Imaging technologies for the detection of sinus pathologies of odontogenic origin. A review / Herramientas imagenológicas para la detección de patologías sinusales de origen odontogénico. Una revisión

Sinus pathologies of odontogenic origin (SPO) are common in the clinical consultation; however, the dentist has some complications to detect them because their discovery is usually incidental and through imaging studies that, in most cases, are of low quality. The objective of this review is to describe the pertinent imaging resources that allow the detection of the most frequent SPO and, at the same time, carry out an updated review of the scientific literature in order to recognize the imaging of both the maxillary sinus and the dental organs. The scientific literature focused on this topic, published between 2014 and 2020, was consulted. The review showed two important results: the first is that Cone Beam Tomography (CBCT) represents the imaging modality with the best performance for the detection of SPO by what can be considered the gold standard for this purpose. The second is that the most frequent SPO is sinus mucositis, which is related to odontogenic conditions such as periapical lesions and periodontal affectations. Although Cone Beam Computed Tomography (CBCT) is the most appropriate tool to detect SPO compared to images obtained by 2D devices, there are also other alternatives such as magnetic resonance imaging and ultrasonography, which seem to have a promising future. (AU)

Las patologías sinusales de origen odontogénico (PSO) son frecuentes en la consulta clínica; sin embargo, el odontólogo tiene algunas complicaciones para detectarlos porque su descubrimiento suele ser incidental y mediante estudios de imagen que, en la mayoría de los casos, son de baja calidad. El objetivo de esta revisión es describir los recursos de imagen pertinentes que permitan la detección de las PSO más frecuentes y, al mismo tiempo, realizar una revisión actualizada de la literatura científica con el fin de reconocer la imagenologia tanto del seno maxilar como de los órganos dentales. Se consultó la literatura científica centrada en este tema, publicada entre 2014 y 2020. La revisión arrojó dos resultados importantes: el primero es que la tomografía de haz cónico (TCHC) representa la modalidad de imagen con mejor desempeño para la detección de PSO, por lo que se puede considerar el estándar de oro para este propósito. La segunda es que la PSO más frecuente es la mucositis sinusal, que se relaciona con afecciones odontogénicas como lesiones periapicales y afectaciones periodontales. Si bien la TCHC es la herramienta más adecuada para detectar la SPO en comparación con las imágenes obtenidas con dispositivos 2D, también existen otras alternativas como la resonancia magnética y la ecografía, que parecen tener un futuro prometedor. (AU)

Maxillary sinus floor elevation using Beta-Tricalcium-Phosphate (beta-TCP) or natural bone: same inflammatory response.

Sinus elevation is a common procedure to increase bone volume in the atrophic maxilla to allow placement of dental implants. Autogenous bone is the gold standard but is limited in quantity and causes morbidity at the donor site. ß-TCP is a synthetic biomaterial commonly used in that purpose. It appears to induce a poor inflammatory response. This study aimed to evaluate the degree of edema of the sinus mucosa after sinus lift surgery according to the type of biomaterial. Forty sinuses (20 patients) were included retrospectively and divided into 2 groups according to the biomaterial that was used: synthetic biomaterial (BTCP group), natural bone (BONE group). A control group (CTRL group) was constituted by the non-grafted maxillary sinuses. Twelve measurements per sinus were realized on pre- and post-operative computed tomography and averaged to provide the sinus membrane thickness value (SM.Th). SM.Th was thicker post-operatively in the BTCP and BONE groups in comparison with the CTRL group and in comparison with pre-operative measurements. No difference was found post operatively between the BTCP and BONE groups. We found that a synthetic biomaterial (ß-TCP) induced the same degree of edema, and thus of inflammation, as natural bone. It constitutes therefore an interesting alternative to autogenous bone for maxillary sinus lifts.

A Case of Fungus Ball-Type Maxillary Sinusitis Due to Penicillium Roqueforti.

The Penicillium genera, encompassing about 225 different species of fungi, are naturally present in the environment. These genera are poorly linked to human disease, except for Penicillium marneffei causing septicemia in immunocompromised hosts. Thus, Penicillium species recovered from respiratory tract samples are often considered as inhaled contaminants in the clinical laboratory. However, we report here a case of fungal maxillary sinusitis due to Penicillium roqueforti diagnosed in a 40-year-old female, a teacher, complaining of moderate pain for months in the maxillary sinus and chronic posterior rhinorrhea. CT scanner and MRI enabled a preliminary diagnosis of left maxillary fungus ball-type sinusitis with calcified material seen on CT and marked very low signal in T2 weighted images seen on MRI. Anatomopathological and mycological examination of sinusal content showed septate hyphae. Direct sequencing of the sinusal content revealed P. roqueforti. P. roqueforti has been traditionally used in France for more than 200 years for cheese ripening. However, to our knowledge, this ascomycetous fungus has very rarely been associated in the literature with human disease. P. roqueforti is associated only with cheese worker's lung, a hypersensitivity pneumonitis affecting employees in blue cheese factories. Other species in the Penicillium genus are reported to cause various disorders such as invasive infection, superficial infection or allergic diseases. P. roqueforti has never previously been reported as a cause of human infection. Thus, we report the first case of fungus ball due to P. roqueforti in an immunocompetent patient.

Multiple Mott Cells in Periapical Lesion of the Oral Cavity.

An entity of bizarre plasma cells has been observed, containing spherical inclusions of immunoglobulins within the cytoplasm. These cells are termed as Mott cells and are believed to occur commonly in cases of chronic inflammation. Until now, they were reported to occur in systemic diseases, various hematolymphoid malignancies and in some syndromes; but their occurrence in chronic periapical infections of the oral cavity, given the paucity of available literature, raises questions about their obscure nature. In the present case report, a 24-year male presented with a draining sinus and periapical lesion involving the maxillary right incisors. After clinical and radiographic examination, an excisional biopsy sample of the periapical lesion was obtained. Histopathological examination revealed multiple bizarre Mott cells in the connective tissue stroma. The significance, nature or fate of these Mott cells is still unknown. Frequently overlooked or a chance occurrence, the presence of these multiple Mott cells in chronic inflammatory lesions of the oral cavity could be of some significance and demand increased awareness and further research.

[Pseudo-tumoral invasive fungus infection of the maxillary sinus in Abidjan]. / Infection invasive à champignon filamenteux pseudotumorale du sinus maxillaire à Abidjan.

INTRODUCTION: The invasive fungal infection of the maxillary sinus is a rare and serious disease generally favored by immunosuppression. We report an exceptional case of pseudotumoral invasive fungal infection of the maxillary sinus in an immunocompetent patient. OBSERVATION: A 32-year-old patient consulted for labial and left temporal swelling associated with proptosis and chemosis that has been developing for 18 months. The scanner objectified a filling of the left maxillary sinus, and the ipsilateral orbital cavity, and the surrounding muscles. Histological examination of the surgical specimen revealed invasive fungal infection of the left maxillary sinus. The relevant antifungal therapy, namely voriconazole, could not be administered due to the unavailability of the medicine. However, the patient has received 200mg of itraconazole every 12hours for three weeks. The change proved disappointing with recurrence and significant sequelae, sort of sagging of the right hemifacial, severe limitation of mouth opening and functional loss of the right eye. CONCLUSION: The invasive fungus infections of the maxillary sinus and the orbit are exceptional in immunocompetent patient. Healing is based on early diagnosis and administration of the reference antifungal to face the risk of recurrence.

Association between Odontogenic Conditions and Maxillary Sinus Disease: A Study Using Cone-beam Computed Tomography.

INTRODUCTION: The maxillary sinus can be affected by dental infections because of its close relationship with upper teeth. This study aimed to assess the most common types of maxillary sinus alterations and to associate them with odontogenic conditions using cone-beam computed tomographic (CBCT) images. METHODS: CBCT scans of 400 patients showing sinus disease in 1 or both maxillary sinuses were evaluated. Sinus alteration was considered as follows: generalized or localized mucosal thickening (MT), maxillary sinusitis (MS), and retention cysts (RCs). The odontogenic conditions evaluated were inadequate endodontic treatment, periapical lesions, and periodontal bone loss. Descriptive and multiple logistic regression analyses were performed. RESULTS: Sinus diseases were observed in 85.9% of the maxillary sinuses. The most prevalent condition was generalized MT (65.2%) followed by localized MT (24.8%), MS (6.4%), and RCs (3.6%). Generalized MT was more related to males (odds ratio = 1.45, P < .05) and periodontal bone loss (P < .05). Localized MT was associated with periapical lesions (odds ratio = 3.09, P < .05) and showed a close anatomic relationship between teeth and the sinus floor (odds ratio = 2.77, P < .05). There were no statistically significant associations between either MS or RCs and the odontogenic conditions studied. CONCLUSIONS: The most prevalent sinus diseases were the generalized and localized MT, and they were the only ones related to odontogenic conditions (periodontal bone loss and periapical lesions, respectively). We emphasize that CBCT imaging is an appropriate method for evaluating the maxillary sinus findings and their associated odontogenic conditions.

Prevalence of chronic maxillary sinusitis in children from rural and urban skeletal populations in Poland.

Maxillary sinuses of 100 subadults from Cedynia, an early-urban site (stronghold), dated to the 10th-14th centuries AD, and of 28 subadults from Slaboszewo, a rural site, dated to the 14th-17th centuries AD, were examined for bone formation indicative of chronic sinusitis in order to explore the effect of urban and rural environments on the occurrence of upper respiratory tract infections in the past. We expected a higher prevalence of sinusitis in subadults from a stronghold than from a village, because of such factors as crowding, rapid spread of infections, and pollution from workshops located in the streets. We found a statistically non-significant tendency toward a higher prevalence of the condition in Cedynia compared to Slaboszewo (18.0% and 7.1%, respectively). The majority of maxillary lesions were classified as spicules. Changes to bone morphology suggestive of sinusitis of dental origin were not found. The development of observed osseous lesions may be attributed to culturally determined risk factors such as low quality of housing, air pollution caused by smoke from the household hearth and street workshops, poor levels of hygiene, and water contamination.

Evaluation of Periapical Lesions and Their Association with Maxillary Sinus Abnormalities on Cone-beam Computed Tomographic Images.

INTRODUCTION: Periapical inflammation is often responsible for distinct maxillary sinus (MS) changes. This retrospective, cross-sectional study evaluated the association between the clinical characteristics of periapical lesions (presence, size, and distance) in maxillary posterior teeth and the presence of sinus abnormalities by evaluating cone-beam computed tomographic (CBCT) images obtained from an archived collection. Apart from sex, no other patient information was available. METHODS: The study sample was composed of CBCT images of 143 MSs of patients with at least 1 maxillary posterior tooth with a periapical lesion and 178 MSs of patients without periapical radiolucent lesions. Sinus abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification; periapical radiolucent areas were classified using the CBCT periapical index, and the distance between the periapical lesion edge and the MS floor was measured. Data were analyzed using chi-square tests at a level of significance set at α = 0.05. RESULTS: Most sinus abnormalities were associated with at least 1 maxillary posterior tooth with a periapical lesion (P > .05). The most frequent sinus abnormality in the presence of a periapical lesion was mucosal thickening. All teeth with a CBCT periapical index score of 5 were associated with sinus abnormalities. The highest frequency of abnormalities was found when the radiolucent area was subjacent to the sinus floor. CONCLUSIONS: Maxillary posterior teeth with periapical radiolucent lesions had the highest frequency of sinus abnormalities. The size of a periapical lesion was not associated with the frequency of sinus abnormalities. A close spatial relationship between periapical lesions and sinuses resulted most frequently in sinus abnormalities.

IRAK4 gene polymorphism and odontogenic maxillary sinusitis.

OBJECTIVES: This study aimed to evaluate whether a specific interleukin-1 receptor-associated kinase-4 (IRAK4) gene polymorphism had any influence on the development of changes in maxillary sinus, particularly in the presence of etiological factors of dental origin. MATERIALS AND METHODS: The study population included 153 Portuguese Caucasians that were selected from a database of 504 retrospectively analysed computed tomography (CT) scans. A genetic test was performed, and a model was created through logistic analysis and regression coefficients. The statistical methodologies included were the independent Chi test, Fisher's exact test, binary logistic regression and the receiver operating characteristic (ROC) curve. RESULTS: The estimated prevalence of IRAK4 gene polymorphism found in a Portuguese Caucasian population was 26.8 % (CI 95%) [20.1, 34.7 %]. A model to predict the inflammatory response in the maxillary sinus in the presence etiological factors of dental origin was constructed. This model had the following as variables: previously diagnosed sinusitis, sinus pressure symptoms, cortical bone loss observed on CT, positive genetic test result and radiographic examination that revealed the roots of the teeth communication with the maxillary sinus, which are interpreted as risk factors. CONCLUSIONS: The constructed model should be considered an initial clinical tool. The area under the ROC curve found, AUC = 0.91, revealed that the model correctly predicts the outcome in 91.1% of cases. CLINICAL RELEVANCE: The clinical relevance of this study lies in trying to achieve a potential tool (a model) that may assist the clinician in the implementation of suitable dental treatment plans in complex cases, with probable involvement of the maxillary sinus.

Staphylococcal enterotoxin burden determines the type of T helper cell response and pathology of the maxillary sinus mucosa in rabbits.

Staphylococcal enterotoxin (SE) induces T lymphocyte activation along with nasal allergic inflammation during rhinosinusitis, but it is under debate on which types of T helper (Th) cells respond exclusively or whether they respond synergically. We hypothesize that their responses may vary based on dose of SE. To test this hypothesis, we initiated to determine the nature of the T cell response and pathological feature upon repeated exposure to staphylococcal enterotoxin A (SEA) at different doses in the maxillary sinus of rabbits. SEA (0.6 or 60 ng) was instilled daily into the left maxillary sinus of rabbits for 28 days. The right maxillary sinus receiving normal saline was used as control. Mucosal histological changes were examined by hematoxylin-eosin and toluidine blue staining. Tissue expression of myeloperoxidase (MPO), eosinophil cationic protein (ECP), T-box expressed in T cells (T-bet), and GATA binding protein 3 (GATA-3) were examined using immunohistochemistry. Mucosal levels of representative pro-inflammatory cytokines were measured using ELISA. SEA at 60 ng/day induced acute rhinosinusitis, as confirmed by CT scan. Histopathologic examination revealed epithelial disruption, subepithelial edema, and inflammatory cell infiltration. MPO and T-bet expression, as well as interleukin (IL)-2 and interferon (IFN)-γ levels, were up-regulated. However, 0.6 ng/day SEA did not cause discharge. Histological examination revealed prominent eosinophilic infiltration. ECP and GATA-3 expression, as well as IL-4 and IL-5 levels, were increased at this lower dose. In conclusion, SEA induces acute rhinosinusitis associated with a Th1-type immune response at high dose, and a predominantly Th2-biased allergic inflammation at low dose.

[Odontogenic maxillary sinusitis caused by dental restoration].

We report herein on 5 patients with odontogenic maxillary sinusitis caused by a dental restoration (caries cutting, cavity preparation, inlay restoration). Odontogenic maxillary sinusitis was noted following dental restoration. Even though the pulp cavity and dental pulp were intact, the odontogenic maxillary sinusitis occurred caused by an apical lesion. Infection by way of the dentinal tubules was suggested to be a cause of the pathophysiology. Endoscopic sinus surgery was indicated in patients with intractable odontogenic maxillary sinusitis caused by the dental restoration. Cone-beam x-ray CT was useful for the accurate diagnosis of odontogenic maxillary sinusitis caused by a dental restoration. Physicians should thus be aware of the possibility that a tooth, which has undergone dental restoration, may cause odontogenic maxillary sinusitis.

[Changes in the mucous membrane of the patients with chronic maxillary sinusitis caused by foreign bodies].

The objective of the present work was to study the morphofunctional changes in maxillary sinus mucosa of the patients with odontogenic maxillary sinusitis (OMS) associated with the presence of a foreign body depending on its duration. A total of 105 hospitalized patients were examined and operated. Biopsy samples taken from mucosa and contents of the maxillary sinuses during surgery were investigated. The histological study included the standard sample processing followed by paraffin embedding of the material and staining of the micropreparations with hematoxylin and eosin. It was shown that foreign bodies present in the maxillary sinuses cause marked structural reorganization of the mucous membrane usually with the predominance of hypertrophic and polypous changes.

Maxillary sinus atelectasis (silent sinus syndrome): treatment with balloon sinuplasty.

INTRODUCTION: Maxillary sinus atelectasis is a form of chronic rhinosinusitis of uncertain aetiology. Previously, the conventional treatment for this condition has been standard endoscopic surgery. There are no reports in the literature of successful treatment using balloon sinuplasty. METHODS: A case of a patient with right maxillary sinus atelectasis is presented, who was treated using the balloon sinuplasty technique. RESULTS: The patient's right maxillary sinus atelectasis was successfully treated using balloon sinuplasty. Three-month follow-up evaluation documented retention of the remodelled form of the uncinate process, and of maxillary sinus os patency. CONCLUSION: This is the first report of successful use of the balloon sinuplasty technique for the treatment of maxillary sinus atelectasis. Follow up demonstrated resolution of the underlying pathophysiology. Further study of the balloon sinuplasty technique for the treatment of maxillary sinus atelectasis is required to determine whether it has widespread applicability, given the current standard treatment.

Cone beam CT analysis of Haller cells: prevalence and clinical significance.

OBJECTIVES: Haller cells are anterior ethmoid air cells located in the medial orbital floor immediately lateral to the maxillary infundibulum. The purpose of this study was to demonstrate the prevalence and relationship between the existence and size of these cells with ipsilateral maxillary sinusitis and orbital floor dehiscence as visualized on cone beam CT (CBCT) images. METHODS: CBCT image volumes of 50 patients were retrieved and analysed. All CBCT images were acquired with a 9-inch field of view scan. χ(2) and Cochran-Mantel-Haenszel tests were used for statistical analysis of the obtained data, and p-values of <0.05 were considered to be statistically significant. RESULTS: There was no statistically significant association between the existence and size of Haller cells and maxillary sinusitis. There was a significant association between Haller cells and orbital floor dehiscence. CONCLUSIONS: The explanation of maxillary sinusitis on the basis of mechanical obstruction is unlikely. This study provides evidence for the usefulness of CBCT scan in delineation of the sinonasal anatomy.

[Frequency of detection of anaerobic microorganisms in the maxillary sinuses of patients with different forms of chronic maxillary sinusitis].

The aim of the investigation was to determine the frequency of detection of anaerobic microorganisms in the maxillary sinuses of patients with different forms of chronic maxillary sinusitis. 36 patients were examined. Fence clinical material was carried out from the walls of the maxillary sinus with transport tubes Ames during "Operation maxillary sinusotomy." In order to create anaerobic conditions, we used a set of equipment and supplies (manufacturer bio Mérieux, France) of a company bio Merieux in Ukraine--"Company Diaveritas." It was found that the presence of anaerobic infection is not typical for chronic sinusitis of the odontogenic origin. A wider range of pathogens (60%), observed in chronic odontogenic sinusitis with the presence of a foreign body in the lumen of the sinus. In the mixed associations set aside 50% of anaerobic flora.