- Clinic of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 41914 Bucharest, Romania;
| | - Dan Valean
- County Clinical Emergency Hospital, 400000 Cluj Napoca, Romania;
| | - Veronica Elena Trombitaș
- Department of Otorhinolaryngology, University of Medicine and Pharmacy ‘Iuliu Hațieganu’, 400349 Cluj Napoca, Romania; (V.E.T.); (S.A.)
| | - Silviu Albu
- Department of Otorhinolaryngology, University of Medicine and Pharmacy ‘Iuliu Hațieganu’, 400349 Cluj Napoca, Romania; (V.E.T.); (S.A.)
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21
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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: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Zaharescu A, Mârțu I, Luchian AI, Mârțu MA, Șufaru IG, Mârțu C, Solomon SM. Role of adjunctive therapy with subantimicrobial doses of doxycycline in glycemic control (HbA1c) in patients with diabetes and endo-periodontal lesions to prevent sinus complications. Exp Ther Med 2021; 21:277. [PMID: 33603884 PMCID: PMC7851643 DOI: 10.3892/etm.2021.9708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 12/21/2022] Open
Abstract
The present study aimed to analyze local and regional changes in regards to odontogenic sinusitis in subjects with endo-periodontal lesions and diabetes mellitus and to investigate the effect on the level of glycemic control (glycated hemoglobin) that could be generated by adjunctive therapy with subantimicrobial doses of doxycycline. This study was performed on 51 subjects with diabetes who were divided into two therapeutic groups: 31 patients with diabetes (the study group) who underwent conventional endo-periodontal therapy and subantimicrobial doses of doxycycline and 20 patients with diabetes who followed only conventional endo-periodontal therapy (the control group). Patients underwent endodontic and periodontal clinical examination, with retro-dental-alveolar radiographs and CBCT examinations. For each patient, glycated hemoglobin A1c (HbA1c) was determined. This evaluation was performed at the beginning of the study, as well as 3, 6 and 12 months after baseline. A significant percentage of patients, both in the study group and in the control group, showed radiological signs of odontogenic sinusitis, totaling 29 patients (56.86%). Periodontal parameters revealed lower levels in patients who underwent the regimen which consisted of subantimicrobial doses of doxycycline; these results were maintained over the study period. Moreover, we demonstrated significantly reduced glycated hemoglobin levels throughout the study (12 months) in the doxycycline-treated group. This fact has far-reaching effects in the sphere of loco-regional complications as well, and the risk of odontogenic sinusitis can be significantly reduced.
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Affiliation(s)
- Anamaria Zaharescu
- Department of Periodontology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Mârțu
- Department of Implantology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandru-Ionuț Luchian
- Department of Periodontology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria-Alexandra Mârțu
- Department of Periodontology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Irina-Georgeta Șufaru
- Department of Periodontology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristian Mârțu
- Department of ENT, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Sorina-Mihaela Solomon
- Department of Periodontology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Abstract
BACKGROUND The histopathology and microbiology associated with silent sinus syndrome (SSS) have not been well described. OBJECTIVE This study details the histopathological and microbiological characteristics in addition to radiographic findings of SSS in comparison to those of chronic maxillary sinusitis (CRS). METHODS 42 patients diagnosed with SSS at Mayo Clinic Hospital in Arizona were identified. Paranasal computed tomography scans of the 42 SSS patients as well as 42 matched CRS patients were analyzed in order to assess differences in the prevalence of septal spurs/deviation. 20 of the SSS patients and 19 of the matched CRS patients also had histopathology and microbiology reports, which were compiled and summarized. Additionally, 19 SSS and 19 matched CRS patients were contacted via phone survey for a more complete patient history regarding maxillary dental disease/surgery. RESULTS SSS patients have a significantly higher prevalence of septal spurs/deviation than CRS patients. The microbiomes of SSS patients more closely resemble those of healthy controls than those of CRS patients. Analysis of the histopathology of SSS reveals chronic, non-specific inflammation similar to that seen in non-eosinophilic CRS without polyps. SSS patients were significantly more likely to have a history of maxillary dental disease requiring surgery. CONCLUSION These data support the hypothesis that the pathogenesis of SSS is more likely due to anatomical/mechanical factors than inflammatory/microbiological factors.
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Affiliation(s)
- Henry D Zheng
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey C Mecham
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Yassmeen Abdel-Aty
- Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Devyani Lal
- Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Michael J Marino
- Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
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24
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Jeican II, Barbu Tudoran L, Florea A, Flonta M, Trombitas V, Apostol A, Dumitru M, Aluaș M, Junie LM, Albu S. Chronic Rhinosinusitis: MALDI-TOF Mass Spectrometry Microbiological Diagnosis and Electron Microscopy Analysis; Experience of the 2nd Otorhinolaryngology Clinic of Cluj-Napoca, Romania. J Clin Med 2020; 9:E3973. [PMID: 33302509 DOI: 10.3390/jcm9123973] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Chronic rhinosinusitis (CRS) represents a wide range of infectious-inflammatory processes affecting, simultaneously, the nose and paranasal sinuses mucosa. The paper presents outcomes of the investigation of CRS microbiological characteristics in a group of 32 patients. (2) Methods: The purulent samples were collected during functional endoscopic sinus surgery. Agar plates were incubated and examined. All types of colonies were identified using Matrix-Assisted Laser Desorption - Ionisation-Time of Flight Mass Spectrometry (MALDI-TOF MS). For scanning electron microscopy, samples were fixed and sputter-coated with 10 nm gold and analyzed using a scanning electron microscope. For transmission electron microscopy, samples were fixed, postfixed, and dehydrated. After polymerization, ultrathin sections were collected on carbon coated copper grids and analyzed with Jeol JEM1010 TEM. (3) Results: Positive microbiological diagnosis was obtained in 62.5% of cases. The most frequent species found are Staphylococcus aureus and Streptococcus constellatus subsp. pharyngis. Corynebacterium aurimucosum and Eggerthia catenaformis were unreported species in CRS until the present. Biofilm was evidenced in 43.7% of sinus mucosa samples. Ciliary disorientation, atrophy, and no ciliated cells were also identified. (4) Conclusion: The microbial factor—pathogen or opportunistic—is one of the most important pathological links in chronic rhinosinusitis. MALDI-TOF MS allows easily and quickly identification of germs.
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25
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Felisati E, Saibene AM, Borloni R, Prades JM, Felisati G. Mini-Invasive Endoscopic Approaches to the Maxillary Sinus Floor: A Comparative Anatomical Study. Am J Rhinol Allergy 2020; 35:467-473. [PMID: 33023295 DOI: 10.1177/1945892420964096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND While middle antrostomy (MA) is the most common approach to the maxillary sinus (MS), it is known for not allowing to fully inspect the whole MS, especially in its inferior and anterior portions. To overcome this limitation, alternative approaches have been proposed, such as inferior antrotomy (IA) and canine fossa accesses (CFA). OBJECTIVE Given the lack of studies on the MS floor visualization with different accesses, our study aims, in a cadaver lab setting, to systematically compare three different approaches (MA, IA and CFA) in these regards. METHODS Eight cadaver heads, previously submitted to CTscan, were prepared inserting fixtures corresponding to teeth 2, 4, 6, 11, 13 and 15 and into the canine fossae. Three approaches were prepared: a wide MA, an IM and a CFA. We endoscopically evaluated, for each specimen, side, access type and scope angle (0°, 30°, 45°, and 70°), which fixtures were visible on the maxillary sinus floor and whether the canine fossa fixture was visible (MA and IA only). RESULTS IA allowed to visualize all fixtures in nearly all cases (14/16 with 70° endoscope), while MA showed poor visualization results (3/16 with 70° endoscope); CFA failed to gain full visualization in most specimens (7/16 with 70°endoscope). Such difference was statistically significant. MA proved unable to visualize the canine fossa fixture in most cases while IA showed excellent possibilities. All differences were statistically significant (p < .001, Mcnemar's test). CONCLUSIONS Our data show that the IA grants a statistically significant superior surgical field vision when compared to MA and CFA, though in vivo validation of these results is still required.
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Affiliation(s)
- Elena Felisati
- Otolaryngology Unit, University of Jean Monnet, Saint Etienne, France
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo and Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Roberto Borloni
- Otolaryngology Unit, ASST Santi Paolo and Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Jean Michel Prades
- Otolaryngology Unit, University of Jean Monnet, Saint Etienne, France.,Departement of Anatomy, University of Jean Monnet, Saint Etienne, France
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo and Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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26
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Nurchis MC, Pascucci D, Lopez MA, Moffa A, Passarelli PC, Bressi F, Casale M, Damiani G. Epidemiology of odontogenic sinusitis: an old, underestimated disease, even today. A narrative literature review. J BIOL REG HOMEOS AG 2020; 34:195-200. Technology in Medicine. [PMID: 33386049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Odontogenic sinusitis is an inflammatory condition of the paranasal sinuses resulting from dental pathology. The aim of this study is to provide an overview of the current literature on the dimensions of the phenomenon, quality of life, economic considerations, and approaches to odontogenic sinusitis. A narrative review was conducted following the methodology proposed by Green et al. (2006). There appears to have been an increase in the incidence over the last decade. Nowadays, evidence in the literature reports that 10-12% up to 40% of all sinusitis cases are associated with odontogenic infections. The iatrogenia was by far the leading cause of odontogenic sinusitis (55.97%) while the first and second molars were the most affected teeth with an incidence of 35.6% and 22%. If not properly diagnosed and treated, these infections may lead to a rapid spread, giving rise to potentially life-threatening complications with a significant general health-related Quality of Life detriment. The proper management of patients in a pre-implant logical setting leads to substantial savings, ranging from €38 million to €152 million, for the Italian National Health Service. Odontogenic sinusitis management should involve shared decisionmaking between the otolaryngologist, dental provider, and patient, where the benefits and risks of dental treatment and endoscopic sinus surgery are discussed.
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Affiliation(s)
- M C Nurchis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Pascucci
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M A Lopez
- Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - A Moffa
- Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - P C Passarelli
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, Rome, Italy
| | - F Bressi
- Department of Physical and Rehabilitation Medicine, Campus Bio-Medico University, Rome, Italy
| | - M Casale
- Unit of Otolaryngology - Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - G Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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27
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Abstract
BACKGROUND The treatment options for odontogenic sinusitis (OS) include medical management including antibiotics and saline nasal irrigation, endoscopic sinus surgery (ESS), and dental treatment. OBJECTIVE The purpose of this study was to evaluate whether OS caused by dental caries and periapical abscess can be cured by dental treatment alone and which patients should consider surgery early. METHODS A total of 33 patients with OS caused by dental caries and periapical abscess were enrolled. Patients with OS caused by dental implants, trauma, surgery, or tooth extraction were excluded. All patients were initially treated with dental treatment and medical management without ESS. The patients were divided into two groups according to the results of dental treatment and multiple clinical parameters were compared between the two groups. RESULTS Among the 33 enrolled patients, 22 patients (67%) were cured with dental and medical management, and 11 patients (33%) required ESS after the failure of dental and medical management. Based on the multivariate analysis results, patients who were smokers (OR 33.4) and had a higher Lund-Mackay score on CT (OR 2.0) required ESS after the failure of dental and medical treatment. CONCLUSIONS Two-thirds of the patients with OS caused by dental caries and periapical abscess were cured with dental treatment and medical management without ESS. We recommend dental treatment and medical management first in OS caused by dental caries and periapical abscess. However, we recommend early ESS in patients with smoking habits and severe CT findings of the sinus.
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Affiliation(s)
- Byung Joon Yoo
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Seon Min Jung
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Ha Na Lee
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hyung Gu Kim
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Ho Chung
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
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28
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Yassin-Kassab A, Bhargava P, Tibbetts RJ, Griggs ZH, Peterson EI, Craig JR. Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 11:40-47. [PMID: 32656998 DOI: 10.1002/alr.22627] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bacterial odontogenic sinusitis (ODS) is distinct from other forms of rhinosinusitis. Diagnosing ODS can be challenging because of nonspecific clinical presentations and underrepresentation in the literature. The purpose of this study was to compare maxillary sinus bacterial cultures between patients with ODS and chronic rhinosinusitis (CRS), to determine whether certain bacteria are associated with ODS. METHODS This was a retrospective case-control study of 276 consecutive patients from August 2015 to August 2019 who underwent endoscopic sinus surgery (ESS) for bacterial ODS, CRS without nasal polyps (CRSsNP), or CRS with nasal polyps (CRSwNP). When present, pus was sterilely cultured from maxillary sinuses after maxillary antrostomy, and aerobic and anaerobic cultures were immediately sent for processing. Demographics and culture results were compared between ODS and CRS patients, and then separately between ODS and CRSsNP, and ODS and CRSwNP. ODS culture results were also compared between different dental pathologies (endodontic vs oroantral fistula). RESULTS The following bacteria were significantly more likely in ODS compared to CRS: mixed anaerobes, Fusobacterium spp., Eikenella corrodens, Streptococcus intermedius, Streptococcus anginosus, and Streptococcus constellatus. Staphylococcus aureus and Pseudomonas aeruginosa were inversely related to ODS. There were no significant differences in cultures between the different dental pathologies. CONCLUSION Certain bacteria were more likely to be associated with ODS compared to CRS when purulence was cultured from the maxillary sinus. Physicians should evaluate for an odontogenic source of sinusitis when these ODS-associated bacteria are identified in maxillary sinus cultures.
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Affiliation(s)
| | - Pallavi Bhargava
- Department of Internal Medicine, Division of Infectious Disease, Henry Ford Health System, Detroit, MI
| | - Robert J Tibbetts
- Department of Public Health Services, Henry Ford Health System, Detroit, MI
| | - Zachary H Griggs
- Department of Otolaryngology, Henry Ford Health System, Detroit, MI
| | - Edward I Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, MI
| | - John R Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, MI
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29
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Goyal VK, Ahmad A, Turfe Z, Peterson EI, Craig JR. Predicting Odontogenic Sinusitis in Unilateral Sinus Disease: A Prospective, Multivariate Analysis. Am J Rhinol Allergy 2020; 35:164-171. [PMID: 32646233 DOI: 10.1177/1945892420941702] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Odontogenic sinusitis (ODS) is a common cause of unilateral sinus disease (USD), but can be challenging to diagnose due to nonspecific clinical presentations, potentially subtle to absent dental pathology on sinus computed tomography (CT), and underrepresentation in the sinusitis literature. OBJECTIVE Identify sinonasal clinical variables predictive of ODS in patients presenting with unilateral maxillary sinus opacification on sinus CT. METHODS A prospective cohort study was conducted on 131 consecutive patients with USD and at least partial or complete maxillary sinus opacification on sinus CT. Patients' demographics, sinonasal symptoms (anterior and posterior drainage, nasal obstruction, facial pressure, smell loss, and foul smell), 22-item sinonasal outcome test, nasal endoscopy findings, CT findings, and histopathology were collected. Patients' diagnoses included ODS, chronic rhinosinusitis with or without nasal polyps, and inverted papilloma. Demographic and clinical data were compared between patients with unilateral ODS and non-odontogenic disease using univariate and multivariate analyses. RESULTS Of the 131 USD patients, 65 had ODS and 66 had non-odontogenic disease. The following variables were significantly associated with unilateral ODS on multivariate analysis: middle meatal pus on endoscopy (OR= 17.67, 95% CI-5.69, 54.87; p = 0.001), foul smell (OR= 6.11, 95% CI-1.64, 22.82; p=.007), facial pressure (OR= 3.55, 95% CI-1.25, 10.12; p = 0.018), and any frontal opacification on CT (OR= 5.19, 95% CI-1.68, 16.06; p = 0.004). Any sphenoid opacification on CT was inversely related to ODS (OR = 0.14, 95% CI-0.03, 0.69; p = 0.016). The study was adequately powered. CONCLUSION With unilateral maxillary sinus disease, the following features were significantly associated with ODS: foul smell, ipsilateral facial pressure, middle meatal pus on endoscopy, and any frontal sinus opacification on sinus CT. Additionally, any sphenoid sinus opacification on CT was inversely related to ODS. Presence or absence of these clinical variables can be used to increase or decrease one's suspicion of an odontogenic source of sinusitis.
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Affiliation(s)
- Vinay K Goyal
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
| | - Abid Ahmad
- Wayne State Medical University, Detroit, Michigan
| | - Zaahir Turfe
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
| | - Edward I Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, Michigan
| | - John R Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
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30
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Craig JR, Tataryn RW, Aghaloo TL, Pokorny AT, Gray ST, Mattos JL, Poetker DM. Management of odontogenic sinusitis: multidisciplinary consensus statement. Int Forum Allergy Rhinol 2020; 10:901-912. [PMID: 32506807 DOI: 10.1002/alr.22598] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Odontogenic sinusitis (ODS) can present a therapeutic dilemma because multiple treatment strategies have been reported. ODS review articles have been published, but they have lacked multidisciplinary collaboration and an evidence-based methodology. The purpose of this article was to perform an evidence-based review of ODS management options, and develop a multidisciplinary consensus statement on ODS management options. METHODS An evidence-based review of dental and medical literature on ODS management was performed using PubMed, EMBASE, and Cochrane Review Databases up to December 2019. Exclusion criteria included non-English-language articles, case series with fewer than 10 patients, fungal sinusitis, and studies that did not report treatment success rates. Because aggregate levels of evidence for recommendations were no higher than level C, a clinical consensus statement was conducted using a modified Delphi method. RESULTS Sixteen articles met inclusion criteria for the evidence-based review on the following ODS management options: dental treatment alone or combined with ESS for various dental pathologies, and endoscopic sinus surgery (ESS) alone for dental implant-related ODS. Strong consensus was achieved for 9 of the 10 clinical statements, the strongest being the use of shared decision-making for selecting management strategies. No consensus was reached for determining the extent of ESS necessary for uncomplicated ODS. CONCLUSION Strong consensus was reached that ODS management should involve shared decision-making between the otolaryngologist, dental provider, and patient, where the benefits and risks of dental treatment and ESS are discussed. Higher-quality studies are necessary to develop evidence-based treatment recommendations for ODS.
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Affiliation(s)
- John R Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, MI
| | - Roderick W Tataryn
- Tataryn Endodontics, Spokane, WA.,Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA
| | - Tara L Aghaloo
- University of California, Los Angeles (UCLA) School of Dentistry, UCLA, Los Angeles, CA
| | - Alan T Pokorny
- Spokane ENT Clinic, Spokane, WA.,Department of Otolaryngology, University of Washington, Seattle, WA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Jose L Mattos
- Department of Otolaryngology, University of Virginia, Charlottesville, VA
| | - David M Poetker
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI
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Simuntis R, Kubilius R, Tušas P, Leketas M, Vaitkus J, Vaitkus S. Chronic Odontogenic Rhinosinusitis: Optimization of Surgical Treatment Indications. Am J Rhinol Allergy 2020; 34:767-774. [PMID: 32475127 DOI: 10.1177/1945892420929265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The treatment of chronic odontogenic and nonodontogenic rhinosinusitis is different. It requires the elimination of odontogenic cause and optimal sinus surgical treatment. To date, there are no clear indications when sinus surgical treatment is necessary. OBJECTIVE Our aim was to define clear indication(s) for sinus surgical treatment in patients with chronic odontogenic rhinosinusitis after elimination of odontogenic cause. METHODS A group of 96 patients with chronic odontogenic rhinosinusitis caused by apical periodontitis completed a Sino-Nasal Outcome Test 22 (SNOT-22) questionnaire with incorporated additional symptom "malodor" before treatment. Moreover, they were distributed according to computed tomography (CT) radiological criteria such as degree of periapical pathology, anatomical ratio between maxillary lateral teeth and sinus floor, sinus mucosal thickening, and ostiomeatal complex condition. The elimination of odontogenic cause was performed by extracting causative tooth. Questionnaire was filled again 2 weeks, 3 months, and 6 months after treatment. All data were analyzed to search the clear indications for sinus surgical treatment. RESULTS Of 96 patients, 74 (77.1%) patients had full resolution of symptoms after dental cause was eliminated. For other 22 (22.9%) patients, symptoms persisted and sinus surgical treatment was indicated. In recovered group, mean SNOT-22 score was different between all periods of measuring, while within nonrecovered group, small differences were seen only when compared to before treatment. No statistically significant correlation between radiological criteria and rhinosinusitis healing after tooth extraction was found (P > .05). Statistically significant correlation was found between the disappearance of malodor/SNOT-22 score reduction after elimination of dental cause and healing success (P < .005). CONCLUSIONS Our study revealed that extraction of causative tooth is an effective treatment of chronic odontogenic rhinosinusitis caused by apical periodontitis. CT criteria are not valuable indicator for sinus surgery, but persistence of malodor after 2 weeks is the strongest indication for this type of treatment.
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Affiliation(s)
- Regimantas Simuntis
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ričardas Kubilius
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Tušas
- Faculty of Medicine, Institute of Dentistry, Vilnius University, Vilnius, Lithuania
| | - Marijus Leketas
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justinas Vaitkus
- Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Saulius Vaitkus
- Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Safadi A, Ungar OJ, Oz I, Koren I, Abergel A, Kleinman S. Endoscopic sinus surgery for dental implant displacement into the maxillary sinus-a retrospective clinical study. Int J Oral Maxillofac Surg 2020; 49:966-72. [PMID: 32005571 DOI: 10.1016/j.ijom.2020.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/18/2019] [Accepted: 01/15/2020] [Indexed: 12/16/2022]
Abstract
The aims of this retrospective clinical study were to present our management protocol for the retrieval of impacted dental implants that have become displaced into the maxillary sinus cavity and to define the role of endoscopic sinus surgery in this setting. All 24 patients (25 implants) who underwent surgical retrieval of dental implants displaced into the maxillary sinus between 2012 and 2019 were included. Data on surgical interventions and complications were collected retrospectively. Eleven patients (46%) had chronic sinusitis associated with the migrated implant. All implants were successfully retrieved via transnasal endoscopic approach alone: 80% via a middle meatal antrostomy and 20% via a combined middle and inferior meatal antrostomy. Five patients required a concomitant transoral approach for oro-antral fistula repair. None required a transoral approach for displaced implant retrieval. All patients healed uneventfully without complications. Transnasal endoscopic sinus surgery via a middle meatal antrostomy or a combined middle and inferior antrostomy is recommended as the primary choice for dental implant retrieval from the maxillary sinus. A transoral approach should be performed simultaneously only for oro-antral fistula repair. This surgical protocol proved to be safe and efficient, and it obviated the need for osteotomies of the anterolateral maxillary wall.
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Turfe Z, Ahmad A, Peterson EI, Craig JR. Odontogenic sinusitis is a common cause of unilateral sinus disease with maxillary sinus opacification. Int Forum Allergy Rhinol 2019; 9:1515-1520. [PMID: 31529785 DOI: 10.1002/alr.22434] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/17/2019] [Accepted: 08/29/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Unilateral sinus disease (USD) carries a broader differential diagnosis than bilateral sinus disease, including various inflammatory and neoplastic conditions. Odontogenic sinusitis (ODS) is a common cause of unilateral maxillary sinusitis, but few studies have examined its incidence among all USD etiologies. The main purposes of this prospective study were to determine the incidences of ODS and other etiologies causing USD with complete maxillary sinus opacification on computed tomography (CT), and to compare CT features of ODS and non-odontogenic USD patients. In addition, clinical features of the ODS cohort are described. METHODS A prospective case series of 134 patients with USD with complete maxillary sinus opacification on CT was conducted from August 2015 to November 2018. Based on nasal endoscopy, sinus CT, and dental examination and imaging, patients were categorized as having unilateral ODS or non-odontogenic USD. Patients with non-odontogenic USD were categorized as inflammatory or neoplastic. Demographic and clinical data were reported for ODS patients. RESULTS Of the 134 patients, 45% had ODS, 36% had non-odontogenic inflammatory conditions, 17% had inverted papilloma, and 2% had malignancies. Of the 60 ODS cases, 86.7% were associated with middle meatal purulence on nasal endoscopy. On CT, 88.3% had extramaxillary sinus disease extension, and 65.5% of CT reports made no mention of dental pathology. CONCLUSION ODS caused nearly 50% of all USD cases with maxillary sinus opacification on CT, and was the most common individual etiology. ODS was frequently associated with anterior ethmoid and frontal sinus disease on CT, and middle meatal purulence on nasal endoscopy.
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Affiliation(s)
- Zaahir Turfe
- Department of Otolaryngology, Henry Ford Health System, Detroit, MI
| | - Abid Ahmad
- Wayne State University School of Medicine, Wayne State Medical University, Detroit, MI
| | - Edward I Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, MI
| | - John R Craig
- Department of Otolaryngology, Henry Ford Health System, Detroit, MI
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Haider AA, Marino MJ, Yao WC, Citardi MJ, Luong AU. The Potential of High-Throughput DNA Sequencing of the Paranasal Sinus Microbiome in Diagnosing Odontogenic Sinusitis. Otolaryngol Head Neck Surg 2019; 161:1043-1047. [PMID: 31382814 DOI: 10.1177/0194599819866692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE High-throughput DNA sequencing of the paranasal sinus microbiome has potential in the diagnosis and treatment of sinusitis. The objective of this study is to evaluate the use of high-throughput DNA sequencing to diagnose sinusitis of odontogenic origin. STUDY DESIGN Case series with chart review. SETTING Single tertiary care academic medical center. SUBJECTS AND METHODS A chart review was performed of DNA sequencing results from the sinus aspirates obtained under endoscopic visualization in 142 patients with sinusitis. The identification of any potentially pathogenic bacteria associated with oral flora in a sample was classified as a positive result for sinusitis of odontogenic etiology. The sensitivity, specificity, and predictive values of using high-throughput DNA sequencing to diagnose sinusitis of odontogenic etiology were determined, with the patient's computed tomography sinus scan as the reference standard. On computed tomography scans, an odontogenic source was determined by the presence of a periapical lucency perforating the schneiderian membrane. RESULTS Seven of the 142 patients enrolled in this study had an odontogenic source based on computed tomography scans. Relative to this reference standard, high-throughput DNA sequencing produced a sensitivity of 85.7% (95% CI, 42.1%-99.6%), a specificity of 81.5% (95% CI, 73.9%-87.6%), a positive predictive value of 19.4% (95% CI, 13.1%-27.7%), and a negative predictive value of 99.1% (95% CI, 94.7%-99.9%). CONCLUSION This study supports the use of high-throughput DNA sequencing in supplementing other methods of investigation for identifying an odontogenic etiology of sinusitis.
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Affiliation(s)
- Asad A Haider
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael J Marino
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,McGovern Medical School, The University of Texas Health Science Center at Houston, Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, Houston, Texas, USA
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Bajoria AA, Sarkar S, Sinha P. Evaluation of Odontogenic Maxillary Sinusitis with Cone Beam Computed Tomography: A Retrospective Study with Review of Literature. J Int Soc Prev Community Dent 2019; 9:194-204. [PMID: 31058071 PMCID: PMC6489515 DOI: 10.4103/jispcd.jispcd_435_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/21/2019] [Indexed: 12/20/2022] Open
Abstract
Aim and Objectives: The purpose of this study was to describe the radiographic characteristics of odontogenic maxillary sinusitis as seen on cone beam computed tomography (CBCT) scans and determine whether any tooth or any tooth root, was more frequently associated with this disease. Materials and Methods: The present study included 500 CBCT images that included the entire maxillary sinus of both the sides in all the three planes. The modified classification of Abrahams and Glassberg was used to assess maxillary sinusitis of odontogenic origin. Furthermore, the proximity of the tooth root to the sinus floor, periapical pathology, and the septae within the maxillary sinus were also assessed. Results: In the present study, 1000 hemimaxillas were analyzed. Majority of the cases (74.9%) the apex of either tooth was touching the floor of the sinus. While 16.9% were in close relationship to the sinus while 8.2% of the cases, the apices were present within the sinus. Furthermore, in the present study, 38 of the total cases had an odontogenic cause of maxillary sinusitis, whereas 273 of them had a nonodontogenic cause, 96 have an undetermined cause, and the rest 593 cases had healthy sinus. Conclusion: The incidence of odontogenic sinusitis is likely under-reported in the available literature. The introduction of low-dose CBCT is particularly useful to establish a definitive diagnosis to augment in the treatment of chronic maxillary sinusitis of odontogenic origin.
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Affiliation(s)
- Atul Anand Bajoria
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Shromona Sarkar
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Pallawi Sinha
- Consultant Prosthodontist, KIIT University, Bhubaneswar, Odisha, India
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Zhang Y, Lan F, Li Y, Wang C, Zhang L. Formation of papillary mucosa folds and enhancement of epithelial barrier in odontogenic sinusitis. Int Forum Allergy Rhinol 2019; 9:1281-1288. [PMID: 30620087 DOI: 10.1002/alr.22277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/11/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Odontogenic sinusitis (OS) presents more satisfactory therapeutic effect after endoscopic surgery compared with chronic rhinosinusitis (CRS) of other origin. The aim of the present study was to investigate the clinical characteristics, morphological features, and epithelial barrier function of sinus mucosa of OS and discuss the possible relationship with good prognosis. METHODS A total of 25 subjects with OS, 7 CRS without nasal polyps (CRSsNP), 10 CRS with nasal polyps (CRSwNP), and 9 control subjects were recruited. The biopsy specimens were stained with hematoxylin and eosin for general observation of cytomorphologic features. Epithelial tight junctions (TJs) protein claudin-4 expression was determined to evaluate the epithelial barrier integrity by using immunofluorescence and Image-Pro Plus software analysis. The representative cytokine profiles regarding T helper 1 (Th1) (interferon [IFN]-γ), Th2 (interleukin [IL]-5), and Th17 (IL-17) were examined by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS Extensively small papillary protrusions could be seen in the maxillary sinus mucosa of OS patients under nasal endoscopy, similar to the morphological behavior, which also presented as papillary folds in the surface of the epithelium. The epithelium in OS kept an increased claudin-4 expression compared with that seen in CRSsNP, CRSwNP, and control subjects. The inflammatory pattern analysis demonstrated that OS belonged to the lymphocyte and plasma cell-dominant cellular phenotypes, whereas IL-17 was dominant compared with IFN-γ as well as IL-5. CONCLUSION The odontogenic infections might induce the formation of papillary mucosa folds and enhance the epithelial TJ barrier function. OS exhibited as lymphocyte and plasma cell-dominant cellular phenotypes and Th17 cytokine profiles.
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Affiliation(s)
- 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
| | - Feng Lan
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Ying Li
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 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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Simuntis R, Vaitkus J, Kubilius R, Padervinskis E, Tušas P, Leketas M, Šiupšinskienė N, Vaitkus S. Comparison of Sino-Nasal Outcome Test 22 Symptom Scores in Rhinogenic and Odontogenic Sinusitis. Am J Rhinol Allergy 2018; 33:44-50. [PMID: 30311505 DOI: 10.1177/1945892418804975] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Odontogenic maxillary sinusitis (OMS) and rhinogenic sinusitis (RS) are the main types of chronic rhinosinusitis (CRS) and have a significant impact on health-related quality of life (HRQL), but the difference in HRQL and symptom presentation between them has not been specifically evaluated to date. Obejctive: Our aim was to compare patterns of symptoms and HRQL disease-specific domains in patients affected with these 2 types of CRS. METHODS A group of 201 patients with CRS (99 with rhinogenic and 102 with odontogenic origin) completed the Sino-Nasal Outcome Test 22 (SNOT-22) questionnaire before treatment. Data sets were analyzed by using principal component analysis (PCA) to identify a set of symptom components together with the items excluded from PCA, which were then analyzed for differences between patients with OMS and RS. RESULTS PCA of SNOT-22 items identified 5 components: "rhinologic," "extranasal rhinologic," "ear/facial," "sleep and functional disturbance," and "emotional disturbance." Sneezing was excluded from PCA and treated as separate outcome variable and was significantly worse in RS patients. Patients with OMS scored significantly higher scores with regard to emotional disturbance, while RS patients scored significantly worse in sleep and functional disturbance. The extra symptom "malodor" was the most different symptom and was significantly worse in OMS patients. The total SNOT-22 score was not significantly different between the groups. CONCLUSION With controlling of covariates that may influence the severity of the disease, this study showed some significant differences in symptom patterns and HRQL impairment between patients with OMS and RS. Malodor is the most characteristic feature of OMS. Therefore, OMS should always be suspected in patients complaining of bad breath.
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Affiliation(s)
- Regimantas Simuntis
- 1 Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justinas Vaitkus
- 2 Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ričardas Kubilius
- 1 Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Evaldas Padervinskis
- 2 Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Tušas
- 1 Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Marijus Leketas
- 1 Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Nora Šiupšinskienė
- 2 Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,3 Faculty of Health Science, Klaipėda University, Klaipėda, Lithuania
| | - Saulius Vaitkus
- 2 Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Schreindorfer K, Kiss Á, Marada G. [Maxillary sinusitis as a diagnostical adverse finding of the dental cone-beam computed tomography study]. Orv Hetil 2018; 158:1747-1753. [PMID: 29086594 DOI: 10.1556/650.2017.30881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cone-beam computed tomography is a frequently used diagnostical method in the head and neck region. The thickening of the maxillary sinus mucosa is often observed in these images. AIM Determining the prevalence of teeth and roots that can be identified as cause of maxillary odontogenic sinusitis, and recording the average observed mucosa thickening on these images. METHOD The scans that give the base of the study have been performed by the Department of Dentistry of Medical University of Pécs between 2015-2016. The size of the voxels had been varied between 0.25 and 0.4 mm and the size of the image had been set up to 15×12 cm. The acquisition time had been set up to 27 seconds. RESULTS 170 cases of the 260 revised records fulfilled the initial criterion conditions. The average mucosa thickness was 8.8 mm. During the present study, the upper first molars palatal and the second molars mesiobuccal roots were mainly associated with maxillary odontogenic sinusitis. CONCLUSION Whether in the case of chronic maxillary sinusitis that is not or only temporarily responsive to conventional therapy, may it be justifiable to provide dental consultation and cone-beam computed tomography to exclude the dental origin of sinusitis. Orv Hetil. 2017; 158(44): 1747-1753.
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Affiliation(s)
- Károly Schreindorfer
- Fogászati és Szájsebészeti Klinika, Konzerváló Fogászati és Parodontológiai Tanszék, Pécsi Tudományegyetem, Klinikai Központ Pécs, Dischka Győző u. 5., 7621
| | - Ágnes Kiss
- Fogászati és Szájsebészeti Klinika, Pécsi Tudományegyetem, Klinikai Központ Pécs
| | - Gyula Marada
- Fogászati és Szájsebészeti Klinika, Fogpótlástani Tanszék, Pécsi Tudományegyetem, Klinikai Központ Pécs
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Kim SJ, Park JS, Kim HT, Lee CH, Park YH, Bae JH. Clinical features and treatment outcomes of dental implant-related paranasal sinusitis: A 2-year prospective observational study. Clin Oral Implants Res 2015; 27:e100-e104. [PMID: 25675967 DOI: 10.1111/clr.12570] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES As dental implant-related paranasal sinusitis has different pathophysiology and clinical features from primarily rhinogenic paranasal sinusitis, the standard treatment protocol for dental implant-related paranasal sinusitis has not yet been established. The aim of this study was to analyze the clinical characteristics and treatment results of dental implant-related paranasal sinusitis. MATERIAL AND METHODS We conducted a prospective single-center study of 19 patients who were treated for odontogenic sinusitis developing in relation to dental implant from September 2008 through May 2012. The age of the patients ranged from 33 to 78 years, with the mean age of 54.5 years. Foul odor and postnasal dripping were the two most common complaints. All patients underwent nasal endoscopic examination and paranasal sinus CT before treatment, and initial conservative treatment for 1 week. Patients unresponsive to medical treatment underwent endoscopic sinus surgery (ESS). All patients were classified into the conservative and surgical groups for analysis and followed up for 2 years after initial diagnosis. RESULTS Four patients (21%) were successfully treated conservatively, while 15 patients (79%) underwent surgical treatment. One of these 15 patients required revision surgery. After 2 years, all patients were successfully treated, so there were no more clinical signs of recurrent sinusitis in any patients. The survival rate of implants was 100%. Compared to those of the conservative group, symptom duration, the Lund-MacKay CT score, status of the ostiomeatal unit (OMU), and the condition of the maxillary sinus floor were significantly more severe in the surgical group. CONCLUSION In our study, the majority of patients who once developed paranasal sinusitis associated with dental implants required surgical treatment. Findings of paranasal sinus CT may be important in determining treatment option.
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Affiliation(s)
- So Jeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Jee Soo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Hee Tae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Cha Hee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Yun Hwi Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Jung Ho Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine, Seoul, Korea.
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Carini F, Longoni S, Amosso E, Carini S, Garavello W, Porcaro G. Odontogenic maxillary sinusitis with oro-nasal fistula: a case report. Ann Stomatol (Roma) 2014; 5:37-39. [PMID: 25678949 PMCID: PMC4308966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM OF THE STUDY The odontogenic sinusitis has an incidence between 38 and 40.6%. Increased risk of maxillary sinusitis has been reported with the presence of periapical abscesses, periodontal disease, dental trauma, tooth extraction and implant placement when the sinusal membrane is perforated. MATERIALS AND METHODS A patient with odontogenic maxillary sinusitis associated with oro-nasal fistula was treated. RESULTS The follow-up at six months showed the complete resolution of maxillary sinusitis, palatal fistula got closed and pain symptoms disappeared. CONCLUSION This case report describes a rare complication of odontogenic maxillary sinusitis: the oro-nasal fistula.
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Affiliation(s)
- Fabrizio Carini
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Salvatore Longoni
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Ernesto Amosso
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Stefania Carini
- School of Medicine, University of Milan-Bicocca, Monza, Italy
| | - Werner Garavello
- Clinica Otorinolaringoiatrica, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Gianluca Porcaro
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
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Abstract
Rhinosinusitis is a very common condition which is normally readily recognizable. Given the intimate anatomic relationship between the antrum and the posterior maxillary teeth, maxillary sinusitis can present as odontalgia. Distinguishing between odontogenic orofacial pain and pain associated with maxillary sinusitis is important to prevent unnecessary dental intervention and to direct patients to medical colleagues. Conversely, odontogenic infection can spread to involve the antrum, termed odontogenic sinusitis, or maxillary sinusitis of dental origin. Odontogenic sinusitis accounts for about 10-40% of all cases of sinusitis, and usually requires combined dental and medical treatment. Maxillary sinusitis can also be a complication of exodontia, resulting from tuberosity fractures, displaced teeth or root fragments and the creation of oroantral communications and fistulae. Dental implants and endodontic materials can also impinge on the maxillary sinus, and are rare causes of sinusitis. Often it is stated that rhinosinusitis may contribute to a halitosis complaint, and widely used diagnostic protocols for rhinosinusitis sometimes list halitosis as a minor criterion. However, gold standards in halitotosis research such as organoleptic assessment or gas chromatography have not been used to validate a correlation between objective (genuine) halitosis and sinusitis. The pathophysiology of this mechanism is unclear, and the relative importance of this alongside other causes of extraoral halitosis is debated.
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Affiliation(s)
- M Ferguson
- Marfleet Primary Healthcare Centre, Hull, United Kingdom
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Pokorny A, Tataryn R. Clinical and radiologic findings in a case series of maxillary sinusitis of dental origin. Int Forum Allergy Rhinol 2013; 3:973-9. [PMID: 24039196 DOI: 10.1002/alr.21212] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 06/24/2013] [Accepted: 07/13/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Maxillary sinusitis of dental origin (MSDO) has been described for decades, but tends to be overlooked as a possible cause of chronic sinusitis by both clinicians and radiologists. The incidence of MSDO in published series is reported to be from 10% to 40% in bacterial sinusitis. We present this series to highlight clinical and radiologic indicators of MSDO. METHODS Databases from the authors' otolaryngology and endodontic practices were reviewed to identify patients who had been seen mutually. Sixty-seven (67) patients were identified. Both authors then reviewed the clinical records and associated computed tomography (CT) scans and determined that 31 patients had MSDO and 2 of had bilateral MSDO, for a total of 33 cases. The clinical and radiologic features related to these cases were then tabulated. RESULTS The clinical characteristics of the 33 cases of MSDO were as follows: sinus pain (88%), postnasal drainage (64%), congestion (45%), maxillary toothache (39%), and foul drainage (15%). Radiographic CT findings of MSDO showed periapical abscess in 18 cases (55%), periodontal abscess in 3 cases (9%), and no obvious dental pathology in 12 cases (36%). The extent of associated sinusitis was variable from mucoperiosteal thickening to florid unilateral sinusitis involving multiple sinuses. Eighteen maxillary sinuses (55%) were found to have either patent maxillary infundibula or prior surgical antrostomy. Twenty-four patients (77%) had unilateral maxillary sinus disease. CONCLUSION MSDO should be considered highly likely when radiographic evidence of dental pathology is associated with maxillary sinus disease. Regardless of negative CT evidence of dental pathology, MSDO should be suspected when unilateral maxillary sinus disease is seen, particularly when associated with a patent infundibulum. When MSDO is suspected, a clinical endodontic examination should be performed to rule out or treat an odontogenic etiology.
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Affiliation(s)
- Al Pokorny
- Spokane ENT Clinic, Spokane, WA; University of Washington, Department of Otolaryngology-Head and Neck Surgery, Seattle, WA
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