Recognizing odontogenic sinusitis: A national survey of otolaryngology chief residents.

PURPOSE: Odontogenic sinusitis is underrepresented in sinusitis literature as well as in the otolaryngology teaching curriculum sponsored by the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngologists and residents in training may therefore have a decreased awareness of the condition. The objective of this study was to survey otolaryngology chief residents toward the ends of their training to determine how often they considered odontogenic sinusitis as a cause of unilateral sinus disease. MATERIALS AND METHODS: An online REDCap survey was conducted from December 2018 to January 2019. Online surveys were emailed to 119 Otolaryngology residency program directors in the United States of America, which were then forwarded to their chief residents. Surveys included 3 demographic and 4 clinical questions. Clinical questions included 3 computed tomography-based questions requiring either differential diagnoses or most likely diagnosis, and 1 question on residents' perceived prevalence of odontogenic sinusitis as a cause of unilateral sinus opacification. Answer choices were tabulated and compared based on geographic region and post-residency career plans. RESULTS: Of 293 chief residents emailed, 94 completed the survey (32.1%). While answer choices on imaging-based questions varied, odontogenic sinusitis was generally underrecognized. Approximately 70% of residents felt odontogenic sinusitis represented 0%-40% of unilateral sinus opacification. There were no statistically significant differences in answers based on geographic distribution or post-residency career plans. CONCLUSIONS: Otolaryngology chief residents recognized odontogenic sinusitis with variable accuracy on imaging, and generally underestimated its prevalence as a cause of unilateral sinus opacification. Efforts should be made to teach otolaryngology residents about odontogenic sinusitis.

The Rationale for Endoscopic Inferior Meatal Antrostomy.

BACKGROUND: Complete removal of some maxillary sinus pathologies may be challenging. We describe our experience in performing endoscopic inferior meatal antrostomy (EIMA) when approaching certain chronic maxillary sinus disease. METHODS: Retrospectively reviewing charts of all patients whose surgery included EIMA between the years 2012 and 2015. EIMA was performed either after routine endoscopic middle meatal antrostomy (EMMA) failed to completely resect the lesion, or as the sole selected approach for specific maxillary pathologies. RESULTS: A total of 56 patients were included in the study. Indications for EIMA included antrochoanal polyps (ACP), maxillary sinus chronic inflammatory disease, maxillary sinus pathology before sinus lift, and odontogenic maxillary sinusitis. In nearly one third of the patients, sinus surgery included only EIMA, of which, the majority were resection of ACP. Follow-up time ranged between 12 and 34 months (mean 14). Residual EIMA opening was variable in size. In the vast majority of our patients, the maxillary sinus cavities were cleared of disease. No major complications and no recirculation were observed in any of the patients. CONCLUSION: EIMA should be considered for various maxillary sinus pathologies. It provides better access to anteroinferior lesions of the maxillary sinus. EMMA is not mandatory for every maxillary sinus disease.

[The radicular cyst in the maxillary sinus encountered in the clinical otorhinolaryngological practice]. / Radikuliarnaia kista verkhnei cheliusti v praktike otorinolaringologa.

This article was designed to report the clinical case of the radicular cyst localized in the maxillary sinus of the 23 year-old man that had been detected before the surgical intervention was undertaken for its treatment. In the preceding visits of the patient to other medical settings, this condition was misinterpreted as a genuine (rhinogenic) cyst. It accounted for the choice of the inadequate surgical strategy for the management of this pathology. As a result, the patient experienced two relapse episodes of the disease. The thorough analysis of the patient's medical history and CT images of the sinus obtained during the 4 year follow up period allowed to establish the definitive diagnosis of odontogenic cyst of the upper jaw. The authors present a brief overview of the relevant scientific literature concerning etiology and pathogenesis as well as the methods of diagnostics and treatment of radicular cyst of the upper jaw.

Maxillary sinus functions and complications with lateral window and osteotome sinus floor elevation procedures followed by dental implants placement: a retrospective study in 60 patients.

AIM: The aim of the study was to evaluate retrospectively maxillary sinus functions and complications by using generally accepted diagnostic criteria with lateral window and osteotome sinus floor elevation (OSFE) procedures followed by dental implants placement. MATERIALS AND METHODS: A group of 60 patients in whom a SFE with the two procedures (lateral window and OSFE) followed by dental implants placement had been performed were evaluated retrospectively for sinus functions and complications from the time of procedure up to 24 months using a questionnaire, conventional clinical and radiographic examination. RESULTS: Number of patients suffered dizziness accompanied by nausea immediately after OSFE was more than the lateral window procedure and the symptoms disappeared within 2 to 4 weeks. Maxillary sinus membrane perforations occurred and small for 4 out of 79 procedures, two cases for OSFE and two for lateral window procedure had been repaired. No more complications had been detected for all the patients up to 24 months. CONCLUSION: Based on the results of this study, SFE with lateral window and osteotome procedures followed by dental implants placement did not interfere with maxillary sinus function and no obvious complications had been detected up to 24 months. CLINICAL SIGNIFICANCE: The clinician performs SFE with either lateral window or osteotome procedures needs to understand the difficulties and morbidity arising in the event of complications and must be able to correctly judge the individual risk and the presence of modifying factors that may cause these complications.

Orbital abscess arising from an odontogenic infection.

AIM: Presenting a rare complication of an odontogenic infection extending to the orbit. BACKGROUND: A 45-year-old male patient reported with periorbital swelling of eyelids, of the left eye, foul smelling nasal discharge and a pus draining sinus on the left lower eyelid area. CASE DESCRIPTION: The patient gave history of pain in the left upper first molar tooth 1 week back. His intraoral examination showed poor oral hygiene with tenderness on percussion on the left maxillary first molar. Investigations showed possible extension of infection from left maxillary molar root to maxillary sinus and to the orbital floor. CONCLUSION: A case of periapical infection of a maxillary left molar resulting in an orbital abscess is presented. Identification of odontogenic source of infections, institution of drainage, removal of offending teeth and appropriate antimicrobial therapy are mandatory in preventing loss of vision and cerebral extensions. The pathways of spread of the infection, treatment aspects, are discussed and complications are reviewed.

[Diseases of the maxillary sinus: an overview]. / Afwijkingen van de sinus maxillaris: een overzicht.

Because of the intimate relationship between the maxillary teeth and the maxillary sinus, it is no surprise that odontogenic infections, odontogenic cysts and tumours which have their origin in the mucosa and the bone of the maxilla may extend into the maxillary sinus and, occasionally, into the nasal cavity. Diseases of the maxillary sinus can also extend into the oral cavity and can cause symptoms that mimic those of odontogenic diseases. Important diseases of the maxillary sinus are maxillary sinusitis, oroantral communications, antroliths, cysts and neoplasms.

Diseases of the maxillary sinus: an overview for the dentists.

Because of the intimate relationship between the upper dentition and the maxillary sinus, it is no surprise that inflammatory, cystic and neoplastic odontogenic diseases may extend into the maxillary sinus and, occasionally, into the nasal cavity. On the other hand, diseases of the maxillary sinus may extend into the oral cavity or may cause symptoms that mimic those of diseases of odontogenic origin. An overview is presented of the various odontogenic and nonodontogenic diseases that may involve the maxillary sinus.

Frontal Ostium Grade (FOG): A New Computer Tomography Grading System for Endoscopic Frontal Sinus Surgery.

OBJECTIVE: The location and size of the frontal sinus ostium are critical in determining surgical difficulty. The more anterior the ostium, the more difficult is the surgical access. We propose a novel computed tomography (CT) grading specific to the anatomical position of the frontal ostium. STUDY DESIGN: Observational study followed by a prospective part. SETTINGS: Tertiary rhinology practice. SUBJECT AND METHODS: On a specified sagittal CT cut, a vertical line was drawn through the posterior edge of the frontal process of the maxilla (frontal buttress/beak) along its vertical axis (reference [R-] line). A second (S-) line was placed at the point of upturn of the skull base. Based on if the S-line was posterior or anterior to the R-line, the frontal ostium was graded positive and more easily accessible or negative and thereby more challenging, respectively. If both lines overlapped, then a neutral (0) grading existed. RESULTS: A total of 297 CTs (594 ostia) were analyzed. In total, 394 (65%) ostia were grade positive, 52 (8.75%) were grade negative, and 103 (17.3%) were grade neutral. Ninety frontal sinusotomies were then performed using this grading system: 48 were positive, 21 negative, and 21 neutral. The average time to complete a frontal sinusotomy was 9.96 minutes for grade positive compared to 11.4 minutes for neutral and 16.05 minutes for grade negative (P < .005). CONCLUSION: This novel anatomical CT grading system is designed to be useful in planning and predicting the level of difficulty in endoscopic frontal sinus surgery.

Pseudomembranous disease (ligneous inflammation) of the female genital tract, peritoneum, gingiva, and paranasal sinuses associated with plasminogen deficiency.

Pseudomembranous disease (or ligneous inflammation) is a rare condition characterized by accumulations of fibrin-rich eosinophilic material. Recent investigations have linked the etiology of this condition to plasminogen deficiency (hypoplasminogenemia). Although much of the literature concerning this disease has focused upon the often clinically striking ocular manifestations, it is important to note that pathologic changes may develop in a variety of anatomic locations, including the oral cavity, upper and lower respiratory tract, female genital tract, kidneys, and gastrointestinal tract. Here, we report an unusual case of a 33-year-old woman who initially presented with gingival inflammation. In subsequent years, she developed additional signs and symptoms related to sinonasal and genital tract involvement. Despite numerous clinical evaluations, biopsies, and laboratory tests, the patient's diagnosis remained elusive for 7 years. Ultimately, it was the distinctive appearance of the gingiva that led to a diagnosis of plasminogen deficiency. Unfortunately, the complicated clinical course and elapsed time between initial presentation and diagnosis illustrated by the present case are not uncommon among patients with this condition. Greater familiarity with the clinical and histopathologic features of this condition among pathologists and treating clinicians is essential for timely diagnosis and management.

Paranasal sinus complications caused by dental implants and complementary procedures.

OBJECTIVE: To describe the paranasal complications that may occur after dental implantation. STUDY DESIGN: A literature search was performed in order to review currently available information about the complications of dental implantations and complementary procedures. RESULTS: The use of dental implants has gained great popularity due to their convenience, natural look, and better speech and chewing efficiency, as well as their potential to slow and even stop jawbone atrophy. Nevertheless, an increasing number of publications have drawn attention to the possible complications of the procedure for the paranasal sinuses. Both short-term and long-term complications have been described that should be familiar to otolaryngologists. CONCLUSIONS: Although the procedure is performed by dentists, dental implantations may also have a major impact on the paranasal sinuses. Complications may necessitate the knowledge and cooperation of both dentists and otolaryngologists.

Odontogenic sinusitis is a common cause of unilateral sinus disease with maxillary sinus opacification.

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.

Silent sinus syndrome presenting as enophthalmos long after orbital trauma.

Late enophthalmos is a well-known consequence of large orbital floor fractures. In rare cases, late enophthalmos can occur after direct trauma to the maxillary ostiomeatal complex and present as silent sinus syndrome (SSS). We report two cases of SSS manifesting as enophthalmos years after facial trauma. The first patient developed SSS 4 years after a minimally displaced orbital floor fracture. The second patient had progressive enophthalmos as a result of atelectasis of the maxillary sinus years after facial trauma and surgical repair of nasal fractures. There have been two prior reports of SSS presenting after orbital trauma. Our patients differ from these prior reports in that the enophthalmos was discovered years after the initial facial trauma. In the first patient, surgery addressing the blockage of the ostiomeatal complex arrested the enophthalmos; in the second patient, it reversed the enophthalmos.

Association of cholesterol granuloma and aspergillosis in the sphenoid sinus.

Cholesterol granuloma (CG) is usually associated with chronic middle ear disease, and is not common in the paranasal sinuses. Additionally, it is very rare for cases of CG to be associated with a fungal infection. However, in this paper, we report a case of sphenoid sinus CG that is associated with aspergilloma in a 78-year-old male patient who presented with right hemifacial pain, headache and toothache. CT revealed the presence of an expansile cystic mass lesion in the sphenoid sinus that showed a high signal intensity on both the T1 and T2 weighted images. This mass was later determined to be CG. The suspected etiologic mechanisms of both CG and aspergilloma of the paranasal sinuses are similar, and impaired drainage and obstruction of the ventilation of the paranasal sinuses are considered to be the causative mechanism of both diseases. Overall, the results of this study indicate that the use of MRI findings could be helpful for differentiating CG from other paranasal sinus mass lesions.

Ghost cell odontogenic carcinoma with suspected cholesterol granuloma of the maxillary sinus in a patient treated with combined modality therapy: A case report and the review of literature.

RATIONALE: Ghost cell odontogenic carcinoma (GCOC) is a rare malignant odontogenic tumor with aggressive growth characteristics. PATIENT CONCERNS: A 41-year-old Chinese male visited our hospital in 2013, with a 4-month history of bloody purulent rhinorrhea with a peculiar smell in the right nasal cavity. DIAGNOSES: The patient suffered from recurrent GCOC with suspected cholesterol granuloma of the maxillary sinus. The patient was incorrectly diagnosed with a calcifying epithelial odontogenic tumor at his first recurrence. Physical examination, radiological examination, and histopathology were used to identify GCOC. INTERVENTIONS: Considering the recurrence of GCOC and poor effects of single surgery, postoperative adjuvant chemotherapy and concurrent chemoradiotherapy were performed after radical surgical excision. OUTCOMES: So far, no significant evidence has suggested recurrence or metastasis after a long-term follow-up. LESSONS: We advocate wide surgery with clean margins at the first accurate diagnosis. Combined modality therapy could be taken for the recurrent GCOC. We expect to provide a new treatment strategy to prevent the growth of this neoplasm.

Orbital abscess as a complication of odontogenic infection. A case report and review of the literature.

Orbital abscess is a rare complication of odontogenic infection. This report describes a case of an orbital abscess in a 42-year-old HIV-seropositive woman who developed this condition as a complication by direct spread via the maxillary sinus of a dento-alveolar abscess of the maxillary first premolar, resulting in the loss of her eye.

[Maxillary mucocele after an orthognathic surgery: case report]. / Mucocele maxilar secundario a cirugía ortognática: reporte de un caso.

Mucoceles are not often found in the maxillary sinus, and is a rare surgery complication, in this case, orthognathic. This review describes a mucocele that partially occupies the right maxillary sinus, causing a chronic nasal obstruction. This is the case of a 44 year-old female patient, which after 12 years of several orthognathic surgeries, presents facial pain and right nasal obstruction. The paranasal sinus computed tomography reveals a mass with liquid content that occupies the lower part of the right maxillary sinus and compromises the right nasal cavity. The patient was treated with an intranasal marsupialization and a middle meatotomy with endoscopic nasal approach. Evolution was satisfactory two years after the intervention.

El mucocele es un tumor pseudoquístico poco frecuente en el seno maxilar y una rara complicación de la cirugía ortognática. El caso reportado describe la presentación de un mucocele que afecta parcialmente el seno maxilar y se presenta clínicamente como un tumor nasal. Se trata de una mujer de 44 años que, luego de 12 años de realizarse cirugías ortognáticas, presenta dolor facial y obstrucción de la fosa nasal derecha. La tomografía axial computarizada de senos paranasales revela una masa de contenido líquido que ocupa la mitad inferior del seno maxilar derecho, extendiéndose a la fosa nasal ipsilateral. La paciente es intervenida por vía endoscópica realizándose una marsupialización intranasal y meatotomía media, evolucionando satisfactoriamente en un seguimiento de dos años.

[Imploding antrum syndrome: three cases with different management approaches]. / Síndrome de implosión maxilar: tres casos y sus diferentes abordajes de tratamiento.

BACKGROUND: Silent sinus or imploding antrum syndrome is a very rare condition, consisting of a usually asymptomatic spontaneous collapse of the sinus walls and floor of the orbit. It is associated with negative pressures, and when this occurs, it presents with manifestations such as enophthalmos, hypoglobus, and tilt flow orbital floor. As its incidence is very low, it is frequently missed as a diagnosis, and in fact there are currently fewer than 150 cases reported in the literature. CLINICAL CASES: Three patients have been identified in our practice over a period of two years, with different symptoms that influenced the decision of the treatment modality, which were: watch and wait, endoscopic sinus surgery, or endoscopic sinus surgery plus orbitoplasty. CONCLUSIONS: Despite being a rare entity, it stills catches the attention of the ENT, OMF surgery and Ophthalmologist. The diagnosis is mainly radiological, due to the late clinical manifestations and symptomatology. The treatment should be individualised and based on the symptoms and the individual decision of each patient, firstly by Functional Endoscopic sinus surgery, and once sinus permeability is restored, it may require augmentation surgery of the orbital floor, either with autologous bone implant, titanium or other material. It is important to be aware of this pathology, to know and to suspect it, avoiding misdiagnosis.

Silent sinus syndrome: A traumatic case.

INTRODUCTION: Silent sinus syndrome is an unusual cause of progressive enophthalmos and hypoglobus due to atelectasia of the maxillary sinus associated with osteolysis of the orbital floor. This syndrome is classically idiopathic, but the term is also used to describe traumatic or iatrogenic (surgical orbital decompression) cases. CASE REPORT: We report the case of a 33-year-old man who presented with a left orbital trauma without functional disorder. Computed tomography (CT) scan revealed a nondisplaced fracture of the left orbital floor. No surgical indication was made. Three months later, the patient presented with progressive enophthalmos. CT revealed a complete lysis of the left orbital floor and a left maxillary sinus atelectasia. DISCUSSION: The original nondisplaced fracture of the orbital floor was not responsible for enophthalmos but the associated fracture of the left uncinate process that induced the closure of the left maxillary sinus infundibulum. This induced in turn hypoventilation of the sinus and a left orbital floor lysis. Treatment consisted in surgical opening of the maxillary sinus ostium and reconstruction of the orbital floor.

Management of recurrent sinus disease in children with cystic fibrosis: a combined approach.

OBJECTIVE: To determine whether a combined approach (CA) consisting of functional endoscopic sinus surgery (FESS), Caldwell-Luc operation, and medial maxillectomy is beneficial for children with cystic fibrosis (CF) with refractory sinonasal disease previously treated with endoscopic procedures alone. STUDY DESIGN: Retrospective review and comparison of outcomes of CA and FESS alone for each CF patient. OUTCOMES MEASURED: sinonasal symptoms, endoscopic findings, number of hospitalizations, antibiotic courses, and forced expiratory volume in 1 second (FEV1). SETTING: Referral hospital. RESULTS: Fifteen children underwent CA between 1996 and 2000 (7 males, 8 females; 13.8 years mean age; 42 months average follow-up period). Significant decrease in number of hospitalizations and intravenous antibiotic courses, with increased mean FEV1 (from 70.2% preoperation to 89.3% postoperation, P < 0.0001) were found. Marked clinical improvement persisted for several years. CONCLUSION: Applying the CA after multiple failed endoscopic procedures in CF patients reduced morbidity and resulted in successful management of sinonasal disease. CA is suggested after multiple failed endoscopic procedures. Further studies of CA as a first-line procedure for difficult sinus cases in children with CF is recommended. EBM RATING: C-4.