Diagnosis and Management of Maxillary Sinusitis of Endodontic Origin.

The anatomic proximity of maxillary posterior teeth to the maxillary sinus provides a natural conduit for the spread of dental pathology into the maxillary sinus. This diffusion results in the development of sinus disease attributable to endodontic pathology, and is termed "maxillary sinusitis of endodontic origin" (MSEO). Ultimately, suspicion of odontogenic causes of sinus disease should come as a relief to the provider and patient alike as the conditions are very treatable by noninvasive means with high expected success. This article reviews the diagnosis and management of odontogenic sinusitis with an emphasis on CBCT imaging as part of the interdisciplinary diagnostic workup. Illustrative cases documenting the treatment of MSEO are also presented.

[Optimization of the puncture treatment method for acute bacterial maxillary sinusitis]. / Optimizatsiya metoda punktsionnogo lecheniya ostrogo bakterial'nogo verkhnechelyustnogo sinusita.

OBJECTIVE: Optimization of the method of puncture treatment of acute bacterial maxillary sinusitis (ABMS) through the development of original devices for drainage of the maxillary sinus (MS). MATERIAL AND METHODS: Registration and comparative analysis of the results of puncture methods of treatment of 120 patients with ABMS using developed new original devices for drainage of MS with one channels and with two channels in comparison with the Kulikovsky's needle (KN) was carried out. Based on the results of the analysis, the effectiveness of the original devices was assessed. During the clinical study, patients were divided into two groups: in group I, patients underwent of the MS puncture using KN, in group II, using original devices. Groups I and II, depending on the absence or presence of a block of the natural anastomosis MS, was divided into subgroups A and B, respectively. After puncture of the MS, the pain syndrome was assessed by patients using Visual Analogue Scale (VAS) and by doctors - using Touch Visual Pain (TVP) scale. RESULTS: Our study showed that when puncturing the upper jaw with an original needle with one channels and with two channels, compared with the use of KN, there is a decrease in pain (the average VAS score was 1.5±0.3 and 1.7±0.3 points, respectively; the average TVP scale score was 0.9±0.2 and 1.8±0.3 points, respectively, the difference is significant, p≤0.05). Patients of subgroup IB were manipulated with two KN, patients of subgroup IIB manipulated using the original device with two channels without an additional needle (the average VAS score was 3.0±0.4 and 1.3±0.3 points, respectively; the average TVP scale score was 2.7±0.4 and 1.0±0.2 points, respectively, the difference is significant, p≤0.05). The doctors also assessed the devices used for puncture of the upper jaw. As a result of the study, the high efficiency and safety of using new original devices was established.

Augmentation of Therapeutic Efficacy of Extraction of Causative Teeth by Irrigation for Odontogenic Maxillary Sinusitis.

BACKGROUND/AIM: Odontogenic maxillary sinusitis is a clinically popular disease, but radical surgery and endoscopic surgery are often required. In the present study, we compared for the first time the therapeutic efficacy of the extraction of causative teeth with or without irrigation of the extraction fossa. PATIENTS AND METHODS: A total of 60 patients underwent extraction of causative tooth. Among them, 34 patients underwent irrigation, while other 26 patients did not. Based on computed tomography (CT) images, treatment efficacy was quantified by the percentage of the remaining maxillary sinus mucosal lesions. The extent of therapeutic efficacy was evaluated following five grades, based on the percentage of remaining lesions: Grade 1 (0%) (disappearance of lesions), Grade 2 (roughly 10%), Grade 3 (roughly 30%), Grade 4 (approximately 50%) and Grade 5 (100%) (no improvement of the lesions). RESULTS: Irrigation significantly augmented the therapeutic efficacy of tooth extraction for maxillary sinus mucosal lesions (mean grade: decreasing from 3.27 to 1.35). CONCLUSION: The combination of tooth extraction and irrigation may contribute to the reduction of the necessity of surgery for the maxillary sinuses.

Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment.

ABSTARCT: Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multi-disciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.

[Dynamic indicators of the use of puncture method for the treatment of acute maxillary sinusitis in healthcare institutions of the city of Moscow]. / Dinamicheskie pokazateli primeneniya punktsionnogo metoda lecheniya ostrogo verkhnechelyustnogo sinusita v uchrezhdeniyakh zdravookhraneniya goroda Moskvy.

According to the statistical forms medical and preventive treatment centres (MPTC), the analysis of dynamic indicators of the treatment of patients with acute sinusitis (AS) in outpatient polyclinic centers (OPC) and ENT hospitals in Moscow for the period from 2017 to 2021 was carried out. The total number of visits to an otorhinolaryngologist in the OPC in Moscow for 2017-2021 amounted to 6 834 952 patients, including 245 172 patients with AS (3.6%).The total number of hospitalizations in the departments of otorhinolaryngology for the same period amounted to 184 735 patients, including 12 906 patients with AS (7%).The number of patients with AS who was consulted by an otorhinolaryngologist from 2017 to 2021 decreased by 18.2%, which can be explained by a change in the routing of patients with mild form of AS to general practitioners. An analysis of the dynamic indicators of maxillary sinus punctures carried out in the medical and preventive treatment centres (MPTC) in Moscow during the period from 2017 to 2021 showed that there was a redistribution of this manipulation from ENT hospitals to the OPC. At the same time, the proportion of patients requiring puncture treatment in the OPC for 2017-2019 was stable and amounted to 9.3%. However, since 2020, there has been an increase in this indicator by more than 2 times (21.7%), which probably indicates an increase in the treatment of patients with moderate forms of AS in the OPC. The frequency of maxillary sinus punctures that were performed in ENT hospitals in 2017-2019 amounted to 83.5%, in 2020-2021 decreased to 63.4%. The average number of maxillary sinus punctures per patient in ENT hospitals from 2017 to 2019 was 13.3. Since 2020, this value has decreased by about 2 times and has become equal to 8.5. The decrease in the number of maxillary sinus punctures that were performed in ENT hospitals is probably due to the fact that patients with severe and complicated forms of acute sinusitis hospitalized from 2020 to 2021 required more radical surgical treatment.

Healing of Unilateral Maxillary Sinusitis by Endodontic and Periodontal Treatment of Maxillary Teeth.

Inflammatory conditions of dental origin may spread to the bone tissue, causing its destruction, and to anatomical structures located in the vicinity of the tooth affected with inflammation. Maxillary premolars and molars may develop inflammatory lesions of the Schneiderian membrane and lead to tooth-borne lesions in the maxillary sinuses. Unilateral inflammation of the maxillary sinuses should be diagnosed and treated. The aim of this study was to determine whether and after what time from the applied endodontic or nonsurgical periodontal treatment the inflammation in the maxillary sinus was diminished (assessed by the decrease in the Schneiderian membrane hypertrophy). A retrospective study was performed to analyze the records of endodontically, periodontally, or endodontically-periodontally treated patients with unilateral inflammation of the maxillary sinuses along with diagnostic Cone Beam Computed Tomography. The method for determination of the inflammation was measurements registered in millimeters in Carestream software. The analysis included the situation before treatment and 3 months, 6 months, and 12 months after completion of the treatment. Regardless of the origin of the maxillary sinus lesion, healing of inflammation of the sinus has been reported after the implementation of causative treatment of the maxillary tooth. Dental treatment reduces the need to implement conservative or surgical ENT treatment.

Ten-year experience with multidisciplinary diagnosis and treatment of odontogenic sinusitis.

BACKGROUND: Odontogenic sinusitis is an underdiagnosed entity and is one cause of failure of conventional treatments of sinusitis. Unfortunately, there is no consensus so far on the best management protocol. This retrospective study aimed to suggest a practical management protocol that can reduce misdiagnosis and improve treatment outcomes. METHODS: The study included 74 patients with confirmed odontogenic sinusitis who were diagnosed and treated over 10 years (2010-2019). The patient data were recorded and analysed. RESULTS: Dental pain was reported in only 31.1 per cent of patients. Fifty-six patients (75.7 per cent) had received dental treatment during the last year, but only 13 (23.1 per cent) reported it. Dental pathology was missed on initial computed tomography evaluation in 24 patients (32.4 per cent). Forty-one patients (55.4 per cent) were successfully treated by dental procedures and antibiotics. Fourteen patients needed functional endoscopic sinus surgery in addition to dental procedures. CONCLUSION: Successful management of odontogenic sinusitis requires good communication between rhinologists, radiologists and dentists. Dental treatment should be the logical first step in the treatment protocol, unless otherwise indicated.

Odontogenic Sinusitis: Current Concepts in Diagnosis and Treatment.

Odontogenic sinusitis is a unique cause of sinus disease that deserves special consideration. An astute clinician can elicit historical findings such as recent dental work, and symptoms such as unilateral facial pain and foul drainage, despite a relatively benign oral cavity examination. Otolaryngologists and dental professionals who care for these patients must be able to interpret imaging studies for dental disorder such as periapical abscesses and periodontal disease. Treatment is frequently some combination of antibiotic therapy, dental procedures, and endoscopic sinus surgery. More prospective studies are needed to determine the best approach to caring for this patient population.

Odontogenic chronic rhinosinusitis patients undergoing tooth extraction: oral surgeon and otolaryngologist viewpoints and appropriate management.

OBJECTIVE: This study aimed to propose appropriate management for odontogenic chronic rhinosinusitis. METHOD: Thirty-one adult patients with odontogenic chronic rhinosinusitis undergoing maxillary extraction were retrospectively analysed. Patients with (n = 21) and without (n = 10) oroantral fistula on computed tomography were classified. Functional endoscopic sinus surgery was performed when sinusitis did not improve after extraction. The critical indicators for surgical requirement in the management of odontogenic chronic rhinosinusitis were analysed. RESULTS: Sinusitis significantly improved after extraction in both groups. Patients without oroantral fistula had significantly more severe remnant sinusitis than those with oroantral fistula after extraction on computed tomography (p = 0.0037). The requirement for functional endoscopic sinus surgery was statistically significant for patients without orofacial fistula over those with orofacial fistula (p < 0.0001). The surgical improvement ratio was 93 per cent. CONCLUSION: The absence of oroantral fistula and severe sinusitis can be critical indicators for the requirement of functional endoscopic sinus surgery after extraction in the management of odontogenic chronic rhinosinusitis.

A case report of successful eradication of new isolates of Burkholderia cenocepacia in a child with cystic fibrosis.

Chronic respiratory infection with Burkholderia cenocepacia (Bc) in patients with cystic fibrosis (CF) is associated with accelerated decline in lung function and increased mortality. It is therefore important to attempt to eradicate new isolates, especially in children. However, there are no standardized guidelines to eradicate Bc. We report a case of successful eradication of new isolates of Bc in a 2-year-old child with CF using a combination of IV, nebulized antibiotics and sinus surgery.

Multidisciplinary approaches to odontogenic lesions.

PURPOSE OF REVIEW: To give an overview of technical considerations and relevant literature in the management odontogenic pathology with involvement of the maxillary sinus. RECENT FINDINGS: Infections, cysts, benign neoplasms (odontogenic and nonodontogenic), and inflammatory conditions impact the maxillary sinus in various ways, could result in significant expansion within the maxillary sinus and significant infections. SUMMARY: This manuscript provides an overview of common pathologic entities of the oral cavity proper that impacts the maxillary sinus health, with discussion of the role of the otorhinolaryngologist and the dental specialist.

Diagnóstico y tratamiento de la sinusitis maxilar odontogénica / Diagnosis and treatment of odontogenic maxillary sinusitis

RESUMEN Introducción: La patología sinusal inflamatoria e infecciosa puede comprometer la mucosa sinusal maxilar, etmoidal, esfenoidal o frontal, y su etiología es variada. Se ha observado que la patología odontológica es uno de los factores causales de la sinusitis maxilar, con una incidencia del 10% al 40% según diversas series de casos. El diagnóstico y tratamiento se debe realizar de manera interdisciplinaria entre las especialidades de otorrinolaringología y de cirugía maxilofacial. Se elaboró un documento descriptivo sobre la sinusitis odontogénica y orientador sobre su manejo, de acuerdo a una revisión de la literatura. Se realizaron búsquedas en las bases de datos PubMed, Lilacs y Google Académico, utilizando términos relevantes para la sinusitis odontogénica, con el fin de elaborar el documento. Se utilizaron 43 artículos, todos publicados desde el año 1986 hasta la fecha. Se concluye que la sinusitis odontogénica difiere tanto en la clínica como en la microbiología de otras enfermedades sinusales. El tratamiento se basa en el trabajo interdisciplinario e incluye cirugía endoscópica funcional, realizada por el otorrinolaringólogo, en conjunto con el tratamiento odontológico, siendo fundamental la buena comunicación entre ambos equipos.

ABSTRACT Introduction: Infectious and inflammatory sinus diseases have a varied etiology and can be associated to the maxillary, ethmoidal, sphenoidal and frontal sinuses. Dental pathology can be one of the etiological factors associated to maxillary sinus disease, with frequency rates of 10-40%. Diagnosis and treatment require interdisciplinary work, with participation of otorhinolaryngology and oral and maxillofacial surgery. The development of a descriptive document on odontogenic sinusitis and management guidelines according to literature review. Pubmed, Lilacs and Google Academic database were searched using terms relevant to odontogenic sinusitis, in order to prepare the document. 43 articles were used, all published from 1986 onwards. We conclude that odontogenic sinusitis differs clinically and microbiologically from other sinus pathologies. Treatment modalities are based upon interdisciplinary surgery, including functional endoscopic surgery done by otolaryngologists and dental treatment, being fundamental close communication between the two teams.

The Potential of High-Throughput DNA Sequencing of the Paranasal Sinus Microbiome in Diagnosing Odontogenic Sinusitis.

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.

Challenges in diagnosing odontogenic lesions in maxillary sinuses.

<b>Objectives:</b> The study aimed to identify the patients with pathological lesions in the maxillary sinuses in which the reported symptoms might be indicative of odontogenic origin, as well as to establish specific causative risk factors promoting their development. <br><b>Methods and Materials:</b> The study covered 44 patients with suspected odontogenic maxillary sinusitis. Dental examination and Cone Beam Computed Tomography were completed. The age of patients ranged between 19 and 69 years, and the mean age was 43 (SD = 13.9) years. <br><b>Results:</b> Out of 44 patients, 22 (50%) had non-odontogenic lesions in maxillary sinuses, while in 15 (34.1%) dental origin was established. In the remaining 7 (15.9%) patients, no pathological changes were found in the sinuses. The median of reported symptoms was 10 months (Q1 = 4, Q3 = 24). The reported complaints were not associated with the actual cause of pathological lesions. <br><b>Conclusions:</b> Odontogenic cause of the lesions in the sinuses should primarily be hypothesized, especially in patients with long-term disease symptoms, also regarding any unilateral inflammations.

Burkholderia gladioli sinonasal infection.

INTRODUCTION: Burkholderia gladioli are non-fermenting, Gram-negative, rod-shaped aerobic bacteria that were first identified as a plant pathogen. Most of the B. gladioli infections reported in the literature have involved immunocompromised adults and newborn infants. B. gladioli in humans is often associated with a poor prognosis. CASE REPORT: We describe the first case of sinonasal infection due to B. gladioli and Staphylococcus aureus in an immunocompetent patient who had recently travelled to the Congo. DISCUSSION: As in the few other reported cases involving immunocompetent patients, the appropriate approach to this multidrug-resistant B. gladioli infection was a combination of surgery and antibiotics chosen in the light of an antibiogram.