Expected Costs of Primary Dental Treatments and Endoscopic Sinus Surgery for Odontogenic Sinusitis.

OBJECTIVES: Treatment of odontogenic sinusitis (ODS) due to apical periodontitis (AP) is highly successful when both dental treatment and endoscopic sinus surgery (ESS) are performed. Variation exists in the literature with regard to types and timing of dental treatments and ESS when managing ODS. This study modeled expected costs of different primary dental and sinus surgical treatment pathways for ODS due to AP. STUDY DESIGN: Decision-tree economic model. METHODS: Decision-tree models were created based on cost and treatment success probabilities. Using Medicare and consumer online databases, cost data were obtained for the following dental and sinus surgical treatments across the United States: root canal therapy (RCTx), revision RCTx, apicoectomy, extraction, dental implant, bone graft, and ESS (maxillary, ± anterior ethmoid, ± frontal). A literature review was performed to determine probabilities of dental and sinus disease resolution after different dental treatments. Expected costs were determined for primary dental extraction, RCTx, and ESS pathways, and sensitivity analyses were performed. RESULTS: Expected costs for the three different primary treatment pathways when dental care was in-network and all diseased sinuses opened during ESS were as follows: dental extraction ($4,753.83), RCTx ($4,677.34), and ESS ($7,319.85). CONCLUSIONS: ODS due to AP can be successfully treated with primary dental treatments, but ESS is still frequently required. Expected costs of primary dental extraction and RCTx were roughly equal. Primary ESS had a higher expected cost, but may still be preferred in patients with prominent sinonasal symptoms. Patients' insurance coverage may also impact decision-making. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1346-1355, 2022.

Assessment of the necessity of frontal sinostomy in cases of frontal sinusitis associated with fungus ball of the maxillary sinus.

PURPOSE: This study was conducted to evaluate outcomes in patients presenting with fungus ball of the maxillary sinus (MSFB) and frontal sinusitis who were treated via middle meatal antrostomy alone. METHODS: This was a randomized, controlled study with a parallel group design. Patients with MSFB and frontal sinusitis were randomly assigned to the maxillary middle meatal antrostomy (MMMA) or control (MMMA + frontal sinusotomy) groups. Patient demographics, complaints, imaging findings were analyzed, and surgical outcomes were evaluated using the Lund-Kennedy endoscopic score (LKES) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. RESULTS: In total, 40 patients were separated into two groups, with similar symptoms including nasal obstruction, mucopurulent rhinorrhea, maxillary or frontal pain, blood stained nasal discharge, nasal cacosmia and orbital pain being observed in both groups. Total LKES and SNOT-22 scores were significantly improved in both groups at 6 months post-treatment, with no significant differences in these scores between groups within a mean 6.8-month follow-up. CONCLUSION: These results suggest that frontal sinusotomy is not required to resolve frontal sinusitis associated with MSFB. As such frontal sinusitis appears to be a reactive process caused by fungal ball obstruction, it regresses spontaneously following fungus ball removal, drainage of the maxillary sinus, and middle meatal antrostomy.

[Comprehensive treatment of patients with chronic odontogenic perforative maxillary sinusitis].

The results of treatment of 244 patients with chronic odontogenic perforative maxillary sinusitis, using sparing sinusotomy show high effectiveness of the method. Number of complications, as well as period of disability decreased, economic effect were significant.

Electron microscopy assessment of the recovery of sinus mucosa after sinus surgery.

OBJECTIVES: To determine the level of injury to the maxillary sinus mucosa due to chronic infection and the capacity of sinus mucosa to recover after sinus surgery. MATERIAL AND METHODS: Scanning and transmission electron microscopy (SEM and TEM, respectively) were used for examination of maxillary sinus mucosa at the time of endoscopic sinus surgery and 6 months postoperatively. RESULTS: SEM showed non-ciliated cells, metaplasia, ciliary disorientation, abundant goblet cells, microvilli and compound cilia perioperatively. Six months postoperatively the numbers of non-ciliated cells and microvilli had increased but the degree of metaplasia and disorientation and the number of compound cilia had decreased. Perioperative TEM revealed metaplasia, disorientation, tubulus anomalies, compound cilia and one patient with short dynein arms. CONCLUSIONS: As a result of this study we conclude that sinus mucosa repairs slowly after surgery. There are still many pathological findings in the mucosa 6 months postoperatively and some of these findings may even be irreversible. Patients need frequent follow-up after their operation and we suggest that a follow-up time for sinus surgery patients of at least 1 year should be allowed before final evaluation of the operation and its outcomes is made.

An assessment of concentrations of soluble CD4 and CD8 receptors in serum before and after surgical treatment in patients with chronic maxillary sinusitis.

BACKGROUND: The aim of this study was to assess the concentrations of soluble CD4 (sCD4) and sCD8 receptors in serum of patients before and after surgical treatment of chronic maxillary sinusitis. METHODS: We examined 57 patients, aged 20-63 years (mean age, 41 +/- 0.5 years), and divided them into four groups: group I, 14 patients with chronic maxillary sinusitis without allergy; group II, 15 patients with chronic maxillary sinusitis with allergy; group III, 16 patients with cyst of maxillary sinuses without allergy (control); and group IV, 12 patients with cyst of maxillary sinuses with allergy (control). The assay of sCD4 and sCD8 receptor concentrations was performed by means of enzyme-linked immunosorbent assay method. The concentrations of sCD4 and sCD8 receptors before and after 30 days of surgical treatment of maxillary sinuses were examined. RESULTS: In our studies the increase of concentration of sCD4 in groups I and II in comparison with the concentration in control groups were statistically significant. The differences between mean concentrations of sCD8 in groups I and II and in the control groups were not statistically significant. After surgical treatment of chronic maxillary sinusitis, a significant decrease in values of sCD4 and sCD8 in comparison with the results before surgical treatment suggest that the measurement of cell suppression product concentration can be used to assess the extirpation of the inflammatory process and the effectiveness of the operation method. CONCLUSION: Changes in concentration of sCD4 and sCD8 manifest activation or suppression of cells with particular receptor expression.